Tawara K1, Okuda T1, Omura S1, Sakamoto A1, Miura Y1, Haruma J2, Oka T2, Arisawa T2, Fujii T1
1Fukuyama City Hospital, Department of Rehabilitation, Fukuyama, Japan, 2Fukuyama City Hospital, Department of Neurosurgery, Fukuyama, Japan
Background: Neurorehabilitation is indispensable for recovery from sequelae, such as paralysis due to stroke. However, only few reports have evaluated brain activity changes during exercise therapy despite the importance of evaluation of brain activation during exercise therapy for efficient neurorehabilitation.
Purpose: We report two cases of near-infrared spectroscopy (NIRS)-based evaluation of brain activity during exercise therapy using a single-joint hybrid assistive limb (HAL-SJ; Cyberdyne Inc.).
Methods: Two cases of stroke hemiplegia, a case of subarachnoid hemorrhage and a case of cerebral infarction, were evaluated. For brain activation measurement, 8 pairs of fibers of a functional NIRS system (SPEEDNIRS, Shimadzu Corporation) were used. The amount of oxygenated hemoglobin (oxy-Hb) was measured with channel settings centered on the bilateral sensory motor area with three central rows of the whole head holder. The bilateral elbow bending and stretching exercises on the paralyzed and non-paralyzed sides were classified into three task type patterns as follows:
1) paralyzed elbow flexion exercise unassisted with a HAL-SJ;
2) paralyzed elbow flexion movement assisted with a HAL-SJ; and
3) application of an electrode on the non-paralyzed side assisted with a HAL-SJ.
The measurement protocol was 20-second rest, 20-second task, and 20-second rest, repeated three times. In the analysis, the integrated value up to 20 seconds after the start of the task till the end of oxy-Hb measurement and the left-right difference in brain activity (laterality index) were calculated.
Results: In both cases, brain activation on the non-disabled side was observed in pattern (2) rather than in pattern (1), but brain activation was not observed on the disabled side. In pattern (3), brain activation on the paralyzed side, which was not observed in patterns (1) and (2), was observed.
Conclusion(s): Brain activation during exercise therapy using HAL-SJ could be visualized using NIRS. In the NIRS-based evaluation of the two cases presented herein, exercise therapy using HAL-SJ for only the upper limb on the paralyzed side did not induce cerebral activation on the disabled side. However, by simultaneously exercising the paralyzed and nonparalyzed upper limbs, brain activation on the disabled side was confirmed. Therefore, this study suggests that simultaneous exercise of the paralyzed and nonparalyzed upper limbs may promote brain activation on the disabled side. In addition, applying the electrode of the HAL-SJ on the nonparalyzed upper limb can be considered a training method that can be used even for patients with moderate to severe motor paralysis.
Implications: This report suggests that performing elbow flexion exercises on both the paralyzed and nonparalyzed sides may help prevent and improve learning unused (learned nonuse) after moderate-to-severe stroke. It is meaningful report on the training methods suitable for patients with motor paralysis .
Keywords: HAL-SJ, NIRS, Stroke
Funding acknowledgements:There is no Conflict of Interest(COI) should be disclosed.
Thank all cooperated in the creation of this report.
Purpose: We report two cases of near-infrared spectroscopy (NIRS)-based evaluation of brain activity during exercise therapy using a single-joint hybrid assistive limb (HAL-SJ; Cyberdyne Inc.).
Methods: Two cases of stroke hemiplegia, a case of subarachnoid hemorrhage and a case of cerebral infarction, were evaluated. For brain activation measurement, 8 pairs of fibers of a functional NIRS system (SPEEDNIRS, Shimadzu Corporation) were used. The amount of oxygenated hemoglobin (oxy-Hb) was measured with channel settings centered on the bilateral sensory motor area with three central rows of the whole head holder. The bilateral elbow bending and stretching exercises on the paralyzed and non-paralyzed sides were classified into three task type patterns as follows:
1) paralyzed elbow flexion exercise unassisted with a HAL-SJ;
2) paralyzed elbow flexion movement assisted with a HAL-SJ; and
3) application of an electrode on the non-paralyzed side assisted with a HAL-SJ.
The measurement protocol was 20-second rest, 20-second task, and 20-second rest, repeated three times. In the analysis, the integrated value up to 20 seconds after the start of the task till the end of oxy-Hb measurement and the left-right difference in brain activity (laterality index) were calculated.
Results: In both cases, brain activation on the non-disabled side was observed in pattern (2) rather than in pattern (1), but brain activation was not observed on the disabled side. In pattern (3), brain activation on the paralyzed side, which was not observed in patterns (1) and (2), was observed.
Conclusion(s): Brain activation during exercise therapy using HAL-SJ could be visualized using NIRS. In the NIRS-based evaluation of the two cases presented herein, exercise therapy using HAL-SJ for only the upper limb on the paralyzed side did not induce cerebral activation on the disabled side. However, by simultaneously exercising the paralyzed and nonparalyzed upper limbs, brain activation on the disabled side was confirmed. Therefore, this study suggests that simultaneous exercise of the paralyzed and nonparalyzed upper limbs may promote brain activation on the disabled side. In addition, applying the electrode of the HAL-SJ on the nonparalyzed upper limb can be considered a training method that can be used even for patients with moderate to severe motor paralysis.
Implications: This report suggests that performing elbow flexion exercises on both the paralyzed and nonparalyzed sides may help prevent and improve learning unused (learned nonuse) after moderate-to-severe stroke. It is meaningful report on the training methods suitable for patients with motor paralysis .
Keywords: HAL-SJ, NIRS, Stroke
Funding acknowledgements:There is no Conflict of Interest(COI) should be disclosed.
Thank all cooperated in the creation of this report.
Topic: Robotics & technology; Neurology; Neurology: stroke
Ethics approval required: No
Institution: Fukuyama City Hospital
Ethics committee: Fukuyama City Hospital
Reason not required: Because it is a case report.
All authors, affiliations and abstracts have been published as submitted.
