qualitative-comparative-cortical-activity-data-analyses-from

Qualitative and Comparative Cortical Activity Data Analyses from a Functional Near-Infrared Spectroscopy Experiment Applying Block Design

Neuroimaging studies play a pivotal role in the evaluation of pre- vs. post-interventional neurological conditions such as in rehabilitation and surgical ...

Fukuoka University

Fukuoka University Hospital

The purpose of the present study was to investigate the effectiveness of acute phase hybrid assistive limb (HAL) rehabilitation training for patients after stroke by measuring the difference in the severity of paralysis. Fifty-three acute stroke patients were enrolled in this prospective cohort study. HAL training was administered about twice per week, and the mean number of sessions was 3.9 ± 2.7. The walking training was performed on a treadmill with individually adjustable body weight support and speed and there was a 10-m walk test (10MWT) before and after each session. Assessment at baseline and at endpoint consisted of the Glasgow Coma Scale (GCS), Revised Hasegawa's Dementia Scale (HDS-R), Brunnstrom stage (Brs), Functional Independence Measure (FIM), Barthel index (BI), and 10MWT. We measured these assessments at the first walking training session and at the end of the final training session without the HAL. To evaluate the feasibility of training with the HAL, the outcome measures of BI, FIM, and speed and number of steps of 10MWT were compared before and after training using a paired Wilcoxon's signed-rank test in different Brs. Except for Brs IV, the Brs III or higher subgroups displayed significant amelioration in BI, and the Brs III subgroup displayed significant amelioration in FIM. The Brs V and VI subgroups displayed significant amelioration in 10-m walking speed and steps. In acute phase rehabilitation after stroke, it is thought that the HAL is more effective for patients with less lower-limb paralysis, such as Brs III or higher. 

Effectiveness of Acute Phase Hybrid Assistive Limb Rehabilitation in Stroke Patients Classified by Paralysis Severity.

Pain reduction associated with improved functional interhemispheric balance following transcranial direct current stimulation for post-stroke central pain: A case study.

This article investigated the feasibility of a tailor-made neurorehabilitation approach using multiple types of hybrid assistive limb (HAL) robots for acute stroke patients. We investigated the clinical outcomes of patients who underwent rehabilitation using the HAL robots. The Brunnstrom stage, Barthel index (BI), and functional independence measure (FIM) were evaluated at baseline and when patients were transferred to a rehabilitation facility. Scores were compared between the multiple-robot rehabilitation and single-robot rehabilitation groups. Nine hemiplegic acute stroke patients (five men and four women; mean age 59.4 ± 12.5 years; four hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using multiple types of HAL robots for 19.4 ± 12.5 days, and 14 patients (six men and eight women; mean age 63.2 ± 13.9 years; nine hemorrhagic stroke and five ischemic stroke) underwent rehabilitation using a single type of HAL robot for 14.9 ± 8.9 days. The multiple-robot rehabilitation group showed significantly better outcomes in the Brunnstrom stage of the upper extremity, BI, and FIM scores. To the best of the authors' knowledge, this is the first pilot study demonstrating the feasibility of rehabilitation using multiple exoskeleton robots. The tailor-made rehabilitation approach may be useful for the treatment of acute stroke.

Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study.

We aimed to evaluate the feasibility of robot-assisted rehabilitation in an early postoperative setting to improve knee mobility following total knee arthroplasty (TKA). A total of 20 patients were alternatively assigned to robotassisted rehabilitation (n = 10; all women) or a control group (n = 10; 2 men and 8 women). The use of a single-joint hybrid assistive limb (HAL-SJ) in active assistive knee exercise was performed for the robot-assisted rehabilitation group while the control patients underwent conventional active assistive knee exercise. We measured the extension lag (defined as the difference between active and passive range of knee extension). We also evaluated the visual analog scale score (VAS) during active movements and active assistive movement. Concerning the extension lag, the robot-assisted rehabilitation group showed 89.4% ± 15.7% improvement (p < 0.01) while the control group showed 34.8% ± 32.1% improvement (p = 0.016). As to the VAS, the robot-assisted rehabilitation group showed 40.7% ± 23.5% improvement while the control group showed 20.4% ± 25.8% improvement (p < 0.01). The use of HAL-SJ may facilitate early recovery from knee surgery and prevent long-term complications such as quadriceps arthrogenic muscle inhibition.

Feasibility of rehabilitation using the single-joint hybrid assistive limb to facilitate early recovery following total knee arthroplasty: A pilot study.

It remains unclear how deep brain stimulation (DBS) modulates the global neuronal network involving cortical activity. We aimed to evaluate changes in cortical activity in six (two men; four women) patients with Parkinson's disease (PD) who underwent unilateral globus pallidus interna (GPI) DBS surgery using a multi-channel near infrared spectroscopy (NIRS) system. As five of the patients were right-handed, DBS was performed on the left in these five cases. The mean age was 66.8 ± 4.0 years. The unified Parkinson's disease rating scale (UPDRS) motor scores were evaluated at baseline and 1- and 6-month follow-up. Task-related NIRS experiments applying the block design were performed at baseline and 1-month follow-up. The mean of the total UPDRS motor score was 48.5 ± 11.1 in the off-medication state preoperatively. Postoperatively, total UPDRS motor scores improved to 26.8 ± 16.6 ( < 0.05) and 22.2 ± 8.6 ( < 0.05) at 1- and 6-month follow-up, respectively. A task-related NIRS experiment showed a postoperative increase in the cortical activity of the prefrontal cortex comparable to the preoperative state. To our knowledge, this is the first study to use a multi-channel NIRS system for PD patients treated with DBS. In this pilot study, we showed changes in motor-associated cortical activities following DBS surgery. Therapeutic DBS was concluded to have promoted the underlying neuronal network remodeling.

Changes in Motor-Related Cortical Activity Following Deep Brain Stimulation for Parkinson's Disease Detected by Functional Near Infrared Spectroscopy: A Pilot Study.

We investigated the combination of robot-assisted rehabilitation (RT) using a single-joint hybrid assistive limb (HAL-SJ) and botulinum toxin A (BTX-A) as therapy for paretic arm with spasticity in post-stroke patients. Participants were seven patients (4 females, 3 males; mean (±SD) age: 60.6±8.4years) who had spastic hemiplegia following chronic stroke. On the day following BTX-A injection, we started RT, which was performed for 20 sessions of 60min each over a two-week period. Clinical outcome measures, including Fugl-Meyer Assessment (FMA), Motor Activity Log (MAL), and Disability Assessment Scale (DAS), and cortical activity were evaluated at baseline, and two weeks, and four months following BTX-A injection. Cortical activity associated with elbow joint movement of the affected arm was assessed via functional near infrared spectroscopy (fNIRS). FMA, MAL, and DAS scores significantly improved at two weeks and four months (p<0.05), except DAS scores at four months (p=0.068). The fNIRS study showed that cortical activation increased in the ipsilesional primary sensorimotor area at two weeks and at the four months follow-up. Our pilot study showed that the combination of RT and BTX-A therapy was an effective approach for treating spastic hemiplegia due to stroke, and functional imaging study showed neuroplasticity induced by the treatment.

Combined therapy using botulinum toxin A and single-joint hybrid assistive limb for upper-limb disability due to spastic hemiplegia.

We report the changes in cortical activity evaluated using functional near-infrared spectroscopy (fNIRS) in 2 cases with cerebellar stroke.

Contralateral Cerebral Hypometabolism After Cerebellar Stroke: A Functional Near-Infrared Spectroscopy Study.

Robot-assisted rehabilitation has been increasingly drawing attention in the field of neurorehabilitation. The hybrid assistive limb (HAL) is an exoskeleton robot developed based on the "interactive biofeedback" theory, and several studies have shown its efficacy for patients with stroke. We aimed to investigate the mechanisms of the facilitative effect of neurorehabilitation using a single-joint HAL (HAL-SJ) and functional near-infrared spectroscopy (fNIRS).

Biofeedback effect of hybrid assistive limb in stroke rehabilitation: A proof of concept study using functional near infrared spectroscopy.

Robotic therapy has drawn attention in the rehabilitation field including home-based rehabilitation. A previous study has reported that home-based therapy could be more effective for increasing upper limb activity than facility-based therapy. The single-joint hybrid assistive limb (HAL-SJ) is an exoskeleton robot developed according to the interactive biofeedback theory, and several studies have shown its effectiveness for upper limb function in stroke patients. A study of home-based robotic therapy has shown to enhance rehabilitation effectiveness for stroke patient with a paretic upper limb. However, home-based therapy involving a HAL-SJ in stroke patients with paretic upper limbs has not been investigated. The present study aimed to investigate paretic upper limb activity and function with home-based robotic therapy involving a HAL-SJ in stroke patients.

Effects of Home-Based Robotic Therapy Involving the Single-Joint Hybrid Assistive Limb Robotic Suit in the Chronic Phase of Stroke: A Pilot Study.

The Hybrid Assistive Limb (HAL) is a robotic exoskeleton designed to support impaired limbs.

Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty.

The single-joint Hybrid Assistive Limb (HAL-SJ) robot is an exoskeleton-type suit developed for the neurorehabilitation of upper limb function. Several studies have addressed the usefulness of the robot; however, the appropriate patient selection remains unclear. In this study, we evaluated the effectiveness of the HAL-SJ exoskeleton in improving upper limb function in the subacute phase after a stroke, as a function of the severity of arm paralysis. Our analysis was based on a retrospective review of 35 patients, treated using the HAL-SJ exoskeleton in the subacute phase after their stroke, between October 2014 and December 2018. The severity of upper limb impairment was quantified using the Brunnstrom recovery stage (BRS) as follows: severe, BRS score 1-2, n = 10; moderate, BRS 3-4, n = 12; and mild, BRS 5-6, n = 13. The primary endpoint was the improvement in upper limb function, from baseline to post-intervention, measured using the Fugl-Meyer assessment upper limb motor score (ΔFMA-UE; range 0-66). The ΔFMA-UE score was significant for all three severity groups (P <0.05). The magnitude of improvement was greater in the moderate group than in the mild group (P <0.05). The greatest improvement was attained for patients with a moderate level of upper limb impairment at baseline. Our findings support the feasibility of the HAL-SJ to improve upper limb function in the subacute phase after a stroke with appropriate patient selection. This study is the first report showing the effect of robot-assisted rehabilitation using the HAL-SJ, according to the severity of paralysis in acute stroke patients with upper extremity motor deficits.

Feasibility of Robot-assisted Rehabilitation in Poststroke Recovery of Upper Limb Function Depending on the Severity.

This pilot study aimed to investigate the safety and efficacy of transcranial direct current stimulation (tDCS) for chronic stroke in adult and pediatric patients. We also aimed to verify the efficacy of botulinum toxin A and peripheral neuromuscular electrical stimulation combined therapy involving bilateral tDCS in adult patients with chronic stroke.

Article	Year
Effectiveness of Acute Phase Hybrid Assistive Limb Rehabilitation in Stroke Patients Classified by Paralysis Severity. Neurologia medico-chirurgica\| PubMed ID: 26041627	2015
Pain reduction associated with improved functional interhemispheric balance following transcranial direct current stimulation for post-stroke central pain: A case study. Journal of the neurological sciences\| PubMed ID: 26349403	2015
Tailor-made rehabilitation approach using multiple types of hybrid assistive limb robots for acute stroke patients: A pilot study. Assistive technology : the official journal of RESNA\| PubMed ID: 26478988	2016
Feasibility of rehabilitation using the single-joint hybrid assistive limb to facilitate early recovery following total knee arthroplasty: A pilot study. Assistive technology : the official journal of RESNA\| PubMed ID: 27689789	2017
Changes in Motor-Related Cortical Activity Following Deep Brain Stimulation for Parkinson's Disease Detected by Functional Near Infrared Spectroscopy: A Pilot Study. Frontiers in human neuroscience\| PubMed ID: 28018196	2016
Combined therapy using botulinum toxin A and single-joint hybrid assistive limb for upper-limb disability due to spastic hemiplegia. Journal of the neurological sciences\| PubMed ID: 28131185	2017
Contralateral Cerebral Hypometabolism After Cerebellar Stroke: A Functional Near-Infrared Spectroscopy Study. Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association\| PubMed ID: 28209317	2017
Biofeedback effect of hybrid assistive limb in stroke rehabilitation: A proof of concept study using functional near infrared spectroscopy. PloS one\| PubMed ID: 29338060	2018
Effects of Home-Based Robotic Therapy Involving the Single-Joint Hybrid Assistive Limb Robotic Suit in the Chronic Phase of Stroke: A Pilot Study. BioMed research international\| PubMed ID: 31011576	2019
Feasibility of supplemental robot-assisted knee flexion exercise following total knee arthroplasty. Journal of back and musculoskeletal rehabilitation\| PubMed ID: 31561326	2020
Feasibility of Robot-assisted Rehabilitation in Poststroke Recovery of Upper Limb Function Depending on the Severity. Neurologia medico-chirurgica\| PubMed ID: 32173715	2020
Feasibility of single and combined with other treatments using transcranial direct current stimulation for chronic stroke: A pilot study. SAGE open medicine\| PubMed ID: 32685151	2020

Kazuya Saita

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