Purpose. This proof-of-concept study investigated whether feedback-mediated exercise (FME) of the affected arm of hemiplegic patients increases patient motivation and promotes greater improvement of motor function, compared to no-feedback exercise (NFE).Method. We developed a feedback-mediated treatment that uses gaming scenarios and allows online and offline monitoring of both temporal and spatial characteristics of planar movements. Twenty poststroke hemiplegic inpatients, randomly assigned to the FME and NFE group, received therapy five days a week for three weeks. The outcome measures were evaluated from the following: (1) the modified drawing test (mDT), (2) received therapy time—RTT, and (3) intrinsic motivation inventory—IMI.Results. The FME group patients showed significantly higher improvement in the speed metric (P<0.01), and smoothness metric (P<0.01), as well as higher RTT (P<0.01). Significantly higher patient motivation is observed in the FME group (interest/enjoyment subscale (P<0.01) and perceived competence subscale (P<0.01)).Conclusion. Prolonged endurance in training and greater improvement in certain areas of motor function, as well as very high patient motivation and strong positive impressions about the treatment, suggest the positive effects of feedback-mediated treatment and its high level of acceptance by patients.

We designed a new surface multi-pad electrode for the electrical stimulation of the forearm that is effective in controlling functional grasp in hemiplegic patients. The electrode shape and size were designed on the basis of the surface stimulation map of the forearm, determined from measurements in seven hemiplegic patients who had limited or absent voluntary movements of the fingers, thumb and wrist. The stimulation map for each patient was assessed with a conventional set of single pad Pals Platinum electrodes. Since the sites for the stimulation varied greatly between patients, the end result was a rather large multi-pad electrode. Modulating multi-pad electrode size, shape, position and individual pad stimulation parameters allows us to accommodate the diversity of the neural tissues in patients that need to be activated for functional grasp. This also allows asynchronous activation of different portions of the muscle and dynamic adaptation of the stimulation sites to appropriate underlying tissues during functional use. The validity of the determined stimulation map was tested in the same group of hemiplegic patients. The selected set of active pads resulted in fully functional and reproducible palmar and lateral grasps similar to healthy-like grasps.

The ArmAssist is a simple low-cost robotic system for upper limb motor training that combines known benefits of repetitive task-oriented training, greater intensity of practice, and less dependence on therapist assistance. The aim of this preliminary study was to compare the efficacy of ArmAssist (AA) robotic training against matched conventional arm training in subacute stroke subjects with moderate-to-severe upper limb impairment. Twenty-six subjects were enrolled within 3 months of stroke and randomly assigned to the AA group or Control group (n=13each). Both groups were trained 5 days per week for 3 weeks. The primary outcome measure was Fugl-Meyer Assessment-Upper Extremity (FMA-UE) motor score, and the secondary outcomes were Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS) and Barthel index (BI). The AA group, in comparison to the Control group, showed significantly greater increases in FMA-UE score (18.0 ± 9.4 versus 7.5 ± 5.5,p=0.002) and WMFT-FAS score (14.1 ± 7.9 versus 6.7 ± 7.8,p=0.025) after 3 weeks of treatment, whereas the increase in BI was not significant (21.2 ± 24.8 versus 13.1 ± 10.7,p=0.292). There were no adverse events. We conclude that arm training using the AA robotic device is safe and able to reduce motor deficits more effectively than matched conventional arm training in subacute phase of stroke. The study has been registered at the ClinicalTrials.gov, ID:NCT02729649.

Study Design: Two-group, repeated-measures reliability study. Objectives: To determine interrater and intrarater reliability of ultrasound measurements of transverse abdominal (TrA) and lumbar multifidus (LM) muscle thickness, during rest and contraction, in subjects with low back pain (LBP) and healthy subjects over 3 consecutive days, performed by an experienced and a novice rater. Background: Previous reliability studies of TrA or LM thickness did not simultaneously account for muscle state, rater experience, and multiday assessment in large subject samples. Methods: The 2 raters measured TrA and LM thickness on 3 consecutive days in 42 healthy subjects and 56 subjects with LBP, during rest and contraction, and calculated the percent thickness change from rest to contraction. Intraclass correlation coefficients (ICC_2,k) and 95% minimal detectable change in thickness were derived for a single measure (day 1) and an average measure (days 1–3). Results: The interrater ICC_2,1 values for single-measure thickness (LBP group, 0.71–0.87; healthy group, 0.94–1.00) were similar to those for average-measure thickness (LBP group, 0.73–0.84; healthy group, 0.93–1.00). Both interrater ICC_2,1 and ICC_2,3 were lower for the relative thickness change (0.61–0.96). Intrarater ICC_2,1 values across 3 consecutive days were high for both raters across the 2 groups (LBP group, 0.95–1.00; healthy group, 0.93–1.00), albeit lower for the relative thickness change (0.79–0.99). The 95% minimal detectable changes were less than 0.3 mm for the TrA and less than 2 mm for the LM (but, in most cases, less than 10% of average thickness). Conclusion: Both experienced and trained novice raters provided reliable measurements of TrA and LM thickness in participants with LBP and healthy participants, during rest and contraction. One-time measurements were similar to averaged measurements. Small absolute errors were observed. Public trial registry: Australian New Zealand Clinical Trials Registry ACTRN12613001077752. J Orthop Sports Phys Ther 2014;44(12):979–988. Epub 3 November 2014. doi:10.2519/jospt.2014.5141