New technologies and concepts for rehabilitation in the acute phase of stroke: a collaborative matrix.
The process of developing a successful stroke rehabilitation methodology requires four key components: a good understanding of the pathophysiological mechanisms underlying this brain disease, clear neuroscientific hypotheses to guide therapy, adequate clinical assessments of its efficacy on multiple timescales, and a systematic approach to the application of modern technologies to assist in the everyday work of therapists. Achieving this goal requires collaboration between neuroscientists, technologists and clinicians to develop well-founded systems and clinical protocols that are able to provide quantitatively validated improvements in patient rehabilitation outcomes. In this article we present three new applications of complementary technologies developed in an interdisciplinary matrix for acute-phase upper limb stroke rehabilitation - functional electrical stimulation, arm robot-assisted therapy and virtual reality-based cognitive therapy. We also outline the neuroscientific basis of our approach, present our detailed clinical assessment protocol and provide preliminary results from patient testing of each of the three systems showing their viability for patient use.
Siekierka
E M
EM
Department of Neurology, University Hospital Zurich, Zurich, Switzerland. ewa.siekierka@usz.ch
Eng
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Bassetti
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Blickenstorfer
A
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M S
MS
Dietz
V
V
Duff
A
A
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F
F
Ettlin
T
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Riener
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Schuster
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Tosi
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Verschure
P F M J
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Zimmerli
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D000328:Adult; D000368:Aged; D001132:Arm / Q000294:innervation / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000473:pathology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003299:Cooperative Behavior; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D020127:Recovery of Function; D020521:Stroke / Q000473:pathology / Q000503:physiopathology / Q000523:psychology*; D000071939:Stroke Rehabilitation; D013813:Therapy, Computer-Assisted / Q000379:methods* / Q000639:trends; D013997:Time Factors