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  1. Article: Robotic Assisted Upper Limb Training Post Stroke: A Randomized Control Trial Using Combinatory Approach Toward Reducing Workforce Demands.

    Budhota, Aamani / Chua, Karen S G / Hussain, Asif / Kager, Simone / Cherpin, Adèle / Contu, Sara / Vishwanath, Deshmukh / Kuah, Christopher W K / Ng, Chwee Yin / Yam, Lester H L / Loh, Yong Joo / Rajeswaran, Deshan Kumar / Xiang, Liming / Burdet, Etienne / Campolo, Domenico

    Frontiers in neurology

    2021  Volume 12, Page(s) 622014

    Abstract: Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive ... ...

    Abstract Post stroke upper limb rehabilitation is a challenging problem with poor outcomes as 40% of survivors have functionally useless upper limbs. Robot-aided therapy (RAT) is a potential method to alleviate the effort of intensive, task-specific, repetitive upper limb exercises for both patients and therapists. The present study aims to investigate how a time matched combinatory training scheme that incorporates conventional and RAT, using H-Man, compares with conventional training toward reducing workforce demands. In a randomized control trial (NCT02188628, www.clinicaltrials.gov), 44 subacute to chronic stroke survivors with first-ever clinical stroke and predominant arm motor function deficits were recruited and randomized into two groups of 22 subjects: Robotic Therapy (RT) and Conventional Therapy (CT). Both groups received 18 sessions of 90 min; three sessions per week over 6 weeks. In each session, participants of the CT group received 90 min of 1:1 therapist-supervised conventional therapy while participants of the RT group underwent combinatory training which consisted of 60 min of minimally-supervised H-Man therapy followed by 30 min of conventional therapy. The clinical outcomes [Fugl-Meyer (FMA), Action Research Arm Test and, Grip Strength] and the quantitative measures (smoothness, time efficiency, and task error, derived from two robotic assessment tasks) were independently evaluated prior to therapy intervention (week 0), at mid-training (week 3), at the end of training (week 6), and post therapy (week 12 and 24). Significant differences within group were observed at the end of training for all clinical scales compared with baseline [mean and standard deviation of FMA score changes between baseline and week 6; RT: Δ4.41 (3.46) and CT: Δ3.0 (4.0);
    Language English
    Publishing date 2021-06-02
    Publishing country Switzerland
    Document type Case Reports
    ZDB-ID 2564214-5
    ISSN 1664-2295
    ISSN 1664-2295
    DOI 10.3389/fneur.2021.622014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: A preliminary study on the relationship between proprioceptive deficits and motor functions in chronic stroke patients.

    Cherpin, Adele / Kager, Simone / Budhota, Aamani / Contu, Sara / Vishwanath, Deshmukh / Kuah, Christopher Wk / Ng, Chwee Yin / Yam, Lester Hl / Xiang, Liming / Hussain, Asif / Karen S G, Chua / Campolo, Domenico

    IEEE ... International Conference on Rehabilitation Robotics : [proceedings

    2019  Volume 2019, Page(s) 465–470

    Abstract: Although motor and sensory impairments of the upper limb after stroke have been widely studied, the relationship between sensory deficits and motor functions has been less thoroughly explored. In this ongoing study, we investigated the relationship ... ...

    Abstract Although motor and sensory impairments of the upper limb after stroke have been widely studied, the relationship between sensory deficits and motor functions has been less thoroughly explored. In this ongoing study, we investigated the relationship between proprioceptive impairments and motor functions with 20 chronic stroke survivors. Their proprioceptive abilities were assessed with a passive joint position matching test using H-Man and their motor functions were assessed with ARAT (Action Research Arm Test) and FMA (Fugl Meyer Upper Extremity Assessment) clinical scores. The assessments were conducted before, during and after the therapy. Results indicated a significant difference between the proprioceptive outcomes of healthy and stroke participants (at baseline) in both matching accuracy (absolute error, p=0.02) and precision (variability of the signed error, p=0.03). Significant correlations were found between the proprioceptive assessment outcomes (assessed before the beginning of the motor rehabilitation) of stroke participants with impaired proprioception and their ARAT clinical scores assessed at the first follow-up (week 12) (rho =- 0.74 and p=0.047 for the absolute error; rho =-0.78 and p= 0.03 for the variability of the signed error). The results from this preliminary study indicated a significant relationship between proprioceptive impairments and motor function performances in proprioceptively impaired chronic stroke participants.
    MeSH term(s) Adult ; Aged ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Motor Activity ; Proprioception ; Stroke/physiopathology ; Upper Extremity/physiopathology
    Language English
    Publishing date 2019-07-31
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1945-7901
    ISSN (online) 1945-7901
    DOI 10.1109/ICORR.2019.8779447
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  3. Article ; Online: Recovery of upper limb dexterity in patients more than 1 year after stroke: Frequency, clinical correlates and predictors.

    Kong, Keng-He / Chua, Karen S G / Lee, Jeanette

    NeuroRehabilitation

    2011  Volume 28, Issue 2, Page(s) 105–111

    Abstract: Objective: The objectives of this study are to establish frequency, clinical correlates and predictors of upper limb dexterity in patients who have survived 1 year or more after a stroke.: Design: Cross-sectional study.: Setting: Outpatient clinic ...

    Abstract Objective: The objectives of this study are to establish frequency, clinical correlates and predictors of upper limb dexterity in patients who have survived 1 year or more after a stroke.
    Design: Cross-sectional study.
    Setting: Outpatient clinic of a tertiary rehabilitation centre.
    Participants: One hundred and forty patients who were more than a year after stroke onset.
    Interventions: Nil.
    Main outcome measures: Motor Assessment Scale (MAS) for measurement of upper limb dexterity, Ashworth Scale for spasticity, Upper Extremity Motricity Index (UEMI) and Lower Extremity Motricity Index (LEMI) for motor power and Modified Barthel Index (MBI) for functional status. Spasticity was categorized as absent to moderate and severe. Potential predictors of dextrous function were chosen based on retrospective review of the patient's medical records during admission for inpatient rehabilitation.
    Results: The mean age was 61.0 ± 13.3 years and patients were evaluated at 41.7 ± 35.1 months after stroke onset. Upper limb dexterity was present in 40 (28.3% patients. Sensory impairment, severe spasticity and low scores on the MBI, UEMI and LEMI were significantly correlated to poor dextrous function, with severe spasticity (p < 0.001) and UEMI score (p = 0.025) being the most important. Poor dextrous function was predicted by a severe stroke, neglect, sensory impairment, total/partial anterior circulation stroke and low MBI, UEMI and LEMI scores on rehabilitation admission. The most important predictor of dexterity was UEMI score on admission to rehabilitation (p=0.005).
    Conclusion: Upper limb dexterity was present in 28.3% of a cohort of chronic stroke patients. The most important correlates of limb dexterity were upper limb strength and severe spasticity and the most significant predictor of dexterity was the severity of upper limb paresis on admission to rehabilitation.
    MeSH term(s) Activities of Daily Living ; Aged ; Cross-Sectional Studies ; Disability Evaluation ; Female ; Follow-Up Studies ; Hand/physiopathology ; Humans ; Male ; Middle Aged ; Motor Skills/physiology ; Muscle Spasticity/etiology ; Muscle Spasticity/rehabilitation ; Recovery of Function/physiology ; Retrospective Studies ; Severity of Illness Index ; Stroke/complications ; Treatment Outcome ; Upper Extremity/physiopathology
    Language English
    Publishing date 2011
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1087912-2
    ISSN 1878-6448 ; 1053-8135
    ISSN (online) 1878-6448
    ISSN 1053-8135
    DOI 10.3233/NRE-2011-0639
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  4. Article ; Online: Sport concussion assessment in New Zealand high school rugby players: a collaborative approach to the challenges faced in primary care.

    Salmon, Danielle M / Chua, Jason / Sullivan, S John / Whatman, Chris / Brown, James / Register-Mihalik, Johna / Murphy, Ian / Walters, Simon / Clacy, Amanda / Sole, Gisela / Kerr, Zachary Y / Rasmussen, Karen / England, Mike

    Brain injury

    2022  Volume 36, Issue 2, Page(s) 258–270

    Abstract: Primary objective: To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players.: Methods: This study, ... ...

    Abstract Primary objective: To describe the collaborative development of a New Zealand Rugby Concussion Assessment (NZRCA) for primary care and to provide normative baseline data from a representative group of high school rugby players.
    Methods: This study, conducted over the 2018 and 2019 community rugby season where players were baseline tested during the pre- or start of season period.
    Results: Data were collected from 1428 players (males n = 1121, females n = 307) with a mean age of 15.9 ± 1.4 years. The mean ± SD symptom severity score was 11.3 ± 8.6, the mean number of endorsed symptoms was 8.5 ± 5.3 and the percentage feeling "normal" was 80.2 ± 15.3%. Only 5.3% of players reported no symptoms at baseline. The most common reported were: 'distracted easily' (72.5%), 'forgetful' (68.5%), and 'often tired' (62.6%). None of the participants achieved a perfect score for the SAC50. The majority of participants (89.7%) passed the tandem gait test with a time of 12.2 ± 1.7 seconds. Age, gender, and ethnicity were associated with NZRCA performance; albeit weakly.
    Conclusion: This study provides normative reference values for high-school rugby players. These data will aid healthcare providers in their identification of suspected concussion in the absence of individualized baselines.
    MeSH term(s) Adolescent ; Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Female ; Football ; Humans ; Male ; Neuropsychological Tests ; New Zealand/epidemiology ; Primary Health Care ; Rugby ; Schools
    Language English
    Publishing date 2022-02-10
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639115-1
    ISSN 1362-301X ; 0269-9052
    ISSN (online) 1362-301X
    ISSN 0269-9052
    DOI 10.1080/02699052.2022.2033839
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  5. Article ; Online: Deep venous thrombosis in Asian traumatic brain injury patients during rehabilitation: prevalence and risk factors.

    Chua, Karen S G / Kong, Keng-He / Arul, Earnest

    The Journal of head trauma rehabilitation

    2009  Volume 24, Issue 3, Page(s) 178–186

    Abstract: Objectives: To determine the prevalence and risk factors of asymptomatic lower-limb deep venous thrombosis (DVT) among Asians in inpatient rehabilitation after traumatic brain injury (TBI).: Design: a prospective observational study.: Participants!# ...

    Abstract Objectives: To determine the prevalence and risk factors of asymptomatic lower-limb deep venous thrombosis (DVT) among Asians in inpatient rehabilitation after traumatic brain injury (TBI).
    Design: a prospective observational study.
    Participants: Fifty-six (35 males and 21 females) Asian individuals with TBI with a median of 25 days to rehabilitation. The mean age was 49.3 +/- 20.4 years and 64.3% (36) were Chinese, 19.6% (11) were Malay, 10.7% (6) were Indian, and 5.4% (3) were of other races.
    Main measures: quantitative D-dimer assay (DDA) and targeted hemiplegic/weaker lower extremity venous duplex ultrasonography (VDU) for patients with elevated DDA levels (>or=0.34 microg/mL). Outcome measures included the incidence of DVT based on VDU diagnosis.
    Results: All 34 (60.7%) patients who had elevated DDA levels underwent single limb VDU, revealing an incidence of 5.4% (3) of lower-limb DVT, including 1 case of proximal and 2 of distal DVT. Logistic regression analyses did not reveal any significant predictive factors for DVT, but tracheostomy, higher admission Glasgow Coma Scale (GCS) score, and lower Functional Independence Measure (FIM)-walk scores correlated significantly with elevated DDA levels (P < .05). Receiver-operating characteristic analysis showed that cutoff DDA levels of 1.37 mg/mL resulted in a sensitivity of 100% and a specificity of 67.7%.
    Conclusion: Asymptomatic DVT is uncommon in Asian TBI rehabilitation patients. Our low incidence could be related to the small sample size, ethnic protective factors, early walking during rehabilitation, and timing of VDU during possible declining thrombotic risk.
    MeSH term(s) Asian Continental Ancestry Group ; Brain Injuries/complications ; Brain Injuries/ethnology ; Brain Injuries/rehabilitation ; Female ; Fibrin Fibrinogen Degradation Products/analysis ; Humans ; Incidence ; Male ; Prospective Studies ; Rehabilitation Centers/statistics & numerical data ; Risk Factors ; Singapore/epidemiology ; Venous Thrombosis/diagnosis ; Venous Thrombosis/epidemiology
    Chemical Substances Fibrin Fibrinogen Degradation Products ; fibrin fragment D
    Language English
    Publishing date 2009-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639221-0
    ISSN 1550-509X ; 0885-9701
    ISSN (online) 1550-509X
    ISSN 0885-9701
    DOI 10.1097/HTR.0b013e3181a0b265
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  6. Article: Rehabilitation outcomes in elderly patients with traumatic brain injury in Singapore.

    Yap, Samantha G M / Chua, Karen S G

    The Journal of head trauma rehabilitation

    2008  Volume 23, Issue 3, Page(s) 158–163

    Abstract: Objective: To identify and characterize injury variables and outcomes in persons with traumatic brain injury (TBI) 55 years and older admitted to a tertiary rehabilitation unit.: Design: Retrospective study of 52 individuals with TBI covering a 4- ... ...

    Abstract Objective: To identify and characterize injury variables and outcomes in persons with traumatic brain injury (TBI) 55 years and older admitted to a tertiary rehabilitation unit.
    Design: Retrospective study of 52 individuals with TBI covering a 4-year period.
    Outcome measures: Admission and discharge Modified Barthel Index scores; total acute and rehabilitation length of stay; Glasgow Coma Scale (GCS); duration of posttraumatic amnesia (PTA); Glasgow Outcome Scale at discharge and at 6 months postinjury; Ranchos Los Amigos Scale; and discharge disposition.
    Results: Most common mechanism of injury was falls (61.5%), and predominant computed tomographic scan finding was lobar contusion (44%). Thirty-one percent had GCS score less than 9, but 90% had PTA duration of more than 1 week. Mean length of stay in acute and rehabilitation facilities was 26.4 (SD = 15.9) days and 29.8 (SD = 14.4) days, respectively. Difference between admission and discharge Modified Barthel Index was significant (P < .001), and 90% were discharged home. There was improvement in Glasgow Outcome Scale score at 6 months.
    Conclusions: Most patients in this cohort had severe brain injury, which may be due to a higher incidence of intracerebral hematoma. The GCS score underestimates the severity of brain injury in elderly persons with TBI; PTA duration was more representative of severity. Older patients with TBI do benefit from rehabilitation with significant functional gains and a high rate of return to home and to community.
    MeSH term(s) Activities of Daily Living ; Aged ; Aged, 80 and over ; Brain Injuries/rehabilitation ; Female ; Glasgow Coma Scale ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Neuropsychological Tests ; Outcome Assessment (Health Care) ; Retrospective Studies ; Singapore ; Tracheostomy ; Trauma Severity Indices
    Language English
    Publishing date 2008-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639221-0
    ISSN 1550-509X ; 0885-9701
    ISSN (online) 1550-509X
    ISSN 0885-9701
    DOI 10.1097/01.HTR.0000319932.15085.fe
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  7. Article ; Online: An ideal image: effusive constrictive pericarditis.

    Azarisman, Shah M / Richardson, James D / Chua, S K / Cunningham, Michael S / Teo, Karen S / Worthley, Stephen G

    The American journal of medicine

    2013  Volume 126, Issue 1, Page(s) 25–26

    MeSH term(s) Adult ; Candida albicans/isolation & purification ; Candidiasis, Invasive/complications ; Humans ; Magnetic Resonance Imaging ; Male ; Pericarditis, Constrictive/diagnosis ; Pericarditis, Constrictive/microbiology
    Language English
    Publishing date 2013-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 80015-6
    ISSN 1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
    ISSN (online) 1555-7162 ; 1873-2178
    ISSN 0002-9343 ; 1548-2766
    DOI 10.1016/j.amjmed.2012.08.014
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  8. Article ; Online: Quantitative assessment of motor functions post-stroke: Responsiveness of upper-extremity robotic measures and its task dependence.

    Hussain, Asif / Budhota, Aamani / Contu, Sara / Kager, Simone / Vishwanath, Deshmukh A / Kuah, Christopher W K / Yam, Lester H L / Chua, Karen S G / Masia, Lorenzo / Campolo, Domenico

    IEEE ... International Conference on Rehabilitation Robotics : [proceedings

    2017  Volume 2017, Page(s) 1037–1042

    Abstract: Technology aided measures offer a sensitive, accurate and time-efflcient approach for the assessment of sensorimotor function after neurological impairment compared to standard clinical assessments. This preliminary study investigated the relationship ... ...

    Abstract Technology aided measures offer a sensitive, accurate and time-efflcient approach for the assessment of sensorimotor function after neurological impairment compared to standard clinical assessments. This preliminary study investigated the relationship between task definition and its effect on robotic measures using a planar, two degree of freedom, robotic-manipulator (H-Man). Four chronic stroke participants (49.5±11.95 years, 2 Female, FMA: 37.5±13.96) and eight healthy control participants (26.25± 4.70 years, 2 Female) participated in the study. Motor functions were evaluated using line tracing and circle tracing tasks with dominant and nondominant hand of healthy and affected vs. non affected hand of stroke participants. The results show significant dependence of quantitative measures on investigated tasks.
    MeSH term(s) Adult ; Biomechanical Phenomena ; Female ; Humans ; Male ; Middle Aged ; Motor Skills/physiology ; Robotics/instrumentation ; Stroke Rehabilitation/instrumentation ; Stroke Rehabilitation/methods ; Task Performance and Analysis ; Upper Extremity/physiopathology ; Young Adult
    Language English
    Publishing date 2017-08-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 1945-7901
    ISSN (online) 1945-7901
    DOI 10.1109/ICORR.2017.8009386
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  9. Article ; Online: Proprioceptive assessment in clinical settings: Evaluation of joint position sense in upper limb post-stroke using a robotic manipulator.

    Contu, Sara / Hussain, Asif / Kager, Simone / Budhota, Aamani / Deshmukh, Vishwanath A / Kuah, Christopher W K / Yam, Lester H L / Xiang, Liming / Chua, Karen S G / Masia, Lorenzo / Campolo, Domenico

    PloS one

    2017  Volume 12, Issue 11, Page(s) e0183257

    Abstract: Proprioception is a critical component for motor functions and directly affects motor learning after neurological injuries. Conventional methods for its assessment are generally ordinal in nature and hence lack sensitivity. Robotic devices designed to ... ...

    Abstract Proprioception is a critical component for motor functions and directly affects motor learning after neurological injuries. Conventional methods for its assessment are generally ordinal in nature and hence lack sensitivity. Robotic devices designed to promote sensorimotor learning can potentially provide quantitative precise, accurate, and reliable assessments of sensory impairments. In this paper, we investigate the clinical applicability and validity of using a planar 2 degrees of freedom robot to quantitatively assess proprioceptive deficits in post-stroke participants. Nine stroke survivors and nine healthy subjects participated in the study. Participants' hand was passively moved to the target position guided by the H-Man robot (Criterion movement) and were asked to indicate during a second passive movement towards the same target (Matching movement) when they felt that they matched the target position. The assessment was carried out on a planar surface for movements in the forward and oblique directions in the contralateral and ipsilateral sides of the tested arm. The matching performance was evaluated in terms of error magnitude (absolute and signed) and its variability. Stroke patients showed higher variability in the estimation of the target position compared to the healthy participants. Further, an effect of target was found, with lower absolute errors in the contralateral side. Pairwise comparison between individual stroke participant and control participants showed significant proprioceptive deficits in two patients. The proposed assessment of passive joint position sense was inherently simple and all participants, regardless of motor impairment level, could complete it in less than 10 minutes. Therefore, the method can potentially be carried out to detect changes in proprioceptive deficits in clinical settings.
    Language English
    Publishing date 2017
    Publishing country United States
    Document type Journal Article
    ISSN 1932-6203
    ISSN (online) 1932-6203
    DOI 10.1371/journal.pone.0183257
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  10. Article ; Online: Baseline concussion assessment performance of community-based senior rugby players: a cross-sectional study.

    Salmon, Danielle M / Chua, Jason / Sullivan, S John / Whatman, Chris / Brown, James / Register-Mihalik, Johna / Murphy, Ian / Walters, Simon / Clacy, Amanda / Sole, Gisela / Kerr, Zachary Y / Rasmussen, Karen / England, Mike

    Brain injury

    2021  Volume 35, Issue 11, Page(s) 1433–1442

    Abstract: Objective: To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics.: Design: A cross-sectional study using the New Zealand Rugby ... ...

    Abstract Objective: To report pre-season baseline concussion assessment performance among senior rugby players and explore associations between assessment performance and player demographics.
    Design: A cross-sectional study using the New Zealand Rugby Concussion Assessments (NZRCA), comprising symptom, cognitive and dynamic coordination assessments was conducted in the 2018-2019 season.
    Methods: Players' baseline assessments were characterised using descriptive statistics; effect sizes (ES) and t-tests were used to explore associations between player demographic characteristics and NZRCA performance.
    Results: A total of 733 players (11.4% female) aged between 16 and 52 years completed the NZRCA. The median (range) value for symptom severity, endorsed symptoms and "percentage normal" was respectively, 5 (0-40), 5 (0-21) and 90% (30-100%). A perfect standardised assessment of concussion score was achieved by one participant; seven achieved ≥27/30 for immediate recall, and 22 achieved a perfect delayed recall score. Most participants (n = 674, 92%) passed the tandem gait test. Associations between NZRCA performance and gender, concussion history, and Pasifika ethnicity were observed with effect sizes ranging from small (0.18) to large (0.70). Six hundred and twenty-three (85%) participants reported at least one symptom.
    Conclusions: The results from this study could help support decision-making by clinicians, improving the management of concussions in the community setting.
    MeSH term(s) Adolescent ; Adult ; Athletic Injuries/diagnosis ; Brain Concussion/diagnosis ; Cross-Sectional Studies ; Female ; Football ; Humans ; Male ; Middle Aged ; Neuropsychological Tests ; Rugby ; Young Adult
    Language English
    Publishing date 2021-10-18
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639115-1
    ISSN 1362-301X ; 0269-9052
    ISSN (online) 1362-301X
    ISSN 0269-9052
    DOI 10.1080/02699052.2021.1972452
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