Haptics in Stroke Rehabilitation: Difference between revisions

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== Theoretical Framework ==
== Theoretical Framework ==


Various Virtual reality systems have been studied with different Haptic devices employed to restore hand function post-stroke. These devices increase immersion through the application of vibrotactile stimulation with kinaesthetic feedback.<ref name=":0" /> This multi-modal feedback has been proposed to improve strength, motor control, and dexterity in integration with the repetitive practice of relevant motor tasks through the mechanism of neuroplasticity.<ref>Levin MF, Magdalon EC, Michaelsen SM, Quevedo AA. Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in individuals with Stroke. IEEE Trans Neural Syst Rehabil Eng. 2015 Nov;23(6):1047-55. doi:10.1109/TNSRE.2014.2387412</ref><ref>Yeh SC, Lee SH, Chan RC, Wu Y, Zheng LR, Flynn S. The Efficacy of a Haptic-Enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation. J Healthc Eng. 2017;2017:9840273. doi:10.1155/2017/9840273</ref><ref>Lehmann, I., Baer, G. & Schuster-Amft, C. (2017) Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study, Physiotherapy. 2017 doi:10.1016/j.physio.2017.03.001</ref><ref>Maris A, Coninx K, Seelen H, Truyens V, De Weyer T, Geers R, Lemmens M, CoolenJ, Stupar S, Lamers I, Feys P. The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke. Disabil Rehabil Assist Technol. 2018 Jan;13(1):1-9. DOI: 10.1080/17483107.2016.1278467</ref><ref>Thielbar KO, Triandafilou KM, Barry AJ, Yuan N, Nishimoto A, Johnson J, Stoykov ME, Tsoupikova D, Kamper DG. Home-based upper extremity stroke therapy using a multi-user virtual reality environment: a randomized trial. Arch Phys Med Rehabil. 2019 Nov 9. PII: S0003-9993(19)31365-6. doi:10.1016/j.apmr.2019.10.182</ref>
Various Virtual reality systems have been studied with different Haptic devices employed to restore hand function post-stroke. These devices increase immersion through the application of vibrotactile stimulation with kinaesthetic feedback.<ref name=":0" /> This multi-modal feedback has been proposed to improve strength, motor control, and dexterity in integration with the repetitive practice of relevant motor tasks through the mechanism of neuroplasticity.<ref name=":3">Levin MF, Magdalon EC, Michaelsen SM, Quevedo AA. Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in individuals with Stroke. IEEE Trans Neural Syst Rehabil Eng. 2015 Nov;23(6):1047-55. doi:10.1109/TNSRE.2014.2387412</ref><ref name=":4">Yeh SC, Lee SH, Chan RC, Wu Y, Zheng LR, Flynn S. The Efficacy of a Haptic-Enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation. J Healthc Eng. 2017;2017:9840273. doi:10.1155/2017/9840273</ref><ref name=":5">Lehmann, I., Baer, G. & Schuster-Amft, C. (2017) Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study, Physiotherapy. 2017 doi:10.1016/j.physio.2017.03.001</ref><ref name=":6">Maris A, Coninx K, Seelen H, Truyens V, De Weyer T, Geers R, Lemmens M, CoolenJ, Stupar S, Lamers I, Feys P. The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke. Disabil Rehabil Assist Technol. 2018 Jan;13(1):1-9. DOI: 10.1080/17483107.2016.1278467</ref><ref name=":7">Thielbar KO, Triandafilou KM, Barry AJ, Yuan N, Nishimoto A, Johnson J, Stoykov ME, Tsoupikova D, Kamper DG. Home-based upper extremity stroke therapy using a multi-user virtual reality environment: a randomized trial. Arch Phys Med Rehabil. 2019 Nov 9. PII: S0003-9993(19)31365-6. doi:10.1016/j.apmr.2019.10.182</ref>


==== The Sensory side of Motor rehabilitation ====
==== The Sensory side of Motor rehabilitation ====
One of the most relevant sources of sensory information for the motor system is Somesthesis<ref name=":2" />. The somatosensory system processes information and represents, several modalities of somatic sensation (i.e., touch, pain, temperature, proprioception). However, substantial processing occurs even in the motor system. A good example of the functional interplay between somatosensory and motor systems is the gating of sensory input for motor control. Sensory gating is exerted by integrating afferent somatosensory inputs from peripheral receptors with the motor output at several levels in the ascending sensory pathway and the cerebral cortex, consistent with serial transmission of afferent sensory activity from the spinal cord to the primary somatosensory cortex(SI), and then to primary motor cortex (MI)<ref name=":2">Ghez C, Pisa M. Inhibition of afferent transmission in the cuneate nucleus during voluntary movement in the cat. Brain Research. 1972; 40(1):145–151.</ref><ref>Hantman AW, Jessell TM. Clarke’s column neurons as the focus of a corticospinal corollary circuit. Nature Neuroscience. 2010; 13(10):1233–1239. </ref><ref>Jiang W, Lamarre Y, Chapman CE. Modulation of cutaneous cortical evoked potentials during isometric and isotonic contractions in the monkey. Brain Research. 1990; 536(1):69–78. </ref><ref>Seki K, Fetz EE. Gating of sensory input at spinal and cortical levels during preparation and execution of voluntary movement. The Journal of Neuroscience. 2012; 32(3):890–902.</ref> Various forms of somatosensory stimulation such as peripheral nerve stimulation, muscle tendon vibration, paired associative stimulation and tactile learning have been shown to facilitate motor behaviour and enhance motor performance by increasing corticospinal excitability and enlarging the representation of the stimulated body part in MI.<ref>Edwards DJ, Dipietro L, Demirtas-Tatlidede A, Medeiros AH, Thickbroom GW, Mastaglia FL, Krebs HI, Pascual-Leone A. Movement-generated afference paired with transcranial magnetic stimulation: An associative stimulation paradigm. Journal of Neuroengineering and Rehabilitation. 2014; 11(1):31. </ref> <ref>Ridding MC, Brouwer B, Miles TS, Pitcher JB, Thompson PD. Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Experimental Brain Research. 2000; 131(1):135–143</ref>


==== Evidence on Effectiveness ====
* One of the most relevant sources of sensory information for the motor system is Somesthesis<ref name=":2" />. The somatosensory system processes information and represents, several modalities of somatic sensation (i.e., touch, pain, temperature, proprioception). However, significant processing occurs even in the motor system.
* A good example of the functional interplay between somatosensory and motor systems is the gating of sensory input for motor control. Sensory gating is exerted by integrating afferent somatosensory inputs from peripheral receptors with the motor output at several levels in the ascending sensory pathway and the cerebral cortex, consistent with serial transmission of afferent sensory activity from the spinal cord to the primary somatosensory cortex(SI), and then to primary motor cortex (MI)<ref name=":2">Ghez C, Pisa M. Inhibition of afferent transmission in the cuneate nucleus during voluntary movement in the cat. Brain Research. 1972; 40(1):145–151.</ref><ref>Hantman AW, Jessell TM. Clarke’s column neurons as the focus of a corticospinal corollary circuit. Nature Neuroscience. 2010; 13(10):1233–1239. </ref><ref>Jiang W, Lamarre Y, Chapman CE. Modulation of cutaneous cortical evoked potentials during isometric and isotonic contractions in the monkey. Brain Research. 1990; 536(1):69–78. </ref><ref>Seki K, Fetz EE. Gating of sensory input at spinal and cortical levels during preparation and execution of voluntary movement. The Journal of Neuroscience. 2012; 32(3):890–902.</ref>
* Various forms of somatosensory stimulation such as peripheral nerve stimulation, muscle tendon vibration, paired associative stimulation and tactile learning have been shown to facilitate motor behaviour and enhance motor performance by increasing corticospinal excitability and enlarging the representation of the stimulated body part in MI.<ref>Edwards DJ, Dipietro L, Demirtas-Tatlidede A, Medeiros AH, Thickbroom GW, Mastaglia FL, Krebs HI, Pascual-Leone A. Movement-generated afference paired with transcranial magnetic stimulation: An associative stimulation paradigm. Journal of Neuroengineering and Rehabilitation. 2014; 11(1):31. </ref> <ref>Ridding MC, Brouwer B, Miles TS, Pitcher JB, Thompson PD. Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Experimental Brain Research. 2000; 131(1):135–143</ref>
 
== Evidence on Effectiveness ==
Rehabilitation is an integral component of any program aimed at improving motor function in stroke survivors.<ref>Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005;36:e100 –143.</ref> <ref>Teasell R, Meyer MJ, McClure A, Pan C, Murie-Fernandez M, Foley N, Salter K. Stroke rehabilitation: an international perspective. Top Stroke Rehabil. 2009;16:44 –56.</ref> In order to overcome the benefits of conventional rehabilitation, novel strategies are becoming available.<ref>Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8:741–754.</ref>
 
In the present literature review, we found case studies and a crossover RCT.  Majority of the studies showed a benefit for the primary outcome. There was a significant improvement in fine motor performance.<ref name=":4" />  Similarly, there was a substantial improvement in motor impairment. <ref name=":3" /><ref name=":5" /><ref name=":6" /><ref name=":7" />
 
 
 


Rehabilitation is an integral component of any program aimed at improving motor function in stroke survivors.<ref>Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005;36:e100 –143.</ref> <ref>Teasell R, Meyer MJ, McClure A, Pan C, Murie-Fernandez M, Foley N, Salter K. Stroke rehabilitation: an international perspective. Top Stroke Rehabil. 2009;16:44 –56.</ref> In order to overcome the  benefits of conventional rehabilitation, novel strategies are becoming available. 9,2




== Conclusions ==


Haptic devices enhance motor recovery post-stroke through sensory feedback. Presently such devices are unwieldy, expensive and impractical for daily clinical use. Therefore, economical, smaller and ergonomically designed Haptic devices may allow future studies to make stronger arguments for their inclusion in hand rehabilitation after stroke.
== References ==
== References ==

Revision as of 18:51, 21 November 2021

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Introduction[edit | edit source]

Stroke is one of the leading causes of disability which results in minor to severe impairments. Post-stroke sequelae comprise impairments such as loss of range of motion, muscle weakness and motor deficits resulting from impaired force generation.[1] The most common impairment after stroke is reduced upper extremity function. Among these, hand function is commonly impaired after stroke, strongly affecting the power to perform daily activities.[2][3][4] .Virtual Reality-based hand rehabilitation promotes function by providing immediate, appropriate and accurate feedback through audio-visual cues.[5][6] Although there is expansive evidence supporting the use of Virtual Reality in the functional recovery of stroke patients, the integration of haptic feedback is poorly studied.


Background[edit | edit source]

Contextually, the word "haptic" is derived from the Greek verb “to touch” or "to handle". Presently, it refers to the expanding subject that is associated with the study of touch through human-computer interaction. The recently emerged haptic technology has developed rapidly and has been the focal point of many research communities. Subsequently, haptic-related products have been deployed commercially, in development, and for research purposes, as well as serving as prototypes. Virtual environments are strongly associated with haptic-based applications. Such environments require the visual sensory channel to produce more realistic sensations. [7] Virtual reality (VR) simulations, can provide an engaging, realistic and motivating environment when linked with robots, movement tracking, and sensing glove systems, where the motion of the limb or tool displayed in the virtual world is a replication of the motion produced in the real world by the subject.[6][5]

Theoretical Framework[edit | edit source]

Various Virtual reality systems have been studied with different Haptic devices employed to restore hand function post-stroke. These devices increase immersion through the application of vibrotactile stimulation with kinaesthetic feedback.[6] This multi-modal feedback has been proposed to improve strength, motor control, and dexterity in integration with the repetitive practice of relevant motor tasks through the mechanism of neuroplasticity.[8][9][10][11][12]

The Sensory side of Motor rehabilitation[edit | edit source]

  • One of the most relevant sources of sensory information for the motor system is Somesthesis[13]. The somatosensory system processes information and represents, several modalities of somatic sensation (i.e., touch, pain, temperature, proprioception). However, significant processing occurs even in the motor system.
  • A good example of the functional interplay between somatosensory and motor systems is the gating of sensory input for motor control. Sensory gating is exerted by integrating afferent somatosensory inputs from peripheral receptors with the motor output at several levels in the ascending sensory pathway and the cerebral cortex, consistent with serial transmission of afferent sensory activity from the spinal cord to the primary somatosensory cortex(SI), and then to primary motor cortex (MI)[13][14][15][16]
  • Various forms of somatosensory stimulation such as peripheral nerve stimulation, muscle tendon vibration, paired associative stimulation and tactile learning have been shown to facilitate motor behaviour and enhance motor performance by increasing corticospinal excitability and enlarging the representation of the stimulated body part in MI.[17] [18]

Evidence on Effectiveness[edit | edit source]

Rehabilitation is an integral component of any program aimed at improving motor function in stroke survivors.[19] [20] In order to overcome the benefits of conventional rehabilitation, novel strategies are becoming available.[21]

In the present literature review, we found case studies and a crossover RCT. Majority of the studies showed a benefit for the primary outcome. There was a significant improvement in fine motor performance.[9] Similarly, there was a substantial improvement in motor impairment. [8][10][11][12]




References[edit | edit source]

  1. ↑ J David, S Alma, T Marilyn, C Grigore, A Sergia, R Michael et al.Virtual Reality Enhanced Stroke Rehabilitation. IEEE Trans. Neural Syst. Rehabilitation Eng. 2001:3
  2. ↑ Nakayama H, Jorgensen HS, Rasschou HO, Olsen TS. Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1994;75:394–8.
  3. ↑ Persson HC, Parziali M, Danielsson A, Sunnerhagen KS. Outcome and upper extremity function within 72 hours after the first occasion of stroke in an unselected population at a stroke unit. A part of the SALGOT study. BMC Neurology. 2012;12:162.
  4. ↑ Hayward, K.S., Kramer, S.F., Thijs, V. et al. A systematic review protocol of timing, efficacy and cost-effectiveness of upper limb therapy for motor recovery post-stroke. Syst Rev 8, 187 (2019).
  5. ↑ 5.0 5.1 Iosa M. Virtual reality in stroke rehabilitation: virtual results or real values? Arq Neuropsiquiatr. 2019 Oct 24;77(10):679-680. DOI: 10.1590/0004-282X20190123
  6. ↑ 6.0 6.1 6.2 Merians AS, Fluet GG, Qiu Q, Lafond I, Adamovich SV. Learning in a virtual environment using haptic systems for movement re-education: can this medium be used for remodelling other behaviours and actions? J Sci Technol. 2011 Mar 1;5(2):301-8.
  7. ↑ Shakra I, Orozco M, El Saddak A, Shirmohammadi S, Lemaire E. Instrumentation for Physical Rehabilitation of Stroke Patients. IEEE Trans. Neural Syst. Rehabilitation Eng.:1-5
  8. ↑ 8.0 8.1 Levin MF, Magdalon EC, Michaelsen SM, Quevedo AA. Quality of Grasping and the Role of Haptics in a 3-D Immersive Virtual Reality Environment in individuals with Stroke. IEEE Trans Neural Syst Rehabil Eng. 2015 Nov;23(6):1047-55. doi:10.1109/TNSRE.2014.2387412
  9. ↑ 9.0 9.1 Yeh SC, Lee SH, Chan RC, Wu Y, Zheng LR, Flynn S. The Efficacy of a Haptic-Enhanced Virtual Reality System for Precision Grasp Acquisition in Stroke Rehabilitation. J Healthc Eng. 2017;2017:9840273. doi:10.1155/2017/9840273
  10. ↑ 10.0 10.1 Lehmann, I., Baer, G. & Schuster-Amft, C. (2017) Experience of an upper limb training program with a non-immersive virtual reality system in patients after stroke: a qualitative study, Physiotherapy. 2017 doi:10.1016/j.physio.2017.03.001
  11. ↑ 11.0 11.1 Maris A, Coninx K, Seelen H, Truyens V, De Weyer T, Geers R, Lemmens M, CoolenJ, Stupar S, Lamers I, Feys P. The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke. Disabil Rehabil Assist Technol. 2018 Jan;13(1):1-9. DOI: 10.1080/17483107.2016.1278467
  12. ↑ 12.0 12.1 Thielbar KO, Triandafilou KM, Barry AJ, Yuan N, Nishimoto A, Johnson J, Stoykov ME, Tsoupikova D, Kamper DG. Home-based upper extremity stroke therapy using a multi-user virtual reality environment: a randomized trial. Arch Phys Med Rehabil. 2019 Nov 9. PII: S0003-9993(19)31365-6. doi:10.1016/j.apmr.2019.10.182
  13. ↑ 13.0 13.1 Ghez C, Pisa M. Inhibition of afferent transmission in the cuneate nucleus during voluntary movement in the cat. Brain Research. 1972; 40(1):145–151.
  14. ↑ Hantman AW, Jessell TM. Clarke’s column neurons as the focus of a corticospinal corollary circuit. Nature Neuroscience. 2010; 13(10):1233–1239.
  15. ↑ Jiang W, Lamarre Y, Chapman CE. Modulation of cutaneous cortical evoked potentials during isometric and isotonic contractions in the monkey. Brain Research. 1990; 536(1):69–78.
  16. ↑ Seki K, Fetz EE. Gating of sensory input at spinal and cortical levels during preparation and execution of voluntary movement. The Journal of Neuroscience. 2012; 32(3):890–902.
  17. ↑ Edwards DJ, Dipietro L, Demirtas-Tatlidede A, Medeiros AH, Thickbroom GW, Mastaglia FL, Krebs HI, Pascual-Leone A. Movement-generated afference paired with transcranial magnetic stimulation: An associative stimulation paradigm. Journal of Neuroengineering and Rehabilitation. 2014; 11(1):31.
  18. ↑ Ridding MC, Brouwer B, Miles TS, Pitcher JB, Thompson PD. Changes in muscle responses to stimulation of the motor cortex induced by peripheral nerve stimulation in human subjects. Experimental Brain Research. 2000; 131(1):135–143
  19. ↑ Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD, Katz RC, Lamberty K, Reker D. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005;36:e100 –143.
  20. ↑ Teasell R, Meyer MJ, McClure A, Pan C, Murie-Fernandez M, Foley N, Salter K. Stroke rehabilitation: an international perspective. Top Stroke Rehabil. 2009;16:44 –56.
  21. ↑ Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8:741–754.
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