functional occupational therapy for patients with right hemisphere damage to study brain function remodeling

Functional OT and Near-IR Spectroscopy to Study Brain Function Remodeling

Cerebral hemispheric damage can lead to sensory and motor dysfunction of the contralateral limbs1,2,3, negatively affecting patients&#39; motor control, mobility, and functional learning to various degrees4 and therefore imposing heavy burdens on families and society5. For patients with right hemisphere damage (RHD), the speed of recovery is less than satisfactory. However, in most RHD cases, the affected left limbs, being on the non-dominant side of the body, have received insufficient attention from the patient and the caregivers. Given that dysfunction of the upper limbs and hands seriously affects the ability to perform daily activities and quality of life, a more suitable method to improve the rehabilitation effect of upper limb function in RHD patients is needed6,7,8,9,10.
Exercise therapy is an important method to help patients recover their limb function. For the early rehabilitation of patients with brain injury, passive movement (PM) and assisted active movement (AAM) training methods are usually used. AAM entails the activity of specific joints completed through a combination of their own muscle strength and outside assistance11. The key is for the patient to actively participate in assisted rehabilitation. The readiness of the human brain to activate can help stimulate and integrate the motor system in the cycle of motor control. Many studies have shown that AAM can induce neuroplastic changes, thereby leading to increased functional recovery in patients12,13.
Functional near-infrared spectroscopy (fNIRS) is an imaging technique based on optical principles. According to the correlation between the attenuation of light in the tissue and the different concentrations of light-absorbing substances, fNIRS can quantitatively analyze concentration changes in oxygenated hemoglobin and deoxygenated hemoglobin in brain tissue, thereby monitoring the functional activity of the cerebral cortex14. Many studies have shown that fNIRS is an important means of monitoring brain oxygenation and energy metabolism after cerebral hemisphere injury15,16,17. Therefore, fNIRS might be a suitable monitoring method for studying cerebral cortex changes related to upper limb motor function recovery after cerebral hemisphere injury.
The motor signals produced by different sensory input methods and the adjustment states of the sensory cortex are different18,19. The sensory stimuli produced by passive and active movements are closely related to the stability of perception and the ability to build accurate representations of one&#39;s environment, which then guide one&#39;s behavior20. This study was designed to explore the effects of different modes of exercise on early upper limb rehabilitation and brain activation in patients with cerebral hemispheric injuries by analyzing fNIRS data and to provide scientific strategies for the comprehensive rehabilitation of patients in the future.
The purpose of this study was to investigate the effects of FOT combined with different types of exercise on upper limb function and brain remodeling in RHD patients. We hypothesized that FOT-AAM is more effective than FOT-PM in improving upper limb function and brain activation in RHD patients.

Author Spotlight: Advancing Upper Limb Rehabilitation in Patients with Right Hemisphere Damage Using Assisted Active Exercise

Investigating the Effect of Different Types of Exercise on Upper Limb Functional Recovery in Patients with Right Hemisphere Damage Based on fNIRS

We are trying to address upper limb rehabilitation for spinal cord injury patients, and we have studied the effectiveness of assisted active exercise in functional occupational therapy for patients with right hemisphere damage. We currently used head rehabilitation robotics and the near-infrared functional brain imagining technology for our research. Challenges encountered so far include the need for the patient to keep his head stable during fNIRS testing and the need to carefully adjust to the optical and to ensure good quality channel signal.Our findings suggest that patients should be fully motivated and assisted with active rehabilitation exercise rather than purely passive exercise in the future, as this is more effective in the rehabilitation training for brain function remodeling.

Functional Occupational Therapy for Patients with Right Hemisphere Damage to Study Brain Function Remodeling

To begin, identify the subject and the control group. Move the shoulder, elbow, wrist, thumb, and fingers of the affected limb of the patient for one minute. Then instruct the patient to actuate the affected hand using the unaffected hand to push a foam roller, lift a wooden peg, lift a small wooden stick, and hold a ball.For assisted active movement, select Smart Mirror mode, and set the time to 10 minutes on the rehabilitation training device. Ask the patient about their feelings, and choose from levels one to 10 according to the patient's experience and tolerance. Then click the Start button.As the patient voluntarily performs the grasping action with the unaffected hand, instruct them to observe the movement and try to grasp with the affected hand using the glove. Similarly, instruct the patient to observe the finger movements of the unaffected hand, and try to open the fingers of the affected hand. For passive movement, place the corresponding glove on the affected hand.Using the same device, select Passive mode. Set the time to 10 minutes, and adjust the intensity levels according to the patient's sensations. After starting the device, let the patient close and open the affected hand for 10 minutes.

functional-occupational-therapy-for-patients-with-right-hemisphere

Research

JoVE Journal

Medicine

To investigate the effects of functional occupational therapy (FOT) combined with different types of exercise on upper limb motor function recovery and brain function remodeling in patients with right hemisphere damage (RHD) by analyzing functional near-infrared spectroscopy (fNIRS). Patients (n = 32) with RHD at Beijing Bo'ai Hospital were recruited and randomly allocated to receive either FOT combined with passive motion (N=16) or FOT combined with assisted active movement (N=16). The passive motion group (FOT-PM) received functional occupational therapy for 20 min and passive exercise for 10 min in each session, while the assisted active movement group (FOT-AAM) received functional occupational therapy for 20 min and assisted active exercise for 10 min. Both groups received conventional drug therapy and other rehabilitation therapy. Treatment was performed once a day, 5 times a week for 4 weeks. The recovery of motor function and activities of daily living (ADL) was assessed using Fugl-Meyer Assessment upper extremity (FMA-UE) and modified Barthel index (MBI) before and after treatment, and brain activation of the bilateral motor area was analyzed with fNIRS. The findings suggested that FOT combined with AAM was more effective than FOT combined with PM in improving the motor function of RHD patients' upper limbs and fingers, improving their ability to perform activities of daily living, and facilitating brain function remodeling of the motor area.

Here, we investigate the effect of functional occupational therapy combined with assisted active or passive motion on the upper limb function of patients with right hemisphere damage and explore the effect of functional near-infrared spectroscopy on brain function remodeling.

To investigate the effects of functional occupational therapy (FOT) combined with different types of exercise on upper limb motor function recovery and ...

Functional Near-Infrared Spectroscopy to Assess Post-Intervention Brain Function Remodeling

To begin, offer functional occupational therapy to the patients and the control group. For fNIRS, open the computer interface and enter the basic information of the subject. Then choose the optode arrangement, 2x4R, 2x4L followed by the 15-30-15 task paradigm, and set the assessment time to 5.Place the near-infrared system device on the patient according to the optode layout, and adjust the positions of the emitters and detectors. After removing the hair to facilitate close contact with the scalp, click the OK button. Next, click Standby, followed by Start Auto Adjust to calibrate all channels to display green.Then place the glove on the affected hand of the patient. After clicking the Start button on the fNIRS computer interface, measure the initial resting phase for 15 seconds as the patient sits quietly, avoiding external thoughts. Then click the Start button of the hand device, and after 30 seconds, click the Stop button to end the exercise.To complete the test, initiate another 15-second rest period. Finally, repeat the rest task rest test five times to complete the fNIRS. After the intervention, the fNIRS data showed a significant difference in the overall means of right hemisphere integral value for the subject in the control group and the experimental group, whereas no significant differences in the centroid values were observed between the two groups.