Wim Saeys

Additional Exercises Improve Trunk Performance After Stroke: A Pilot Randomized Controlled Trial:

Background. Sitting balance and the ability to perform selective trunk movements are important predictors of functional outcome after stroke. However, studies evaluating the effect of exercises aimed at improving trunk performance are sparse. Objective. To examine the effect of additional trunk exercises on trunk performance after stroke. Methods. An assessor-blinded randomized controlled trial was carried out at an inpatient stroke rehabilitation center. In total 33 participants were assigned to an experimental group (n = 17) or a control group (n = 16). In addition to conventional therapy, the experimental group received 10 hours of individual and supervised trunk exercises; 30 minutes, 4 times a week, for 5 weeks. Trunk performance was evaluated by the Trunk Impairment Scale (TIS) and its subscales of static and dynamic sitting balance and coordination. A general linear repeated measures model was used to analyze the results of our study. Results. No significant differences were found pretreatment between the 2 groups for the collected demographic variables, stroke-related parameters, clinical measures, number of therapy sessions received, and primary outcome measure used. Posttreatment, a significantly better improvement was noted in the experimental group compared to the control group for the dynamic sitting balance subscale only; measuring selective lateral flexion initiated from the upper and lower part of the trunk, (P = .002, post hoc power calculation = .90, effect size = 1.16). Conclusions. Our results suggest that, in addition to conventional therapy, trunk exercises aimed at improving sitting balance and selective trunk movements have a beneficial effect on the selective performance of lateral flexion of the trunk after stroke.

Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility.

Background. Sitting balance and the ability to perform selective truncal movements are important predictors of functional outcome after stroke. However, few clinical trials have evaluated the effect of truncal exercises. Objective. The authors assessed the effect of additional truncal exercises on truncal function, standing balance, and mobility. Methods. An assessor-blinded randomized controlled trial was carried out at a stroke rehabilitation hospital. A total of 33 participants (mean 35 days post onset) were randomly assigned to an experimental group (n = 18) or a control group (n = 15). In addition to conventional therapy, the experimental group received 16 hours of truncal exercises. The control group received 16 hours of sham treatment. Truncal function was evaluated by the Trunk Impairment Scale (TIS) and standing balance and mobility by the Tinetti Test. The Romberg with eyes open and eyes closed, Four Test Balance Scale (FTBS), Berg Balance Scale (BBS), Rivermead Motor Assessment Battery (RMAB), Functional Ambulation Categories, and Dynamic Gait Index (DGI) were performed to elucidate the findings of the primary outcome measures. Results. A treatment effect was found for the experimental group on the TIS (P < .001), Tinetti Test (P < .001), FTBS (P = .014), BBS (P = .007), RMAB (P < .001), and DGI (P = .006). Conclusions. In addition to conventional therapy, truncal exercises have a beneficial effect on truncal function, standing balance, and mobility in people after stroke.

Influence of sensory loss on the perception of verticality in stroke patients

Purpose: The aim of this study was to investigate the relationship between somatosensory loss and perception of verticality in stroke patients suffering single-hemisphere lesions. Method: Somatosensory loss was measured using the Rivermead Assessment for Somatosensory Performance (RASP). Perception of verticality was assessed with the Subjective Visual Vertical (SVV) and the Subjective Postural Vertical (SPV) tests. Absolute Values of SVV and SPV were used to analyze the amount of deviation in relation to somatosensory loss. Results: Thirty-two patients were included in the study (mean age = 45.91 SD = 31.88 years). Analysis showed that somatosensory loss was related to results of the SVV (r = −0.552, p = 0.001, Pearson Rank) and the SPV (r = −0.661, p < 0.001, Spearman Ï). Furthermore, results showed that both joint-related (SVV: r = −0.411, p = 0.019, Pearson Rank; SPV: r = −0.597, p = 0.001, Spearman Ï) and skin-related (SVV: r = −0.595, p < 0.001, Pearson Rank; SPV: r = −0.663, p < 0.001, Spearman Ï) somatosensory information is related to verticality perception. Conclusions: This study provides evidence that perception of verticality is related to somatosensory loss, which means that somatosensory loss will lead to a larger amount of deviation of SVV and SPV in relation to the gravitational vector. Furthermore, it is interesting to note that both SVV and SPV are influenced by somatosensory loss. Implications for Rehabilitation Somatosensory information is related to both visual and postural aspects of verticality perception. Both joint- and cutaneous-related modalities of sensory information are related to perception of verticality. Sensory training could be important in the recovery of verticality perception.

Trunk biomechanics during hemiplegic gait after stroke: A systematic review

Stroke commonly results in trunk impairments that are associated with decreased trunk coordination and limited trunk muscle strength. These impairments often result in biomechanical changes during walking. Additionally, the so-called pelvic step might be influenced by these impairments. Therefore, the aim of this review was twofold. First, to gain more insight into trunk biomechanics during walking in stroke patients compared to healthy individuals. Second, to investigate the influence of walking speed on trunk biomechanics. The search strategy was performed by the PRISMA guidelines and registered in the PROSPERO database (no. CRD42016035797). Databases MEDLINE, Web of Science, Cochrane Library, ScienceDirect, and Rehabdata were systematically searched until December 2016. Sixteen of the 1099 studies met the eligibility criteria and were included in this review. Risk of bias was assessed by the Newcastle-Ottawa Scale. The majority of studies reported on trunk kinematics during walking, data on trunk kinetics and muscle activity is lacking. Following stroke, patients walk with increased mediolateral trunk sway and larger sagittal motion of the lower trunk. Although rotation of the upper trunk is increased, the trunk shows a more in-phase coordination. Acceleration of the trunk diminishes while instability and asymmetry increase as there are less movement towards the paretic side. However, it is of great importance to differentiate between compensatory trunk movements and intrinsic trunk control deficits. Specific exercise programs, assistive devices and orthoses might be of help in controlling these deficits. Importantly, studies suggested that more natural trunk movements were observed when walking speed was increased.

Prognostic factors for discharge destination after acute stroke: a comprehensive literature review.

Abstract Purpose: In the future, budget constraints will make efficient care for stroke patients more important. The cost of hospitalization for stroke is high. It is desirable to consider a patient’s discharge destination soon after onset and thereby screen patients for further care. This study aims to review the evidence of factors that determine discharge destinations after acute phase of stroke in adult patients. Methods: The systematic literature search was performed in seven databases. This systematic review was conducted by the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). Full-text articles were included and assessed for methodological quality by two independent researchers. Results: Eighteen articles were selected that demonstrate factors defining discharge destination. Younger age, good post-stroke admission to a teaching hospital, and a number of medical factors are determinants to a favorable discharge destination. Determinants for unfavorable discharge destinations were a severe stroke, high body mass index, alcohol abuse, statin withdrawal during hospitalization, the presence of comorbidities like respiratory failure and dementia or having a Medicaid insurance. Conclusion: Patient initial medical care, age and sex, neurological and medical complications and environmental/socio-economic factors should be considered in the decision-making process for discharge destination. Implications for Rehabilitation Systematic screening for prognostic factors may improve discharge planning. Discharge destination to home may be predicted by a number of factors including a young age, being Caucasian, having few medical comorbidities, achieving a physical and cognitive level of independence and being admitted to a teaching hospital, having an insurance may also play a role.

Transcranial direct current stimulation in the recovery of postural control after stroke: a pilot study

Abstract Purpose: This pilot study aimed to evaluate the effectiveness of multiple sessions of transcranial Direct Current Stimulation (tDCS) during 4 weeks on balance and gait parameters after stroke. Method: Thirty-one stroke patients were included in this randomised, double-blind, sham-controlled crossover study. The Tinetti test was used to assess functional balance and gait after stroke. Secondary measures, Rivermead Motor Assessment (RMA) and Trunk Impairment Scale (TIS), were registered to asses both motricity and trunk performance. All tests were administered at baseline, after 4 and 8 weeks. Patients were randomly divided into two groups. Both groups received both sixteen 20-min sessions of tDCS and sixteen 20-min sessions of Sham stimulation. Application method between groups was changed after 4 weeks. A general linear repeated measures model was used to analyse the results of our study. Results: Results revealed an effect on the total score of the Tinetti test (p = 0.049). No significant results were obtained for the RMA (p = 0.166) and the TIS (p = 0.479). Conclusions: This pilot study indicates that 16 tDCS-sessions could have a beneficial effect on balance and gait in stroke patients measured with the Tinetti test. However, further research is needed to elucidate these findings. Implications for Rehabilitation Sixteen sessions of tDCS is beneficial in the recovery of postural control in stroke patients. tDCS has to be applied as soon as possible to enhance beneficial effects.

Three sources, three receivers, six degrees of freedom: An ultrasonic sensor for pose estimation & motion capture

Motion capture systems have become a common utility in a wide variety of fields and rely on various underlying principles to estimate the pose of one or multiple mobile objects. The most popular applications for pose estimation systems can be found in the entertainment sector where it is used for computer animation purposes or in sports for performance measurements. These systems present millimeter accuracy but also come with a high cost. We wish to reduce the cost of such a motion capture system while retaining the high accuracy by using an embedded ultrasonic measurement system. The proposed system comprises of one or multiple mobile nodes containing a small microphone array (at least 3 microphones) which receives multiple simultaneously emitted coded and broadband ultrasonic transmissions from at least three fixed transmitters. Using this technique, the complete pose (six degrees-of-freedom) of every mobile sensor can be estimated while retaining the low-cost aspect of the system. Motion capture systems which combine low cost with high accuracy open many new fields of application such as physiotherapy practices.

Are unstable support surfaces superior to stable support surfaces during trunk rehabilitation after stroke? A systematic review

Abstract Objective: To investigate the effect of trunk rehabilitation using unstable support surfaces compared to stable support surfaces, on static and dynamic balance after stroke. Materials and methods: A systematic review was conducted to identify relevant articles from the following databases: Medline (PubMed), Web of Science, PEDro, REHAB+, Rehabdata, Science Direct, CIRRIE, and Cochrane library. Studies were included when they involved adult stroke patients; were controlled clinical trials; assessed static and dynamic balance; and incorporated trunk exercises on stable or unstable support surfaces. Databases were systematically screened until April 2017. Risk of bias assessment was performed by means of the PEDro scale. Results: Seven studies met the inclusion criteria, of which one had a low risk of bias and six a high risk. In total, 184 stroke patients were evaluated. Unstable support surfaces used during therapy were physio balls, balance pads, air cushions, tilting boards, and slings. Trunk training was provided either as additional therapy or without conventional therapy. All modalities, except for the sling, showed larger improvements compared to stable support surfaces on balance performance. Conclusions: Trunk training on unstable support surfaces seemed to be superior to stable support surfaces in improving static and dynamic balance. However, more research is necessary, since the risk of bias of the included studies was high. Implications for Rehabilitation Trunk training on unstable surfaces seems to be superior to stable surfaces in improving static and dynamic balance. Physio balls, air cushions, balance pads, and unstable boards are appropriate supports to enhance balance during stroke rehabilitation. Implementing unstable supports early in rehabilitation might be more beneficial.

Vibrotactile feedback as a tool to improve motor learning and sports performance: a systematic review

Background Evidence concerning the use of vibrotactile feedback for acquiring and learning new motor skills is limited. Although various concepts and applications for tactile feedback have been proposed, little is known about the suitability of this feedback mechanism in sports training. Aim The goal of this systematic review was to gather knowledge on the efficacy of the use of vibrotactile feedback in improving sports performance skills. Design Systematic review. Methods Comprehensively searched databases were: PubMed, Cochrane and Web of Science. Studies investigating the effects of using vibrotactile feedback in sports training in healthy subjects were included in this review. Results No consensus was found regarding the positive effectiveness on performance using vibrotactile feedback in a sports context. No evidence was found that the addition of tactile feedback is effective for acquiring new motor skills. None of the studies show a significant learning effect.

An Ultrasonic Six Degrees-of-Freedom Pose Estimation Sensor

Motion capture and human body pose estimation systems have become a more common appliance nowadays because of the movie and video game industry. These measurement systems have been proven to be useful for other applications besides entertainment. One of these applications is motion analysis, which can be used for improving the form of athletes or for providing an objective validation tool for rehabilitation treatments. These analyses are done using high-accuracy measurement systems which result in high costs. Although there are some consumer products (e.g. the Microsoft Kinect) that offer movement tracking at a low cost, the accuracy does not suffice for clinical movement analysis applications. This paper therefore focuses on reducing the cost of a human body pose estimation system while retaining the required accuracy. The proposed solution comprises of an embedded ultrasonic transmitter and receiver subsystem. The receiver subsystem consists of multiple mobile nodes that are equipped with a small microphone array (at least three microphones). Each mobile receiver node captures the encoded simultaneously broadcast ultrasonic transmissions from a distributed transmitter array (which consists of at least three elements). Using signal processing, a distance can be calculated between each transmitter and microphone resulting in at least nine distances for each mobile node. Using these distances in combination with the position of the transmitters and the microphone array configuration, the XYZ-position of the mobile node and its rotation about these axes (six degrees-of-freedom) can be estimated. The combination of low-cost embedded and ultrasonics hardware that forms the transducer and receiver subsystem (consisting of multiple mobile receiver nodes) together with powerful signal processing techniques yields a high-accuracy pose estimation system, which can be used as an affordable tool in various fields and applications (e.g., gait analysis for rehabilitation purposes).