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Mathieu E, Gasq D, Crémoux S, Delcamp C, Cormier C, Pudlo P, Amarantini D. Upper limb motor dysfunction is associated with fragmented kinetics after brain injury. Clin Biomech (Bristol, Avon) 2024; 114:106221. [PMID: 38471423 DOI: 10.1016/j.clinbiomech.2024.106221] [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: 09/12/2023] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Characterization of motor deficits after brain injury is important for rehabilitation personalization. While studies reported abnormalities in the kinematics of paretic and non-paretic elbow extension for patients with brain injuries, kinematic analysis is not sufficient to explore how patients deal with musculoskeletal redundancy and the energetic aspect of movement execution. Conversely, interarticular coordination and movement kinetics can reflect patients' motor strategies. This study investigates motor strategies of paretic and non-paretic upper limb after brain injury to highlight motor deficits or compensation strategies. METHODS 26 brain-injured hemiplegic patients and 24 healthy controls performed active elbow extensions in the horizontal plane, with both upper limbs for patients and, with the dominant upper limb for controls. Elbow and shoulder kinematics, interarticular coordination, net joint kinetics were quantified. FINDINGS Results show alterations in kinematics, and a strong correlation between elbow and shoulder angles, as well as time to reach elbow and shoulder peak angular velocity in both upper limbs of patients. Net joint kinetics were lower for paretic limb and highlighted a fragmented motor strategy with increased number of transitions between concentric and eccentric phases. INTERPRETATION In complement to kinematic results, our kinetic results confirmed patients' difficulties to manage both spatially and temporally the joint degrees of freedom redundancy but revealed a fragmented compensatory motor strategy allowing patients upper limb extension despite quality alteration and decrease in energy efficiency. Motor rehabilitation should improve the management of this fragmentation strategy to improve the performance and the efficiency of active movement after brain injury.
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Affiliation(s)
- Emilie Mathieu
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
| | - David Gasq
- ToNIC, Université de Toulouse, Inserm, UT3, Toulouse, France; Department of Functional Physiological Explorations, Motion Analysis Center, University Hospital of Toulouse, Hôpital de Purpan, Toulouse, France
| | - Sylvain Crémoux
- Centre de Recherche Cerveau et Cognition, UMR 5549, CNRS, Université Paul Sabatier, Toulouse 3, 31052 Toulouse, France
| | - Célia Delcamp
- Department of Neurology, University of California, Los Angeles, United State of America
| | - Camille Cormier
- ToNIC, Université de Toulouse, Inserm, UT3, Toulouse, France; Department of Functional Physiological Explorations, Motion Analysis Center, University Hospital of Toulouse, Hôpital de Purpan, Toulouse, France
| | - Philippe Pudlo
- Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France
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Borges H, de Freitas S, Liebano R, Alouche S. Hemiplegic shoulder pain affects ipsilesional aiming movements after stroke: a cross-sectional study. Physiother Theory Pract 2024; 40:241-252. [PMID: 36062585 DOI: 10.1080/09593985.2022.2118004] [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] [Received: 03/28/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Hemiplegic shoulder pain (HSP) is common after stroke. The pain perception may exacerbate changes in the motor behavior of the ipsi-lesional upper limb, contributing to the functional decline of an individual's motor performance. OBJECTIVE This study evaluates the influence of pain perception on the aiming movements performed with the ipsilesional upper limb in individuals with unilateral chronic stroke. METHODS A cross-sectional study was conducted with 41 participants divided into three groups: 1) stroke with contralesional shoulder pain ≥ 3 by the Visual Numerical Pain Scale (SPSG; n = 13); 2) stroke no shoulder pain (nSPSG; n = 14); and 3) healthy control (CTG; n = 14) matched by sex and age. Individuals with stroke were matched for the severity of sensorimotor impairment by the Fugl-Meyer upper limb subscale and the injured hemisphere side. Stroke groups performed aiming movements with the ipsilesional upper limb and the CTG with the corresponding limb using a pen tip on the sensitive surface of a digitizing tablet. Performance across groups was compared by one-way analysis of variance, considering the time since injury as a covariate. The planning and execution variables of the movement trajectory were analyzed, and the significance was set at 5%. RESULTS Trajectories of the SPSG were slower (p = .010; η2 = 0.22), were less smooth (p = .002; η2 = 0.30), had more directional error (p = .002; η2 = 0.28), and were less accurate (p = .034; η2 = 0.17) than the CTG. The nSPSG and CTG showed similar performance. CONCLUSIONS The perception of pain impairs aiming movements performed with the ipsilesional upper limb in individuals with unilateral chronic stroke.
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Affiliation(s)
- Heloise Borges
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physiotherapy, Centro Universitário Nossa Senhora do Patrocínio, Itú, Brazil
| | - Sandra de Freitas
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Richard Liebano
- Physiotherapeutic Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (Ufscar), São Carlos/SP, Brazil
| | - Sandra Alouche
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Petruseviciene L, Sack AT, Kubilius R, Savickas R. High-Frequency Ipsilesional versus Low-Frequency Contralesional Transcranial Magnetic Stimulation after Stroke: Differential Effects on Ipsilesional Upper Extremity Motor Recovery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1955. [PMID: 38004004 PMCID: PMC10672822 DOI: 10.3390/medicina59111955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Stroke is a major cause of death and disability worldwide; therefore, transcranial magnetic stimulation (TMS) is being widely studied and clinically applied to improve motor deficits in the affected arm. However, recent studies indicate that the function of both arms can be affected after stroke. It currently remains unknown how various TMS methods affect the function of the ipsilesional upper extremity. Materials and Methods: Thirty-five subacute stroke patients with upper extremity motor deficits were enrolled in this study and randomly allocated into three groups, receiving either (1) low-frequency rTMS over the contralesional hemisphere; (2) high-frequency rTMS over the ipsilesional hemisphere; or (3) no stimulation. Experimental groups received 10 rTMS sessions over two weeks alongside standard rehabilitation, and the control group received the same procedures except for rTMS. Both affected and unaffected upper extremity motor function was evaluated using hand grip strength and Functional Independence Measure (FIM) tests before and after rehabilitation (7 weeks apart). Results: All groups showed significant improvement in both the affected and unaffected hand grip and FIM scores (p < 0.05). HF-rTMS led to a notably higher increase in unaffected hand grip strength than the control group (p = 0.007). There was no difference in the improvement in affected upper extremity motor function between the groups. The FIM score increase was lower in the control group compared to experimental groups, although not statistically significant. Conclusions: This study demonstrates the positive effect of ipsilesional HF-rTMS on the improvement in unaffected arm motor function and reveals the positive effect of both LF- and HF-rTMS on the affected upper extremity motor function recovery.
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Affiliation(s)
- Laura Petruseviciene
- Department of Rehabilitation, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (R.K.); (R.S.)
- Department of Physical Medicine and Rehabilitation, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania
| | - Alexander T. Sack
- Faculty of Psychology and Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Raimondas Kubilius
- Department of Rehabilitation, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (R.K.); (R.S.)
- Department of Physical Medicine and Rehabilitation, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania
| | - Raimondas Savickas
- Department of Rehabilitation, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (R.K.); (R.S.)
- Department of Physical Medicine and Rehabilitation, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, 50161 Kaunas, Lithuania
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de Andrade FPPV, de Freitas SMSF, Giangiardi VF, Banjai RM, Alouche SR. Aiming Movement After Stroke: Do Time-Since-Injury and Impairment Severity Influence Ipsilateral Performance? Percept Mot Skills 2023; 130:2069-2086. [PMID: 37442542 DOI: 10.1177/00315125231189339] [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: 07/15/2023]
Abstract
In this cross-sectional study, we evaluated post-stroke ipsilesional (less affected) upper limb aiming movement in individuals whose strokes were either 2-5 months (n = 16) or >6 months (n = 17) prior to our testing; we also compared both stroke groups to a control group of healthy individuals (n = 14). We evaluated the participants' level of movement impairment in the contralateral upper limb from the site of the cerebrovascular lesion as an indicator of the severity of the participants' impairment. Participants were asked to move a stylus on a tablet with their ipsilesional upper limb according to a visual stimulus seen on a monitor. Those who had experienced more recent strokes showed poorer movement planning and execution, regardless of their impairment level. Since the stroke occurred, the amount of time was significantly associated with the ipsilesional aiming movement, and improvement over time brought performance levels closer to that of healthy controls.
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Affiliation(s)
- Flávia Priscila Paiva Vianna de Andrade
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physical Therapy, Universidade do Vale do Sapucaí, Pouso Alegre, Brazil
| | | | - Vivian Farahte Giangiardi
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physical Therapy, Universidade de Ribeirão Preto, Guarujá, Brazil
| | - Renata Morales Banjai
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- School of Physical Therapy, Universidade de Ribeirão Preto, Guarujá, Brazil
- School of Physical Therapy, Universidade Santa Cecília, Santos, Brazil
| | - Sandra Regina Alouche
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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de Oliveira DSV, Alouche SR, de Freitas SMSF, Oba GH, Giangiardi VF, de Sá CDSC. Planning and Executing Aiming Movements in Middle Childhood. Percept Mot Skills 2022; 129:1362-1380. [PMID: 35790415 DOI: 10.1177/00315125221112243] [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: 11/16/2022]
Abstract
Harmonious voluntary movements require efficiency in their planning and execution. Throughout middle childhood structural changes in the central nervous and musculoskeletal systems influence these processes and resultant motor behavior. In this study, we evaluated the characteristics of the motor planning and executing of aiming movements directed at targets located in different positions in space in children aged 7, 9, and 11 years. We divided 43 right-handed children, into three age groups and instructed them to perform aiming movements directed at targets using a stylus on a digital tablet. The children performed the movement with their dominant upper limbs from a starting point towards targets positioned ipsilaterally or contralaterally to this dominant limb. We analyzed temporal and spatial variables of motor performance. Younger (7-year-old) children made more errors in the initial movement direction and more frequently corrected their movements during task execution when compared to 9- and 11-year-old children who did not differ from each other. All age groups were similar in movement accuracy and precision. Movements toward contralateral targets were slower and more accurate than movements toward ipsilateral targets for all groups. These results show that performing aiming movements develop with the onset of middle childhood.
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Affiliation(s)
- Danielle S V de Oliveira
- Departamento de Ciências do Movimento Humano, 28105Universidade Federal de São Paulo, Santos, Brasil
| | - Sandra R Alouche
- Departamento de Fisioterapia, 149944Universidade Cidade de São Paulo, São Paulo, Brasil
| | | | - Gabriela H Oba
- Departamento de Fisioterapia, 149944Universidade Cidade de São Paulo, São Paulo, Brasil
| | - Vivian F Giangiardi
- Departamento de Fisioterapia, 149944Universidade Cidade de São Paulo, São Paulo, Brasil
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Chilvers MJ, Hawe RL, Scott SH, Dukelow SP. Investigating the neuroanatomy underlying proprioception using a stroke model. J Neurol Sci 2021; 430:120029. [PMID: 34695704 DOI: 10.1016/j.jns.2021.120029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
Neuroanatomical investigations have associated cortical areas, beyond Primary Somatosensory Cortex (S1), with impaired proprioception. Cortical regions have included temporoparietal (TP) regions (supramarginal gyrus, superior temporal gyrus, Heschl's gyrus) and insula. Previous approaches have struggled to account for concurrent damage across multiple brain regions. Here, we used a targeted lesion analysis approach to examine the impact of specific combinations of cortical and sub-cortical lesions and quantified the prevalence of proprioceptive impairments when different regions are damaged or spared. Seventy-seven individuals with stroke (49 male; 28 female) were identified meeting prespecified lesion criteria based on MRI/CT imaging: 1) TP lesions without S1, 2) TP lesions with S1, 3) isolated S1 lesions, 4) isolated insula lesions, and 5) lesions not impacting these regions (other regions group). Initially, participants meeting these criteria (1-4) were grouped together into right or left lesion groups and compared to each other, and the other regions group (5), on a robotic Arm Position Matching (APM) task and a Kinesthesia (KIN) task. We then examined the behaviour of individuals that met each specific criteria (groups 1-5). Proprioceptive impairments were more prevalent following right hemisphere lesions than left hemisphere lesions. The extent of damage to TP regions correlated with performance on both robotic tasks. Even without concurrent S1 lesions, TP and insular lesions were associated with impairments on the APM and KIN tasks. Finally, lesions not impacting these regions were much less likely to result in impairments. This study highlights the critical importance of TP and insular regions for accurate proprioception. SIGNIFICANCE STATEMENT: This work advances our understanding of the neuroanatomy of human proprioception. We validate the importance of regions, beyond the dorsal column medial lemniscal pathway and S1, for proprioception. Further, we provide additional evidence of the importance of the right hemisphere for human proprioception. Improved knowledge on the neuroanatomy of proprioception is crucial for advancing therapeutic approaches which target individuals with proprioceptive impairments following neurological injury or with neurological disorders.
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Affiliation(s)
- Matthew J Chilvers
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
| | - Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; School of Kinesiology, University of Minnesota, 1900 University Ave SE, Minneapolis, MN 55455, United States
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queens University, Kingston, ON K7L 3N6, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Unilateral traumatic brain injury of the left and right hemisphere produces the left hindlimb response in rats. Exp Brain Res 2021; 239:2221-2232. [PMID: 34021800 PMCID: PMC8282563 DOI: 10.1007/s00221-021-06118-4] [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: 02/09/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Traumatic brain injury and stroke result in hemiplegia, hemiparesis, and asymmetry in posture. The effects are mostly contralateral; however, ipsilesional deficits may also develop. We here examined whether ablation brain injury and controlled cortical impact (CCI), a rat model of clinical focal traumatic brain injury, both centered over the left or right sensorimotor cortex, induced hindlimb postural asymmetry (HL-PA) with contralesional or ipsilesional limb flexion. The contralesional hindlimb was flexed after left or right side ablation injury. In contrast, both the left and right CCI unexpectedly produced HL-PA with flexion on left side. The flexion persisted after complete spinal cord transection suggesting that CCI triggered neuroplastic processes in lumbar neural circuits enabling asymmetric muscle contraction. Left limb flexion was exhibited under pentobarbital anesthesia. However, under ketamine anesthesia, the body of the left and right CCI rats bent laterally in the coronal plane to the ipsilesional side suggesting that the left and right injury engaged mirror-symmetrical motor pathways. Thus, the effects of the left and right CCI on HL-PA were not mirror-symmetrical in contrast to those of the ablation brain injury, and to the left and right CCI produced body bending. Ipsilateral effects of the left CCI on HL-PA may be mediated by a lateralized motor pathway that is not affected by the left ablation injury. Alternatively, the left-side-specific neurohormonal mechanism that signals from injured brain to spinal cord may be activated by both the left and right CCI but not by ablation injury.
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Varghese R, Winstein CJ. Relationship Between Motor Capacity of the Contralesional and Ipsilesional Hand Depends on the Side of Stroke in Chronic Stroke Survivors With Mild-to-Moderate Impairment. Front Neurol 2020; 10:1340. [PMID: 31998211 PMCID: PMC6961702 DOI: 10.3389/fneur.2019.01340] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/04/2019] [Indexed: 01/13/2023] Open
Abstract
There is growing evidence that after a stroke, sensorimotor deficits in the ipsilesional hand are related to the degree of impairment in the contralesional upper extremity. Here, we asked if the relationship between the motor capacities of the two hands differs based on the side of stroke. Forty-two pre-morbidly right-handed chronic stroke survivors (left hemisphere damage, LHD = 21) with mild-to-moderate paresis performed distal items of the Wolf Motor Function Test (dWMFT). We found that compared to RHD, the relationship between contralesional arm impairment (Upper Extremity Fugl-Meyer, UEFM) and ipsilesional hand motor capacity was stronger (R L H D 2 = 0.42;R R H D 2 < 0.01; z = 2.12; p = 0.03) and the slope was steeper (t = -2.03; p = 0.04) in LHD. Similarly, the relationship between contralesional dWMFT and ipsilesional hand motor capacity was stronger (R L H D 2 = 0.65;R R H D 2 = 0.09; z = 2.45; p = 0.01) and the slope was steeper (t = 2.03; p = 0.04) in LHD compared to RHD. Multiple regression analysis confirmed the presence of an interaction between contralesional UEFM and side of stroke (β3 = 0.66 ± 0.30; p = 0.024) and between contralesional dWMFT and side of stroke (β3 = -0.51 ± 0.34; p = 0.05). Our findings suggest that the relationship between contra- and ipsi-lesional motor capacity depends on the side of stroke in chronic stroke survivors with mild-to-moderate impairment. When contralesional impairment is more severe, the ipsilesional hand is proportionally slower in those with LHD compared to those with RHD.
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Affiliation(s)
- Rini Varghese
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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