ZigBee-based Wireless Neuro-Stimulator for Improving Stroke Recovery

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Abstract

Stroke is a leading cause of adult disability and the second-leading cause of death in Korea. It is also the third-leading cause of death in the United States, leading to a serious demand for new interventions to improve the quality of life in stroke survivors. To this end, direct cortical stimulation using an epidural electrode has been reported with promising results in animal and human studies, showing the potential for enhancing the recovery in chronic stroke patients. For optimal results, doctors must be able to modify the stimulation pattern as frequently as needed over a period of time for a given patient. However, severe aftereffects caused by stroke limit patients' activities, making regular doctor visits for treatment difficult. This study aims to develop a prototype of a telemedicine system to enhance stroke recovery by using a ZigBeebased wireless neuro-stimulator. The ZigBee is a stable platform for many low-power wireless applications. To allow stroke patients to remotely obtain neuro-stimulation treatments from their doctors, we connected the ZigBee to the internet. The system also allows doctors to personalize treatment based on the history of the stimulation parameters. The system developed here can also be beneficial as a common platform for a wide range of brain diseases and clinical care for which electric stimulation is used.

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Most cited references 36

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Recovery of motor function after stroke.

R Bonita, R Beaglehole (1988)

The natural history of recovery of motor function after stroke is described using data from a 1-year community-based study in Auckland, New Zealand. Of 680 patients, 88% presented with a hemiparesis; the proportion of survivors with a persisting deficit declined to 71% at 1 month and 62% at 6 months after the onset of the stroke. At onset, there were equal proportions of people with mild, moderate, and severe motor deficits, but the majority (76%) of those who survived 6 months had either no or only a mild deficit. Recovery of motor function was associated with the stroke severity but not with age or sex; patients with a mild motor deficit at onset were 10 times more likely to recover their motor function than those with a severe stroke. Our results confirm the reasonably optimistic outcome for survivors of stroke and further suggest that recovery of motor function is confined to patients whose motor deficit at onset is either mild or moderate.

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Motor recovery after stroke: a systematic review of the literature.

Henk T Hendricks, Jacques van Limbeek, Alexander C. H. Geurts … (2002)

To collect and integrate existing data concerning the occurrence, extent, time course, and prognostic determinants of motor recovery after stroke using a systematic methodologic approach. A computer-aided search in bibliographic databases was done of longitudinal cohort studies, original prognostic studies, and randomized controlled trials published in the period 1966 to November 2001, which was expanded by references from retrieved articles and narrative reviews. After a preliminary screening, internal, external, and statistical validity was assessed by a priori methodologic criteria, with special emphasis on the internal validity. The studies finally selected were discussed, based on the quantitative analysis of the outcome measures and prognostic determinants. Meta-analysis was pursued, but was not possible because of substantial heterogeneity. The search resulted in 174 potentially relevant studies, of which 80 passed the preliminary screening and were subjected to further methodologic assessment; 14 studies were finally selected. Approximately 65% of the hospitalized stroke survivors with initial motor deficits of the lower extremity showed some degree of motor recovery. In the case of paralysis, complete motor recovery occurred in less than 15% of the patients, both for the upper and lower extremities. Hospitalized patients with small lacunar strokes showed relatively good motor recovery. The recovery period in patients with severe stroke was twice as long as in patients with mild stroke. The initial grade of paresis was the most important predictor for motor recovery (odds ratios [OR], >4). Objective analysis of the motor pathways by motor-evoked potentials (MEPs) showed even higher ORs (ORs, >20). Our knowledge of motor recovery after stroke in more accurate, quantitative, and qualitive terms is still limited. Nevertheless, our data synthesis and quantitative analysis comprises data from many methodologically robust studies, which may support the clinician in the management of stroke patients. With respect to early prognosis of motor recovery, our review confirms clinical experience that the initial grade of paresis (as measured on admission in the hospital) is the most important predictor, although the accuracy of prediction rapidly improves during the first few days after stroke. Initial paralysis implies the worst prognosis for subsequent motor recovery. Remarkably, the prognostic accuracy of MEPs appears much higher than that of clinical examination for different subgroups of patients. Copyright 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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Measurement of motor recovery after stroke. Outcome assessment and sample size requirements.

Stuart Goldstein, J R Feussner, Rebecca Duncan … (1992)

The purpose of this study was to analyze recovery of motor function in a cohort of patients presenting with an acute occlusion in the carotid distribution. Analysis of recovery patterns is important for estimating patient care needs, establishing therapeutic plans, and estimating sample sizes for clinical intervention trials. We prospectively measured the motor deficits of 104 stroke patients over a 6-month period to identify earliest measures that would predict subsequent motor recovery. Motor function was measured with the Fugl-Meyer Assessment. Fifty-four patients were randomly assigned to a training set for model development; 50 patients were assigned to a test set for model validation. In a second analysis, patients were stratified on basis of time and stroke severity. The sample size required to detect a 50% improvement in residual motor function was calculated for each level of impairment and at three points in time. At baseline the initial Fugl-Meyer motor scores accounted for only half the variance in 6-month motor function (r2 = 0.53, p less than 0.001). After 5 days, both the 5-day motor and sensory scores explained 74% of the variance (p less than 0.001). After 30 days, the 30-day motor score explained 86% of the variance (p less than 0.001). Application of these best models to the test set confirmed the results obtained with the training set. Sample-size calculations revealed that as severity and time since stroke increased, sample sizes required to detect a 50% improvement in residual motor deficits decreased. Most of the variability in motor recovery can be explained by 30 days after stroke. These findings have important implications for clinical practice and research.

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Author and article information

Journal

Journal ID (nlm-ta): Exp Neurobiol

Journal ID (publisher-id): EN

Title: Experimental Neurobiology

Publisher: The Korean Society for Brain and Neural Science

ISSN (Print): 1226-2560

ISSN (Electronic): 2093-8144

Publication date (Print): December 2010

Publication date (Electronic): 31 December 2010

Volume: 19

Issue: 3

Pages: 165-172

Affiliations

[1 ]Electronics and Telecommunication Research Institute (ETRI), Daejeon 305-700, Korea.

[2 ]Korea Institute of Industrial Technology (KITECH), Cheonan 330-825, Korea.

[3 ]Department of Biomedical Engineering, Chonbuk National University, Jeonju 561-756, Korea.

[4 ]Department of Rehabilitation Medicine, Pusan National University School of Medicine and Pusan National University Hospital Medical Research Institute, Yangsan 626-770, Korea.

[5 ]Institute of Medical System Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju 500-712, Korea.

Author notes

To whom correspondence should be addressed. TEL: 82-63-270-4068, FAX: 82-63-270-2247, ysyangg@ 123456gmail.com

Article

DOI: 10.5607/en.2010.19.3.165

PMC ID: 3214784

PubMed ID: 22110356

SO-VID: 8cf2ac4e-abf8-40cb-a547-8035dd1c0cf0

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ZigBee-based Wireless Neuro-Stimulator for Improving Stroke Recovery

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Good practices in (cog-neuro) science and science communication

Most cited references 36

Recovery of motor function after stroke.

Motor recovery after stroke: a systematic review of the literature.

Measurement of motor recovery after stroke. Outcome assessment and sample size requirements.

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