Open AccessNewer challenges to restore hemiparetic upper extremity after stroke: HANDS therapy and BMI neurorehabilitation
Author(s) -
Meigen Liu,
Toshiyuki Fujiwara,
Keiichiro Shindo,
Yuko Kasashima,
Yohei Otaka,
Takao Tsuji,
Junichi Ushiba
Publication year - 2012
Publication title -
hong kong physiotherapy journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.343
H-Index - 15
eISSN - 1876-441X
pISSN - 1013-7025
DOI - 10.1016/j.hkpj.2012.05.001
Subject(s) - physical medicine and rehabilitation , neurorehabilitation , medicine , stroke (engine) , motor imagery , rehabilitation , functional electrical stimulation , electromyography , hemiparesis , spasticity , wrist , constraint induced movement therapy , neurofeedback , biofeedback , brain stimulation , physical therapy , motor function , brain–computer interface , stimulation , electroencephalography , mechanical engineering , engineering , lesion , psychiatry , radiology
Because recovery of upper extremity (UE) functions to a practical level has been considered difficult in many patients with stroke, compensatory approaches have been emphasised. Recently, based on basic and clinical research indicating a greater potential for plastic changes in the brain, approaches directed toward functional restoration are becoming increasingly popular. Meta-analysis has indicated the effectiveness of constraint-induced movement therapy, electromyography biofeedback, electrostimulation, mental practice, and robot exercise to improve UE functions, but not hand functions. Therefore, we devised two new interventions to improve the paretic hand. One is hybrid assistive neuromuscular dynamic stimulation therapy, designed to facilitate daily use of the hemiparetic UE by combining electromyography (EMG)-triggered electrical stimulation with a wrist splint. We demonstrated improvement of motor function, spasticity, functional scores, and neurophysiologic parameters in chronic hemiparetic stroke. With a randomised controlled trial, we also demonstrated its effectiveness in subacute stroke. The other is brain-machine interface neurofeedback training, which provides real-time feedback based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extension of the affected fingers. This elicited new voluntary EMG activities, and improved finger functions and neurophysiological parameters. These interventions may offer powerful neurorehabilitative tools for improving hemiparetic UE function after stroke