Jane Burridge

• University of Southampton

Background: Home-based, self-managed stroke rehabilitation can complement limited healthcare resources. Computer-based programs offer a potential for rehabilitation without the need for complex technology or direct therapist supervision. Objective: The overall objective of this article is to compare effectiveness of a home-based web rehabilitation...

Objectives To evaluate the delivery of rehabilitation using implicit motor learning principles in an acute stroke setting. Design Pilot, assessor-blind, cluster randomised controlled trial with nested qualitative evaluation. Setting Eight inpatient stroke units, UK. Participants People within 14 days of stroke onset, presenting with lower limb h...

Introduction Technology-facilitated, self-directed upper limb (UL) rehabilitation, as an adjunct to conventional care, could enhance poststroke UL recovery compared with conventional care alone, without imposing additional resource burden. The proposed pilot randomised controlled trial (RCT) aims to assess whether stroke survivors will engage in se...

Objectives To gain a consensus among therapists for reasons why a person who had a stroke may not receive the Royal College of Physicians’ recommended minimum of 45 min of daily therapy. Design Three-round remote e-Delphi study. Setting National study, based in the UK. Participants Occupational therapists and physiotherapists with experience of...

Objectives To generate qualitative data on the views of Occupational Therapists and Physiotherapists about why people do not receive the Royal College of Physicians’ recommended minimum of 45 minutes (min) of daily therapy after stroke, in order to inform a Delphi study. Design Focus group study. Setting Stroke services in the South of England....

Background Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. Methods Using a standardized methodology, which...

Background Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. Methods Using a standardized methodology, which...

Purpose: To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. Methods: Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evid...

BACKGROUND Upper Limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose; rehabilitation technologies present pragmatic solutions to dose enhancement. To date, technologies promoting self-directed rehabilitation have been poorly adopted. Understanding the barriers to adoption may shape strategies to enhance technology use, an...

Background Upper limb (UL) recovery after stroke is strongly dependent upon rehabilitation dose. Rehabilitation technologies present pragmatic solutions to dose enhancement, complementing therapeutic activity within conventional rehabilitation, connecting clinicians with patients remotely, and empowering patients to drive their own recovery. To dat...

Functional Electrical Stimulation (FES) has been used to support mobility for people with upper motor neuron conditions such as stroke and multiple sclerosis for over 25 years. Recent development and publication of clinical practice guidelines (CPGs) provide evidence to guide clinical decision making for application of FES to improve mobility. Unde...

This document describes the evidence based clinical practice recommendations for best use of Functional Electrical Stimulation (FES) to improve mobility in adults with lower limb impairment due to an upper motor neuron lesion. These guidelines are intended to inform all stakeholders, including people who may be able to benefit from using FES, p...

p>Some Western countries, such as England, the Netherlands, Canada, and Australia, have clinical guidelines that provide different time-based recommendations for rehabilitation after stroke. This review seeks to understand the effect of time spent in rehabilitation, to support service providers to optimize recovery for people following stroke. It d...

EEG-based neurofeedback uses mental behaviours (MB) to enable voluntary self-modulation of brain activity, and has potential to relieve central neuropathic pain (CNP) after a spinal cord injury (SCI). This study aimed to understand neurofeedback learning and the relationship between MB and neurofeedback success. Twenty-five non-CNP participants and...

Objective(s) To describe a) how motor learning principles are applied during post stroke physiotherapy, with a focus on lower limb rehabilitation; and b) the context in which these principles are used, in relation to patient and/or task characteristics. Design Direct non-participation observation of routine physiotherapy sessions, with data collec...

Purpose: Post-stroke survivors report that feedback helps to increase training motivation. A wearable system (M-MARK), comprising movement and muscle sensors and providing feedback when performing everyday tasks was developed. The objective reported here was to create an evidence-based set of upper-limb tasks for use with the system. Materials an...

Objective : To produce guidance and validated examples of tasks that promote an external focus of attention, for use in lower limb rehabilitation in an inpatient stroke care setting. Design : Electronic survey, using e-Delphi methodology. Participants : A multi-professional expert panel of 14 clinicians and researchers, with expertise in stroke r...

Background: the Trunk Impairment Scale (TIS) is recommended for use in clinical research to assess trunk impairment post-stroke. However, it is observer dependent and does not consider the quality of trunk movement. To address these challenges, this study proposes an instrumented TIS (iTIS). Objective: this study aims to investigate the intra-rate...

Is functional electrical stimulation effective for improving walking characteristics in adults with lower limb weakness due to an upper motor neuron lesion? Protocol for an overview of systematic reviews and meta-analyses. PROSPERO 2019 CRD42019150899 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019150899 Review qu...

Inertial sensing suites now permeate all forms of smart automation, yet a plateau exists in real-world derivation of global orientation. Magnetic field fluctuations and inefficient sensor fusion still inhibit deployment. We introduce a new algorithm, an Extended Complementary Filter (ECF), to derive 3D rigid body orientation from inertial sensing s...

Introduction: The Mechanical Muscle Activity with Real-time Kinematics project aims to develop a device incorporating wearable sensors for arm rehabilitation following stroke. These will record kinematic activity using inertial measurement units and mechanical muscle activity. The gold standard for measuring muscle activity is electromyography; ho...

Background: The Trunk Impairment Scale (TIS) is recommended for clinical research use to assess trunk impairment post-stroke. However, it is observer-dependent and neglects the quality of trunk movements. This study proposes an instrumented TIS (iTIS) using the Valedo system, comprising portable inertial sensors, as an objective measure of trunk im...

Background: Although implicit and explicit learning approaches have been well investigated in healthy populations, there is less evidence regarding the relative benefits of each approach in clinical practice. Studies in stroke typically investigate single elements of an implicit learning approach (ILA; eg, reduced quantity feedback or an external...

br/>Background: Trunk control post-stroke can be affected by muscle weakness, reduced position sense and poor coordination leading to decreases in balance and functional ability. Virtual reality (VR) technology in stroke rehabilitation has been demonstrated to improve function and activity. However, the feasibility of using VR to deliver post-stro...

Intra and inter-rater reliability of Valedo System to measure trunk range of movement in healthy and chronic stroke participants during the streamlined Wolf Motor Function Test Busselli G.1, Alhwoaimel N. 2, Warner M. 2, Hughes A.-M. 2, Burridge J. 2, Turk R. 2 1University of Verona, Verona, Italy 2University of Southampton, Southampton, United Kin...

Background: Upper limb impairment is a common problem for people with neurological disabilities, affecting activity, performance, quality of life, and independence. Accurate, timely assessments are required for effective rehabilitation, and development of novel interventions. International consensus on upper limb assessment is needed to make resear...

BACKGROUND Although implicit and explicit learning approaches have been well investigated in healthy populations, there is less evidence regarding the relative benefits of each approach in clinical practice. Studies in stroke typically investigate single elements of an implicit learning approach (ILA; eg, reduced quantity feedback or an external fo...

Purpose: Reliability of motor evoked potential threshold and amplitude measurement of upper limb muscles is important when detecting changes in cortical excitability. The objective of this study was to investigate intra-rater, test-retest reliability and minimal detectable change of resting motor threshold and amplitude of a proximal and distal upp...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: • To establish if greater time spent in rehabilitation results in greater improvement in measures of activity than less time spent in rehabilitation. • To assess the effect of total time spent (in minutes) in rehabilitation on activity/activity limitations follo...

This chapter discusses the need for arm rehabilitation in people with stroke and mechanisms for rehabilitation, providing justification for the growing role for technology. The challenges of designing for a home environment are discussed along with results from a survey identifying the most important factors in arm rehabilitation technologies for b...

Background: Critical illness myopathy (CIM) and polyneuropathy (CIP) are a common complication of critical illness. Both cause intensive-care-unit-acquired (ICU-acquired) muscle weakness (ICUAW) which increases morbidity and delays rehabilitation and recovery of activities of daily living such as walking ability. Focused physical rehabilitation of...

After stroke, the ability to perform two tasks concurrently is diminished, which may contribute to less pronounced gains on activity level after rehabilitation. The current study investigated whether upper extremity dual-task performance is compromised after stroke, as a first step towards examining whether cortical stimulation can reduce dual-task...

Background: The need for cost-effective neurorehabilitation is driving investment into technologies for patient assessment and treatment. Translation of these technologies into clinical practice is limited by a paucity of evidence for cost-effectiveness. Methodological issues, including lack of agreement on assessment methods, limit the value of m...

Objectives: To describe the time course of recovery of sit-to-stand function in patients with intensive-care-unit-acquired muscle weakness and the impact of recovery. Methods: A cohort study in post-acute intensive care unit and rehabilitation units. Patients with chronic critical illness and intensive-care-unit-acquired muscle weakness were inc...

An increased burden on health care and rehabilitation resources is due to the number of people suffering a stroke and if the capacity of health services is to meet future demand novel approaches to rehabilitation are required. In this chapter recent research is surveyed where iterative learning control , developed initially for robots executing com...

Objectives: To quantify the intra-rater and test-retest reliability of the motor evoked potential (MEP) resting threshold (RT) and MEP amplitude of the anterior deltoid (AD) and extensor digitorum (ED) of healthy adults using Transcranial Magnetic Stimulation (TMS). Methods: Stimulation was performed on healthy adults with a Magstim® 2002 device...

The clinical application of Functional Electrical Stimulation (FES) has evolved over the last five decades. However, the use of the Randomized Control Trial (RCT) methodology in evaluating the clinical effectiveness of new and existing applications of FES is a demanding process adding time and cost to these trials. Consequently, there has been a lo...

Background/Aims This paper illustrates the application of a technique, cognitive interviewing, which was used in the development of three questionnaires to determine the views of use of functional electrical stimulation by people with spinal cord injury, health care professionals and researchers working in spinal cord injury. Methods Three questio...

Constraint Induced Therapy (CIT) is an evidence-based intervention that combines constraint of the unaffected hand and intensive one-to-one motor training. A study, trialing CIT at home without therapist support, identified lack of motivation and poor adherence. A web-supported CIT system (LifeCIT) was developed to address these barriers and a feas...

Tremor is an involuntary, oscillating, debilitating movement which affects over 50% of people with Multiple Sclerosis. In this paper an advanced paradigm, combining linearising action and repetitive control (RC), is developed to suppress tremor using functional electrical stimulation (FES) applied to wrist extensors/flexors. This innovative biomech...

Background: Neurorehabilitation technologies such as robot therapy (RT) and transcranial Direct Current Stimulation (tDCS) can promote upper limb (UL) motor recovery after stroke. Objective: To explore the effect tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke. Methods: A pilot ran...

Applying explicit and implicit learning models during early gait rehabilitation post stroke: a feasibility trial Relevance Motor learning can be either explicit or implicit. Explicit learning is conscious and cognitive, occurring with task specific knowledge. Implicit learning is sub-conscious and unintentional, occurring in the absence of conscio...

Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Our primary obj...

Iterative learning control (ILC) has its origins in the control of processes that perform a task repetitively with a view to improving accuracy from trial to trial by using information from previous executions of the task. This brief shows how a classic application of this technique – trajectory following in robots – can be extended to neurological...

Building on work reported in previous chapters, the system developed and evaluated in this chapter includes stimulation of the wrist and hand extensors. This directly targets activities of daily living, comprising real-world tasks that require manipulation of objects using the hand and wrist.

Building on the planar results of the previous chapter, an extension to a 3D task is developed where the ability to lift the arm is also rehabilitated. As stroke patients have difficulty lifting their affected arm, a gravity unweighting robot is used and the development again leads to a clinical trial. The analysis is extended to compensate for mus...

This chapter gives the required background on iterative learning control. After introducing the defining characteristic of this form of control, attention is restricted to the laws used in the stroke rehabilitation research.

This chapter details how an ILC based system for planar tasks has been developed to the stage of a small scale clinical trial. The results of tests conducted on 18 unimpaired volunteers who do not provide voluntary effort are given. These results contributed to the granting of ethical approval for the clinical trial with 5 stroke patients.

The link that extends ILC from industrial robotics to robotic-assisted stroke rehabilitation is described together with the methods a health professional uses to assess the ability and progress of a patient. This material underpins the remainder of the monograph.

Stroke is the largest cause of disability in developed countries, where a relatively small percentage of patients with upper-limb impairment following stroke regain full function. In particular, many of these patients experience difficulty performing everyday reaching and grasping tasks. Functional electrical stimulation (FES) can assist stroke pat...

To systematically review the methodology in particular treatment options and outcomes and the effect of multiple sessions of transcranial direct current stimulation (tDCS) with rehabilitation programmes for upper extremity recovery post stroke. A search was conducted for randomised controlled trials involving tDCS and rehabilitation for the upper e...

Background Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Obje...

Trunk control is thought to contribute to upper extremity (UE) function. However, this common assumption has not been validated. To investigate the effect of providing an external trunk support on trunk control and UE function, and examine the relationship between trunk control and UE function in people with chronic stroke and healthy controls. A c...

Background Functional electrical stimulation (FES) during repetitive practice of everyday tasks can facilitate recovery of upper limb function following stroke. Reduction in impairment is strongly associated with how closely FES assists performance, with advanced iterative learning control (ILC) technology providing precise upper-limb assistance. T...

People re-learning skills after a stroke go through the same process as someone learning to play tennis, but they have a problem because they can hardly move at all so they cannot practise, which means they dont get feedback. Muscles can be made to work by electrical stimulation where electrical impulses travel along the nerves in much the same way...

Abstract Purpose: To investigate the feasibility of combining physiotherapy and functional electrical stimulation to improve gait post stroke. Methods: A parallel group partially single-blinded randomised clinical trial. Adults living at home, less than 6 months post stroke, were randomised to Group A (physiotherapy, n = 10) or Group B (physiothera...

Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', care...

. Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery. . To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in...

Intensive care unit (ICU) acquired or generalised weakness due to critical illness myopathy (CIM) and polyneuropathy (CIP) are major causes of chronically impaired motor function that can affect activities of daily living and quality of life. Physical rehabilitation of those affected might help to improve activities of daily living. Our primary obj...

This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of rehabilitation therapies for people with CIP and CIM. The primary objective is to assess the effectiveness of such interventions in improving daily activities such as walking, bathing, dressing and eating. Secondary objectives are to...

Nonlinear optimisation-based search algorithms have been developed for the precise stimulation of muscles in the wrist and hand, to enable stroke patients to attain predefined gestures. These have been integrated in a system comprising a 40 element surface electrode array that is placed on the forearm, an electrogoniometer and data glove supplying...

Functional strength training in addition to conventional physical therapy could enhance upper limb recovery early after stroke more than movement performance therapy plus conventional physical therapy. To determine (a) the relative clinical efficacy of conventional physical therapy combined with functional strength training and conventional physica...

Assistive Technologies, defined as "electrical or mechanical devices designed to help people recover movement" have demonstrated clinical benefits in upper-limb stroke rehabilitation. Stroke services are becoming community-based and more reliant on self-management approaches. Assistive technologies could become important tools within self-managemen...

An upper-limb stroke rehabilitation system is developed that assists patients in performing real world functionally relevant reaching tasks. The system provides de-weighting of the arm via a simple spring support whilst functional electrical stimulation is applied to the anterior deltoid and triceps via surface electrodes, and to the wrist and hand...

Therapies using functional electrical stimulation (FES) in conjunction with practice of everyday tasks have proven effective in facilitating recovery of upper limb function following stroke. The aim of the current study is to develop a multi-channel electrical stimulation system that precisely controls the assistance provided in goal-orientated tas...

Background The OTTER (OsTeoarthritis Thumb ThERapy) trial is a two-year developmental study for a full randomised controlled trial (RCT) into the clinical and cost effectiveness of an occupational therapy and splint intervention for thumb base OA. To develop an optimal package of care for evaluation within a multi-centre RCT, the views of both clin...

This study explored adjustment in people with spinal cord injury; data from four focus groups are presented. Thematic analysis revealed four themes, managing goals and expectations, comparison with others, feeling useful and acceptance, showing participants positively engaged in life, positively interpreted social comparison information and set rea...

Background: Focus of attention is known to play an important role in motor skill learning, yet little is known about how attention is directed within the context of stroke rehabilitation. Objective: The aims of this study were: (1) to identify physical therapists' use of internal and external focus of attention during gait rehabilitation for ind...

DEFINING OPTIMAL NHS OCCUPATIONAL THERAPY TREATMENT, INDIVIDUALISED SPLINT, AND PLACEBO SPLINT FOR PATIENTS WITH THUMB BASE OA: A DELPHI STUDY Background: The OTTER (OsTeoarthritis Thumb ThERapy) trial is a two-year development study for a full RCT into the clinical and cost effectiveness of an occupational therapy and splint intervention for thum...

Introduction Following stroke, over 50% of patients have an impairment of one arm, affecting their ability to perform everyday reach and grasp tasks. Functional electrical stimulation (FES) has been shown to restore movement, with effectiveness increased when combined with voluntary intention. Recent clinical trials that incorporated an advanced co...

Functional electrical stimulation (FES) has been shown to be an effective approach to upperlimb stroke rehabilitation, where it assists patients' arm and shoulder movement. Model-based FES controllers have recently confirmed significant potential to improve accuracy of functional reaching tasks, but they typically require a reference trajectory to...

For nearly half a century FES has been used in the treatment and management of physical problems encountered by people with SCI, such as bladder and bowel control, pain relief, and improvement of movement. Despite intensive research and development, only a small percentage of people who potentially benefit use FES illustrating with the translation...

Intention tremor is a common debilitating complication of Parkinson's disease and Multiple Sclerosis and there are approximately half a million sufferers in Europe. Its distinguishing characteristic is a continuous, oscillating, almost sinusoidal, motion during visually-guided voluntary movement that increases in amplitude, becoming more apparent a...

Objectives: To test parameters needed for the design of a larger trial including the following: 1) identifying eligible participants, recruitment, and retention rates; 2) the feasibility and acceptability of delivering functional electrical stimulation (FES) to the gluteus maximus and quadriceps femoris for acute stroke patients in a hospital reha...

Background Novel stroke rehabilitation techniques that employ electrical stimulation (ES) and robotic technologies are effective in reducing upper limb impairments. ES is most effective when it is applied to support the patients’ voluntary effort; however, current systems fail to fully exploit this connection. This study builds on previous work usi...

To provide effective stroke rehabilitation, a control scheme is developed for upper arm tracking in 3D space using electrical stimulation. In accordance with clinical need, the case where stimulation is applied to two muscles in the arm and shoulder is considered, with the arm supported against gravity by an exoskeletal mechanism. An upper limb mod...

About 65 percent of stroke survivors cannot involve their affected upper limb (UL) into their activities of daily living (Bruce & Dobkin 2005). Robot Therapy (RT) is one technique that can increase the intensity of rehabilitation and evidence shows that robot-assisted arm training results in reduction of UL motor impairments (Lo et al. 2010). Recen...

Stroke affects 110 000 people every year in England (Dept. Health, 2007). Post-stroke upper limb impairment often restricts reach to grasp tasks. This work forms part of on-going research aimed at developing a rehabilitation system using functional electrical stimulation (FES), mediated by advanced iterative learning control (ILC) algorithms. Perfo...

Annually, 15 million people worldwide suffer a stroke, and 5 million are left permanently disabled. A stroke is usually caused when a blood clot blocks a vessel in the brain and acts like a dam, stopping the blood reaching the regions downstream. Alternatively, it may be caused by a hemorrhage, in which a vessel ruptures and leaks blood into surrou...

The wavelet transform seems particularly suited to analyse the electromyographic signal (EMG) during gait of asymptomatic and pathological subjects. Firstly, because physiologically the electrical activity generated by the muscles derives from a weighted sum of individual physiological components having limited support in time and in frequency. Sec...