A.I.R. Kottink

Therapeutic Effect of an Implantable Peroneal Nerve Stimulator in Subjects With Chronic Stroke and Footdrop: A Randomized Controlled Trial

Background and Purpose:Footdrop, characterized by a persons inability to raise the foot at the ankle, is a common problem in patients with stroke. A randomized controlled trial was performed to determine the therapeutic effect of using a new implantable, 2-channel peroneal nerve stimulator for 6 months versus an ankle-foot orthosis (AFO). Subjects: Twenty-nine patients with chronic stroke and footdrop participated in the study. The mean time from stroke was 7.3 years (SD=7.3), and all subjects were community ambulators. Methods: The study used a randomized controlled trial design. The functional electrical stimulation (FES) group received the implantable stimulation system for correction of their footdrop. The control group continued using their conventional walking device (ie, AFO, orthopedic shoes, or no walking device). All subjects were measured at baseline and at weeks 4, 8, 12, and 26 in the gait laboratory. The therapeutic effect of FES on the maximum value of the root mean square (RMSmax) of the tibialis anterior (TA) muscle with both flexed and extended knees and walking speed were selected as the primary outcome measures. The RMSmax of the peroneus longus (PL), gastrocnemius (GS), and soleus (SL) muscles with both flexed and extended knees and muscle activity of the TA muscle of the affected leg during the swing phase of gait were selected as secondary outcome measures. Results: A significantly higher RMSmax of the TA muscle with extended knee was found after using FES. No change in walking speed was found when the stimulator was not switched on. A significantly increased RMSmax of the GS muscle with both flexed and extended knees was found after using FES. Discussion and Conclusion: Functionally, no therapeutic effect of implantable peroneal nerve stimulation was found. However, the significantly increased voluntary muscle output of the TA and GS muscles after the use of FES suggests that there was a certain extent of plasticity in the subjects in this study.

Wii™-habilitation of upper extremity function in children with Cerebral Palsy. An explorative study

Objective: Commercially available virtual reality systems can possibly support rehabilitation objectives in training upper arm function in children with Cerebral Palsy (CP). The present study explored the effect of the Nintendo Wii™ training on upper extremity function in children with CP. Methods: During six weeks, all children received twice a week training with the Wii™, with their most affected arm. The Melbourne Assessment of Upper Limb Function and ABILHAND-Kids were assessed pre- and post- training. In addition, user satisfaction of both children and health professionals was assessed after training. Enjoyment in gaming was scored on a visual analogue scale scale after each session by the children. Results: Fifteen children with CP participated in the study. The quality of upper extremity movements did not change (−2.1, p > 0.05), while a significant increase of convenience in using hands/arms during performance of daily activities was found (0.6, p < 0.05). Conclusion: Daily activities seem to be easier performed after Wii™ training for most of the included children with CP.

The effect of Arm Support combined with rehabilitation games on upper-extremity function in subacute stroke: A randomized controlled trial

Background. Use of rehabilitation technology, such as (electro)mechanical devices or robotics, could partly relieve the increasing strain on stroke rehabilitation caused by an increasing prevalence of stroke. Arm support (AS) training showed improvement of unsupported arm function in chronic stroke. Objective. To examine the effect of weight-supported arm training combined with computerized exercises on arm function and capacity, compared with dose-matched conventional reach training in subacute stroke patients. Methods. In a single-blind, multicenter, randomized controlled trial, 70 subacute stroke patients received 6 weeks of training with either an AS device combined with computerized exercises or dose-matched conventional training (CON). Arm function was evaluated pretraining and posttraining by Fugl-Meyer assessment (FM), maximal reach distance, Stroke Upper Limb Capacity Scale (SULCS), and arm pain via Visual Analogue Scale, in addition to perceived motivation by Intrinsic Motivation Inventory posttraining. Results. FM and SULCS scores and reach distance improved significantly within both groups. These improvements and experienced pain did not differ between groups. The AS group reported higher interest/enjoyment during training than the CON group. Conclusions. AS training with computerized exercises is as effective as conventional therapy dedicated to the arm to improve arm function and activity in subacute stroke rehabilitation, when applied at the same dose.

Effects of an implantable two-channel peroneal nerve stimulator versus conventional walking device on spatiotemporal parameters and kinematics of hemiparetic gait

OBJECTIVE The aims of this study were: (i) to compare the neuro-prosthetic effect of implantable peroneal nerve stimulation to the orthotic effect of a standard of care intervention (no device, shoe or ankle foot orthosis) on walking, as assessed by spatiotemporal parameters; and (ii) to examine whether there is evidence of an enhanced lower-limb flexion reflex with peroneal nerve stimulation and compare the kinematic effect of an implantable peroneal nerve stimulation device vs standard of care intervention on initial loading response of the paretic limb, as assessed by hip, knee and ankle kinematics. DESIGN Randomized controlled trial. SUBJECTS A total of 23 chronic stroke survivors with drop foot. METHODS The intervention group received an implantable 2-channel peroneal nerve stimulator for correction of drop foot. The control group continued using a conventional walking device. Spatiotemporal parameters and hip, knee and ankle kinematics were measured while subjects walked with the device on using a 3-dimensional video camera system during baseline and after a follow-up period of 26 weeks. RESULTS Peroneal nerve stimulation normalized stance and double support of the paretic limb and single support of the non-paretic limb, in comparison with using a conventional walking device. In addition, peroneal nerve stimulation is more effective to provide ankle dorsiflexion during swing and resulted in a normalized initial loading response. CONCLUSION Although peroneal nerve stimulation and ankle foot orthosis are both prescribed to correct a drop foot in the same patient population, spatiotemporal parameters, dorsiflexion during swing and loading response are influenced in a functionally different way.

The Sensitivity and Selectivity of an Implantable Two-Channel Peroneal Nerve Stimulator System for Restoration of Dropped Foot

The objective of this study was to evaluate the stimulation responses on each channel of an implantable two‐channel stimulator that stimulates the peroneal nerve branches innervating the muscles for dorsiflexion and eversion movements. Currently five Dutch patients and five English patients have been implanted with this system. Isometric ankle torque measurements were carried out in the patient with the longest follow‐up period (1 y). A force sensor measured the three components of moment generated at the ankle joint. Stimulation intensity can be adjusted with great accuracy. Dorsiflexion moments are almost entirely determined by the setting of channel 1. Eversion moments are determined mainly by channel 2 and to a lesser extent by channel 1. Both channels determined abduction/adduction moments. We conclude that stimulation responses in both dorsiflexion and eversion direction can be set individually and with great accuracy and are reproducible over a prolonged period.

Gaming and Conventional Exercises for Improvement of Arm Function After Stroke: A Randomized Controlled Pilot Study

OBJECTIVE The use of new technologies in rehabilitation, such as virtual reality and/or computerized gaming exercises, may be useful to enable patients to practice intensively in a motivating way. The objective of the present randomized controlled pilot study was to compare the effect of reach training using a target group specific-designed rehabilitation game to time-matched standardized conventional reach training on arm function after stroke. MATERIALS AND METHODS Twenty chronic stroke patients were randomized to either the rehabilitation game group or the conventional training group. Both groups received three arm training sessions of 30 minutes each week, during a period of 6 weeks. Arm (the upper extremity part of Fugl-Meyer [FM] assessment) and hand (the Action Research Arm [ARA] test) functions were tested 1 week before (T0) and 1 week after (T1) training. A follow-up measurement was performed at 1 month after T1 (T2). RESULTS ARA and FM scores improved significantly within both groups. Post hoc comparisons revealed significant increases in test scores between T0 and T1 and between T0 and T2 for both ARA and FM, but not for changes from T1 to T2. There were no significant differences between both groups for either clinical test. CONCLUSIONS The present randomized controlled pilot study showed that both arm and hand function improved as much after training with a rehabilitation game as after time-matched conventional training.

Measuring Quality of Life in Stroke Subjects Receiving an Implanted Neural Prosthesis for Drop Foot

The aim was to determine if the treatment of a drop foot by means of an implantable two-channel peroneal nerve stimulator improves health-related quality of life (HRQoL). All subjects were measured at baseline and after a follow-up period of 12 and 26 weeks. Twenty-nine stroke survivors with chronic hemiplegia with drop foot who fulfilled the predefined inclusion and exclusion criteria were included in the present randomized controlled trial. The intervention group received an implantable two-channel peroneal nerve stimulator for correction of their drop foot. The control group continued using their conventional walking device, consisting of an ankle-foot orthosis, orthopedic shoes, or no device. HRQoL was assessed in two different ways: (i) by taking descriptive measures, that is, the Short Form-36 (SF-36; generic measure) and the Disability Impact Profile (DIP; specific measure); and (ii) by obtaining preference-based utilities both measured with the time trade-off (direct way) and by calculating them from the EuroQol (EQ-5D) and SF-36. A significant positive effect of the implantable device was found on the physical functioning domain, the general health domain, and the physical component summary score of the SF-36. For the DIP, a significant improvement was found on the domains mobility, self-care, and psychological status in the intervention group. Regarding the preference-based utility measures, a significant effect was found for the utility index calculated from the EQ-5D. The implantable two-channel peroneal nerve stimulator seems to be efficient to improve HRQoL, mainly the domains related to physical functioning. A relation was present between the utility indexes calculated from the EQ-5D and SF-36.

Quantifying loss of independent joint control in acute stroke with a robotic evaluation of reaching workspace

Early recovery after stroke is significant for slow emergence of volitional movement. Initial movements are constrained by stereotypical co-activation of muscle groups such as shoulder abductors and distal limb flexors resulting in the loss of independent joint control. The objective of this study was to utilize new quantitative methods to evaluate the emergence and progression of the loss of independent joint control in the acute phase of recovery from stroke. Fifteen participants have been followed a maximum range of 2 to 32 weeks post-stroke. Participants underwent weekly and monthly robotic evaluations of horizontal plane reaching workspace as a function of abduction loading (0%–200% of limb weight). The magnitude of loss of independent joint control, indicated by the rate of work area reduction as a function of abduction loading, was evident even as early as 2 weeks post-stroke. Group analysis indicated that individuals with mild stroke show immediate presence of the impairment with an exponential rate of recovery over time while individuals with severe stroke show persistent impairment. Early detection and quantification of reaching impairments, such as the loss of independent joint control, will allow clinicians to more efficiently identify patients who would benefit from impairment-based targeted interventions. For example, patients with severe loss of independent joint control will likely benefit from early administration of an intervention attempting to reduce abnormal shoulder abductor/distal limb flexor co-activations during reaching. The field of rehabilitation robotics has demonstrated such interventions to be promising in the chronic severe stroke population.

User-centred input for a wearable soft-robotic glove supporting hand function in daily life

Many stroke patients and elderly have a reduced hand function, resulting in difficulties with independently performing activities of daily living (ADL). Assistive technology is a promising alternative to support the upper limb in performing ADL. To avoid device abandonment, end-users should be involved early in the design and development phase to identify user requirements for assistive technology. The present study applies a user-centred approach to identify user requirements for wearable soft-robotic gloves targeted at physical support of hand function during ADL for elderly and stroke patients. Elderly, stroke patients and healthcare professionals, participating in focus groups, specified requirements regarding: 1) activities that need support of assistive technology, 2) design of wearable robotic devices for hand support, and 3) application of assistive technology as training tool at home. Assistive technology for the support of the hand is considered valuable by users for assisting ADL, but only if the device is wearable, compact, lightweight, easy to use, quickly initialized, washable and only supports the particular function(s) that an individual need(s) assistance with, without taking over existing function(s) from the user.

Relationship Between Participation in Leisure Time Physical Activities and Aerobic Fitness in Children With DCD

Purpose: (1) To explore participation in leisure time physical activities (LTPAs) in children with developmental coordination disorder (DCD) compared with children developing typically. (2) To examine the association between participation in LTPA and aerobic fitness. Methods: Thirty-eight children with DCD (aged 7–12 years) were age and gender matched with 38 children developing typically. Participation in LTPA was self-administered by using an activity questionnaire, and aerobic fitness was estimated using a Shuttle Run Test. Results: Children with DCD spent significantly less time in overall, nonorganized, and vigorous LTPA compared with children developing typically. Aerobic fitness was significantly lower for children with DCD. The best model, including age, group, and overall LTPA, explained 46.2% of the variance in aerobic fitness. Conclusions: Suitable physical activities should be fostered in children with DCD, who have a low participation rate and aerobic fitness level.