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Liu Z, Li Z, Duan C. Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study. Medicine (Baltimore) 2024; 103:e38184. [PMID: 38758885 PMCID: PMC11098168 DOI: 10.1097/md.0000000000038184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. METHODS From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. RESULTS There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). CONCLUSION Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.
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Affiliation(s)
- Ziqing Liu
- Department of Rehabilitation, Shanghai Yangpu Hospital of TCM, Shanghai, China
| | - Zhangjie Li
- Department of Rehabilitation, Yangpu Hospital, Tongji University, Shanghai, China
| | - Chaoyang Duan
- Department of Rehabilitation, Shanghai Yangpu Hospital of TCM, Shanghai, China
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Safdar A, Smith MC, Byblow WD, Stinear CM. Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review. Neurorehabil Neural Repair 2023; 37:837-849. [PMID: 37947106 PMCID: PMC10685705 DOI: 10.1177/15459683231209722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Noninvasive brain stimulation (NIBS) is a promising technique for improving upper limb motor performance post-stroke. Its application has been guided by the interhemispheric competition model and typically involves suppression of contralesional motor cortex. However, the bimodal balance recovery model prompts a more tailored application of NIBS based on ipsilesional corticomotor function. OBJECTIVE To review and assess the application of repetitive transcranial magnetic stimulation (rTMS) protocols that aimed to improve upper limb motor performance after stroke. METHODS A PubMed search was conducted for studies published between 1st January 2005 and 1st November 2022 using rTMS to improve upper limb motor performance of human adults after stroke. Studies were grouped according to whether facilitatory or suppressive rTMS was applied to the contralesional hemisphere. RESULTS Of the 492 studies identified, 70 were included in this review. Only 2 studies did not conform to the interhemispheric competition model, and facilitated the contralesional hemisphere. Only 21 out of 70 (30%) studies reported motor evoked potential (MEP) status as a biomarker of ipsilesional corticomotor function. Around half of the studies (37/70, 53%) checked whether rTMS had the expected effect by measuring corticomotor excitability (CME) after application. CONCLUSION The interhemispheric competition model dominates the application of rTMS post-stroke. The majority of recent and current studies do not consider bimodal balance recovery model for the application of rTMS. Evaluating CME after the application rTMS could confirm that the intervention had the intended neurophysiological effect. Future studies could select patients and apply rTMS protocols based on ipsilesional MEP status.
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Affiliation(s)
- Afifa Safdar
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Marie-Claire Smith
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Winston D. Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Cathy M. Stinear
- Department of Medicine, University of Auckland, Auckland, New Zealand
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Heredia-Callejón A, García-Pérez P, Armenta-Peinado JA, Infantes-Rosales MÁ, Rodríguez-Martínez MC. Influence of the Therapeutic Alliance on the Rehabilitation of Stroke: A Systematic Review of Qualitative Studies. J Clin Med 2023; 12:4266. [PMID: 37445301 DOI: 10.3390/jcm12134266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The therapeutic alliance is a fundamental component of rehabilitation in order to achieve effective outcomes. However, what develops, maintains or hinders this relationship has not been sufficiently explored. The aim of this systematic review is to recognize the role of the therapeutic alliance in the neurological rehabilitation process. A search for articles was carried out in the databases PubMed, Web of Science, SCOPUS, CINAHL, APA PsycInfo, OTseeker and Dialnet. They were selected according to the eligibility criteria. Internal quality assessment of the articles was measured with the Consolidated Criteria for Reporting Qualitative Research (COREQ). The systematic review was registered in PROSPERO (ID 346523). The search in the databases identified 1596 articles, from which 9 different studies were finally included in the systematic review, reflecting the limitations of studies in this field. All studies are qualitative, from the point of view of the patients themselves, their relatives and healthcare professionals. The total sample of the included studies is 182 participants (96 health professionals, 76 users and 10 relatives). Semi-structured interviews, focus group discussions and written reflections were mainly used to collect the data. In conclusion, the therapeutic alliance can be an active component in the post-stroke rehabilitation process. Being recognized as a person, collaboration with the therapeutic team, empathy, empowerment, confidence, professional skills, maintenance of hope and the role of the family have been identified as aspects that can have an influence on the therapeutic alliance.
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Affiliation(s)
| | - Patricia García-Pérez
- Occupational Therapy Department, Hospital Marítimo, Servicio Andaluz de Salud (SAS), 29620 Malaga, Spain
| | - Juan Antonio Armenta-Peinado
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - Miguel Ángel Infantes-Rosales
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
| | - María Carmen Rodríguez-Martínez
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Biomedical Research Institute (IBIMA), 29590 Malaga, Spain
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Anti-spastic effect of contralesional dorsal premotor cortex stimulation in stroke patients with moderate-to-severe spastic paresis: a randomized, controlled pilot trial. Acta Neurol Belg 2023:10.1007/s13760-023-02212-2. [PMID: 36809647 DOI: 10.1007/s13760-023-02212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/12/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE This study aimed at investigating the effect of a single-session repetitive transcranial magnetic stimulation (rTMS) of the contralesional dorsal premotor cortex on poststroke upper-limb spasticity. MATERIAL AND METHODS The study consisted of the following three independent parallel arms: inhibitory rTMS (n = 12), excitatory rTMS (n = 12), and sham stimulation (n = 13). The primary and secondary outcome measures were the Modified Ashworth Scale (MAS) and F/M amplitude ratio, respectively. A clinically meaningful difference was defined as a reduction in at least one MAS score. RESULTS There was a statistically significant change in MAS score within only the excitatory rTMS group over time [median (interquartile range) of - 1.0 (- 1.0 to - 0.5), p = 0.004]. However, groups were comparable in terms of median changes in MAS scores (p > 0.05). The proportions of patients achieving at least one MAS score reduction (9/12 in the excitatory rTMS group, 5/12 in the inhibitory rTMS group, and 5/13 in the control group) were also comparable (p = 0.135). For the F/M amplitude ratio, main time effect, main intervention effect, and time-intervention interaction effect were not statistically significant (p > 0.05). CONCLUSIONS Modulation of the contralesional dorsal premotor cortex with a single-session of excitatory or inhibitory rTMS does not appear to have an immediate anti-spastic effect beyond sham/placebo. The implication of this small study remains unclear and further studies into excitatory rTMS for the treatment of moderate-to-severe spastic paresis in poststroke patients should be undertaken. CLINICAL TRIAL REGISTRATION NO NCT04063995 (clinicaltrials.gov).
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de Freitas Zanona A, Romeiro da Silva AC, Baltar do Rego Maciel A, Shirahige Gomes do Nascimento L, Bezerra da Silva A, Piscitelli D, Monte-Silva K. Sensory and motor cortical excitability changes induced by rTMS and sensory stimulation in stroke: A randomized clinical trial. Front Neurosci 2023; 16:985754. [PMID: 36760794 PMCID: PMC9907709 DOI: 10.3389/fnins.2022.985754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/29/2022] [Indexed: 01/26/2023] Open
Abstract
Background The ability to produce coordinated movement is dependent on dynamic interactions through transcallosal fibers between the two cerebral hemispheres of the brain. Although typically unilateral, stroke induces changes in functional and effective connectivity across hemispheres, which are related to sensorimotor impairment and stroke recovery. Previous studies have focused almost exclusively on interhemispheric interactions in the primary motor cortex (M1). Objective To identify the presence of interhemispheric asymmetry (ASY) of somatosensory cortex (S1) excitability and to investigate whether S1 repetitive transcranial magnetic stimulation (rTMS) combined with sensory stimulation (SS) changes excitability in S1 and M1, as well as S1 ASY, in individuals with subacute stroke. Methods A randomized clinical trial. Participants with a single episode of stroke, in the subacute phase, between 35 and 75 years old, were allocated, randomly and equally balanced, to four groups: rTMS/sham SS, sham rTMS/SS, rTMS/SS, and sham rTMS/Sham SS. Participants underwent 10 sessions of S1 rTMS of the lesioned hemisphere (10 Hz, 1,500 pulses) followed by SS. SS was applied to the paretic upper limb (UL) (active SS) or non-paretic UL (sham SS). TMS-induced motor evoked potentials (MEPs) of the paretic UL and somatosensory evoked potential (SSEP) of both ULs assessed M1 and S1 cortical excitability, respectively. The S1 ASY index was measured before and after intervention. Evaluator, participants and the statistician were blinded. Results Thirty-six participants divided equally into groups (nine participants per group). Seven patients were excluded from MEP analysis because of failure to produce consistent MEP. One participant was excluded in the SSEP analysis because no SSEP was detected. All somatosensory stimulation groups had decreased S1 ASY except for the sham rTMS/Sham SS group. When compared with baseline, M1 excitability increased only in the rTMS/SS group. Conclusion S1 rTMS and SS alone or in combination changed S1 excitability and decreased ASY, but it was only their combination that increased M1 excitability. Clinical trial registration clinicaltrials.gov, identifier (NCT03329807).
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Affiliation(s)
- Aristela de Freitas Zanona
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil,Occupational Therapy Department and Post-Graduate Program in Applied Health Sciences, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - Adriana Baltar do Rego Maciel
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Amanda Bezerra da Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Kinesiology, University of Connecticut, Storrs, CT, United States,*Correspondence: Daniele Piscitelli, ,
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Fan J, Fu H, Xie X, Zhong D, Li Y, Liu X, Zhang H, Zhang J, Huang J, Li J, Jin R, Zheng Z. The effectiveness and safety of repetitive transcranial magnetic stimulation on spasticity after upper motor neuron injury: A systematic review and meta-analysis. Front Neural Circuits 2022; 16:973561. [PMID: 36426136 PMCID: PMC9679509 DOI: 10.3389/fncir.2022.973561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
To systematically evaluate the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on spasticity after upper motor neuron (UMN) injury. Eight electronic databases were searched from inception to August 6, 2022. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS on spasticity after UMN injury were retrieved. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Review Manager 5.3 and Stata 14.0 software were used to synthesize data. The certainty of the evidence was appraised with the Grade of Recommendation, Assessment, Development and Evaluation tool. Forty-two studies with a total of 2,108 patients were included. The results of meta-analysis revealed that, compared with control group, rTMS could significantly decrease scores of the Modified Ashworth Scale (MAS) in patients with UMN injury. The subgroup analysis discovered that rTMS effectively decreased the MAS scores in patients with stroke. Meanwhile, rTMS treatment > 10 sessions has better effect and rTMS could decrease the MAS scores of upper limb. Thirty-three patients complained of twitching facial muscles, headache and dizziness, etc. In summary, rTMS could be recommended as an effective and safe therapy to relieve spasticity in patients with UMN injury. However, due to high heterogeneity and limited RCTs, this conclusion should be treated with caution.
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Affiliation(s)
- Jin Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Hui Fu
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaolong Xie
- Department of Rehabilitation Medicine, The Affiliated Meishan Hospital of Chengdu University of Traditional Chinese Medicine, Meishan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huiling Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiaxi Huang
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Juan Li,
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,*Correspondence: Rongjiang Jin,
| | - Zhong Zheng
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China,Zhong Zheng,
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Chen G, Wu M, Lin T, Cai G, Xu J, Ding Q, Li W, Wu C, Chen H, Lan Y. Effects of repetitive transcranial magnetic stimulation on sequelae in patients with chronic stroke: A systematic review and meta-analysis of randomized controlled trials. Front Neurosci 2022; 16:998820. [PMID: 36340781 PMCID: PMC9630949 DOI: 10.3389/fnins.2022.998820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Stroke is the second leading cause of death worldwide, with a large proportion of survivors suffering from motor dysfunction and neuropsychiatric sequelae. Repetitive transcranial magnetic stimulation (rTMS) is a promising stroke rehabilitation intervention and is effective in improving neurological system function in stroke patients. In the current systemic review and meta-analysis, an overview of the most recent studies regarding the effectiveness of rTMS's potential to help chronic stroke patients recover from sequelae was provided. Methods Relevant randomized controlled trials were retrieved from three online databases (Web of Science, Medline, and Embase). A total of 25 RCTs (N = 535 participants) were included. A meta-analysis was performed using a fixed-effects model or a random-effects model, and effect sizes were reported as weighted mean differences or standardized mean differences. Results Administration of rTMS significantly improved upper limb function, hand function, and muscle tone in stroke patients throughout the chronic phase [≥6 months], but not lower limb mobility and strength. In terms of cognitive function, rTMS has a considerable positive impact on patients' cognitive performance. rTMS also alleviated apathy in stroke patients more than post-stroke depressive symptoms regarding mental functioning. Balance and walking function, as well as functional activities of daily living, of patients were dramatically improved by rTMS. However, the current conclusions should be taken carefully due to the small sample size of the meta-analysis. Conclusions This is the first meta-analysis of rTMS treatment in patients with chronic stroke to inform the selection of the optimal treatment strategy for patients with chronic stroke, which demonstrated that rTMS treatment has the potential to improve the effects of sequelae by improving upper limb function, hand function, and muscle tone. Systematic review registration https://inplasy.com/inplasy-2022-7-0095/, identifier: INPLASY202270095.
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Affiliation(s)
- Gengbin Chen
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Postgraduate Research Institute, Guangzhou Sport University, Guangzhou, China
| | - Manfeng Wu
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Tuo Lin
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jiayue Xu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qian Ding
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wanqi Li
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Wu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Hongying Chen
- Department of Rehabilitation Medicine, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, China
- *Correspondence: Yue Lan
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Wei X, Xia N, Li YA, Gu M, Zhang T, Gao W, Liu Y. Immediate and short-term effects of continuous theta burst transcranial magnetic stimulation over contralesional premotor area on post-stroke spasticity in patients with severe hemiplegia: Study protocol for a randomized controlled trial. Front Neurol 2022; 13:895580. [PMID: 36081877 PMCID: PMC9445437 DOI: 10.3389/fneur.2022.895580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Post-stroke spasticity is an important complication that greatly affects survivors' functional prognosis and daily activities. Increasing evidence points to aberrant contralesional neuromodulation compensation after brain injury as a possible culprit for increased spasticity in patients with severe stroke. Hyperactivity of the contralesional premotor area (cPMA) was supposed to be highly correlated with this progression. This study aims to demonstrate the immediate and short-term efficacy of continuous theta-burst stimulation (cTBS) targeting cPMA on upper limb spasticity in severe subacute stroke patients. Methods This trial is a single-center, prospective, three-group randomized controlled trial. Forty-five eligible patients will be recruited and randomized into three groups: the sham-cTBS group (sham cTBS targeting contralesional PMA), the cTBS-cM1 group (cTBS targeting contralesional M1), and the cTBS-cPMA group (cTBS targeting contralesional PMA). All subjects will undergo comprehensive rehabilitation and the corresponding cTBS interventions once a day, five times a week for 4 weeks. Clinical scales, neurophysiological examinations, and neuroimaging will be used as evaluation tools in this study. As the primary outcome, clinical performance on muscle spasticity of elbow/wrist flexor/extensors and upper-limb motor function will be evaluated with the modified Ashworth scale and the Fugl-Meyer Assessment of Upper Extremity Scale, respectively. These scale scores will be collected at baseline, after 4 weeks of treatment, and at follow-up. The secondary outcomes were neurophysiological examinations and Neuroimaging. In neurophysiological examinations, motor evoked potentials, startle reflex, and H reflexes will be used to assess the excitability of the subject's motor cortex, reticulospinal pathway, and spinal motor neurons, respectively. Results of them will be recorded before and after the first cTBS treatment, at post-intervention (at 4 weeks), and at follow-up (at 8 weeks). Neuroimaging tests with diffusion tensor imaging for all participants will be evaluated at baseline and after the 4-week treatment. Discussion Based on the latest research progress on post-stroke spasticity, we innovatively propose a new neuromodulation target for improving post-stroke spasticity via cTBS. We expected that cTBS targeting cPMA would have significant immediate and short-term effects on spasticity and related neural pathways. The effect of cTBS-cPMA may be better than that of cTBS via conventional cM1. The results of our study will provide robust support for the application of cTBS neuromodulation in post-stroke spasticity after a severe stroke. Clinical trial registration This trial was registered with chictr.org.cn on June 13, 2022 (protocol version). http://www.chictr.org.cn/showproj.aspx?proj=171759.
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Affiliation(s)
- Xiupan Wei
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Yang-An Li
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Minghui Gu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Tongming Zhang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
| | - Wei Gao
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Wei Gao
| | - Yali Liu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- World Health Organization Collaborating Centre for Training and Research in Rehabilitation, Wuhan, China
- *Correspondence: Yali Liu
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Interhemispheric Facilitatory Effect of High-Frequency rTMS: Perspective from Intracortical Facilitation and Inhibition. Brain Sci 2022; 12:brainsci12080970. [PMID: 35892411 PMCID: PMC9332419 DOI: 10.3390/brainsci12080970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/04/2023] Open
Abstract
The activity of excitatory and inhibitory neural circuits in the motor cortex can be probed and modified by transcranial magnetic stimulation (TMS) and repetitive TMS (rTMS), noninvasively. At present, not only has a consensus regarding the interhemispheric effect of high frequency rTMS not been reached, but the attributes of these TMS-related circuits are also poorly understood. To address this question comprehensively, we integrated a single- and paired-pulse TMS evaluation with excitatory 20-Hz rTMS intervention in order to probe the interhemispheric effect on the intracortical circuits by high-frequency rTMS. In the rest state, after 20-Hz rTMS, a significant increase of single-pulse MEP and paired-pulse intracortical facilitation (ICF) in the non-stimulated hemisphere was observed with good test–retest reliability. Intracortical inhibition (measured by the cortical silent period) in the unstimulated hemisphere also increased after rTMS. No significant time–course change was observed in the sham-rTMS group. The results provide the evidence that 20-Hz rTMS induced a reliable interhemispheric facilitatory effect. Findings from the present study suggest that the glutamatergic facilitatory system and the GABAergic inhibitory system may vary synchronously.
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Tosatto D, Bonacina D, Signori A, Pellicciari L, Cecchi F, Cornaggia CM, Piscitelli D. Spin of information and inconsistency between abstract and full text in RCTs investigating upper limb rehabilitation after stroke: An overview study. Restor Neurol Neurosci 2022; 40:195-207. [PMID: 35723125 DOI: 10.3233/rnn-211247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Researchers may be tempted to favorably distort the interpretation of their findings when reporting the abstract (i.e., spin). Spin bias overemphasizes the beneficial effects of the intervention compared with the results shown in the full text. OBJECTIVE To assess the occurrence of spin bias and incompleteness in reporting abstracts in post-stroke upper limb (UL) rehabilitation randomized clinical trials (RCTs). METHODS A sample of 120 post-stroke UL rehabilitation RCTs (indexed in PEDro database), published in English between 2012 and 2020, was included. The completeness of reporting and spin were assessed using the Consolidated Standards of Reporting Trials for Abstracts (CONSORT-A) and the spin checklist. The relationship between CONSORT-A and spin checklist scores with RCT and journal characteristics was assessed. RESULTS CONSORT-A and spin checklist scored 5.3±2.4 (max 15-points, higher scores indicating better reporting) and 5.5±2.0 (max 7-points, higher scores indicating presence of spin), respectively; Significant differences were detected between abstract and full-text scores in the CONSORT-A checklist (p < 0.01) and the spin checklist (p < 0.01). Items of the CONSORT-A checklist in the abstracts and full text showed a fair agreement (k = 0.31), while a moderate agreement (k = 0.59) for the spin checklist was detected. Completeness of abstract was associated (R2 = 0.46) with journal Impact Factor (p < 0.01), CONSORT Guideline endorsement (p = 0.04), and abstract word number (p = 0.02). A lower spin was associated with a higher journal Impact Factor (p = 0.01) and CONSORT Guideline endorsement (p = 0.01). CONCLUSIONS Post-stroke UL rehabilitation RCTs abstracts were largely incomplete showing spin. Authors, reviewers, publishers, and stakeholders should be aware of this phenomenon. Publishers should consider allowing more words in abstracts to improve the completeness of reporting abstracts. Although we have investigated only stroke rehabilitation, our results suggest that health care professionals of all disciplines should avoid clinical decision-making based solely upon abstracts.
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Affiliation(s)
- Diego Tosatto
- Istituti Clinici Zucchi - Gruppo San Donato, Carate Brianza (MB), Italy
| | - Daniele Bonacina
- Istituti Clinici Zucchi - Gruppo San Donato, Carate Brianza (MB), Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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11
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Bai Z, Zhang J, Fong KNK. Effects of transcranial magnetic stimulation in modulating cortical excitability in patients with stroke: a systematic review and meta-analysis. J Neuroeng Rehabil 2022; 19:24. [PMID: 35193624 PMCID: PMC8862292 DOI: 10.1186/s12984-022-00999-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background Transcranial magnetic stimulation (TMS) has attracted plenty of attention as it has been proved to be effective in facilitating motor recovery in patients with stroke. The aim of this study was to systematically review the effects of repetitive TMS (rTMS) and theta burst stimulation (TBS) protocols in modulating cortical excitability after stroke. Methods A literature search was carried out using PubMed, Medline, EMBASE, CINAHL, and PEDro, to identify studies that investigated the effects of four rTMS protocols—low and high frequency rTMS, intermittent and continuous TBS, on TMS measures of cortical excitability in stroke. A random-effects model was used for all meta-analyses. Results Sixty-one studies were included in the current review. Low frequency rTMS was effective in decreasing individuals’ resting motor threshold and increasing the motor-evoked potential of the non-stimulated M1 (affected M1), while opposite effects occurred in the stimulated M1 (unaffected M1). High frequency rTMS enhanced the cortical excitability of the affected M1 alone. Intermittent TBS also showed superior effects in rebalancing bilateral excitability through increasing and decreasing excitability within the affected and unaffected M1, respectively. Due to the limited number of studies found, the effects of continuous TBS remained inconclusive. Motor impairment was significantly correlated with various forms of TMS measures. Conclusions Except for continuous TBS, it is evident that these protocols are effective in modulating cortical excitability in stroke. Current evidence does support the effects of inhibitory stimulation in enhancing the cortical excitability of the affected M1. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-00999-4.
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Affiliation(s)
- Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China.,Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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12
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A Meta-Analysis: Whether Repetitive Transcranial Magnetic Stimulation Improves Dysfunction Caused by Stroke with Lower Limb Spasticity. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7219293. [PMID: 34876916 PMCID: PMC8645366 DOI: 10.1155/2021/7219293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
Objective To evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving lower limb spasticity after stroke. Methods The PubMed, Web of Science, Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM) disc, China Science and Technology Journal Database (VIP), and Wanfang databases were searched online from their inception to May 2021 for randomized controlled trials (RCTs) involving repetitive transcranial magnetic stimulation for lower extremity spasticity after stroke. Valid data were extracted from the included literature, and the quality evaluation was conducted with the Cochrane Handbook for Systematic Reviews of Interventions along with the Physiotherapy Evidence Database scale (PE-Dro scale). The data that met the quality requirements were systematically analysed using Review Manager 5.4 software. Results A total of 554 patients from seven articles (nine studies) were quantitatively analysed. Outcomes included the Modified Ashworth Scale (MAS), Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Modified Barthel Index (MBI), and Timed Up and Go (TUG), measured as the effect of rTMS compared with controls conditions after treatment. The systematic review showed that rTMS reduced MAS and increased MBI scores, respectively (SMD = -0.24, 95% CI [-0.45, -0.03], P = 0.02; MD = 6.14, 95% CI [-3.93,8.35], P < 0.00001), compared with control conditions. Low-frequency rTMS (LF-rTMS) significantly improved FMA-LE scores (SMD = 0.32, 95% CI [0.13, 0.51], P = 0.001). However, there was no significant difference in FMA-LE scores when using high-frequency rTMS (HF-rTMS) (P > 0.1) and in TUG times (P > 0.1) between the treatment and control groups. Conclusions rTMS was effective in improving spasticity and activities of daily living. LF-rTMS has positive clinical effects on enhancing motor function in patients who experience lower extremity spasticity after stroke. To better validate the above conclusions, more multicentre, high-quality, and double-blind randomized controlled trials are needed.
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13
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Li D, Cheng A, Zhang Z, Sun Y, Liu Y. Effects of low-frequency repetitive transcranial magnetic stimulation combined with cerebellar continuous theta burst stimulation on spasticity and limb dyskinesia in patients with stroke. BMC Neurol 2021; 21:369. [PMID: 34560841 PMCID: PMC8461848 DOI: 10.1186/s12883-021-02406-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/14/2021] [Indexed: 12/17/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) has been reported to treat muscle spasticity in post-stroke patients. The purpose of this study was to explore whether combined low-frequency rTMS (LF-rTMS) and cerebellar continuous theta burst stimulation (cTBS) could provide better relief than different modalities alone for muscle spasticity and limb dyskinesia in stroke patients. Methods This study recruited ninety stroke patients with hemiplegia, who were divided into LF-rTMS+cTBS group (n=30), LF-rTMS group (n=30) and cTBS group (three pulse bursts at 50 Hz, n=30). The LF-rTMS group received 1 Hz rTMS stimulation of the motor cortical (M1) region on the unaffected side of the brain, the cTBS group received cTBS stimulation to the cerebellar region, and the LF-rTMS+cTBS group received 2 stimuli as described above. Each group received 4 weeks of stimulation followed by rehabilitation. Muscle spasticity, motor function of limb and activity of daily living (ADL) were evaluated by modified Ashworth Scale (MAS), Fugl-Meyer Assessment (FMA) and Modified Barthel Index (MBI) scores, respectively. Results The MAS score was markedly decreased, FMA and MBI scores were markedly increased in the three groups after therapy than before therapy. In addition, after therapy, LF-rTMS+cTBS group showed lower MAS score, higher FMA and MBI scores than the LF-rTMS group and cTBS group. Conclusion Muscle spasticity and limb dyskinesia of the three groups are all significantly improved after therapy. Combined LF-rTMS and cTBS treatment is more effective in improving muscle spasticity and limb dyskinesia of patients after stroke than LF-rTMS and cTBS treatment alone.
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Affiliation(s)
- Dawei Li
- Department of Neurological Rehabilitation, Shengli Oilfield Central Hospital, No. 31, Jinan Road, Dongying, 257000, Shandong, China
| | - Aixia Cheng
- Department of Neurological Rehabilitation, Shengli Oilfield Central Hospital, No. 31, Jinan Road, Dongying, 257000, Shandong, China
| | - Zhiyou Zhang
- Department of Neurological Rehabilitation, Shengli Oilfield Central Hospital, No. 31, Jinan Road, Dongying, 257000, Shandong, China
| | - Yuqian Sun
- Department of Neurological Rehabilitation, Shengli Oilfield Central Hospital, No. 31, Jinan Road, Dongying, 257000, Shandong, China
| | - Yingchun Liu
- Department of Neurological Rehabilitation, Shengli Oilfield Central Hospital, No. 31, Jinan Road, Dongying, 257000, Shandong, China.
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14
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Mendonça T, Brito R, Luna P, Campêlo M, Shirahige L, Fontes L, Dias R, Piscitelli D, Monte-Silva K. Repetitive transcranial magnetic stimulation on the modulation of cortical and spinal cord excitability in individuals with spinal cord injury. Restor Neurol Neurosci 2021; 39:291-301. [PMID: 34334434 DOI: 10.3233/rnn-211167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has been applied for modulating cortical excitability and treating spasticity in neurological lesions. However, it is unclear which rTMS frequency is most effective in modulating cortical and spinal excitability in incomplete spinal cord injury (SCI). OBJECTIVE To evaluate electrophysiological and clinical repercussions of rTMS compared to sham stimulation when applied to the primary motor cortex (M1) in individuals with incomplete SCI. METHODS A total of 11 subjects (35±12 years) underwent three experimental sessions of rTMS (10 Hz, 1 Hz and sham stimulation) in a randomized order at 90%intensity of the resting motor threshold and interspersed by a seven-day interval between sessions. The following outcome measures were evaluated: M1 and spinal cord excitability and spasticity in the moments before (baseline), immediately after (T0), 30 (T30) and 60 (T60) minutes after rTMS. M1 excitability was obtained through the motor evoked potential (MEP); spinal cord excitability by the Hoffman reflex (H-reflex) and homosynaptic depression (HD); and spasticity by the modified Ashworth scale (MAS). RESULTS A significant increase in cortical excitability was observed in subjects submitted to 10 Hz rTMS at the T0 moment when compared to sham stimulation (p = 0.008); this increase was also significant at T0 (p = 0.009), T30 (p = 0.005) and T60 (p = 0.005) moments when compared to the baseline condition. No significant differences were observed after the 10 Hz rTMS on spinal excitability or on spasticity. No inter-group differences were detected, or in the time after application of 1 Hz rTMS, or after sham stimulation for any of the assessed outcomes. CONCLUSIONS High-frequency rTMS applied to M1 was able to promote increased cortical excitability in individuals with incomplete SCI for at least 60 minutes; however, it did not modify spinal excitability or spasticity.
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Affiliation(s)
- Thyciane Mendonça
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil.,NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Plínio Luna
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Mayara Campêlo
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil.,NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Brazil
| | - Luís Fontes
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Rebeca Dias
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, UFPE, Recife -PE -Brazil.,NAPeN Network (Núcleo de Assistência e Pesquisa em Neuromodulação), Brazil
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15
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Miget G, Hentzen C, Turmel N, Chesnel C, Le Breton F, Ismael SS, Kerdraon J, Amarenco G. Assessment of sacral spinal excitability using stimulus-response curves of the bulbocavernosus reflex. Clin Neurophysiol 2021; 132:2123-2129. [PMID: 34284247 DOI: 10.1016/j.clinph.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/25/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze and quantify sacral spinal excitability through bulbocavernosus reflex (BCR) stimulus-response curves. METHODS Thirty subjects with upper motor neuron lesions (UMN) and nine controls were included in this prospective, monocentric study. Sacral spinal excitability was assessed using stimulus-response curves of the BCR, modeled at different bladder filling volumes relative to the desire to void (as defined by the International Continence Society) during a cystometry. Variations in α (i.e. the slope of the stimulus-response curve) were considered as an indicator of the modulation of sacral spinal excitability. RESULTS In all subjects, α increased during bladder filling suggesting the modulation of spinal sacral excitability during the filling phase. This increase was over 30% in 96.7% of neurological subjects and 88.9% of controls. The increase was higher before the first sensation to void in the neurological population (163.15%), compared to controls, (29.91%), p < 0.001. CONCLUSIONS We showed the possibility of using BCR stimulus-response curves to characterize sacral spinal response with an amplification of this response during bladder filling as well as a difference in this response amplification in patients with UMN in comparison with a control group. SIGNIFICANCE BCR, through stimulus-response curves, might be an indicator of pelvic-perineal exaggerated reflex response and possibly a tool for evaluating treatment effectiveness.
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Affiliation(s)
- Gabriel Miget
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - Claire Hentzen
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Nicolas Turmel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Camille Chesnel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Frédérique Le Breton
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Samer Sheikh Ismael
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Jacques Kerdraon
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Department of Neuro-urology, Tenon Hospital, AP-HP, 4, rue de la Chine, 75020 Paris, France
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16
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Aoyama T, Kanazawa A, Kohno Y, Watanabe S, Tomita K, Kaneko F. Influence of Visual Stimulation-Induced Passive Reproduction of Motor Images in the Brain on Motor Paralysis After Stroke. Front Hum Neurosci 2021; 15:674139. [PMID: 34239429 PMCID: PMC8258409 DOI: 10.3389/fnhum.2021.674139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Finger flexor spasticity, which is commonly observed among patients with stroke, disrupts finger extension movement, consequently influencing not only upper limb function in daily life but also the outcomes of upper limb therapeutic exercise. Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as a potential treatment for spasticity in patients with stroke. However, it remains unclear whether KINVIS intervention alone could improve finger flexor spasticity and finger extension movements without other intervention modalities. Therefore, the current study investigated the effects of a single KINVIS session on finger flexor spasticity, including its underlying neurophysiological mechanisms, and finger extension movements. To this end, 14 patients who experienced their first episode of stroke participated in this study. A computer screen placed over the patient's forearm displayed a pre-recorded mirror image video of the patient's non-paretic hand performing flexion-extension movements during KINVIS. The position and size of the artificial hand were adjusted appropriately to create a perception that the artificial hand was the patient's own. Before and after the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range of finger extension movements of the paretic hand were determined. Accordingly, MAS scores and active metacarpophalangeal joint extension range of motion improved significantly after the intervention. Moreover, additional experimentation was performed using F-waves on eight patients whose spasticity was reduced by KINVIS to determine whether the same intervention also decreased spinal excitability. Our results showed no change in F-wave amplitude and persistence after the intervention. These results demonstrate the potential clinical significance of KINVIS as a novel intervention for improving finger flexor spasticity and extension movements, one of the most significant impairments among patients with stroke. The decrease in finger flexor spasticity following KINVIS may be attributed to neurophysiological changes not detectable by the F-wave, such as changes in presynaptic inhibition of Ia afferents. Further studies are certainly needed to determine the long-term effects of KINVIS on finger spasticity, as well as the neurophysiological mechanisms explaining the reduction in spasticity.
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Affiliation(s)
- Toshiyuki Aoyama
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Atsushi Kanazawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yutaka Kohno
- Centre for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Shinya Watanabe
- Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Fuminari Kaneko
- Department of Rehabilitation Medicine, Keio University School of Medicine, Shinjuku-ku, Japan
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17
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Baltar A, Piscitelli D, Marques D, Shirahige L, Monte-Silva K. Baseline Motor Impairment Predicts Transcranial Direct Current Stimulation Combined with Physical Therapy-Induced Improvement in Individuals with Chronic Stroke. Neural Plast 2020; 2020:8859394. [PMID: 33299400 PMCID: PMC7710411 DOI: 10.1155/2020/8859394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/12/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) can enhance the effect of conventional therapies in post-stroke neurorehabilitation. The ability to predict an individual's potential for tDCS-induced recovery may permit rehabilitation providers to make rational decisions about who will be a good candidate for tDCS therapy. We investigated the clinical and biological characteristics which might predict tDCS plus physical therapy effects on upper limb motor recovery in chronic stroke patients. A cohort of 80 chronic stroke individuals underwent ten to fifteen sessions of tDCS plus physical therapy. The sensorimotor function of the upper limb was assessed by means of the upper extremity section of the Fugl-Meyer scale (UE-FM), before and after treatment. A backward stepwise regression was used to assess the effect of age, sex, time since stroke, brain lesion side, and basal level of motor function on UE-FM improvement after treatment. Following the intervention, UE-FM significantly improved (p < 0.05), and the magnitude of the change was clinically important (mean 6.2 points, 95% CI: 5.2-7.4). The baseline level of UE-FM was the only significant predictor (R 2 = 0.90, F (1, 76) = 682.80, p < 0.001) of tDCS response. These findings may help to guide clinical decisions according to the profile of each patient. Future studies should investigate whether stroke severity affects the effectiveness of tDCS combined with physical therapy.
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Affiliation(s)
- Adriana Baltar
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Déborah Marques
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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18
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Repetitive transcranial magnetic stimulation as an alternative therapy for stroke with spasticity: a systematic review and meta-analysis. J Neurol 2020; 268:4013-4022. [PMID: 32654060 DOI: 10.1007/s00415-020-10058-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 10/23/2022]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) and intermittent theta-burst stimulation (iTBS) can be used to manage post-stroke spasticity, but a meta-analysis of the recent randomized-controlled trials (RCTs) is lacking. Our aim is to perform a meta-analysis of the RCTs that investigated the efficacy of rTMS in patients with post-stroke spasticity. PubMed, Embase, and Cochrane Library databases were searched for eligible papers published up to February 2020. The primary outcome was the Modified Ashworth Scale (MAS), measured as the effect of rTMS compared with controls and after rTMS (using a change score calculated separately in the active and sham treatment groups). Finally, five papers and eight data sets were included. rTMS had no significant benefit on MAS in patients with post-stroke spasticity compared to sham treatment (WMD = - 0.29, 95% CI - 0.58, 0.00; P = 0.051). When analyzing the change score in the treatment groups, a significant effect of rTMS was observed (WMD = - 0.27, 95% CI - 0.51, - 0.04; P = 0.024). When analyzing the change score in the sham treatment groups, no significant effect of sham treatment was observed, indicating no placebo effect (WMD = 0.32, 95% CI: - 0.40, 1.04; P = 0.387). We included the sample size, year of publication, percentage of male patients, and age difference in each study as covariates, and performed a meta-regression. The results showed no association between these variables and the MAS. Compared with sham stimulation, rTMS did not show a significant reduction in MAS for the patients who experienced post-stroke spasticity, but the patients reported a better outcome in MAS on a before-after scenario.
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19
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Perin C, Bolis M, Limonta M, Meroni R, Ostasiewicz K, Cornaggia CM, Alouche SR, da Silva Matuti G, Cerri CG, Piscitelli D. Differences in Rehabilitation Needs after Stroke: A Similarity Analysis on the ICF Core Set for Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124291. [PMID: 32560129 PMCID: PMC7345505 DOI: 10.3390/ijerph17124291] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/16/2022]
Abstract
Background: Successful rehabilitation is associated with physical, psychological, environmental, social, and personal factors based on the International Classification of Functioning, Disability and Health (ICF) framework. The influence of age has been suggested as crucial personal factors that may affect rehabilitation needs in post-stroke survivors. The aim of this study was to investigate the qualifiers of the ICF core set for stroke to detect differences in rehabilitation needs and goals between older (O, >65 years old) and younger (Y, ≤65 years old,) post-stroke individuals. Materials and methods: In this observational study, the comprehensive core set for stroke was filled during the rehabilitation period. Patient information was obtained using disability scales was translated into certain ICF categories using linking rules. Frequency, similarity, and linear regression analyses were performed for ICF qualifier profiles among Y and O patients. Results: Forty-eight ICF variables were significantly different between Y (n = 35, 46.17 ± 11.27 years old) and O (n = 35, 76.43 ± 6.77 years old) patients. Frequency analysis showed that activity of daily living and basic needs were more prevalent in O patients, whereas regaining of social role and social life were more prevalent in Y patients. The average Jaccard Index result (similarity analysis) was more homogeneous in O than in Y patients. Conclusions: ICF qualifiers are useful to design patient-centered care. Y patients have more heterogeneous needs and require more personalized program than O patients.
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Affiliation(s)
- Cecilia Perin
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
- Correspondence: ; Tel.: +39-03-6298-6446; Fax: +39-03-6298-6439
| | - Marta Bolis
- Casa di cura Beato Palazzolo, 24122 Bergamo, Italy;
| | - Marco Limonta
- Istituti Clinici Zucchi, 20841 Carate Brianza, Italy;
| | - Roberto Meroni
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, Differdange, 4671 Differdange, Luxembourg;
| | | | - Cesare Maria Cornaggia
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
| | - Sandra Regina Alouche
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil;
| | - Gabriela da Silva Matuti
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo 03071-000, Brazil;
- Associação de Assistência à Criança Deficiente (AACD), 04027-000 São Paulo, Brazil;
| | - Cesare Giuseppe Cerri
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, 20126 Milano, Italy; (C.M.C.); (C.G.C.); (D.P.)
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada
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20
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Piscitelli D. Neurorehabilitation: bridging neurophysiology and clinical practice. Neurol Sci 2019; 40:2209-2211. [PMID: 31190252 DOI: 10.1007/s10072-019-03969-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 06/05/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Daniele Piscitelli
- School of Physical & Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada. .,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, QC, Canada.
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