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Lu Z, Zhang Y, Li S, Zhou P. Botulinum toxin treatment may improve myoelectric pattern recognition in robot-assisted stroke rehabilitation. Front Neurosci 2024; 18:1364214. [PMID: 38486973 PMCID: PMC10937383 DOI: 10.3389/fnins.2024.1364214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Yingchun Zhang
- Department of Biomedical Engineering, Desai Sethi Urology Institute, Miami Project to Cure Paralysis, University of Miami, Coral Gables, FL, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, China
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Liu J, He J, Zhang C. Clinical Significance and Value of Serum Homocysteine and Urine 11 Dehydrothromboxane B2 Combined with Transferrin-Specific Peptide in the Diagnosis of Cerebral Apoplexy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:6130413. [PMID: 35620205 PMCID: PMC9129925 DOI: 10.1155/2022/6130413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
Objective To explore the clinical significance and value of serum homocysteine (Hcy) and urine 11 dehydrothromboxane B2 (urine 11-DH-TXB2) combined with transferrin-specific peptide (TF-UP) in the diagnosis of stroke. Methods One hundred stroke patients treated from January 2019 to June 2021 were enrolled in our hospital as the study group. All the patients in the study group met the diagnostic criteria of stroke. The focus of stroke was confirmed by CT or MRI, and the first onset was less than 48 hours. One hundred healthy persons who went through physical examination in our hospital were enrolled as the control group. The comparison was taken to explore the clinical significance and value of Hcy and urine 11-DH-TXB2 combined with TF-UP in the diagnosis of stroke. Results There exhibited no significant difference in the history of smoking, drinking, and atrial fibrillation (P > 0.05). There were significant differences in systolic blood pressure, diastolic blood pressure, eGFR, history of hypertension, diabetes, and coronary heart disease (P < 0.05). In terms of the levels of Hcy, urine 11-DH-TXB2, and TF-UP, the levels of Hcy and urine 11-DH-TXB2 in the study group were higher compared to the control group, while the level of TF-UP in the study group was lower compared to the control group (P < 0.05). The results of logistic regression analysis indicated that there was a significant correlation between Hcy, urine 11-DH-TXB2, TF-UP, and stroke, and Hcy and urine 11-DH-TXB2 indicated positive correlation with stroke disease, while TF-UP level was negatively correlated with stroke disease (P < 0.05). The levels of Hcy, urine 11-DH-TXB2, and TF-UP were adopted as evaluation indexes to draw ROC curve. The results show that the area under the curve (AUC) of Hcy is 0.760 (95% CI 0.670~0.850). The best critical point was 3342.5 pg/mg Ucr, the sensitivity was 65.6%, and the specificity was 77.1%. The AUC of urine 11-DH-TXB2 was 0.773 (95% CI 0.685~0.861). The best critical point was 3354.44 pg/mg Ucr, the sensitivity was 71.2%, and the specificity was 78.3%. The AUC of TF-UP was 0.735 (95% CI 0.641~0.829). The best critical point was 3365.43 pg/mg Ucr, the sensitivity was 68.4%, and the specificity was 80.5%. If Hcy was detected in combination with other indexes, AUC increased to 0.749 when combined with urine 11-DH-TXB2, and AUC increased to 0.797 when combined with TF-UP. When the three are combined, the AUC can reach 0.836, the sensitivity is 79.1%, and the specificity is 80%. It shows that the combined detection of Hcy, urine 11-DH-TXB2, and TF-UP is of higher diagnostic value. The difference of data exhibited statistically significant (P < 0.05). Conclusion There is imbalance between Hcy, urine 11-DH-TXB2, and TF-UP in patients with acute stroke. High Hcy, urine 11-DH-TXB2, and low TF-UP are closely related to the occurrence of cerebral infarction. Hcy, urine 11-DH-TXB2, and TF-UP may be the risk factors of stroke and positively correlated with the degree of neurological impairment. Effective monitoring of Hcy and urine 11-DH-TXB2 combined with TF-UP levels and positive intervention measures may effectively prevent the occurrence and development of cerebral infarction, reduce Hcy and urine 11-DH-TXB2, or increase the level of TF-UP, which may provide new ideas for the treatment of cerebrovascular diseases.
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Affiliation(s)
- Junli Liu
- Laboratory Department, Union Jiangbei Hospital, 430100, China
| | - Juan He
- Laboratory Department, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430079, China
| | - Chang Zhang
- Hubei No. 3 People's Hospital of Jianghan University, Clinical Laboratory, 430033, China
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Lannin NA, Ada L, English C, Ratcliffe J, Faux S, Palit M, Gonzalez S, Olver J, Schneider E, Crotty M, Cameron ID. Long-term effect of additional rehabilitation following botulinum toxin-A on upper limb activity in chronic stroke: the InTENSE randomised trial. BMC Neurol 2022; 22:154. [PMID: 35468766 PMCID: PMC9036685 DOI: 10.1186/s12883-022-02672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is common for people with persistent spasticity due to a stroke to receive an injection of botulinum toxin-A in the upper limb, however post-injection intervention varies. AIM To determine the long-term effect of additional upper limb rehabilitation following botulinum toxin-A in chronic stroke. METHOD An analysis of long-term outcomes from national, multicenter, Phase III randomised trial with concealed allocation, blinded measurement and intention-to-treat analysis was carried out. Participants were 140 stroke survivors who were scheduled to receive botulinum toxin-A in any muscle(s) that cross the wrist because of moderate to severe spasticity after a stroke greater than 3 months ago, who had completed formal rehabilitation and had no significant cognitive impairment. Experimental group received botulinum toxin-A plus 3 months of evidence-based movement training while the control group received botulinum toxin-A plus a handout of exercises. Primary outcomes were goal attainment (Goal Attainment Scale) and upper limb activity (Box and Block Test) at 12 months (ie, 9 months beyond the intervention). Secondary outcomes were spasticity, range of motion, strength, pain, burden of care, and health-related quality of life. RESULTS By 12 months, the experimental group scored the same as the control group on the Goal Attainment Scale (MD 0 T-score, 95% CI -5 to 5) and on the Box and Block Test (MD 0.01 blocks/s, 95% CI -0.01 to 0.03). There were no differences between groups on any secondary outcome. CONCLUSION Additional intensive upper limb rehabilitation following botulinum toxin-A in chronic stroke survivors with a disabled upper limb is not more effective in the long-term. TRIAL REGISTRATION ACTRN12615000616572 (12/06/2015).
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Affiliation(s)
- Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia. .,Alfred Health, Melbourne, Australia. .,School of Allied Health (Occupational Therapy), La Trobe University, Melbourne, Australia.
| | - Louise Ada
- The University of Sydney, Sydney, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Steven Faux
- Sacred Heart Rehabilitation Unit, St Vincent's Hospital, Sydney, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - John Olver
- Epworth Monash Rehabilitation Medicine Research Unit, Monash University, Melbourne, Australia
| | - Emma Schneider
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
| | - Maria Crotty
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Rehabilitation and Aged Care, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, Sydney, Australia
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Rezende AR, Marques IA, Alves CM, Morais Shinosaki JS, Martins Naves EL. Effect of botulinum toxin on spasticity level assessed by tonic stretch reflex threshold: a feasibility pilot study. Ing Rech Biomed 2022. [DOI: 10.1016/j.irbm.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Predictors of Clinically Important Improvements in Motor Function and Daily Use of Affected Arm after a Botulinum Toxin A Injection in Patients with Chronic Stroke. Toxins (Basel) 2021; 14:toxins14010013. [PMID: 35050990 PMCID: PMC8778339 DOI: 10.3390/toxins14010013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Identifying patients who can gain minimal clinically important difference (MCID) in active motor function in the affected upper extremity (UE) after a botulinum toxin A (BoNT-A) injection for post-stroke spasticity is important. Eighty-eight participants received a BoNT-A injection in the affected UE. Two outcome measures, Fugl–Meyer Assessment Upper Extremity (FMA-UE) and Motor Activity Log (MAL), were assessed at pre-injection and after 24 rehabilitation sessions. We defined favorable response as an FMA-UE change score ≥5 or MAL change score ≥0.5.Statistical analysis revealed that the time since stroke less than 36 months (odds ratio (OR) = 4.902 (1.219–13.732); p = 0.023) was a significant predictor of gaining MCID in the FMA-UE. Medical Research Council scale -proximal UE (OR = 1.930 (1.004–3.710); p = 0.049) and post-injection duration (OR = 1.039 (1.006–1.074); p =0.021) were two significant predictors of MAL amount of use. The time since stroke less than 36 months (OR = 3.759 (1.149–12.292); p = 0.028), naivety to BoNT-A (OR = 3.322 (1.091–10.118); p = 0.035), and education years (OR = 1.282 (1.050–1.565); p = 0.015) were significant predictors of MAL quality of movement. The findings of our study can help optimize BoNT-A treatment planning.
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Olszewska Z, Mirek E, Opoka-Kubica K, Szymon Pasiut SP, Filip M. Evaluating the Effects of Botulinum Toxin Injection and Physiotherapy on Post-Stroke Patients During One Year Observation - a Pilot Study. REHABILITACJA MEDYCZNA 2021. [DOI: 10.5604/01.3001.0015.5409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Stroke is a serious health problem in the modern population. Spasticity is one of the consequences of stroke and affects about 30% of people. Increased muscle tone affects postural control disorders. Due to the specificity of spasticity, therapy in post-stroke patients is a challenge for neurological physiotherapy. Therefore, it requires the development of appropriate management standards .
Study aim: The aim of the study was to evaluate the effectiveness of 3 combination therapy cycles based on botulinum toxin injection and physiotherapy for muscle tone, muscle strength and postural stability in post-stroke patients qualified for the spasticity treatment programme of the lower and upper limbs.
Material and methods: The pilot study involved 12 patients (6 from the lower limb and 6 from the upper limb programme). The 1-year combination therapy programmes included 3 botulinum toxin injections and 3 weeks of physiotherapy after each injection. Clinical evaluation was conducted before and after the 1-year observation cycle. The results were evaluated using: MAS (Modified Ashworth Scale), MRC (Medical Research Council Scale) and posture stability test on a balance platform (BiodexSD).
Results: A decrease was observed in muscle tone of the lower and upper limbs, as well as an increase in muscular strength of the upper limb. However, there were no noted statistical significance of the studied parameters.
Conclusions: Physiotherapy in combination with the botulinum toxin is an important element of improvement in post-stroke patients. However, further research is needed to explicitly confirm its effectiveness.
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Affiliation(s)
- Zuzanna Olszewska
- The Bogusław Frańczuk Orthopaedic and Rehabilitation Hospital in Kraków, Poland / Małopolski Szpital Ortopedyczno-Rehabilitacyjny im. Prof. Bogusława Frańczuka w Krakowie
| | - Elżbieta Mirek
- Department of Clinical Rehabilitation, Section of Rehabilitation in Neurology and Psychiatry, University of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Neurologii i Psychiatrii, Wydział Rehabilitacji Ruchowej, Akademia AWF w Krakowie
| | - Kinga Opoka-Kubica
- Doctoral studies (Ph.D), Department of Physical Education, University of Physical Education in Kraków, Poland / Studia doktoranckie, AWF w Krakowie
| | - Szymon Pasiut Szymon Pasiut
- Department of Clinical Rehabilitation, Section of Rehabilitation in Neurology and Psychiatry, University of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Neurologii i Psychiatrii, Wydział Rehabilitacji Ruchowej, Akademia AWF w Krakowie
| | - Magdalena Filip
- Department of Clinical Rehabilitation, Section of Rehabilitation in Neurology and Psychiatry, University of Physical Education in Kraków, Poland / Zakład Rehabilitacji w Neurologii i Psychiatrii, Wydział Rehabilitacji Ruchowej, Akademia AWF w Krakowie
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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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Li S, Francisco GE, Rymer WZ. A New Definition of Poststroke Spasticity and the Interference of Spasticity With Motor Recovery From Acute to Chronic Stages. Neurorehabil Neural Repair 2021; 35:601-610. [PMID: 33978513 DOI: 10.1177/15459683211011214] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The relationship of poststroke spasticity and motor recovery can be confusing. "True" motor recovery refers to return of motor behaviors to prestroke state with the same end-effectors and temporo-spatial pattern. This requires neural recovery and repair, and presumably occurs mainly in the acute and subacute stages. However, according to the International Classification of Functioning, Disability and Health, motor recovery after stroke is also defined as "improvement in performance of functional tasks," i.e., functional recovery, which is mainly mediated by compensatory mechanisms. Therefore, stroke survivors can execute motor tasks in spite of disordered motor control and the presence of spasticity. Spasticity interferes with execution of normal motor behaviors ("true" motor recovery), throughout the evolution of stroke from acute to chronic stages. Spasticity reduction does not affect functional recovery in the acute and subacute stages; however, appropriate management of spasticity could lead to improvement of motor function, that is, functional recovery, during the chronic stage of stroke. We assert that spasticity results from upregulation of medial cortico-reticulo-spinal pathways that are disinhibited due to damage of the motor cortex or corticobulbar pathways. Spasticity emerges as a manifestation of maladaptive plasticity in the early stages of recovery and can persist into the chronic stage. It coexists and shares similar pathophysiological processes with related motor impairments, such as abnormal force control, muscle coactivation and motor synergies, and diffuse interlimb muscle activation. Accordingly, we propose a new definition of spasticity to better account for its pathophysiology and the complex nuances of different definitions of motor recovery.
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Affiliation(s)
- Sheng Li
- University of Texas Health Science Center-Houston, TX, USA.,TIRR Memorial Hermann, Houston, TX, USA
| | - Gerard E Francisco
- University of Texas Health Science Center-Houston, TX, USA.,TIRR Memorial Hermann, Houston, TX, USA.,World Federation of NeuroRehabilitation, North Shields, UK
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Displacement Analysis and Design of a (2–RRU)–URR Parallel Mechanism Performing 2R1T Output Motion for Thumb Rehabilitation. ROBOTICS 2020. [DOI: 10.3390/robotics9030067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The thumb assists other fingers, and any damage in its functionality prevents the human hand from performing dexterous functions. In this paper, the kinematic design of the (2–RRU)–URR parallel mechanism as the application of the thumb rehabilitation device is proposed. This mechanism is an over-constrained mechanism capable of achieving the required mobility with fewer joints. Three degrees of freedom exist—two rotational and one translational mobility—that are related to each thumb movement: adduction–abduction and flexion–extension. Considering the narrow space of the hand, actuators are designed to divide its placement into the surface of the palm. To avoid the collisions between the device and the hand, an offset was adopted. The displacement analysis problem is solved by dividing it into two parts: the planar motion generator (PMG) and orientation generator (OG), according to each functional motion, and the corresponding equations and procedures are presented. To clarify the basic characteristics of this mechanism, the reachable workspace of the PMG and rotational ability and sensitivity of the OG is demonstrated numerically. Because a large input torque difference is dangerous in the rehabilitation mechanism, the effective workspace is determined according to the magnitude of the input torque differences and compared with the measured thumb movements.
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