NeuroRehabilitation - Volume 43, issue 1

Authors: Harvey, Richard L.

Article Type: Editorial

DOI: 10.3233/NRE-180002

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 1-2, 2018

Authors: Winstein, Carolee | Varghese, Rini

Article Type: Review Article

Abstract: BACKGROUND: The extraordinary advances in technology such as body-worn sensors, health information technologies, technological advances in neuroimaging, and computational approaches to predictive modelling using biomarkers offers considerable promise to literally transform our thinking, our approach to the problem, and the design of future clinical trials about arm and hand rehabilitation after stroke. OBJECTIVE: To provide a focused review that considers the past, present and future of arm and hand rehabilitation in stroke. METHOD: We organized this perspective into three parts: 1) Past– we summarize the past decade of the clinical trial enterprise in neurorehabilitation, 2) Present– …we provide a brief review of three research areas where mechanistic studies that rely on uniquely human neural circuits provide a basis for promising intervention tools, and 3) Future–we highlight three unique research domains that are likely to provide the biggest impact on the future of post-stroke arm and hand recovery. RESULTS: The past has not been a complete failure— in particular, the EXCITE RCT put arm and hand rehabilitation on the map. Unfortunately, the majority of clinical trials that followed were based on an immature science of neurorehabilitation. We got drawn in by the seductive preclinical animal model work which suggested that dose and intensity of task-oriented training was the most important ingredient for fostering recovery in humans. While dose, and intensity are clearly important, they are of little value unless the stroke survivor is engaged, motivated, and the neural infrastructure provides enough resource to allow the recovery process. Recently, we noticed an increase in mechanistic and theory-driven studies, findings from which will not only advance our understanding of critical brain-behavior mechanisms, but will provide a more mature science moving into the future. CONCLUSIONS: The good news is that there is evidence that we learned from the past and have invented a future that appears to be much more exciting and promising than the past. Show more

Keywords: Arm and hand rehabilitation, stroke recovery, neural networks, biopsychosocial factors

DOI: 10.3233/NRE-172412

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 3-18, 2018

Authors: Winters, Caroline | Kwakkel, Gert | van Wegen, Erwin E.H. | Nijland, Rinske H.M. | Veerbeek, Janne M. | Meskers, Carel G.M.

Article Type: Research Article

Abstract: BACKGROUND: Stroke rehabilitation aims to reduce impairments and promote activity and participation among patients. A major challenge for stroke rehabilitation research is to develop interventions that can reduce patients’ neurological impairments. Until now, there has been no breakthrough in this research field. To move stroke rehabilitation forward, we need more knowledge about underlying mechanisms that drive spontaneous (i.e., reactive) neurobiological recovery after stroke and factors that can be used to optimize its prediction early after stroke onset. OBJECTIVE: The aim of the present invited review was therefore to elaborate on the time window of reactive neurobiological recovery, the …proportional recovery rule and its generalizability to other neurological impairments, as well as to discuss the consequences for designing stroke recovery and rehabilitation trials. METHODS: In this narrative review, we offer suggestions to optimize the research designs of future stroke rehabilitation and recovery trials post stroke, in order to overcome the current prognostic heterogeneity introduced by variations in the potential for reactive neurobiological recovery. FINDINGS AND CONCLUSIONS: There is an urgent need for high-quality, explanatory trials in the first three months post stroke. These trials should preferably stratify patients based on their initial potential for reactive neurobiological recovery, measure recovery repeatedly at fixed times post stroke, and differentiate in their outcomes between behavioural restitution and compensation of functions. Show more

Keywords: Stroke, prognosis, rehabilitation, proportional recovery, spontaneous neurobiological recovery, research design

DOI: 10.3233/NRE-172393

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 19-30, 2018

Authors: Krakauer, John W. | Cortés, Juan Camilo

Article Type: Research Article

Abstract: BACKGROUND: Stroke is one of the leading causes of disability in the world, with the upper limb being affected up to 80% of the time. Current rehabilitative therapies for the upper limb, primarily centered on task-oriented training, are ineffective at boosting recovery from motor impairment beyond what is expected from spontaneous biological recovery and instead promote compensatory strategies in order to perform specific activities of daily living. PURPOSE: To give a critical overview of animal and clinical literature that support the idea that a non-task-oriented approach may be more fruitful for recovery from motor impairment, and to propose …a novel therapeutic paradigm designed to bolster spontaneous biological recovery early after stroke. CONCLUSIONS: A focus on movement quality, rather than task completion, practiced at high intensity and dosage in an enriching environment may be the training approach that best exploits the sensitive period early after stroke in order to amplify the generalized gains seen with spontaneous biological recovery. Show more

Keywords: Upper extremity rehabilitation, stroke rehabilitation

DOI: 10.3233/NRE-172411

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 31-40, 2018

Authors: Connell, Louise A. | Smith, Marie-Claire | Byblow, Winston D. | Stinear, Cathy M.

Article Type: Research Article

Abstract: BACKGROUND: There is growing interest in using biomarkers to predict motor recovery and outcomes after stroke. The PREP2 algorithm combines clinical assessment with biomarkers in an algorithm, to predict upper limb functional outcomes for individual patients. To date, PREP2 is the first algorithm to be tested in clinical practice, and other biomarker-based algorithms are likely to follow. PURPOSE: This review considers how algorithms to predict motor recovery and outcomes after stroke might be implemented in clinical practice. FINDINGS: There are two tasks: first the prediction information needs to be obtained, and then it needs to be …used. The barriers and facilitators of implementation are likely to differ for these tasks. We identify specific elements of the Consolidated Framework for Implementation Research that are relevant to each of these two tasks, using the PREP2 algorithm as an example. These include the characteristics of the predictors and algorithm, the clinical setting and its staff, and the healthcare environment. CONCLUSIONS: Active, theoretically underpinned implementation strategies are needed to ensure that biomarkers are successfully used in clinical practice for predicting motor outcomes after stroke, and should be considered in parallel with biomarker development. Show more

Keywords: Stroke, prognosis, motor, implementation

DOI: 10.3233/NRE-172395

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 41-50, 2018

Authors: Abdollahi, Farnaz | Corrigan, Molly | Lazzaro, Emily D.C. | Kenyon, Robert V. | Patton, James L.

Article Type: Research Article

Abstract: BACKGROUND: Stroke recovery studies have shown the efficacy of bimanual training on upper limb functional recovery and others have shown the efficacy of feedback technology that augments error. OBJECTIVE: In a double-blinded randomized controlled study (N = 26), we evaluated the short-term effects of bilateral arm training to foster functional recovery of a hemiparetic arm, with half of our subjects unknowingly also receiving error augmentation (where errors were visually and haptically enhanced by a robot). METHODS: Twenty-six individuals with chronic stroke were randomly assigned to practice an equivalent amount of bimanual reaching either with or without …error augmentation. Participants were instructed to coordinate both arms while reaching to two targets (one for each arm) in three 45-minute treatments per week for two weeks, with a follow-up visit after one week without treatment. RESULTS: Subjects’ 2-week gains in Fugl-Meyer score averaged 2.92, and we also observed improvements Wolf Motor Functional Ability Scale average 0.21, and Motor Activity Log of 0.58 for quantity and 0.63 for quality of life scores. The extra benefit of error augmentation over the three weeks became apparent in Fugl-Meyer score only after removing an outlier from consideration. CONCLUSIONS: This modest advantage of error augmentation was detectable over a short interval encouraging further research in interactive self-rehabilitation systems that can enhance error motor recovery. Show more

Keywords: Stroke, upper extremity, self-rehabilitation, robotics rehabilitation, bimanual coordination, error augmentation

DOI: 10.3233/NRE-182413

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 51-61, 2018

Authors: Baliki, Marwan N. | Babbitt, Edna M. | Cherney, Leora R.

Article Type: Research Article

Abstract: BACKGROUND: Recent imaging studies indicate that aphasia is associated with large-scale reorganization of brain networks. Today, neuroimaging studies show that various brain connectivity properties, as measured by resting state fMRI, can partially explain different behavioral symptoms in and across various patient groups. Despite these observations, the neural networks underlying the progress and recovery of aphasia following intensive treatment remains relatively obscure. OBJECTIVE: To examine the role of brain network properties in determining recovery of aphasia following intensive therapy in stroke patients. METHODS: We studied eight patients with left hemispheric lesions who completed an intensive comprehensive aphasia …program (ICAP). Language and cognition were assessed before and after four weeks of intensive treatment. In addition, all patients underwent resting state fMRI prior to and after treatment. We used graph theory analysis to evaluate relationships of baseline brain network properties, such as efficiency, modularity, and connectivity to clinical improvements. RESULTS: We found global properties such as efficiency and interhemispheric connectivity could partially explain recovery. More importantly, we identified two unique brain networks that are significantly associated with improvement in language and attention related behavior. CONCLUSIONS: These results suggest baseline brain functional properties play a key role in determining responsiveness of patients with aphasia to intensive comprehensive aphasia treatment. Furthermore, these results indicate that brain mechanisms underlying language comprehension and processes are different from those involved in spatial attention. Show more

Keywords: Aphasia, stroke, resting-state fMRI, brain networks, intensive treatment

DOI: 10.3233/NRE-182428

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 63-76, 2018

Authors: López-Larraz, E. | Sarasola-Sanz, A. | Irastorza-Landa, N. | Birbaumer, N. | Ramos-Murguialday, A.

Article Type: Review Article

Abstract: BACKGROUND: Motor paralysis after stroke has devastating consequences for the patients, families and caregivers. Although therapies have improved in the recent years, traditional rehabilitation still fails in patients with severe paralysis. Brain-machine interfaces (BMI) have emerged as a promising tool to guide motor rehabilitation interventions as they can be applied to patients with no residual movement. OBJECTIVE: This paper reviews the efficiency of BMI technologies to facilitate neuroplasticity and motor recovery after stroke. METHODS: We provide an overview of the existing rehabilitation therapies for stroke, the rationale behind the use of BMIs for motor rehabilitation, the …current state of the art and the results achieved so far with BMI-based interventions, as well as the future perspectives of neural-machine interfaces. RESULTS: Since the first pilot study by Buch and colleagues in 2008, several controlled clinical studies have been conducted, demonstrating the efficacy of BMIs to facilitate functional recovery in completely paralyzed stroke patients with noninvasive technologies such as the electroencephalogram (EEG). CONCLUSIONS: Despite encouraging results, motor rehabilitation based on BMIs is still in a preliminary stage, and further improvements are required to boost its efficacy. Invasive and hybrid approaches are promising and might set the stage for the next generation of stroke rehabilitation therapies. Show more

Keywords: Brain-machine interfaces (BMI), stroke, rehabilitation, neuroplasticity, motor recovery

DOI: 10.3233/NRE-172394

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 77-97, 2018

Authors: Weber, Lynne M. | Stein, Joel

Article Type: Review Article

Abstract: BACKGROUND: Stroke is among the leading causes of acquired disability in the United States, affecting nearly 800,000 Americans annually. The identification of more effective treatments for hemiparesis has been recognized as a top research priority. Intelligent, motor-driven devices for rehabilitation, or rehabilitation robotics, represent an exciting frontier with considerable potential to address these concerns. PURPOSE: This article presents a state of the science review regarding selected robotic technologies that are representative of current robot-aided rehabilitation strategies, the evidence surrounding their efficacy, barriers to widespread dissemination, and technologies in development. METHODS: Narrative Review. CONCLUSIONS: Based …on this synthesis, we suggest that robotic rehabilitation tools are neither the standard of care, nor entirely experimental, but rather a clinically innovative therapy of some utility. Show more

Keywords: Robotics, stroke rehabilitation, technology, exoskeleton

DOI: 10.3233/NRE-172408

Citation: NeuroRehabilitation, vol. 43, no. 1, pp. 99-110, 2018