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IntroductionVirtual Reality/serious games (SG) and functional electrical stimulation (FES) therapies are used in upper limb stroke rehabilitation. A combination of both approaches seems to be beneficial for therapy success. The feasibility of a combination of SG and contralaterally EMG-triggered FES (SG+FES) was investigated as well as the characteristics of responders to such a therapy.Materials and methodsIn a randomized crossover trial, patients performed two gaming conditions: SG alone and SG+FES. Feasibility of the therapy system was assessed using the Intrinsic Motivation Inventory (IMI), the Nasa Task Load Index, and the System Usability Scale (SUS). Gaming parameters, fatigue level and a technical documentation was implemented for further information.ResultsIn total, 18 patients after stroke (62.1 ± 14.1 years) with a unilateral paresis of the upper limb (MRC ≤4) were analyzed in this study. Both conditions were perceived as feasible. Comparing the IMI scores between conditions, perceived competence was significantly increased (z = −2.88, p = 0.004) and pressure/tension during training (z = −2.13, p = 0.034) was decreased during SG+FES. Furthermore, the task load was rated significantly lower for the SG+FES condition (z = −3.14, p = 0.002), especially the physical demand (z = −3.08, p = 0.002), while the performance was rated better (z = −2.59, p = 0.010). Responses to the SUS and the perceived level of fatigue did not differ between conditions (SUS: z = −0.79, p = 0.431; fatigue: z = 1.57, p = 0.115). For patients with mild to moderate impairments (MRC 3–4) the combined therapy provided no or little gaming benefit. The additional use of contralaterally controlled FES (ccFES), however, enabled severely impaired patients (MRC 0–1) to play the SG.DiscussionThe combination of SG with ccFES is feasible and well-accepted among patients after stroke. It seems that the additional use of ccFES may be more beneficial for severely impaired patients as it enables the execution of the serious game. These findings provide valuable implications for the development of rehabilitation systems by combining different therapeutic interventions to increase patients' benefit and proposes system modifications for home use.Clinical trial registrationhttps://drks.de/search/en, DRKS00025761.

Background. After stroke, paresis of the upper limb (UL) is the most frequent impairment. Hybrid neuroprostheses, i.e., the combination of robots and electrical stimulation, emerge as an option to treat these impairments. Methods. To give an overview on existing devices, their features and how they are linked to clinical metrics, four different databases were systematically searched for studies on hybrid neuroprostheses for the UL rehabilitation after stroke. The evidence on the efficacy of hybrid therapies was synthesized. Results. Seventy-three studies were identified, introducing 32 hybrid systems. Among the most recent devices (n = 20), most actively reinforce movement (3 passively) and are typical exoskeletons (3 end effectors). If classified according to the ICF, systems for proximal support are rather expected to affect body structures and functions, while the activity and participation level is targeted when applying FES distally plus the robotic component proximally. The meta-analysis reveals a significant positive effect on UL functions (p Mdiff between groups in the Fugl-Meyer assessment. This positive effect remains at 3-months follow-up (Mdiff=8.4, p Conclusions. Hybrid neuroprostheses have a positive effect on UL recovery after stroke, with effects persisting at least three months after the intervention. Non-significant studies were those with the shortest intervention periods and the oldest patients. Providentially, improvements in UL functions are not only present in the subacute phase after stroke, but also in long-term chronic stages. In addition to further technical development, more RCTs are needed to make assumptions about determinants of a successful therapy.

Mobilität. Mobil sein. Begriffe mit hoher Relevanz, die wir im Rehabilitationsalltag täglich benutzen. Doch was beinhalten sie genau? Und was bedeuten sie für Patientinnen und Patienten?

Mobilität. Mobil sein. Begriffe mit hoher Relevanz, die wir im Rehabilitationsalltag täglich benutzen. Doch was beinhalten sie genau? Und was bedeuten sie für Patienten?

Background: Alzheimer’s disease (AD) affects several cognitive functions and causes altered motor function. Fine motor deficits during object manipulation are evident in other neurological conditions, but have not been assessed in dementia patients yet. Objective: Investigate reactive and anticipatory grip force control in response to unexpected and expected load force perturbation in AD. Methods: Reactive and anticipatory grip force was investigated using a grip-device with force sensors. In this pilot study, fifteen AD patients and fourteen healthy controls performed a catching task. They held the device with one hand while a sandbag was dropped into an attached receptacle either by the experimenter or by the participant. Results: In contrast to studies of other neurological conditions, the majority of AD patients exerted lower static grip force levels than controls. Interestingly, patients who were slow in the Luria’s three-step test produced normal grip forces. The timing and magnitude of reactive grip force control were largely preserved in patients. In contrast, timing and extent of anticipatory grip forces were impaired in patients, although anticipatory control was generally preserved. These deficits were correlated with decreasing Mini-Mental State Examination scores. Apraxia scores, assessed by pantomime of tool-use, did not correlate with performance in the catching task. Conclusion: We interpreted the decreased grip force in AD in the context of loss of strength and lethargy, typical for patients with AD. The lower static grip force during object manipulation may emerge as a potential biomarker for early stages of AD, but more studies with larger sample sizes are necessary.