Implementation of increased physical therapy intensity for improving walking after stroke: Walk 'n watch protocol for a multisite stepped-wedge cluster-randomized controlled trial.

Rationale: Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n = 75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality-of-life measures over usual care.

Feasibility and preliminary efficacy of a combined virtual reality, robotics and electrical stimulation intervention in upper extremity stroke rehabilitation.

Background: Approximately 80% of individuals with chronic stroke present with long lasting upper extremity (UE) impairments. We designed the perSonalized UPper Extremity Rehabilitation (SUPER) intervention, which combines robotics, virtual reality activities, and neuromuscular electrical stimulation (NMES). The objectives of our study were to determine the feasibility and the preliminary efficacy of the SUPER intervention in individuals with moderate/severe stroke.

Efficacy, safety, and tolerability of bilateral transcranial direct current stimulation combined to a resistance training program in chronic stroke survivors: A double-blind, randomized, placebo-controlled pilot study.

Background: Transcranial direct current stimulation (tDCS) is a promising tool for stroke rehabilitation. Yet, so far, results from the available clinical trials are inconclusive.

Objectives: The primary objective of the present work was to test the efficacy of multiple sessions of tDCS combined with a highly standardized and progressive resistance training program of the affected upper limb in individuals in the chronic phase of recovery after a stroke.

Effects of a tailored strength training program of the upper limb combined with transcranial direct current stimulation (tDCS) in chronic stroke patients: study protocol for a randomised, double-blind, controlled trial.

Background: A significant proportion of individuals are left with poor residual functioning of the affected arm after a stroke. This has a great impact on the quality of life and the ability for stroke survivors to live independently. While strengthening exercises have been recommended to improve arm function, their benefits are generally far from optimal due to the lack of appropriate dosing in terms of intensity.

Using the Borg rating of perceived exertion scale to grade the intensity of a functional training program of the affected upper limb after a stroke: a feasibility study.

Purpose: Intensity of a training program is a critical variable in treatment gains poststroke, but there are no guidelines to adequately dose the intensity of functional training (FT); the recommended type of training to promote poststroke recovery. Such guidelines are made available for strength training (ST) using the 1 repetition maximum (1RM), which has been linked to individuals' self-rated level of exertion using the Borg rating of perceived exertion (BRPE) scale. The BRPE could be a valuable tool for clinicians to dose FT intensity after a stroke, but this remains to be tested.

Neural circuits activated by error amplification and haptic guidance training techniques during performance of a timing-based motor task by healthy individuals.

To promote motor learning, robotic devices have been used to improve subjects' performance by guiding desired movements (haptic guidance-HG) or by artificially increasing movement errors to foster a more rapid learning (error amplification-EA). To better understand the neurophysiological basis of motor learning, a few studies have evaluated brain regions activated during EA/HG, but none has compared both approaches. The goal of this study was to investigate using fMRI which brain networks were activated during a single training session of HG/EA in healthy adults learning to play a computerized pinball-like timing task.

Transcranial direct current stimulation over multiple days enhances motor performance of a grip task.

Background: Recovery of handgrip is critical after stroke since it is positively related to upper limb function. To boost motor recovery, transcranial direct current stimulation (tDCS) is a promising, non-invasive brain stimulation technique for the rehabilitation of persons with stroke. When applied over the primary motor cortex (M1), tDCS has been shown to modulate neural processes involved in motor learning.

Changes in transcranial magnetic stimulation outcome measures in response to upper-limb physical training in stroke: A systematic review of randomized controlled trials.

Background: Physical training is known to be an effective intervention to improve sensorimotor impairments after stroke. However, the link between brain plastic changes, assessed by transcranial magnetic stimulation (TMS), and sensorimotor recovery in response to physical training is still misunderstood. We systematically reviewed reports of randomized controlled trials (RCTs) involving the use of TMS over the primary motor cortex (M1) to probe brain plasticity after upper-limb physical training interventions in people with stroke.

Exerciser for rehabilitation of the Arm (ERA): Development and unique features of a 3D end-effector robot.

Stroke is one of the leading causes of disability worldwide. Consequently, many stroke survivors exhibit difficulties undergoing voluntary movement in their affected upper limb, compromising their functional performance and level of independence. To minimize the negative impact of stroke disabilities, exercises are recognized as a key element in post-stroke rehabilitation.

A single robotic session that guides or increases movement error in survivors post-chronic stroke: which intervention is best to boost the learning of a timing task?

Purpose: Timing deficits can have a negative impact on the lives of survivors post-chronic stroke. Studies evaluating ways to improve timing post stroke are scarce. The goal of the study was to evaluate the impact of a single session of haptic guidance (HG) and error amplification (EA) robotic training interventions on the improvement of post-stroke timing accuracy.

Comparison of haptic guidance and error amplification robotic trainings for the learning of a timing-based motor task by healthy seniors.

With age, a decline in the temporal aspect of movement is observed such as a longer movement execution time and a decreased timing accuracy. Robotic training can represent an interesting approach to help improve movement timing among the elderly. Two types of robotic training-haptic guidance (HG; demonstrating the correct movement for a better movement planning and improved execution of movement) and error amplification (EA; exaggerating movement errors to have a more rapid and complete learning) have been positively used in young healthy subjects to boost timing accuracy.

Corticospinal excitability as a predictor of functional gains at the affected upper limb following robotic training in chronic stroke survivors.

Background: Robotic training can help improve function of a paretic limb following a stroke, but individuals respond differently to the training. A predictor of functional gains might improve the ability to select those individuals more likely to benefit from robot-based therapy. Studies evaluating predictors of functional improvement after a robotic training are scarce.

A crossover pilot study evaluating the functional outcomes of two different types of robotic movement training in chronic stroke survivors using the arm exoskeleton BONES.

Background: To date, the limited degrees of freedom (DOF) of most robotic training devices hinders them from providing functional training following stroke. We developed a 6-DOF exoskeleton ("BONES") that allows movement of the upper limb to assist in rehabilitation. The objectives of this pilot study were to evaluate the impact of training with BONES on function of the affected upper limb, and to assess whether multijoint functional robotic training would translate into greater gains in arm function than single joint robotic training also conducted with BONES.

Effect of visual distraction and auditory feedback on patient effort during robot-assisted movement training after stroke.

Background: Practicing arm and gait movements with robotic assistance after neurologic injury can help patients improve their movement ability, but patients sometimes reduce their effort during training in response to the assistance. Reduced effort has been hypothesized to diminish clinical outcomes of robotic training. To better understand patient slacking, we studied the role of visual distraction and auditory feedback in modulating patient effort during a common robot-assisted tracking task.

Comparison of error-amplification and haptic-guidance training techniques for learning of a timing-based motor task by healthy individuals.

Performance errors drive motor learning for many tasks. Some researchers have suggested that reducing performance errors with haptic guidance can benefit learning by demonstrating correct movements, while others have suggested that artificially increasing errors will force faster and more complete learning. This study compared the effect of these two techniques--haptic guidance and error amplification--as healthy subjects learned to play a computerized pinball-like game.

Biomarkers of recovery after stroke.

Purpose Of Review: A better understanding of the molecular events underlying stroke recovery might be useful to optimize restorative therapies. Measurement of these events, however, is generally inaccessible in humans, at least at the molecular level. Substitute measures, or biomarkers, that are accessible might provide deeper insights into spontaneous recovery in humans.

Effects of cadence on energy generation and absorption at lower extremity joints during gait.

Background: Information regarding kinetic changes associated with walking speed is important for identifying alterations in locomotor disorders caused by pathological processes, as opposed to those arising solely from altered speeds.

Methods: Fourteen healthy subjects were assessed walking at both natural and imposed cadences of 60, 80, and 120 steps/min. A 3D motion analysis system, force platforms, and related software were used to obtain kinematic and kinetic data.

Effect of increases in plantarflexor and hip flexor muscle strength on the levels of effort during gait in individuals with hemiparesis.

Background: Following a stroke, strength gain of the trained affected lower-limb muscles has been observed to result in a change in gait speed, but its effect on other variables related to gait performance has scarcely been studied. The aim of this study was to assess the effect of strength gain of the affected plantarflexors and hip flexors on bilateral levels of effort during gait, in the sagittal plane of movement.

Methods: The levels of effort of 24 chronic hemiparetic participants (mean (standard deviation (SD)): 57.

Bilateral level of effort of the plantar flexors, hip flexors, and extensors during gait in hemiparetic and healthy individuals.

Background And Purpose: Muscle weakness is recognized as a key factor in gait performance of poststroke individuals, but its impact on lower-limb muscular effort has been scarcely studied. The aims of this study were to compare the level of effort of the lower limbs of hemiparetic and able-bodied individuals and to assess the effect of side, cadence, and muscle group.

Methods: Seventeen chronic hemiparetic participants (7 females and 10 males) with a mean age of 60.

Muscular utilization of the plantarflexors, hip flexors and extensors in persons with hemiparesis walking at self-selected and maximal speeds.

Gait performance secondary to a stroke is partially dependent on residual muscle strength. However, to pinpoint more precisely the mechanism of this relationship, biomechanical models, such as the muscular utilization ratio (MUR) that integrates both muscle strength and gait parameters into the concept of level of effort, are warranted. The aim of the present study was to evaluate the MUR of plantarflexors, hip flexors and extensor muscles during their concentric action in 17 chronic hemiparetic participants walking at self-selected and maximal speeds.