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      Assessment of movement quality in robot- assisted upper limb rehabilitation after stroke: a review

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          Abstract

          Abstract

          Studies of stroke patients undergoing robot-assisted rehabilitation have revealed various kinematic parameters describing movement quality of the upper limb. However, due to the different level of stroke impairment and different assessment criteria and interventions, the evaluation of the effectiveness of rehabilitation program is undermined. This paper presents a systematic review of kinematic assessments of movement quality of the upper limb and identifies the suitable parameters describing impairments in stroke patients. A total of 41 different clinical and pilot studies on different phases of stroke recovery utilizing kinematic parameters are evaluated. Kinematic parameters describing movement accuracy are mostly reported for chronic patients with statistically significant outcomes and correlate strongly with clinical assessments. Meanwhile, parameters describing feed-forward sensorimotor control are the most frequently reported in studies on sub-acute patients with significant outcomes albeit without correlation to any clinical assessments. However, lack of measures in coordinated movement and proximal component of upper limb enunciate the difficulties to distinguish the exploitation of joint redundancies exhibited by stroke patients in completing the movement. A further study on overall measures of coordinated movement is recommended.

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          The online version of this article (doi:10.1186/1743-0003-11-137) contains supplementary material, which is available to authorized users.

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          Assessing Wolf motor function test as outcome measure for research in patients after stroke.

          The Wolf Motor Function Test (WMFT) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements. This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population. Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment. Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment (FMA) on 2 occasions (12 to 16 days apart), with scoring performed independently by 2 random raters. The WMFT and FMA demonstrated agreement (P 0.05) from the dominant and nondominant extremities of individuals without impairment. The WMFT and FMA scores were related (P<0.02) for the more affected extremity in individuals after stroke. The interrater reliability, construct validity, and criterion validity of the WMFT, as used in these subject samples, are supported.
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            What do motor "recovery" and "compensation" mean in patients following stroke?

            There is a lack of consistency among researchers and clinicians in the use of terminology that describes changes in motor ability following neurological injury. Specifically, the terms and definitions of motor compensation and motor recovery have been used in different ways, which is a potential barrier to interdisciplinary communication. This Point of View describes the problem and offers a solution in the form of definitions of compensation and recovery at the neuronal, motor performance, and functional levels within the framework of the International Classification of Functioning model.
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              Strategies for stroke rehabilitation.

              Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.
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                Author and article information

                Contributors
                nurdiana@utem.edu.my
                s.xie@auckland.ac.nz
                burkhard@cs.auckland.ac.nz
                Journal
                J Neuroeng Rehabil
                J Neuroeng Rehabil
                Journal of NeuroEngineering and Rehabilitation
                BioMed Central (London )
                1743-0003
                12 September 2014
                12 September 2014
                2014
                : 11
                : 1
                Affiliations
                [ ]Department of Mechanical Engineering, The University of Auckland, 20 Symonds Street, Auckland, New Zealand
                [ ]Department of Computer Science, The University of Auckland, 23 Symonds Street, Auckland, New Zealand
                [ ]Faculty of Electrical Engineering, Universiti Teknikal Malaysia Melaka, Hang Tuah Jaya, Melaka, Malaysia
                [ ]State Key Laboratory of Digital Equipment and Technology, Huazhong University of Science & Technology, Wuhan, China
                Article
                657
                10.1186/1743-0003-11-137
                4180322
                25217124
                608e1cf8-d0e6-4267-92d6-44e4b9a732f6
                © Nordin et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Review
                Custom metadata
                © The Author(s) 2014

                Neurosciences
                robot kinematics,motion analysis,rehabilitation robotics,stroke
                Neurosciences
                robot kinematics, motion analysis, rehabilitation robotics, stroke

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