We are also thankful to the healthcare professionals and staff members at the First Affiliated Hospital of Zhejiang University for their support and cooperation throughout the research process.

This study was approved by the ethics committee of the First Affiliated Hospital of Zhejiang University, China, and all research protocols were formulated in compliance with the principles of the Declaration of Helsinki. All patients provided written informed consent to participate in this study. The study recruited 24 patients with upper limb hemiplegia who were admitted to the rehabilitation ward of the First Affiliated Hospital of Zhejiang University from January 2023 to June 2023. Inclusion criteria were: first ischemic or hemorrhagic stroke confirmed by neuroimaging (CT or MRI), aged 45 to 75 years, within 6 months of onset, upper limb motor function impairment and unilateral hemiplegia (Fugl-Meyer Assessment for Upper Extremity, FMA-UE &#8804;40)12,13, modified Ashworth Scale &#8804;214, Mini-Mental State Examination (MMSE) &#62;20 (indicating adequate cognitive function)15, and a clinically stable condition with underlying diseases well controlled, and signed informed consent. Exclusion criteria were: unstable intracranial condition, cognitive and language impairment, shoulder subluxation, shoulder/elbow/wrist mobility impairment, severe spasticity (Ashworth 3-4), and visual impairment. The details of the robot and the software used in this study are listed in the Table of Materials.
1. Study design
<ol>
	<li>Generate a random number using SAS software to split all patients into two groups: experimental and control, each containing 12 patients.</li>
	<li>Conduct initial assessments of upper limb motor function and self-care ability using FMA-UE12, Brunnstrom score (BRS)16, and modified Barthel index (MBI)17 by a blinded rehabilitation therapist.</li>
	<li>Administer basic drug therapy to all patients throughout the trial, focusing on blood pressure control, blood glucose management, blood lipid regulation, seizure prevention, etc.</li>
	<li>Provide the control group with 30 min of routine upper limb rehabilitation training daily, including active and passive joint training, muscle strengthening, and finger movement exercises18.
	<ol>
		<li>Additionally, include 30 min of sanding board training daily19. Offer specialized therapy for lower limb dysfunction, aphasia, dysphagia, and other functional disorders as needed by professional therapists, administered five times a week for eight weeks.</li>
	</ol>
	</li>
	<li>Offer the experimental group the same 30 min routine upper limb rehabilitation therapy as the control group daily, supplemented with 30 min of upper limb rehabilitation robot training daily. Provide equivalent therapy for other functional disorders as provided to the control group.</li>
</ol>
2. Specific operation steps for the upper limb rehabilitation robot
<ol>
	<li>Evaluation of joint range of motion and motor control ability
	<ol>
		<li>Ask the patient to sit in front of the robot, keeping the chest one punch away from the platform (Figure 1).</li>
		<li>Place the affected hand on the end processor of the robot, and use gloves and binders to secure the wrist and hand to prevent slip-off during exercise.</li>
		<li>Ask the patient to move the upper arm to the maximum and extend it as far as possible. 
		NOTE: The instrument will automatically record the patient&#39;s hand movement trajectory to determine the patient&#39;s active joint movement range.</li>
		<li>Put the healthy hand on the affected hand and maximally move the affected upper arm with the assistance of the healthy side. 
		NOTE: The instrument recorded the patient&#39;s hand movement trajectory and obtained the passive joint range of motion. Passive range of motion measurements may be assisted by the therapist if the patient has bilateral mobility impairment.</li>
		<li>Set the motor control evaluation parameters, including target repetition times, single exercise time, and single relaxation time. 
		NOTE: The motor control evaluation parameters were set by the therapist according to the patient&#39;s FMA-UE score12and weekly evaluations using the robot&#39;s built-in assessment system, such as increasing the difficulty for participants with better upper limb strength, increasing the number of repetitions and reducing the rest time, to more accurately assess the patient&#39;s motor control.</li>
		<li>Control the target point to move in different directions according to the motion path and direction displayed on the screen. 
		NOTE: The instrument will evaluate the patient&#39;s motor control ability according to the patient&#39;s motor performance.</li>
	</ol>
	</li>
	<li>Selection of training mode
	<ol>
		<li>Select the isokinetic passive training mode if the upper limb muscles of the patient cannot contract at all or only have a small amount of contraction (BRS 1-2). 
		NOTE: The robot provides complete help to drive the affected upper limb for the passive movement training exercise task.</li>
		<li>Select the auxiliary movement training mode if the patient&#39;s upper limb can perform partial joint movement, but the movement is very slight, and the voluntary movement ability is poor (BRS 3). 
		NOTE: The system can provide the corresponding auxiliary force in real-time according to the actual force degree of the patient and induce the active participation of the patient&#39;s upper limb to the greatest extent during the whole training process to form the correct movement mode.</li>
		<li>Select the active training mode if the patient&#39;s upper limb muscle strength can produce large force or partial resistance (BRS 4). 
		NOTE: The robot can further strengthen the main movement ability of the patient&#39;s upper limb.</li>
		<li>Select the resistance training mode to further improve the accuracy and aiming control of the patient&#39;s upper limb if the patient&#39;s upper limb strength is already strong and can resist greater resistance (BRS 5-6).</li>
	</ol>
	</li>
	<li>Selection of training procedures
	<ol>
		<li>Choose the training procedure, noting that the system provides more than 10 interesting game programs so that patients can experience different VR scenes and interactive experiences, which greatly improves the training enthusiasm of patients (Figure 2).</li>
	</ol>
	</li>
	<li>Setting game parameters
	<ol>
		<li>Set the training time according to the physical condition of the patient, which can be about 10-20 min in general. 
		NOTE: If the patient&#39;s upper limb strength is good, increase the single training time to improve the patient&#39;s exercise tolerance. If the patient&#39;s upper limb strength is poor, select a shorter single training time and allow the patient to complete the training program in multiple sessions.</li>
		<li>Set the range of motion according to the evaluated range of motion of the joint, selecting from full range, medium range, or small range of motion.</li>
		<li>Set the activity trajectory according to the characteristics of the patient&#39;s upper arm muscle strength, choosing the appropriate activity path to target and strengthen weak muscles.</li>
		<li>Set the power assist or resistance value according to the muscle strength of the patient. 
		NOTE: During the training process, the instrument can also automatically adjust the power assist and friction force according to the actual force feedback of the patient.</li>
		<li>Set the protection threshold using mechanical feedback technology to detect when the patient&#39;s strength reaches the threshold, indicating spasms (manifested as discomfort, a sudden increase in muscle tone, or abnormal joint stiffness and locking). The device will issue an alarm and stop immediately to ensure the safety of the patient&#39;s training.</li>
	</ol>
	</li>
	<li>Specific training process 
	NOTE: Patients are trained with 2-3 game items per day, and different game items can be changed regularly.
	<ol>
		<li>Engage in the vegetable farm: In the virtual farm, ask the patient to control the small hands to grab fruits and vegetables and collect as many stars as possible. 
		NOTE: This activity primarily targets the range of motion in elbow and wrist flexion and extension.</li>
		<li>Participate in defend the base: In the scene of the virtual military base, ask the patient to accurately control the bullseye to shoot all the eliminated monsters. 
		NOTE: This exercise aims to enhance muscle control in the elbow and wrist, improving the accuracy of shooting actions.</li>
		<li>Play color dodgeball: On different roads and obstacles, ask the patient to control the ball to avoid obstacles of different colors to obtain gold coins. 
		NOTE: This exercise involves shoulder, elbow, and wrist movements to improve muscle strength and joint mobility.</li>
		<li>Navigate Star Wars: In the virtual space environment, ask the patient to control the position of the aircraft to shoot to destroy the virus while avoiding movement and enemy attacks, training muscle endurance and reaction force. 
		NOTE: This training boosts upper limb endurance, reaction speed, and accuracy, and improves elbow and shoulder coordination and strength.</li>
		<li>Participate in quality ball: Ask the patient to control the ball to reach and stay in the bull &#39;s-eye; the closer the ball is to the bull &#39;s-eye, the higher the score is. 
		NOTE: This activity exercises elbow flexion, extension, shoulder adduction, abduction, and activates the biceps and triceps for precise control.</li>
		<li>Play super ping-pong: In the virtual ball environment, ask the patient to control the ping-pong board to hit the ball and play table tennis with the opponent. The difficulty is advanced and upgraded, and the reaction and hand-eye coordination abilities are trained.</li>
		<li>Engage in block world: Ask the patient to control bullseye shooting to destroy blocks, watch out for enemy attacks and collect as many coins as possible, train thinking strategy and hand-eye coordination.</li>
		<li>Play ball: Ask the patient to control the ball to touch the target; the ball is scored, watch out for enemy attacks, and collect as many coins as possible.</li>
		<li>Participate in legendary gunner: Ask the patient to hold the handle and continuously exert force in the direction of the arrow. The muscle groups of the upper limbs are isometric contraction, and the force is stored to fire to destroy the target.</li>
	</ol>
	</li>
</ol>
3. Follow-up procedure
<ol>
	<li>Evaluate all patients for FMA, BRS, and MBI again after 8 weeks of training by the same rehabilitation therapist.</li>
	<li>Enter all data into the software for statistical analysis. Use a paired sample t-test for intra-group comparison and two independent sample t-tests for inter-group comparison. Consider P &#60; 0.05 as statistically significant.</li>
</ol>

Integrated Robotic and Conventional Therapy for Post-Stroke Upper Limb Recovery

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The authors declare no conflicts of interest or financial disclosures related to this study.

Building upon previous research20, this study adopts an integrated approach by combining robotic training for upper limb rehabilitation with conventional therapeutic methods for post-stroke recovery. The current findings suggest that this integration substantially enhances upper limb motor function and improves the ability to perform activities of daily living (ADLs), surpassing the outcomes achieved with traditional rehabilitation techniques alone.
This investigation e...

Stroke, identified as an acute neurological event caused by the blockage or rupture of cerebral vessels, interrupts brain circulation1, ranking as the second leading cause of death and a major contributor to long-term disability worldwide. On the initial day following a stroke, up to 80% of survivors experience upper limb dysfunction, with 30%-66% still facing challenges six months later2. After one year, those with upper limb impairments report heightened anxiety, diminished quality of life, and reduced happiness3. Moreover, by 16 months post-stroke, only about 60% of hemiplegic individuals requiring hospital rehabilitation attain functional independence in basic daily activities, with those suffering from sensory, motor, and visual impairments being significantly more reliant on caregiver support4. Additionally, upper limb dysfunction impedes hand utility, particularly noted by increased muscle tension among weakened flexors and extensors during physical tasks5.
Despite various rehabilitation efforts, effectively addressing upper limb injuries in stroke survivors presents a formidable challenge6. High-intensity, repetitive task training has shown optimal outcomes but demands considerable therapist involvement, leading to high costs and logistical burdens7. Therefore, low-cost interventions are needed that do not increase therapists' workload while increasing patient interest in training. The upper limb rehabilitation robot can serve as an alternative treatment to promote high-intensity exercise and reduce dependence on therapists1. It is a newly developed upper limb intelligent feedback rehabilitation robot system (see Table of Materials). The device can output objective metrics (such as speed, torque, range of motion, position, etc.) to assess and monitor patients' improvements and customize treatment according to varying degrees of motor impairment. It has high consistency and reproducibility for widespread use. Additionally, strong evidence supports high-intensity, high-repetitiveness, and task-oriented training in facilitating post-stroke motor recovery8.
On the other hand, rehabilitation robots are a relatively novel assistive treatment approach with advantages like high safety and durability9. The American Stroke Association recently released guidelines reporting that robot-assisted motor training can help patients improve post-stroke motor function and mobility in addition to conventional therapy10. A 2018 article in the Journal of Rehabilitation Medicine reported that combining robot-assisted training with conventional rehabilitation can significantly improve upper limb motor function in stroke patients, warranting clinical promotion11. The system includes four training modes: constant speed training, power-assisted training, active training, and resistance training, and can conduct assessments of joint range of motion. A review of robot-assisted rehabilitation for subacute stroke patients indicated that robotic interventions significantly improved upper extremity functions, particularly in shoulder, elbow, and forearm performance, as assessed by the Functional Independence Measure and Fugl-Meyer Assessment Scale. These interventions also enhanced daily living activities, improving the quality of life10.
This study aims to evaluate the effectiveness of an intelligent feedback rehabilitation robot in rehabilitating upper limb motor functions in patients with early post-stroke hemiplegia, providing a scientific basis for rehabilitation strategies for stroke patients with hemiplegia.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Upper Limb Rehabilitation Robot[Fourier M2]</td>
			<td>Shanghai Fourier Intelligence, China</td>
			<td>ArmMotus M2</td>
			<td>The upper limb intelligent force feedback motion control training system [M2] is a new generation of upper limb intelligent force feedback rehabilitation robot training system independently developed by Shanghai Fourier Intelligence. Based on core technologies such as force feedback, this training system can sense the patient&#39;s force and whether there is any spasticity when the patient completes the predetermined action, and then change the power assist or resistance of the device itself, so as to improve the upper limb motor dysfunction. Through goal-oriented training, M2 endows games with training, increases the enthusiasm of patients, and more effectively exercises the gross motor function and cognitive function of patients&#39; upper limbs.</td>
		</tr>
		<tr>
			<td>SAS software</td>
			<td>SAS Institute</td>
			<td></td>
			<td>https://www.sas.com/en_in/home.html</td>
		</tr>
		<tr>
			<td>SPSS software</td>
			<td>IBM</td>
			<td>version 26</td>
			<td>https://www.ibm.com/products/spss-statistics</td>
		</tr>
	</tbody>
</table>

enhancing upper limb function and motor skills post-stroke through an upper limb rehabilitation robot

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby profoundly affecting individuals' activities of daily living and diminishing their quality of life. Traditional rehabilitation methods for upper limb recovery post-stroke are often hindered by limitations, including therapist and patient fatigue, reliance on singular training methodologies, and lack of sustained motivation. Addressing these challenges, this study introduces an upper limb rehabilitation robot, which uses intelligent feedback motion control to improve therapeutic outcomes. The system is distinguished by its capability to adjust the direction and magnitude of force feedback dynamically, based on the detection of spastic movements during exercises, thereby offering a tailored therapeutic experience. This system is equipped with four distinct training modes, intelligent assessment of joint range of motion, and the ability to personalize training programs. Moreover, it provides an immersive interactive gaming experience coupled with comprehensive safety measures. This multifaceted approach not only elevates the engagement and interest of participants beyond traditional rehabilitation protocols but also demonstrates significant improvements in upper limb functionality and the activities of daily living among hemiplegic patients. The system exemplifies an advanced tool in upper limb rehabilitation, offering a synergistic blend of precision, personalization, and interactive engagement, thereby broadening the therapeutic options available to stroke survivors.

A total of 24 patients were enrolled and randomly assigned to either the control or experimental group (Table 1). There was no statistically significant difference between the two groups for sex, age, disease duration, or stroke type (P &#62; 0.05). After 8 weeks of upper limb training, the Fugl-Meyer Assessment for Upper Extremity (FMA-UE)12 was used to evaluate upper limb motor function, while the Brunnstrom Recovery Stage for Arm (BRS-Arm)16 and...

Author Spotlight: Enhancing Post-Stroke Upper Limb Rehabilitation with Robotic Technologies for Improved Motor Recovery and Functional Outcomes

This protocol describes an upper limb rehabilitation robot that provides intelligent feedback through four modes. These modes enhance upper limb function and flexibility, thereby improving patients' quality of life.

Enhancing Upper Limb Function and Motor Skills Post-Stroke Through an Upper Limb Rehabilitation Robot

Cerebrovascular accidents, commonly known as strokes, represent a prevalent neurological event leading to significant upper limb disabilities, thereby ...

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Research

JoVE Journal

Medicine

557 Views.  Zhejiang University. This protocol describes an upper limb rehabilitation robot that provides intelligent feedback through four modes. These modes enhance upper limb function and flexibility, thereby improving patients' quality of life.

Video: Author Spotlight: Enhancing Post-Stroke Upper Limb Rehabilitation with Robotic Technologies for Improved Motor Recovery and Functional Outcomes

Methods to Quantify Pharmacologically Induced Alterations in Motor Function in Human Incomplete SCI

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, recovery from SCI typically involves long term rehabilitation. While recovery of walking ability is a primary goal in many patients early after injury, those with a motor incomplete SCI, indicating partial preservation of volitional control, may have the sufficient residual descending pathways necessary to attain this goal. However, despite physical interventions, motor impairments including weakness, and the manifestation of abnormal involuntary reflex activity, called spasticity or spasms, are thought to contribute to reduced walking recovery. Doctrinaire thought suggests that remediation of this abnormal motor reflexes associated with SCI will produce functional benefits to the patient. For example, physicians and therapists will provide specific pharmacological or physical interventions directed towards reducing spasticity or spasms, although there continues to be little empirical data suggesting that these strategies improve walking ability.
In the past few decades, accumulating data has suggested that specific neuromodulatory agents, including agents which mimic or facilitate the actions of the monoamines, including serotonin (5HT) and norepinephrine (NE), can initiate or augment walking behaviors in animal models of SCI. Interestingly, many of these agents, particularly 5HTergic agonists, can markedly increase spinal excitability, which in turn also increases reflex activity in these animals. Counterintuitive to traditional theories of recovery following human SCI, the empirical evidence from basic science experiments suggest that this reflex hyper excitability and generation of locomotor behaviors are driven in parallel by neuromodulatory inputs (5HT) and may be necessary for functional recovery following SCI. 
The application of this novel concept derived from basic scientific studies to promote recovery following human SCI would appear to be seamless, although the direct translation of the findings can be extremely challenging. Specifically, in the animal models, an implanted catheter facilitates delivery of very specific 5HT agonist compounds directly onto the spinal circuitry. The translation of this technique to humans is hindered by the lack of specific surgical techniques or available pharmacological agents directed towards 5HT receptor subtypes that are safe and effective for human clinical trials. However, oral administration of commonly available 5HTergic agents, such as selective serotonin reuptake inhibitors (SSRIs), may be a viable option to increase central 5HT concentrations in order to facilitate walking recovery in humans. Systematic quantification of how these SSRIs modulate human motor behaviors following SCI, with a specific focus on strength, reflexes, and the recovery of walking ability, are missing.
This video demonstration is a progressive attempt to systematically and quantitatively assess the modulation of reflex activity, volitional strength and ambulation following the acute oral administration of an SSRI in human SCI. Agents are applied on single days to assess the immediate effects on motor function in this patient population, with long-term studies involving repeated drug administration combined with intensive physical interventions.

This video demonstrates modulation of reflex activity, volitional strength and ambulation through clinical and quantitative assessments in individuals with motor incomplete SCI as a result of acute oral administration of a serotonin reuptake inhibitor (SSRI).

Spinal cord injury (SCI) is a debilitating disorder, which produces profound deficits in volitional motor control. Following medical stabilization, ...

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

The purpose is to present a new method, breathing-control electrical stimulation (BreEStim) for management of neuropathic pain and spasticity.

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

Remote Limb Ischemic Preconditioning:  A Neuroprotective Technique in Rodents

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. Sublethal ischemia has also been shown to upregulate protective mechanisms in remote tissues. A brief period of ischemia (5-10 min) in the hind limb of mammals induces self-protective responses in the brain, lung, heart and retina. The effect is known as remote ischemic preconditioning (RIP). It is a therapeutically promising way of protecting vital organs, and is already under clinical trials for heart and brain injuries. This publication demonstrates a controlled, minimally invasive method of making a limb &#8211; specifically the hind limb of a rat &#8211; ischemic. A blood pressure cuff developed for use in human neonates is connected to a manual sphygmomanometer and used to apply 160 mmHg pressure around the upper part of the hind limb. A probe designed to detect skin temperature is used to verify the ischemia, by recording the drop in skin temperature caused by pressure-induced occlusion of the leg arteries, and the rise in temperature which follows release of the cuff. This method of RIP affords protection to the rat retina against bright light-induced damage and degeneration.

Remote ischemic preconditioning (RIP) is a method of conditioning tissues against damaging stress. We have established a method of remote ischemia at the hind limb, by inflating a sphygmomanometer cuff for 5-10 min. The neuroprotective capabilities of RIP have been demonstrated in a model of retinal degeneration in rodents.

Sublethal ischemia protects tissues against subsequent, more severe ischemia through the upregulation of endogenous mechanisms in the affected tissue. ...

Orthotopic Hind Limb Transplantation in the Mouse

In vivo animal model systems, and in particular mouse models, have evolved into powerful and versatile scientific tools indispensable to basic and translational research in the field of transplantation medicine. A vast array of reagents is available exclusively in this setting, including mono- and polyclonal antibodies for both diagnostic and interventional applications. In addition, a vast number of genotyped, inbred, transgenic, and knock out strains allow detailed investigation of the individual contributions of humoral and cellular components to the complex interplay of an immune response and make the mouse the gold standard for immunological research. 
Vascularized Composite Allotransplantation (VCA) delineates a novel field of transplantation using allografts to replace "like with like" in patients suffering traumatic or congenital tissue loss. This surgical methodological protocol shows the use of a non-suture cuff technique for super-microvascular anastomosis in an orthotopic mouse hind limb transplantation model. The model specifically allows for comparison between established paradigms in solid organ transplantation with a novel form of transplants consisting of various different tissue components. Uniquely, this model allows for the transplantation of a viable vascularized bone marrow compartment and niche that have the potential to exert a beneficial effect on the balance of immune acceptance and rejection. This technique provides a tool to investigate alloantigen recognition and allograft rejection and acceptance, as well as enables the pursuit of functional nerve regeneration studies to further advance this novel field of transplantation.

This novel model for orthotopic hind limb transplantation in the mouse, applying a non-suture cuff technique for super-microvascular anastomosis, provides a powerful tool for in&#160;vivo mechanistic immunological research related to vascularized composite allotransplantation (VCA).

In vivo animal model systems, and in particular mouse models, have evolved into powerful and versatile scientific tools indispensable to basic and ...

A Method for Quantifying Upper Limb Performance in Daily Life Using Accelerometers

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. It has become important to measure a person's activities in daily life, and not just measure their capacity for activity in the structured environment of a clinic or laboratory. A wearable sensor that is now enabling measurement of daily movement is the accelerometer. Accelerometers are commercially-available devices resembling large wrist watches that can be worn throughout the day. Data from accelerometers can quantify how the limbs are engaged to perform activities in peoples' homes and communities. This report describes a methodology to collect accelerometry data and turn it into clinically-relevant information. First, data are collected by having the participant wear two accelerometers (one on each wrist) for 24 h or longer. The accelerometry data are then downloaded and processed to produce four different variables that describe key aspects of upper limb activity in daily life: hours of use, use ratio, magnitude ratio, and the bilateral magnitude. Density plots can be constructed that visually represent the data from the 24 h wearing period. The variables and their resultant density plots are highly consistent in neurologically-intact, community-dwelling adults. This striking consistency makes them a useful tool for determining if upper limb daily performance is different from normal. This methodology is appropriate for research studies investigating upper limb dysfunction and interventions designed to improve upper limb performance in daily life in people with stroke and other patient populations. Because of its relative simplicity, it may not be long before it is also incorporated in clinical neurorehabilitation practice.

This protocol describes a method to quantify upper limb performance in daily life using wrist-worn accelerometers.

A key reason for referral to rehabilitation services after stroke and other neurological conditions is to improve one's ability to function in daily life. ...

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular disease is the development of ischemia. In severe cases, patients can develop critical limb ischemia in which they experience constant pain and an increased risk of limb amputation. Current therapies for peripheral ischemia include bypass surgery or percutaneous interventions such as angioplasty with stenting or atherectomy to restore blood flow. However, these treatments often fail to the continued progression of vascular disease or restenosis or are contraindicated due to the overall poor health of the patient. A promising potential approach to treat peripheral ischemia involves the induction of therapeutic neovascularization to allow the patient to develop collateral vasculature. This newly formed network alleviates peripheral ischemia by restoring perfusion to the affected area. The most frequently employed preclinical model for peripheral ischemia utilizes the creation of hind limb ischemia in healthy rabbits through femoral artery ligation. In the past, however, there has been a strong disconnect between the success of preclinical studies and the failure of clinical trials regarding treatments for peripheral ischemia. Healthy animals typically have robust vascular regeneration in response to surgically induced ischemia, in contrast to the reduced vascularity and regeneration in patients with chronic peripheral ischemia. Here, we describe an optimized animal model for peripheral ischemia in rabbits that includes hyperlipidemia and diabetes. This model has reduced collateral formation and blood pressure recovery in comparison to a model with a higher cholesterol diet. Thus, the model may provide better correlation with human patients with compromised angiogenesis from the common co-morbidities that accompany peripheral vascular disease.

We describe a surgical procedure used to induce peripheral ischemia in rabbits with hyperlipidemia and diabetes. This surgery acts as a preclinical model for conditions experienced in peripheral artery disease in patients. Angiography is also described as a means to measure the extent of introduced ischemia and recovery of perfusion.

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular ...

Brachial Artery Catheterization in Swine

The video describes in detail the catheterization of the distal brachial artery in swine. This technique enables researchers to measure arterial blood pressure continuously and collect arterial blood samples to assess arterial blood gas measurements. Arterial blood pressures and arterial blood gases are important physiological parameters to monitor during experimental procedures. In swine, four common methods of arterial catheterization have been described, including catheterization of the carotid, femoral, auricular, and medial saphenous arteries. Each of these techniques have advantages, such as ease of access for the auricular artery, and disadvantages that include deep tissue dissection for carotid artery catheterization. The described alternative method of arterial catheterization in swine, the catheterization of the distal aspect of the brachial artery, is a rapid procedure that requires relatively minimal tissue dissection and provides information that is in line with data collected from other arterial catheterization sites. The procedure uses a medial approach along an oblique plane of the lower brachium, positioned between the olecranon and the flexor aspect of the elbow joint, and this approach allows researchers the major advantage of unimpeded freedom for procedures that involve the caudoventral, caudodorsal back, or hind limbs of the pig. Due to the location of the upper forelimb of the catheterized vessel and potential challenges of effective homeostasis following catheter removal from the artery, this technique may be limited to non-recovery procedures.

The video describes in detail the catheterization of the distal brachial artery in swine. This procedure accurately measures arterial blood pressure and is a simple and fast method to collect samples for arterial blood gas measurements.

The video describes in detail the catheterization of the distal brachial artery in swine. This technique enables researchers to measure arterial blood ...

Structured Motor Rehabilitation After Selective Nerve Transfers

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on the successful re-innervation of the targets in the periphery and on the motor re-learning process entailing cortical plasticity. While there is an increasing number of methods to improve rehabilitation, their routine implementation in a clinical setting remains a challenge due to their complexity and long duration. Therefore, recommendations for rehabilitation strategies are presented with the aim of guiding medical doctors and therapists through the long-lasting rehabilitation process and providing step-by-step instructions for supporting motor re-learning.
Directly after nerve transfer surgery, no motor function is present, and therapy should focus on promoting activity in the sensory-motor cortex areas of the paralyzed body part. After about two to six months (depending on the severity and modality of injury, the distance of nerve regeneration and many other factors), the first motor activity can be detected via electromyography (EMG). Within this phase of rehabilitation, multimodal feedback is used to re-learn the motor function. This is especially critical after nerve transfers, as muscle activation patterns change due to the altered neural connection. Finally, muscle strength should be sufficient to overcome gravity/resistance of antagonistic muscles and joint stiffness, and more functional tasks can be implemented in rehabilitation.

Here, we present a protocol for the motor rehabilitation of patients with severe nerve injuries and selective nerve transfer surgery. It aims at restoring the motor function proposing several stages in patient education, early-stage therapy after surgery and interventions for rehabilitation after successful re-innervation of the nerve&#8217;s target.

After severe nerve injuries, selective nerve transfers provide an opportunity to restore motor and sensory function. Functional recovery depends both on ...

A Computerized Functional Skills Assessment and Training Program Targeting Technology Based Everyday Functional Skills

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a computerized functional skills training program that was paired in half of the participants with a commercially available cognitive training (CCT) program.
Non-impaired older individuals (NC) aged 60+ (n=45) and similarly aged individuals with mild cognitive impairment (MCI; n=50) were randomized to receive 12 weeks of twice-weekly computerized functional skills training (CFST) or 12 weeks of twice-weekly sessions split between CCT and CFST. Skills trained were use of an ATM; internet banking; ticket kiosk; telephone and internet prescription refill; medication management; and internet shopping. As with previous functional capacity assessments, we focus on completion time for each simulation.
51 participants completed the training program, either by mastering all 6 tasks (34) or completing 12 weeks of training. 44 more participants completed 4 or more training sessions so they were also analyzed for improvement up to their last training session. Completion time for all 6 tests significantly improved from the baseline assessment to the final training session in both groups of participants (all p&#60;0.001 with an average improvement in task completion time of 45%). Further, there was no differential improvement in MCI and NC in the 6 tests from baseline to end of training (all t&#60;1.66, all p&#62;0.12). Finally, combined CCT plus CFST did not differ from CSFT alone on any of the percent-change score measures (all t&#60;1.64, all p&#62;0.11).
Both NC and MCI groups evidenced substantial improvements in performance. CCT supplementation led to similar functional gains with half as many training sessions. The NC participants proceeded through the training fairly rapidly even without CCT supplementation; MCI participants required more training but learned equivalently. These findings suggest that even in cases with memory impairments, functional skills can be efficiently learned with training.

This training protocol uses computerized training to teach technology-related everyday functional skills. These skills include financial skills, travel and transit, as well as medication management.

Today, many functional skills are technology-based, so development of a technology-based training program has broad importance. Here we present a ...

Lower Limb Biomechanical Analysis of Healthy Participants

Biomechanical analysis techniques are useful in the study of human movement. The aim of this study was to introduce a technique for the lower limb biomechanical assessment in healthy participants using commercially available systems. Separate protocols were introduced for the gait analysis and muscle strength testing systems. To ensure maximum accuracy for gait assessment, attention should be given to the marker placements and self-paced treadmill acclimatization time. Similarly, participant positioning, a practice trial, and verbal encouragement are three critical stages in muscle strength testing. The current evidence suggests that the methodology outlined in this article may be effective for the assessment of lower limb biomechanics.

This article introduces a comprehensive experimental methodology on two of the latest technologies available to measure the lower limb biomechanics of individuals.