Brain-Machine-Interface in Chronic Stroke Rehabilitation: A Controlled Study.

Published March 16, 2013

Brain-machine-interface in chronic stroke rehabilitation: A controlled study.

Ann Neurol. 2013 Mar 12;
Ramos-Murguialday A, Broetz D, Rea M, Läer L, Yilmaz O, Brasil FL, Liberati G, Curado MR, Garcia-Cossio E, Vyziotis A, Cho W, Agostini M, Soares E, Soekadar S, Caria A, Cohen LG, Birbaumer N

OBJECTIVE.: Chronic stroke patients with severe hand weakness, respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine-interface training to increase the hypothesized beneficial effects of physiotherapy alone in patients with severe paresis in a double blind sham-controlled design proof of concept study. METHODS.: 32 chronic stroke patients with severe hand weakness, were randomly assigned to two matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms (SMR) with contingent online movements of hand and arm orthoses (experimental group, n=16). In the control group (sham group, n=16) movements of the orthoses occurred randomly. Both groups received identical behavioral physiotherapy immediately following BMI training or the control intervention. Upper limb motor function scores, electromyography from arm and hand muscles, placebo-expectancy effects and functional magnetic resonance imaging (MRI) blood oxygenation level dependent activity were assessed before and after intervention. RESULTS.: A significant group x time interaction in upper limb Fugl-Meyer motor (cFMA) scores was found. cFMA scores improved more in the experimental than in the control group, presenting a significant improvement of cFMA scores (3.41±0.563 points difference, p=0.018) reflecting a clinically meaningful change from no activity to some in paretic muscles. cFMA improvements in the experimental group correlated with changes in functional MRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups. INTERPRETATION.: The addition of BMI training to behaviorally oriented physiotherapy can be used to induce functional improvements in motor function in chronic stroke patients without residual finger movements and may open a new door in stroke neurorehabilitation. ANN NEUROL 2010. HubMed – rehab

Tai Chi practitioners have better postural control and selective attention in stepping down with and without a concurrent auditory response task.

Eur J Appl Physiol. 2013 Mar 14;
Lu X, Siu KC, Fu SN, Hui-Chan CW, Tsang WW

To compare the performance of older experienced Tai Chi practitioners and healthy controls in dual-task versus single-task paradigms, namely stepping down with and without performing an auditory response task, a cross-sectional study was conducted in the Center for East-meets-West in Rehabilitation Sciences at The Hong Kong Polytechnic University, Hong Kong. Twenty-eight Tai Chi practitioners (73.6 ± 4.2 years) and 30 healthy control subjects (72.4 ± 6.1 years) were recruited. Participants were asked to step down from a 19-cm-high platform and maintain a single-leg stance for 10 s with and without a concurrent cognitive task. The cognitive task was an auditory Stroop test in which the participants were required to respond to different tones of voices regardless of their word meanings. Postural stability after stepping down under single- and dual-task paradigms, in terms of excursion of the subject’s center of pressure (COP) and cognitive performance, was measured for comparison between the two groups. Our findings demonstrated significant between-group differences in more outcome measures during dual-task than single-task performance. Thus, the auditory Stroop test showed that Tai Chi practitioners achieved not only significantly less error rate in single-task, but also significantly faster reaction time in dual-task, when compared with healthy controls similar in age and other relevant demographics. Similarly, the stepping-down task showed that Tai Chi practitioners not only displayed significantly less COP sway area in single-task, but also significantly less COP sway path than healthy controls in dual-task. These results showed that Tai Chi practitioners achieved better postural stability after stepping down as well as better performance in auditory response task than healthy controls. The improved performance that was magnified by dual motor-cognitive task performance may point to the benefits of Tai Chi being a mind-and-body exercise. HubMed – rehab

[Causes of blindness in students at the school for blind children in Ilvesheim : Changes between 1885 and 2008.]

Ophthalmologe. 2013 Mar 15;
Rohrschneider K, Mackensen I

PURPOSE: Since 1868, the Department of Ophthalmology at the University of Heidelberg has been providing care for the pupils of the school for blind and visually handicapped children in Ilvesheim, Germany. Previous studies on the causes of low vision have demonstrated the effects of the advances in medicine and ophthalmology with an explicit decrease in the number of inflammatory corneal diseases, followed by a reduced number of students suffering from congenital cataract and glaucoma. The aim of the present study was to evaluate current data and to compare it to previous data. METHODS: Ophthalmological data and additional disorders could be evaluated in 268 students visiting the special education school Schloßschule Ilvesheim between 2000 and 2008. The findings were compared to the results of previous studies concerning the degree of visual impairment and diagnosis. The children were divided according to German social law into blind, severely visually handicapped and visually handicapped. RESULTS: Out of the 268 students 83 (31.0%) were premature infants and 69 of these had additional disabilities, 130 were blind and 51 severely visually handicapped. Of the students 142 had additional learning, mental and/or motor handicaps. The most frequent cause of blindness or severe visual impairment was optic nerve atrophy (36.2 % and 37.3 %, respectively). The frequency of hereditary retinal diseases among the blind children was slightly higher with 24.6 % as compared to the data analysis from 1981 and was 15.7 % and 17.1 % among the severely visually handicapped and visually handicapped, respectively. Retinopathy of prematurity was diagnosed in approximately 20% of blind and severely visually handicapped children. CONCLUSIONS: As a result of the enormous advances of medical capabilities during the last decades the number of (formerly) premature infants has markedly increased. Most of these students are multiply handicapped and need extensive assistance. While the number of students suffering from hereditary retinal diseases was only minimally increasing during the last 40 years, the number of blind students without additional disabilities has decreased due to the improved technical means to integrate even blind students into main-stream schools. HubMed – rehab

Open Respir Med J. 2013; 7: 1-5
McCarroll ML, Pohle-Krauza RJ, Volsko TA, Martin JL, Krauza ML

In pulmonary rehabilitation (PR) effective measures have been taken while in analyzing a patient’s intervention with the help of entry to exit evaluations. The absence of an objective and quantifiable scale are limitations of PR that allow analyzing of a patient’s self reported symptoms throughout PR. The Breathlessness, Cough and Sputum Scale (BCSS(©)) is used to predict patient exacerbations by evaluating common symptoms identified in the COPD population. This study used the BCSS(©) survey to track complex symptom changes throughout the course of PR intervention. The BCSS(©) tool measured the patient’s self reported symptoms in real time for each visit when patient enrolled in PR.Thirty-five patients with COPD from three outpatient PR centers were asked to report the severity of breathlessness, cough, and sputum prior to each PR session using the BCSS(©) survey.There was a significant decrease in self reported symptoms of the mean BCSS(©) score from entry 4.6(± 2.9) to exit 2.3 (± 2.5), p < 0.001. The results showed variable decrease in the self reported symptoms with more PR visits. The secondary outcome showed high correlations with quality of life measures using the Pulmonary Function Status Scale (PFSS) on entry and exit to PR.The BCSS(©) tool is an effective means for measuring the impact of PR on improving patient tolerance and self-reported symptoms as a result of COPD. More research is needed to better assess the complex symptoms of COPD patients in PR to enhance programmatic outcomes. HubMed – rehab

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