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Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study.
J Neuroeng Rehabil. 2019 07 17; 16(1):92.JN

Abstract

BACKGROUND

There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200-300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group.

METHODS

Seven subjects received 8-1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated.

RESULTS

The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group.

CONCLUSIONS

An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.

Authors+Show Affiliations

Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ, 07107, USA. patel421@shp.rutgers.edu.Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ, 07107, USA.Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ, 07107, USA.Movement Neuroscience Laboratory, Department of Physical Therapy, Bouve College of Health Sciences, Movement and Rehabilitation Science, Northeastern University, 308C Robinson Hall - 360 Huntington Avenue, Boston, MA, 02115, USA.Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, The State University of New Jersey, 65 Bergen Street, Newark, NJ, 07107, USA.Movement Neuroscience Laboratory, Department of Physical Therapy, Bouve College of Health Sciences, Movement and Rehabilitation Science, Northeastern University, 308C Robinson Hall - 360 Huntington Avenue, Boston, MA, 02115, USA.Department of Biomedical Engineering, New Jersey Institute of Technology, 616 Fenster Hall - 323 Dr. MLK Jr. BLVD, Newark, NJ, 07102, USA.

Pub Type(s)

Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

31315612

Citation

Patel, Jigna, et al. "Intensive Virtual Reality and Robotic Based Upper Limb Training Compared to Usual Care, and Associated Cortical Reorganization, in the Acute and Early Sub-acute Periods Post-stroke: a Feasibility Study." Journal of Neuroengineering and Rehabilitation, vol. 16, no. 1, 2019, p. 92.
Patel J, Fluet G, Qiu Q, et al. Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study. J Neuroeng Rehabil. 2019;16(1):92.
Patel, J., Fluet, G., Qiu, Q., Yarossi, M., Merians, A., Tunik, E., & Adamovich, S. (2019). Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study. Journal of Neuroengineering and Rehabilitation, 16(1), 92. https://doi.org/10.1186/s12984-019-0563-3
Patel J, et al. Intensive Virtual Reality and Robotic Based Upper Limb Training Compared to Usual Care, and Associated Cortical Reorganization, in the Acute and Early Sub-acute Periods Post-stroke: a Feasibility Study. J Neuroeng Rehabil. 2019 07 17;16(1):92. PubMed PMID: 31315612.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study. AU - Patel,Jigna, AU - Fluet,Gerard, AU - Qiu,Qinyin, AU - Yarossi,Mathew, AU - Merians,Alma, AU - Tunik,Eugene, AU - Adamovich,Sergei, Y1 - 2019/07/17/ PY - 2019/01/18/received PY - 2019/07/03/accepted PY - 2019/7/19/entrez PY - 2019/7/19/pubmed PY - 2020/6/18/medline KW - Acute KW - Early sub-acute KW - Robotic therapy KW - Stroke KW - Transcranial magnetic stimulation KW - Upper limb KW - Virtual reality SP - 92 EP - 92 JF - Journal of neuroengineering and rehabilitation JO - J Neuroeng Rehabil VL - 16 IS - 1 N2 - BACKGROUND: There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200-300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group. METHODS: Seven subjects received 8-1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated. RESULTS: The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group. CONCLUSIONS: An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke. SN - 1743-0003 UR - https://www.unboundmedicine.com/medline/citation/31315612/Intensive_virtual_reality_and_robotic_based_upper_limb_training_compared_to_usual_care_and_associated_cortical_reorganization_in_the_acute_and_early_sub_acute_periods_post_stroke:_a_feasibility_study_ L2 - https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-019-0563-3 DB - PRIME DP - Unbound Medicine ER -