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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

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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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
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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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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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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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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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Article: States of severely altered consciousness: clinical characteristics, medical complications and functional outcome after rehabilitation.

Ng, Yee Sien / Chua, Karen S G

NeuroRehabilitation

2005 Volume 20, Issue 2, Page(s) 97–105

Abstract: Objective: To identify and characterize demographics, injury variables, complications, and functional outcomes in Asian patients presenting in States of Severely Altered Consciousness (SSAC).: Design: Descriptive case series review.: Setting/ ... ...

Abstract	Objective: To identify and characterize demographics, injury variables, complications, and functional outcomes in Asian patients presenting in States of Severely Altered Consciousness (SSAC). Design: Descriptive case series review. Setting/subjects: Acute rehabilitation unit with intensive, comprehensive neurological rehabilitation program. Thirty consecutive patients diagnosed to be in persistent vegetative state (PVS) or minimally conscious (MCS) state over a 4-year period were included. Main outcome measures: Disability Rating Scale (DRS), Ranchos Los Amigos Scale (RLAS), Modified Barthel Index (MBI). Results: Seventeen (57%) were male, with a mean age of 31.8 years (median 25y, range 15-74, SD 16.3y). Twenty-one (70%) had traumatic brain injury, and median GCS on acute admission was 5. The mean length of stays (LOS) in acute and rehabilitation facilities was 90.1 days and 106.3 days respectively. Tracheostomized patients had longer acute LOS. (p = 0.03). All patients had improvement in their DRS scores upon rehabilitation discharge. The MBI was insensitive in identifying low-level changes; though paired analyses were significant for improvement. Seventeen (57%) patients were in PVS and the rest in MCS on admission to rehabilitation. Twelve patients progressed to a state of awareness, with eye responses as the most frequent first sign. There was a greater spread of higher RLAS categories on rehabilitation discharge. Urinary tract infection (16 patients, 53%) was the most common medical complication. Nineteen (63%) had central fever and this group was more functionally disabled (p = 0.045). The mean number of medications on discharge was 6. The majority of patients (22 patients, 73%) were discharged home, and patients continued to make functional progress post-discharge. Conclusions: Despite SSAC states, the majority improve, however profound disability persists. Possible predictors of a worse outcome include tracheostomy, severity of initial disability, initial RLAS II level and presence of central fever.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Glasgow Coma Scale ; Health Status Indicators ; Humans ; Length of Stay ; Male ; Middle Aged ; Persistent Vegetative State/complications ; Persistent Vegetative State/rehabilitation ; Prognosis ; Retrospective Studies ; Tracheostomy ; Treatment Outcome
Language	English
Publishing date	2005
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1087912-2
ISSN	1878-6448 ; 1053-8135
ISSN (online)	1878-6448
ISSN	1053-8135
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Article: Factors associated with delayed discharges after inpatient stroke rehabilitation in Singapore.

Tan, Woan Shin / Chong, Wai Fung / Chua, Karen S G / Heng, Bee Hoon / Chan, Kay Fei

Annals of the Academy of Medicine, Singapore

2010 Volume 39, Issue 6, Page(s) 435–441

Abstract: Introduction: This study determines the extent of, and factors associated with, delayed discharges for stroke patients from inpatient rehabilitation.: Materials and methods: A retrospective cohort study utilising medical notes review was conducted at ...

Abstract	Introduction: This study determines the extent of, and factors associated with, delayed discharges for stroke patients from inpatient rehabilitation. Materials and methods: A retrospective cohort study utilising medical notes review was conducted at an inpatient rehabilitation centre in Singapore. Acute stroke patients (n = 487) admitted between March 2005 and December 2006 were studied. The primary measure was delayed discharge defined as an extension in inpatient stay beyond the planned duration. Factors associated with delays in discharge were categorised as individual, caregiver, medical and organisational. Results: There were a total of 172 delayed discharges (35.6%). The mean [standard deviation (SD)] length of stay was 40.5 days (SD, 19.5 days) and 25.8 days (SD, 11.4 days) for patients with delayed and prompt discharges, respectively. Mean extension of stay was 9.7 days (SD, 13.8 days). Caregiver-related reasons were cited for 79.7% of the delays whereas organisational factors (awaiting nursing home placement, investigations or specialist appointments) accounted for 17.4%. Four factors were found to be independently associated with delayed discharge: discharge to the care of foreign domestic helper, nursing home placement, lower admission Functional Independence Measure (FIM) motor score and discharge planning process. Conclusions: Our study suggests that caregiver and organisational factors were main contributors of delayed discharge. Targeted caregiver training and the provision of post-discharge support may improve the confidence of caregivers of patients with greater motor disability. The use of structured discharge planning programmes may improve the efficiency of the rehabilitation service. To reduce delays, problems with the supply of formal and informal post-discharge care must also be addressed.
MeSH term(s)	Aged ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; Patient Discharge ; Rehabilitation Centers ; Retrospective Studies ; Singapore ; Stroke Rehabilitation
Language	English
Publishing date	2010-06-22
Publishing country	Singapore
Document type	Journal Article
ZDB-ID	604527-3
ISSN	0304-4602
ISSN	0304-4602
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Article: Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation.

Hussain, Asif / Budhota, Aamani / Hughes, Charmayne Mary Lee / Dailey, Wayne D / Vishwanath, Deshmukh A / Kuah, Christopher W K / Yam, Lester H L / Loh, Yong J / Xiang, Liming / Chua, Karen S G / Burdet, Etienne / Campolo, Domenico

Frontiers in neuroscience

2016 Volume 10, Page(s) 477

Abstract: Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures ...

Abstract	Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures to capture differences in planar reaching movements as a function of neurological status (stroke, healthy), direction (front, ipsilateral, contralateral), movement segment (outbound, inbound), and time (baseline, post-training, 2-week follow-up) using a planar, two-degrees of freedom, robotic-manipulator (H-Man). Twelve chronic stroke (age: 55 ± 10.0 years, 5 female, 7 male, time since stroke: 11.2 ± 6.0 months) and nine aged-matched healthy participants (age: 53 ± 4.3 years, 5 female, 4 male) participated in this study. Both healthy and stroke participants performed planar reaching movements in contralateral, ipsilateral and front directions with the H-Man, and the robotic measures, spectral arc length (SAL), normalized time to peak velocities (
Language	English
Publishing date	2016-10-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2411902-7
ISSN	1662-453X ; 1662-4548
ISSN (online)	1662-453X
ISSN	1662-4548
DOI	10.3389/fnins.2016.00477
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Article: Facilitating motor imagery-based brain-computer interface for stroke patients using passive movement.

Arvaneh, Mahnaz / Guan, Cuntai / Ang, Kai Keng / Ward, Tomas E / Chua, Karen S G / Kuah, Christopher Wee Keong / Ephraim Joseph, Gopal Joseph / Phua, Kok Soon / Wang, Chuanchu

Neural computing & applications

2016 Volume 28, Issue 11, Page(s) 3259–3272

Abstract: Motor imagery-based brain-computer interface (MI-BCI) has been proposed as a rehabilitation tool to facilitate motor recovery in stroke. However, the calibration of a BCI system is a time-consuming and fatiguing process for stroke patients, which leaves ... ...

Abstract	Motor imagery-based brain-computer interface (MI-BCI) has been proposed as a rehabilitation tool to facilitate motor recovery in stroke. However, the calibration of a BCI system is a time-consuming and fatiguing process for stroke patients, which leaves reduced time for actual therapeutic interaction. Studies have shown that passive movement (PM) (i.e., the execution of a movement by an external agency without any voluntary motions) and motor imagery (MI) (i.e., the mental rehearsal of a movement without any activation of the muscles) induce similar EEG patterns over the motor cortex. Since performing PM is less fatiguing for the patients, this paper investigates the effectiveness of calibrating MI-BCIs from PM for stroke subjects in terms of classification accuracy. For this purpose, a new adaptive algorithm called filter bank data space adaptation (FB-DSA) is proposed. The FB-DSA algorithm linearly transforms the band-pass-filtered MI data such that the distribution difference between the MI and PM data is minimized. The effectiveness of the proposed algorithm is evaluated by an offline study on data collected from 16 healthy subjects and 6 stroke patients. The results show that the proposed FB-DSA algorithm significantly improved the classification accuracies of the PM and MI calibrated models (
Language	English
Publishing date	2016-03-04
Publishing country	England
Document type	Journal Article
ZDB-ID	1480526-1
ISSN	1433-3058 ; 0941-0643
ISSN (online)	1433-3058
ISSN	0941-0643
DOI	10.1007/s00521-016-2234-7
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