mano: A Wearable Hand Exoskeleton for Activities of Daily Living and Neurorehabilitation

Chronic stroke patients with severe hand weakness respond poorly to rehabilitation efforts. Here, we evaluated efficacy of daily brain-machine interface (BMI) 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. Thirty-two chronic stroke patients with severe hand weakness were randomly assigned to 2 matched groups and participated in 17.8 ± 1.4 days of training rewarding desynchronization of ipsilesional oscillatory sensorimotor rhythms 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 (fMRI) blood oxygenation level-dependent activity were assessed before and after intervention. A significant group × time interaction in upper limb (combined hand and modified arm) Fugl-Meyer assessment (cFMA) motor 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-point 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 fMRI laterality index and with paretic hand electromyography activity. Placebo-expectancy scores were comparable for both groups. 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. Copyright © 2013 American Neurological Association.

Motor imagery (MI) or the mental simulation of action is now increasingly being studied using neuroimaging techniques such as positron emission tomography and functional magnetic resonance imaging. The booming interest in capturing the neural underpinning of MI has provided a large amount of data which until now have never been quantitatively summarized. The aim of this activation likelihood estimation (ALE) meta-analysis was to provide a map of the brain structures involved in MI. Combining the data from 75 papers revealed that MI consistently recruits a large fronto-parietal network in addition to subcortical and cerebellar regions. Although the primary motor cortex was not shown to be consistently activated, the MI network includes several regions which are known to play a role during actual motor execution. The body part involved in the movements, the modality of MI and the nature of the MI tasks used all seem to influence the consistency of activation within the general MI network. In addition to providing the first quantitative cortical map of MI, we highlight methodological issues that should be addressed in future research. Copyright © 2013 Elsevier Ltd. All rights reserved.