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Thomas B, Pattinson R, Bundy C, Davies JL. Somatosensory processing in long COVID fatigue and its relations with physiological and psychological factors. Exp Physiol 2024. [PMID: 39106091 DOI: 10.1113/ep091988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
Fatigue is prevalent amongst people with long COVID, but is poorly understood. The sensory attenuation framework proposes that impairments in sensory processing lead to heightened perception of effort, driving fatigue. This study aims to investigate the role of somatosensory processing impairments in long COVID fatigue and quantify how sensory processing relates to other prominent symptoms of long COVID including autonomic dysfunction, mood and illness beliefs in driving the experience of fatigue. We will recruit 44 individuals with long COVID fatigue and 44 individuals with neither long COVID nor fatigue (controls). Our primary objective is to compare baseline somatosensory processing between individuals with long COVID fatigue and controls. Additionally, we will explore the associations between somatosensory processing, fatigability and the level of fatigue induced by cognitive and physical exertion. Due to the complex nature of fatigue, we will also investigate how long COVID, state fatigue, perceived effort, mood, illness beliefs, autonomic symptoms and autonomic nervous system function interact to predict trait fatigue. This comprehensive investigation aims to elucidate how sensory processing and other prominent symptoms interact to impact the experience of fatigue.
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Affiliation(s)
- Bethan Thomas
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Christine Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Paul AP, Nayak K, Sydnor LC, Kalantaryardebily N, Parcetich KM, Miner DG, Wafford QE, Sullivan JE, Gurari N. A scoping review on examination approaches for identifying tactile deficits at the upper extremity in individuals with stroke. J Neuroeng Rehabil 2024; 21:99. [PMID: 38851741 PMCID: PMC11162071 DOI: 10.1186/s12984-024-01397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024] Open
Abstract
PURPOSE Accurate perception of tactile stimuli is essential for performing and learning activities of daily living. Through this scoping review, we sought to summarize existing examination approaches for identifying tactile deficits at the upper extremity in individuals with stroke. The goal was to identify current limitations and future research needs for designing more comprehensive examination tools. METHODS A scoping review was conducted in accordance with the Joanna Briggs Institute methodological framework and the PRISMA for Scoping Reviews (PRISMA-ScR) guidelines. A database search for tactile examination approaches at the upper extremity of individuals with stroke was conducted using Medline (Ovid), The Cochrane Library (Wiley), CINAHL Plus with Full Text (Ebsco), Scopus (Elsevier), PsycInfo (Ebsco), and Proquest Dissertations and Theses Global. Original research and review articles that involved adults (18 years or older) with stroke, and performed tactile examinations at the upper extremity were eligible for inclusion. Data items extracted from the selected articles included: if the examination was behavioral in nature and involved neuroimaging, the extent to which the arm participated during the examination, the number of possible outcomes of the examination, the type(s) of tactile stimulation equipment used, the location(s) along the arm examined, the peripheral nerves targeted for examination, and if any comparison was made with the non-paretic arm or with the arms of individuals who are neurotypical. RESULTS Twenty-two articles met the inclusion criteria and were accepted in this review. Most examination approaches were behavioral in nature and involved self-reporting of whether a tactile stimulus was felt while the arm remained passive (i.e., no volitional muscle activity). Typically, the number of possible outcomes with these behavioral approaches were limited (2-3), whereas the neuroimaging approaches had many more possible outcomes ( > 15 ). Tactile examinations were conducted mostly at the distal locations along the arm (finger or hand) without targeting any specific peripheral nerve. Although a majority of articles compared paretic and non-paretic arms, most did not compare outcomes to a control group of individuals who are neurotypical. DISCUSSION Our findings noted that most upper extremity tactile examinations are behavioral approaches, which are subjective in nature, lack adequate resolution, and are insufficient to identify the underlying neural mechanisms of tactile deficits. Also, most examinations are administered at distal locations of the upper extremity when the examinee's arm is relaxed (passive). Further research is needed to develop better tactile examination tools that combine behavioral responses and neurophysiological outcomes, and allow volitional tactile exploration. Approaches that include testing of multiple body locations/nerves along the upper extremity, provide higher resolution of outcomes, and consider normative comparisons with individuals who are neurotypical may provide a more comprehensive understanding of the tactile deficits occurring following a stroke.
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Affiliation(s)
- Arco P Paul
- Physical Therapy, Radford University, Radford, Virginia, USA
| | - Karan Nayak
- Neuroscience, Northwestern University, Evanston, Illinois, USA
| | | | | | | | - Daniel G Miner
- Physical Therapy, Radford University, Radford, Virginia, USA
| | - Q Eileen Wafford
- Galter Health Sciences Library & Learning Center, Northwestern University, Evanston, Illinois, USA
| | - Jane E Sullivan
- Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Netta Gurari
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA.
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Mostajeran M, Alizadeh S, Rostami HR, Ghaffari A, Adibi I. Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design. Neurol Sci 2024; 45:2737-2746. [PMID: 38158472 DOI: 10.1007/s10072-023-07288-5] [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: 11/29/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke. DESIGN A pilot, single-subject experimental, A-B-A study. SETTING Stroke unit of an educational hospital and an outpatient occupational therapy clinic. PARTICIPANTS A convenience sample including five people with acute stroke. PROCEDURES Participants received 3 h of an intensive hand and upper limb sensory and motor rehabilitation program, 5 days per week for 3 months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach. OUTCOME MEASURES An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment. RESULTS Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures. CONCLUSIONS The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.
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Affiliation(s)
- Maryam Mostajeran
- Department of Cognitive Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran
| | - Saeed Alizadeh
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Reza Rostami
- Department of Occupational Therapy, Musculoskeletal Research Center, Faculty of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Amin Ghaffari
- Department of Occupational Therapy, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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van Ravestyn C, Gerardin E, Térémetz M, Hamdoun S, Baron JC, Calvet D, Vandermeeren Y, Turc G, Maier MA, Rosso C, Mas JL, Dupin L, Lindberg PG. Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity. Neurorehabil Neural Repair 2024; 38:373-385. [PMID: 38572686 DOI: 10.1177/15459683241245416] [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: 04/05/2024]
Abstract
BACKGROUND Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.
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Affiliation(s)
- Coralie van Ravestyn
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Eloïse Gerardin
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Maxime Térémetz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
| | - Sonia Hamdoun
- Service de Médecine Physique et de Réadaptation, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Claude Baron
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - David Calvet
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Yves Vandermeeren
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Marc A Maier
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Mas
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Lucile Dupin
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Påvel G Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
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Akaguchi R, Takamura Y, Okuno H, Morioka S, Kawashima N. Relative contribution of sensory and motor deficits on grip force control in patients with chronic stroke. Clin Neurophysiol 2024; 161:231-241. [PMID: 38522269 DOI: 10.1016/j.clinph.2024.02.033] [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: 04/15/2023] [Revised: 01/10/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE This study aimed to characterize grasping behavior in static (weight-dependent modulation and stability of control) and dynamic (predictive control) aspects specifically focusing on the relative contribution of sensory and motor deficits to grip force control in patients with chronic stroke. METHODS Twenty-four chronic stroke patients performed three manipulative tasks: five trials of 5-s grasp-lift-holding, 30-s static holding, and vertical dynamic/cyclic oscillation of holding the object. RESULTS Exerted static grip force on the paretic side exhibited statistically greater than that on the non-paretic side. Spearman's rank correlation coefficient revealed that the contribution to static grip force control was larger in sensory deficits than in motor deficits. In addition, the sensory deficit is related to the reduced coupling between grip force and load force, suggesting difficulty in predictive control due to the absence of sensory feedback. CONCLUSIONS Given that grip force control involves predictive feedforward and online feedback control, the evaluation of grip force might be an important and feasible evaluation manner for the assessment of sensorimotor control in patients post-stroke. SIGNIFICANCE Detailed evaluation of grip force control would help to understand the mechanisms underlying hand dysfunction in stroke patients.
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Affiliation(s)
- Ryo Akaguchi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan; Depart of Rehabilitation, Setsunan General Hospital, Osaka, Japan
| | - Yusaku Takamura
- Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Hiroyuki Okuno
- Depart of Rehabilitation, Setsunan General Hospital, Osaka, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan; Neurorehabilitation Research Center of Kio University, Nara, Japan
| | - Noritaka Kawashima
- Department of Rehabilitation for the Movement Functions, Research Institute of National Rehabilitation Center for Persons with Disabilities, Saitama, Japan.
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Arya KN, Pandian S, Joshi AK, Chaudhary N, Agarwal GG, Ahmed SS. Sensory deficits of the paretic and non-paretic upper limbs relate with the motor recovery of the poststroke subjects. Top Stroke Rehabil 2024; 31:281-292. [PMID: 37690032 DOI: 10.1080/10749357.2023.2253629] [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: 03/16/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role. OBJECTIVE To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects. METHODS The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA). RESULTS The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side. CONCLUSION In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Akshay Kumar Joshi
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Neera Chaudhary
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - G G Agarwal
- Department of Statistics, Lucknow University, Lucknow, India
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Li C, Chen Y, Tu S, Lin J, Lin Y, Xu S, Wu M, Xie Y, Jia J. Dual-tDCS combined with sensorimotor training promotes upper limb function in subacute stroke patients: A randomized, double-blinded, sham-controlled study. CNS Neurosci Ther 2024; 30:e14530. [PMID: 37994674 PMCID: PMC11017427 DOI: 10.1111/cns.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Dual transcranial direct current stimulation (tDCS) over the bilateral primary somatosensory cortex (PSC) has potential benefits in stroke. In addition, compared with traditional rehabilitation training, sensorimotor training can significantly improve the sensorimotor function of patients. However, the efficacy of dual-tDCS combined with sensorimotor training in patients with subacute stroke is unknown. OBJECTIVE To assess whether dual-tDCS may enhance the efficacy of sensorimotor training on the upper limb functions in patients with subacute stroke. In addition, this study aims to explore the potential clinical mechanism of this combination therapy. METHODS We randomized 52 individuals with first-ever, unilateral subcortical stroke into the experimental group (n = 26) and the control group (n = 26). Patients in the experimental group received 20 min of dual-tDCS over the PSC and 40 min of sensorimotor training each session, while patients in the control group received sham dual-tDCS. The treatment cycle was a 1-h session of therapy each day, 5 days per week for 4 weeks. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), Box and Block test (BBT), Erasmus MC revised Nottingham sensory assessment scale (Em-NSA), Neurometer sensory nerve quantitative detector (CPT), the Barthel index (BI), and Hospital Anxiety and Depression Scale (HADS) were used to assess upper limb function, activities of daily living (ADL), and mental health before and after the 4-week treatment period. In addition, functional near-infrared spectroscopy (fNIRS) was used to explore potential clinical brain mechanisms. RESULTS Both groups showed significant improvement in all clinical scales (All p < 0.05) after treatment. Compared with sham-tDCS plus sensorimotor training, active dual-tDCS coupled with sensorimotor training can significantly improve the FMA-UE, ARAT, Em-NSA-Stereognosis, and CPT-2K Hz. In addition, dual-tDCS combined with sensorimotor training can significantly activate the left pre-Motor and supplementary motor cortex (PM-SMC) and enhance the functional connection between the left somatosensory association cortex (SAC) and RPM-SMC. Furthermore, the difference of FMA-UE in the experimental group was positively correlated with the functional connectivity of RPM-SMC-LSAC (r = 0.815, p < 0.001). CONCLUSION Dual-tDCS over the PSC combined with sensorimotor training can improve upper limb sensory and motor dysfunction, enhance ADL, and alleviate depression and anxiety for subacute stroke patients. Our results indicated that RPM-SMC-LSAC may be potential therapeutic targets for dual-tDCS in upper limb rehabilitation on stroke.
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Affiliation(s)
- Chong Li
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Yun Chen
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Shuting Tu
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Jiaying Lin
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Yifang Lin
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Shuo Xu
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Maohou Wu
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Yong Xie
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Jie Jia
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
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Lin L, Qing W, Huang Y, Ye F, Rong W, Li W, Jiao J, Hu X. Comparison of Immediate Neuromodulatory Effects between Focal Vibratory and Electrical Sensory Stimulations after Stroke. Bioengineering (Basel) 2024; 11:286. [PMID: 38534560 DOI: 10.3390/bioengineering11030286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024] Open
Abstract
Focal vibratory stimulation (FVS) and neuromuscular electrical stimulation (NMES) are promising technologies for sensory rehabilitation after stroke. However, the differences between these techniques in immediate neuromodulatory effects on the poststroke cortex are not yet fully understood. In this research, cortical responses in persons with chronic stroke (n = 15) and unimpaired controls (n = 15) were measured by whole-brain electroencephalography (EEG) when FVS and NMES at different intensities were applied transcutaneously to the forearm muscles. Both FVS and sensory-level NMES induced alpha and beta oscillations in the sensorimotor cortex after stroke, significantly exceeding baseline levels (p < 0.05). These oscillations exhibited bilateral sensory deficiency, early adaptation, and contralesional compensation compared to the control group. FVS resulted in a significantly faster P300 response (p < 0.05) and higher theta oscillation (p < 0.05) compared to NMES. The beta desynchronization over the contralesional frontal-parietal area remained during NMES (p > 0.05), but it was significantly weakened during FVS (p < 0.05) after stroke. The results indicated that both FVS and NMES effectively activated the sensorimotor cortex after stroke. However, FVS was particularly effective in eliciting transient involuntary attention, while NMES primarily fostered the cortical responses of the targeted muscles in the contralesional motor cortex.
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Affiliation(s)
- Legeng Lin
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Wanyi Qing
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, China
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, China
- Joint Research Centre for Biosensing and Precision Theranostics, The Hong Kong Polytechnic University, Hong Kong, China
- Research Centre on Data Science and Artificial Intelligence, The Hong Kong Polytechnic University, Hong Kong, China
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9
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Wang J, Wu B, Tong Y, Wang X, Lu Z, Wang W. Effect of acupuncture combined with rehabilitation training on sensory impairment of patients with stroke: a network meta-analysis. BMC Complement Med Ther 2024; 24:102. [PMID: 38409065 PMCID: PMC10898000 DOI: 10.1186/s12906-024-04401-9] [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: 03/05/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND The refractory and disabling nature of sensory disorders after stroke seriously affects patients' daily lives and reduces hospital turnover. Acupuncture, as an alternative therapy, is commonly used in combination with rehabilitation training to improve sensory disorders. To compare the effects of different acupuncture-related treatments combined with rehabilitation training on sensory impairment and the daily living ability of patients with stroke, we conducted a network meta-analysis to provide evidence-based findings for clinical practice. METHODS Randomized controlled trials on the treatment of sensory disorders in patients with stroke were systematically retrieved from several databases, including China National Knowledge Infrastructure (CNKI), China Science and Technology Journal(VIP), Wanfang Database, Chinese Biological Medical (CBM), PubMed, Embase, Web of Science, Cochrane Library, and Clinical trials. The retrieval period ranged from January 2012 to December 2023. Two independent reviewers screened the included literature, extracted the data, and assessed the risk quality using Cochrane Handbook 5.1.0 and ReviewManager 5.4.1. Stata16.0 software was employed for data analysis. The study protocol was registered in PROSPERO: CRD42023389180. RESULTS After screening, 20 studies were included, involving a total of 1999 subjects. The network meta-analysis results indicate that, compared to standard rehabilitation, acupuncture plus massage plus rehabilitation showed the most significant reduction in Numbness Syndrome Scores (MD = -0.71(-1.11,-0.31)). Acupuncture combined with rehabilitation demonstrated the most substantial improvement in Sensory Impairment Scores (MD = -0.59,(-0.68,-0.51)) and daily living ability of patients (MD = 17.16,(12.20,22.12)). CONCLUSIONS In comparison to standard rehabilitation, the combination of acupuncture-related treatments and modern rehabilitation training not only improves the symptoms of sensory impairment and numbness after stroke but also enhances the daily living ability of patients, especially when acupuncture is combined with rehabilitation. However, further demonstration is required to strengthen these conclusions.
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Affiliation(s)
- Jiaqi Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bangqi Wu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China.
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
| | - Yuanyuan Tong
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xuhui Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zhaojun Lu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wenqing Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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10
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Essers B, Veerbeek JM, Luft AR, Verheyden G. The feasibility of the adapted H-GRASP program for perceived and actual daily-life upper limb activity in the chronic phase post-stroke. Disabil Rehabil 2024:1-16. [PMID: 38329448 DOI: 10.1080/09638288.2024.2313121] [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: 07/25/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024]
Abstract
(Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity.Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors.
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Affiliation(s)
- Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Andreas R Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, Neurocenter, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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11
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Ensink CJ, Hofstad C, Theunissen T, Keijsers NLW. Assessment of Foot Strike Angle and Forward Propulsion with Wearable Sensors in People with Stroke. SENSORS (BASEL, SWITZERLAND) 2024; 24:710. [PMID: 38276401 PMCID: PMC10818512 DOI: 10.3390/s24020710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
Effective retraining of foot elevation and forward propulsion is a critical aspect of gait rehabilitation therapy after stroke, but valuable feedback to enhance these functions is often absent during home-based training. To enable feedback at home, this study assesses the validity of an inertial measurement unit (IMU) to measure the foot strike angle (FSA), and explores eight different kinematic parameters as potential indicators for forward propulsion. Twelve people with stroke performed walking trials while equipped with five IMUs and markers for optical motion analysis (the gold standard). The validity of the IMU-based FSA was assessed via Bland-Altman analysis, ICC, and the repeatability coefficient. Eight different kinematic parameters were compared to the forward propulsion via Pearson correlation. Analyses were performed on a stride-by-stride level and within-subject level. On a stride-by-stride level, the mean difference between the IMU-based FSA and OMCS-based FSA was 1.4 (95% confidence: -3.0; 5.9) degrees, with ICC = 0.97, and a repeatability coefficient of 5.3 degrees. The mean difference for the within-subject analysis was 1.5 (95% confidence: -1.0; 3.9) degrees, with a mean repeatability coefficient of 3.1 (SD: 2.0) degrees. Pearson's r value for all the studied parameters with forward propulsion were below 0.75 for the within-subject analysis, while on a stride-by-stride level the foot angle upon terminal contact and maximum foot angular velocity could be indicative for the peak forward propulsion. In conclusion, the FSA can accurately be assessed with an IMU on the foot in people with stroke during regular walking. However, no suitable kinematic indicator for forward propulsion was identified based on foot and shank movement that could be used for feedback in people with stroke.
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Affiliation(s)
- Carmen J. Ensink
- Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HB Nijmegen, The Netherlands
| | - Cheriel Hofstad
- Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands
| | - Theo Theunissen
- Department of Information and Communication Technology, HAN University of Applied Sciences, 6524 RN Nijmegen, The Netherlands
| | - Noël L. W. Keijsers
- Department of Research, Sint Maartenskliniek, 6500 GM Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6500 HB Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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12
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Bertrand-Charette M, Perron MP, da Silva RA, Beaulieu LD. Vibration-induced postural reactions: a scoping review on parameters and populations studied. Front Hum Neurosci 2024; 17:1307639. [PMID: 38234593 PMCID: PMC10791994 DOI: 10.3389/fnhum.2023.1307639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 01/19/2024] Open
Abstract
Objective Mechanical vibration is an effective way for externally activating Ia primary endings of the muscle spindles and skin mechanoreceptors. Despite its popularity in proprioception and postural control studies, there is still no review covering the wide variety of vibration parameters or locations used in studies. The main purpose of this scoping review was thus to give an overview of general vibration parameters and to identify, if available, the rationale for justifying methodological choices concerning vibration parameters. Methods Three databases (Pubmed, CINHAL, and SPORTDiscus) were searched from inception to July 2022. Included articles were to focus on the study of muscle spindles and skin mechanoreceptors vibration in humans and assess postural control. Following inclusion, data regarding demographic information, populations, vibration parameters and rationale were extracted and summarized. Results One hundred forty-seven articles were included, mostly targeting lower extremities (n = 137) and adults (n = 126). The parameters used varied widely but were most often around 80 Hz, at an amplitude of 1 mm for 10-20 s. Regarding rationales, nearly 50% of the studies did not include any, whereas those including one mainly cited the same two studies, without elaborating specifically on the parameter's choice. Conclusion This scoping review provided a comprehensive description of the population recruited and parameters used for vibration protocols in current studies with humans. Despite many studies, there remain important gaps of knowledge that needs to be filled, especially for vibration amplitude and duration parameters in various populations.
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Affiliation(s)
- Michaël Bertrand-Charette
- BioNR Research Lab, Université du Québec à Chicoutimi, Saguenay, QC, Canada
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Université du Québec à Chicoutimi (UQAC), Saguenay, QC, Canada
| | - Marie-Pier Perron
- BioNR Research Lab, Université du Québec à Chicoutimi, Saguenay, QC, Canada
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Université du Québec à Chicoutimi (UQAC), Saguenay, QC, Canada
| | - Rubens A. da Silva
- BioNR Research Lab, Université du Québec à Chicoutimi, Saguenay, QC, Canada
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Université du Québec à Chicoutimi (UQAC), Saguenay, QC, Canada
- Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean (CIUSSS SLSJ), Specialized Geriatrics Services–La Baie Hospital, Saguenay, QC, Canada
| | - Louis-David Beaulieu
- BioNR Research Lab, Université du Québec à Chicoutimi, Saguenay, QC, Canada
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Université du Québec à Chicoutimi (UQAC), Saguenay, QC, Canada
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13
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Lorenz EA, Su X, Skjæret-Maroni N. A review of combined functional neuroimaging and motion capture for motor rehabilitation. J Neuroeng Rehabil 2024; 21:3. [PMID: 38172799 PMCID: PMC10765727 DOI: 10.1186/s12984-023-01294-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Technological advancements in functional neuroimaging and motion capture have led to the development of novel methods that facilitate the diagnosis and rehabilitation of motor deficits. These advancements allow for the synchronous acquisition and analysis of complex signal streams of neurophysiological data (e.g., EEG, fNIRS) and behavioral data (e.g., motion capture). The fusion of those data streams has the potential to provide new insights into cortical mechanisms during movement, guide the development of rehabilitation practices, and become a tool for assessment and therapy in neurorehabilitation. RESEARCH OBJECTIVE This paper aims to review the existing literature on the combined use of motion capture and functional neuroimaging in motor rehabilitation. The objective is to understand the diversity and maturity of technological solutions employed and explore the clinical advantages of this multimodal approach. METHODS This paper reviews literature related to the combined use of functional neuroimaging and motion capture for motor rehabilitation following the PRISMA guidelines. Besides study and participant characteristics, technological aspects of the used systems, signal processing methods, and the nature of multimodal feature synchronization and fusion were extracted. RESULTS Out of 908 publications, 19 were included in the final review. Basic or translation studies were mainly represented and based predominantly on healthy participants or stroke patients. EEG and mechanical motion capture technologies were most used for biomechanical data acquisition, and their subsequent processing is based mainly on traditional methods. The system synchronization techniques at large were underreported. The fusion of multimodal features mainly supported the identification of movement-related cortical activity, and statistical methods were occasionally employed to examine cortico-kinematic relationships. CONCLUSION The fusion of motion capture and functional neuroimaging might offer advantages for motor rehabilitation in the future. Besides facilitating the assessment of cognitive processes in real-world settings, it could also improve rehabilitative devices' usability in clinical environments. Further, by better understanding cortico-peripheral coupling, new neuro-rehabilitation methods can be developed, such as personalized proprioceptive training. However, further research is needed to advance our knowledge of cortical-peripheral coupling, evaluate the validity and reliability of multimodal parameters, and enhance user-friendly technologies for clinical adaptation.
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Affiliation(s)
- Emanuel A Lorenz
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Xiaomeng Su
- Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nina Skjæret-Maroni
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Hoh JE, Borich MR, Kesar TM, Reisman DS, Semrau JA. Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians. Top Stroke Rehabil 2024; 31:29-43. [PMID: 37061928 DOI: 10.1080/10749357.2023.2200304] [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: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND PURPOSE Somatosensory impairments are common after stroke, but receive limited evaluation and intervention during neurorehabilitation, despite negatively impacting functional movement and recovery. OBJECTIVES Our objective was to understand the scope of somatosensory assessments used by clinicians in stroke rehabilitation, and barriers to increasing use in clinical practice. METHODS An electronic survey was distributed to clinicians (physical therapists, occupational therapists, physicians, and nurses) who assessed at least one individual with stroke in the past 6 months. The survey included questions on evaluation procedures, type, and use of somatosensory assessments, as well as barriers and facilitators in clinical practice. RESULTS Clinicians (N = 431) indicated greater familiarity with non-standardized assessments, and greater utilization compared to standardized assessments (p < 0.0001). Components of tactile sensation were the most commonly assessed modality of somatosensation (25%), while proprioception was rarely assessed (1%). Overall, assessments of motor function were prioritized over assessments of somatosensory function (p < 0.0001). DISCUSSION Respondents reported assessing somatosensation less frequently than motor function and demonstrated a reliance on rapid and coarse non-standardized assessments that ineffectively capture multi-modal somatosensory impairments, particularly for proprioceptive deficits common post-stroke. In general, clinicians were not familiar with standardized somatosensory assessments, and this knowledge gap likely contributes to lack of translation of these assessments into practice. CONCLUSIONS Clinicians utilize somatosensory assessments that inadequately capture the multi-modal nature of somatosensory impairments in stroke survivors. Addressing barriers to clinical translation has the potential to increase utilization of standardized assessments to improve the characterization of somatosensory deficits that inform clinical decision-making toward enhancing stroke rehabilitation outcomes.
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Affiliation(s)
- Joanna Eskander Hoh
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
| | - Michael R Borich
- Center for Physical Therapy and Movement Science, Emory University, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Trisha M Kesar
- Center for Physical Therapy and Movement Science, Emory University, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darcy S Reisman
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Physical Therapy, University of Delaware, Newark, USA
| | - Jennifer A Semrau
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
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15
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Saragih ID, Everard G, Tzeng HM, Saragih IS, Lee BO. Efficacy of Robots-Assisted Therapy in Patients With Stroke: A Meta-analysis Update. J Cardiovasc Nurs 2023; 38:E192-E217. [PMID: 37816087 DOI: 10.1097/jcn.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robot-assisted therapy (RAT) could address an unmet need to relieve the strain on healthcare providers and intensify treatment in the context of an increasing stroke incidence. A comprehensive meta-analysis could provide firmer data about the topic by considering methodology limitations discovered in previous reviews and providing more rigorous evidence. OBJECTIVE This meta-analysis study identifies RAT's efficacy for patients with stroke. METHODS A systematic search of the 7 databases from January 10 to February 1, 2022, located relevant publications. We used the updated Cochrane risk-of-bias checklist for 52 trials to assess the methodologic quality of the included studies. The efficacy of RAT for patients with stroke was estimated using a pooled random-effects model in the Stata 16 software application. RESULTS The final analysis included 2774 patients with stroke from 52 trials. In those patients, RAT was proven to improve quality of movement (mean difference, 0.15; 95% confidence interval, 0.03-0.28) and to reduce balance disturbances (mean difference, -1.28; 95% confidence interval, -2.48 to -0.09) and pain (standardized mean difference, -0.34; 95% confidence interval, -0.58 to -0.09). CONCLUSIONS Robot-assisted therapy seems to improve the quality of mobility and reduce balance disturbances and pain for patients with stroke. These findings will help develop advanced rehabilitation robots and could improve health outcomes by facilitating health services for healthcare providers and patients with stroke.
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16
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Schlemm E, Cheng B, Thomalla G, Kessner SS. Functional Lesion Network Mapping of Sensory Deficits After Ischemic Stroke. Stroke 2023; 54:2918-2922. [PMID: 37795591 DOI: 10.1161/strokeaha.123.044470] [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: 06/14/2023] [Accepted: 09/05/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Sensory deficits are common after stroke, leading to disability and poor quality of life. Although lesion locations and patterns of structural brain network disruption have been associated with sensory disturbances, the relation with functional lesion connectivity has not yet been established. METHODS Retrospective analysis of a prospective cohort study of patients with acute ischemic stroke. Indirect functional lesion network mapping to identify brain regions remote from the primary lesion associated with deficits on the Rivermead Assessment of Somatosensory Performance test. Associations between Rivermead Assessment of Somatosensory Performance scores and functional connectivity of the lesion site with prespecified components of the somatosensory system. RESULTS One hundred one patients (mean age, 62 years; 32% women) from the TOPOS study (Topological and Clinical Prospective Study About Somatosensation in Stroke). Lesion network mapping identified a bilateral fronto-parietal network associated with sensory deficits in the acute phase after stroke. There were graded associations between deficits and functional lesion connectivity to sensory cortices, but not the thalamus. CONCLUSIONS Infarcts in brain regions remote from, but functionally connected, to the somatosensory network are associated with somatosensory deficits measured by the Rivermead Assessment of Somatosensory Performance test, reflecting the hierarchical functional anatomy of sensory processing. Further research is needed to translate these findings into improved prognosis and personalized rehabilitation strategies.
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Affiliation(s)
- Eckhard Schlemm
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
| | - Bastian Cheng
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
| | - Götz Thomalla
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
| | - Simon S Kessner
- Department of Neurology (E.S., B.C., G.T., S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
- Department of Psychosomatic Medicine and Psychotherapy (S.S.K.), University Medical Center Hamburg-Eppendorf, Germany
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17
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Hassa T, Zbytniewska-Mégret M, Salzmann C, Lambercy O, Gassert R, Liepert J, Schoenfeld MA. The locations of stroke lesions next to the posterior internal capsule may predict the recovery of the related proprioceptive deficits. Front Neurosci 2023; 17:1248975. [PMID: 37854290 PMCID: PMC10579562 DOI: 10.3389/fnins.2023.1248975] [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: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
Background Somatosensory deficits after stroke correlate with functional disabilities and impact everyday-life. In particular, the interaction of proprioception and motor dysfunctions affects the recovery. While corticospinal tract (CST) damage is linked to poor motor outcome, much less is known on proprioceptive recovery. Identifying a predictor for such a recovery could help to gain insights in the complex functional recovery processes thereby reshaping rehabilitation strategies. Methods 50 patients with subacute stroke were tested before and after neurological rehabilitation. Proprioceptive and motor impairments were quantified with three clinical assessments and four hand movement and proprioception measures using a robotic device. Somatosensory evoked potentials (SSEP) to median nerve stimulation and structural imaging data (MRI) were also collected. Voxel-based lesion-symptom mapping (VLSM) along with a region of interest (ROI) analysis were performed for the corticospinal tract (CST) and for cortical areas. Results Before rehabilitation, the VLSM revealed lesion correlates for all clinical and three robotic measures. The identified voxels were located in the white matter within or near the CST. These regions associated with proprioception were located posterior compared to those associated with motor performance. After rehabilitation the patients showed an improvement of all clinical and three robotic assessments. Improvement in the box and block test was associated with an area in anterior CST. Poor recovery of proprioception was correlated with a high lesion load in fibers towards primary sensorymotor cortex (S1 and M1 tract). Patients with loss of SSEP showed higher lesion loads in these tracts and somewhat poorer recovery of proprioception. The VSLM analysis for SSEP loss revealed a region within and dorsal of internal capsule next to the posterior part of CST, the posterior part of insula and the rolandic operculum. Conclusion Lesions dorsal to internal capsule next to the posterior CST were associated with proprioceptive deficits and may have predictive value. Higher lesion load was correlated with poorer restoration of proprioceptive function. Furthermore, patients with SSEP loss trended towards poor recovery of proprioception, the corresponding lesions were also located in the same location. These findings suggest that structural imaging of the internal capsule and CST could serve as a recovery predictor of proprioceptive function.
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Affiliation(s)
- Thomas Hassa
- Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz, Germany
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Christian Salzmann
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Joachim Liepert
- Lurija Institute for Rehabilitation and Health Sciences, University of Konstanz, Konstanz, Germany
- Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Mircea Ariel Schoenfeld
- Department of Neurology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz-Institute for Neurobiology, Magdeburg, Germany
- Neurological Rehabilitation Center Kliniken Schmieder, Heidelberg, Germany
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Carranza E, Bertoni T, Mastria G, Boos A, Bassolino M, Serino A, Pirondini E. Feasibility and Validation of a Robotic-Based Multisensory Integration Assessment in Healthy Controls and a Stroke Patient. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941286 DOI: 10.1109/icorr58425.2023.10304735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
After experiencing brain damage, stroke patients commonly suffer from motor and sensory impairments that impact their ability to perform volitional movements. Visuo-proprioceptive integration is a critical component of voluntary movement, allowing for accurate movements and a sense of ownership over one's body. While recent studies have increased our understanding of the balance between visual compensation and proprioceptive deficits in stroke patients, quantitative methods for studying multisensory integration are still lacking. This study aimed to evaluate the feasibility of adapting a 3D visuo-proprioceptive disparity (VPD) task into a 2D setting using an upper-limb robotic platform for moderate to severe chronic stroke patients. To assess the implementation of the 2D task, a cohort of unimpaired healthy participants performed the VPD task in both a 3D and 2D environment. We used a computational Bayesian model to predict errors in visuo-proprioceptive integration and compared the model's predictions to real behavioral data. Our findings indicated that the behavioral trends observed in the 2D and 3D tasks were similar, and the model accurately predicted behavior. We then evaluated the feasibility of our task to assess post-stroke deficits in a patient with severe motor and sensory deficits. Ultimately, this work may help to improve our understanding of the significance of visuo-proprioceptive integration and aid in the development of better rehabilitation therapies for improving sensorimotor outcomes in stroke patients.
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Senadheera I, Larssen BC, Mak-Yuen YYK, Steinfort S, Carey LM, Alahakoon D. Profiling Somatosensory Impairment after Stroke: Characterizing Common "Fingerprints" of Impairment Using Unsupervised Machine Learning-Based Cluster Analysis of Quantitative Measures of the Upper Limb. Brain Sci 2023; 13:1253. [PMID: 37759854 PMCID: PMC10526214 DOI: 10.3390/brainsci13091253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Altered somatosensory function is common among stroke survivors, yet is often poorly characterized. Methods of profiling somatosensation that illustrate the variability in impairment within and across different modalities remain limited. We aimed to characterize post-stroke somatosensation profiles ("fingerprints") of the upper limb using an unsupervised machine learning cluster analysis to capture hidden relationships between measures of touch, proprioception, and haptic object recognition. Raw data were pooled from six studies where multiple quantitative measures of upper limb somatosensation were collected from stroke survivors (n = 207) using the Tactile Discrimination Test (TDT), Wrist Position Sense Test (WPST) and functional Tactile Object Recognition Test (fTORT) on the contralesional and ipsilesional upper limbs. The Growing Self Organizing Map (GSOM) unsupervised machine learning algorithm was used to generate a topology-preserving two-dimensional mapping of the pooled data and then separate it into clusters. Signature profiles of somatosensory impairment across two modalities (TDT and WPST; n = 203) and three modalities (TDT, WPST, and fTORT; n = 141) were characterized for both hands. Distinct impairment subgroups were identified. The influence of background and clinical variables was also modelled. The study provided evidence of the utility of unsupervised cluster analysis that can profile stroke survivor signatures of somatosensory impairment, which may inform improved diagnosis and characterization of impairment patterns.
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Affiliation(s)
- Isuru Senadheera
- Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia;
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
| | - Beverley C. Larssen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Yvonne Y. K. Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3086, Australia
- Department of Occupational Therapy, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia
| | - Sarah Steinfort
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3086, Australia
| | - Leeanne M. Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; (B.C.L.); (Y.Y.K.M.-Y.); (S.S.); (L.M.C.)
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3086, Australia
| | - Damminda Alahakoon
- Centre for Data Analytics and Cognition, La Trobe Business School, La Trobe University, Melbourne, VIC 3086, Australia;
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Sasaki R, Kojima S, Otsuru N, Yokota H, Saito K, Shirozu H, Onishi H. Beta resting-state functional connectivity predicts tactile spatial acuity. Cereb Cortex 2023; 33:9514-9523. [PMID: 37344255 PMCID: PMC10431746 DOI: 10.1093/cercor/bhad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/23/2023] Open
Abstract
Tactile perception is a complex phenomenon that is processed by multiple cortical regions via the primary somatosensory cortex (S1). Although somatosensory gating in the S1 using paired-pulse stimulation can predict tactile performance, the functional relevance of cortico-cortical connections to tactile perception remains unclear. We investigated the mechanisms by which corticocortical and local networks predict tactile spatial acuity in 42 adults using magnetoencephalography (MEG). Resting-state MEG was recorded with the eyes open, whereas evoked responses were assessed using single- and paired-pulse electrical stimulation. Source data were used to estimate the S1-seed resting-state functional connectivity (rs-FC) in the whole brain and the evoked response in the S1. Two-point discrimination threshold was assessed using a custom-made device. The beta rs-FC revealed a negative correlation between the discrimination threshold and S1-superior parietal lobule, S1-inferior parietal lobule, and S1-superior temporal gyrus connection (all P < 0.049); strong connectivity was associated with better performance. Somatosensory gating of N20m was also negatively correlated with the discrimination threshold (P = 0.015), with weak gating associated with better performance. This is the first study to demonstrate that specific beta corticocortical networks functionally support tactile spatial acuity as well as the local inhibitory network.
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Affiliation(s)
- Ryoki Sasaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
- Discipline of Physiology, School of Biomedicine, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Sho Kojima
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| | - Naofumi Otsuru
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| | - Hirotake Yokota
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| | - Kei Saito
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
| | - Hiroshi Shirozu
- Department of Functional Neurosurgery, National Hospital Organization Nishiniigata Chuo Hospital, 1-14-1 Masago, Nishi-Ku, Niigata City, Niigata 950-2085, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, 1398 Shimami-cho, Kita-Ku, Niigata City, Niigata 950-3198, Japan
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21
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Feller D, Pedri C, Gozzer P, Innocenti T, Trentin F. The Reporting of Somatic Sensory Training Interventions in Individuals After a Stroke Is Suboptimal: A Systematic Review and Meta-research Study. Am J Phys Med Rehabil 2023; 102:701-706. [PMID: 36757855 DOI: 10.1097/phm.0000000000002188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The purpose of this systematic review is to assess adherence to the "template for intervention description and replication" checklist among all published randomized controlled trials of sensory retraining strategies for patients with a history of stroke. METHODS Medline, the Cochrane Register of Controlled Trials, and the Physiotherapy Evidence Database were investigated, without time restrictions, until September 1, 2021. In addition, a search for additional studies was carried out using the included studies' reference list. Only randomized controlled trials of adults with a history of stroke who aimed to improve sensation, via any type of intervention, were included. The template for intervention description and replication checklist was used to assess the completeness of reporting on each intervention. RESULTS A total of 61 trials were included. None of the included studies declared to have used the template for intervention description and replication checklist to report interventions. Overall, the median percentage of adherence to the 12 items of the template for intervention description and replication was 33% (interquartile range, 25%-50%). Only five of the single items were adequately described in more than 50% of the studies. None of the randomized controlled trials reported the entirety of the core intervention components, as described in items 3 to 9. CONCLUSIONS This systematic review demonstrates that interventions in sensory retraining strategy trials are described below desirable standards. Without this information, clinicians and researchers cannot reliably replicate interventions.
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Affiliation(s)
- Daniel Feller
- From the Provincial Agency for Health of the Autonomous Province of Trento, Trento, Italy (DF, PG, FT); Freelance, Trento, Italy (CP); Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands (TI); and GIMBE Foundation, Bologna, Italy (TI)
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22
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Matyas TA, Mak-Yuen YYK, Boelsen-Robinson TP, Carey LM. Calibration of Impairment Severity to Enable Comparison across Somatosensory Domains. Brain Sci 2023; 13:brainsci13040654. [PMID: 37190619 DOI: 10.3390/brainsci13040654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Comparison across somatosensory domains, important for clinical and scientific goals, requires prior calibration of impairment severity. Provided test score distributions are comparable across domains, valid comparisons of impairment can be made by reference to score locations in the corresponding distributions (percentile rank or standardized scores). However, this is often not the case. Test score distributions for tactile texture discrimination (n = 174), wrist joint proprioception (n = 112), and haptic object identification (n = 98) obtained from pooled samples of stroke survivors in rehabilitation settings were investigated. The distributions showed substantially different forms, undermining comparative calibration via percentile rank or standardized scores. An alternative approach is to establish comparable locations in the psychophysical score ranges spanning performance from just noticeably impaired to maximally impaired. Several simulation studies and a theoretical analysis were conducted to establish the score distributions expected from completely insensate responders for each domain. Estimates of extreme impairment values suggested by theory, simulation and observed samples were consistent. Using these estimates and previously discovered values for impairment thresholds in each test domain, comparable ranges of impairment from just noticeable to extreme impairment were found. These ranges enable the normalization of the three test scales for comparison in clinical and research settings.
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Affiliation(s)
- Thomas A Matyas
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Heidelberg, Melbourne, VIC 3084, Australia
| | - Yvonne Y K Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Heidelberg, Melbourne, VIC 3084, Australia
- Department of Occupational Therapy, St Vincent's Hospital Melbourne, Fitzroy, Melbourne, VIC 3065, Australia
| | - Tristan P Boelsen-Robinson
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Heidelberg, Melbourne, VIC 3084, Australia
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23
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Mak-Yuen YYK, Matyas TA, Carey LM. Characterizing Touch Discrimination Impairment from Pooled Stroke Samples Using the Tactile Discrimination Test: Updated Criteria for Interpretation and Brief Test Version for Use in Clinical Practice Settings. Brain Sci 2023; 13:brainsci13040533. [PMID: 37190498 DOI: 10.3390/brainsci13040533] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023] Open
Abstract
Somatosensory loss post-stroke is common, with touch sensation characteristically impaired. Yet, quantitative, standardized measures of touch discrimination available for clinical use are currently limited. We aimed to characterize touch impairment and re-establish the criterion of abnormality of the Tactile Discrimination Test (TDT) using pooled data and to determine the sensitivity and specificity of briefer test versions. Baseline data from stroke survivors (n = 207) and older neurologically healthy controls (n = 100) assessed on the TDT was extracted. Scores were re-analyzed to determine an updated criterion of impairment and the ability of brief test versions to detect impairment. Updated scoring using an area score was used to calculate the TDT percent maximum area (PMA) score. Touch impairment was common for the contralesional hand (83%) but also present in the ipsilesional hand (42%). The criterion of abnormality was established as 73.1 PMA across older adults and genders. High sensitivity and specificity were found for briefer versions of the TDT (25 vs. 50 trials; 12 or 15 vs. 25 trials), with sensitivity ranging between 91.8 and 96.4% and specificity between 72.5 and 95.0%. Conclusion: Updated criterion of abnormality and the high sensitivity and specificity of brief test versions support the use of the TDT in clinical practice settings.
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Affiliation(s)
- Yvonne Y K Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, Australia
- Department of Occupational Therapy, St Vincent's Hospital Melbourne, Melbourne 3065, Australia
| | - Thomas A Matyas
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne 3084, Australia
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24
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Peng M, Wu B, Wang X, Ding Y, Li Y, Cheng X. Clinical Factors Affecting the Recovery of Sensory Impairment After Cerebral Infarction: A Retrospective Study. Neurologist 2023; 28:117-122. [PMID: 35776691 DOI: 10.1097/nrl.0000000000000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND About 75% of patients with cerebral infarction suffer from sensory impairment in varying degrees. It prolongs the time for patients to resume normal life and work. The aim of this study was to retrospectively investigate the clinical characteristics affecting the recovery of sensory impairment. MATERIALS AND METHODS This was a retrospective case-control study. Data of inpatients at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine were investigated. We collected information on the patients with sensory disturbances after cerebral infarction. Cases were defined according to whether the National Institutes of Health Stroke Scale (NIHSS) and visual analogue scale (VAS) scores improved. A total of 1078 inpatients from January 1, 2019, to December 31, 2021, were screened. Among those, 187 cases included in this study were divided into no improvement and improvement groups. We compared the clinical characteristics affecting the rehabilitation of these patients. RESULTS The number of patients aged between 63 and 73 years in the no improvement group were significantly higher ( P <0.05). The incidence of coronary heart disease and thalamus infarction was significantly higher in patients in the no improvement cohort ( P <0.05). Furthermore, coronary heart disease [odds ratio=0.466, 95% confidence interval (0.252, 0.863), P =0.015] and thalamic infarction [odds ratio=0.457, 95% confidence interval (0.230, 0.908), P =0.025] were the independent risk factors against the recovery of sensory disturbance after cerebral infarction. CONCLUSIONS Patients with thalamus infarction and coronary heart disease may be more inclined to recover poorly from somatosensory deficits.
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Affiliation(s)
- Maohan Peng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bangqi Wu
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
| | - Xuhui Wang
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
| | - Yi Ding
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yibing Li
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xinyue Cheng
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
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25
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Liu Y, Ma J, Li H, Shi WY, Xiao ZH, Yang Q, Zhao QQ, Wang F, Tao XL, Bai YF. Which sites better represent the sensory function of hands in convalescent stroke patients? A study based on electrophysiological examination. Front Neurosci 2023; 16:1065629. [PMID: 36711129 PMCID: PMC9875544 DOI: 10.3389/fnins.2022.1065629] [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: 10/10/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
Background Assessing hand sensation in stroke patients is necessary; however, current clinical assessments are time-consuming and inaccurate. Objective This study aimed to explore the nature of light touch sensation and two-point discrimination (2-PD) of different hand sites in convalescent stroke patients based on somatosensory evoked potentials (SEP). Methods Light touch sensation and 2-PD of the thumb, the index finger, the little finger, thenar, and hypothenar were measured (n = 112) using sensory measurement tools. Sensory differences among the hand sites were then compared. The correlation analysis between SEP and the hemiplegic hand function was made. Sensory functions were divided into three levels: sensory intactness, sensory impairment, and sensory loss. Results Light touch sensations were mainly associated with sensory impairment in the finger and palm region. The 2-PD of the finger region was mainly sensory loss and that of the palm region was mainly sensory impairment. There was no statistical difference in the light touch sensation among the sites of the hand. The correlation coefficients between the 2-PD and SEP N20 amplitudes differed. The correlation coefficients of the thenar and hypothenar were the smallest, and that of the finger was the largest. Light touch sensation and 2-PD in patients with stroke were related to the hemiplegic hand function. Conclusion Any site on the hand could be selected as the measurement site for light touch sensation. The little finger and hypothenar may be appropriate sites when screening for 2-PD. To improve the patient's recovery they could receive more sensory stimulation of the hand.
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Affiliation(s)
- Yu Liu
- Department of Rehabilitation Medicine, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Jiang Ma
- Department of Rehabilitation Medicine, Shijiazhuang People’s Hospital, Shijiazhuang, China,*Correspondence: Jiang Ma,
| | - Hong Li
- Department of Rehabilitation Medicine, Shijiazhuang People’s Hospital, Shijiazhuang, China,Physical Education College, Hebei Normal University, Shijiazhuang, China
| | - Wan-ying Shi
- Department of Rehabilitation Medicine, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Zheng-hua Xiao
- Physical Education College, Hebei Normal University, Shijiazhuang, China
| | - Qian Yang
- Department of Electrophysiology, Shijiazhuang People’s Hospital, Shijiazhuang, Hebei, China
| | - Qing-qing Zhao
- School of Nursing and Rehabilitation, North China University of Science and Technology, Tangshan, Hebei, China
| | - Fang Wang
- Physical Education College, Hebei Normal University, Shijiazhuang, China
| | - Xiao-lin Tao
- Department of Rehabilitation Medicine, Shijiazhuang People’s Hospital, Shijiazhuang, China
| | - Yun-fei Bai
- Department of Rehabilitation Medicine, Shijiazhuang People’s Hospital, Shijiazhuang, China
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26
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Milani G, Mantovani L, Baroni A, Lamberti N, Basaglia N, Lavezzi S, Manfredini F, Straudi S. Variations in Health-Related Quality of Life After Stroke: Insights From a Clinical Trial on Arm Rehabilitation With a Long-Term Follow-Up. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2023; 12:27536351231214845. [PMID: 38034067 PMCID: PMC10687933 DOI: 10.1177/27536351231214845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023]
Abstract
Despite rehabilitation, stroke patients continue to have impaired function and reduced health-related quality of life (HRQoL) even in a chronic stage. However, no clear information is available on long-term variations in HRQoL. In this study, we aimed to report the short- and long-term changes in HRQoL in a subacute stroke sample that was enrolled in a clinical trial on arm rehabilitation. Thirty-nine stroke survivors (62% male, mean age 68 years) were assessed using the Stroke Impact Scale Version 2.0 (SIS 2.0) pre and post rehabilitation and at 6 months and 6 years follow-up. Long-term changes in physical function were explored through clinically meaningful changes in the Stroke Impact Scale-16 (SIS-16). After rehabilitation (P < .001), an overall improvement was found in all SIS domains except the memory and thinking, emotions, and communication domains. The baseline SIS-16 score (P < .001), the presence of a sensory deficit, and rehabilitation setting (P < .05) were factors related to the SIS-16 domain scores at the end of rehabilitation and at 6 months follow-up. Patients showed the most deterioration in the mobility (P < .001), strength (P < .003), and hand function (P < .05) domains 6 years after stroke. Stroke severity, male gender, and age ⩾65 years are related with a long-term HRQoL reduction after stroke.
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Affiliation(s)
- Giada Milani
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
- Iit@Unife Center for Translational Neurophysiology, Istituto Italiano Di Tecnologia, Ferrara, Italy
| | | | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Susanna Lavezzi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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27
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Young BM, Yadav R, Rana S, Kim WS, Liu C, Batth R, Sakthi S, Farahmand E, Han S, Patel D, Luo J, Ramsey C, Feldman M, Cardoso-Ferreira I, Holl C, Nguyen T, Brinkman L, Su M, Chang TY, Cramer SC. Wrist Proprioception in Adults with and without Subacute Stroke. Brain Sci 2022; 13:brainsci13010031. [PMID: 36672014 PMCID: PMC9856542 DOI: 10.3390/brainsci13010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits.
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Affiliation(s)
- Brittany M. Young
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Rishika Yadav
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Shivam Rana
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Won-Seok Kim
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, Republic of Korea
| | - Camellia Liu
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Rajan Batth
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Shivani Sakthi
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Eden Farahmand
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Simon Han
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Darshan Patel
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Jason Luo
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Christina Ramsey
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Marc Feldman
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Isabel Cardoso-Ferreira
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Christina Holl
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Tiffany Nguyen
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Lorie Brinkman
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Michael Su
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Tracy Y. Chang
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Steven C. Cramer
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
- Correspondence:
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28
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Carlsson H, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. Efficacy and feasibility of SENSory relearning of the UPPer limb (SENSUPP) in people with chronic stroke: A pilot randomized controlled trial. PM R 2022; 14:1461-1473. [PMID: 35049134 PMCID: PMC10078719 DOI: 10.1002/pmrj.12767] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sensorimotor impairments of the upper limb (UL) are common after stroke, but there is a lack of evidence-based interventions to improve functioning of UL. OBJECTIVE To evaluate (1) the efficacy of sensory relearning and task-specific training compared to task-specific training only, and (2) the feasibility of the training in chronic stroke. DESIGN A pilot randomized controlled trial. SETTING University hospital outpatient clinic. PARTICIPANTS Twenty-seven participants (median age; 62 years, 20 men) were randomized to an intervention group (IG; n = 15) or to a control group (CG; n = 12). INTERVENTION Both groups received training twice weekly in 2.5-hour sessions for 5 weeks. The training in the IG consisted of sensory relearning, task-specific training, and home training. The training in the CG consisted of task-specific training. MAIN OUTCOME MEASURES Primary outcome was sensory function (touch thresholds, touch discrimination, light touch, and proprioception). Secondary outcomes were dexterity, ability to use the hand in daily activities, and perceived participation. A blinded assessor conducted the assessments at baseline (T1), post intervention (T2), and at 3-month follow-up (T3). Nonparametric analyses and effect-size calculations (r) were performed. Feasibility was evaluated by a questionnaire. RESULTS After the training, only touch thresholds improved significantly from T1 to T2 (p = .007, r = 0.61) in the IG compared to the CG. Within the IG, significant improvements were found from T1 to T2 regarding use of the hand in daily activities (p = .001, r = 0.96) and movement quality (p = .004, r = 0.85) and from T1 to T3 regarding satisfaction with performance in meaningful activities (p = .004, r = 0.94). The CG significantly improved the performance of using the hand in meaningful activities from T1 to T2 (p = .017, r = 0.86). The training was well tolerated by the participants and performed without any adverse events. CONCLUSIONS Combined sensory relearning and task-specific training may be a promising and feasible intervention to improve UL sensorimotor function after stroke.
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Affiliation(s)
- Håkan Carlsson
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
| | - Birgitta Rosén
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anders Björkman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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Aphiphaksakul P, Siriphorn A. Home-based exercise using balance disc and smartphone inclinometer application improves balance and activity of daily living in individuals with stroke: A randomized controlled trial. PLoS One 2022; 17:e0277870. [PMID: 36409753 PMCID: PMC9678269 DOI: 10.1371/journal.pone.0277870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Sitting ability is critical for daily activities in individuals who have experienced a stroke. A combination of seated balance training on an unstable surface and real-time visual feedback via a simple mobile inclinometer application may improve trunk control in stroke survivors. OBJECTIVE This randomized controlled trial aimed to determine the effects of home-based exercise utilizing a balance disc with input from a smartphone inclinometer application on sitting balance and activities of daily living in stroke survivors. METHODS This trial enrolled 32 stroke survivors aged 30 to 75 years. Participants were randomly assigned to one of two groups: intervention or control. Both groups underwent four weeks of traditional therapy. Additionally, the intervention group received four weeks of multidirectional lean training utilizing a balance disc and a smartphone application with an inclinometer. The Postural Assessment Scale for Stroke (PASS), the Function in Sitting Test (FIST), and the Barthel Index (BI) were used to assess the results. To compare between group effects, an ANCOVA analysis was performed using a baseline as a covariate. RESULTS The PASS changing posture and BI were considerably greater in the intervention group compared to the control group. Other metrics revealed no statistically significant differences between the groups. CONCLUSION Home-based training with balance discs and input from a smartphone inclinometer application may improve postural control and daily activity in stroke patients. TRIAL REGISTRATION Clinical trials registry number: TCTR20210617004.
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Affiliation(s)
- Pantawit Aphiphaksakul
- Department of Physical Therapy, Human Movement Performance Enhancement Research Unit, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Akkradate Siriphorn
- Department of Physical Therapy, Human Movement Performance Enhancement Research Unit, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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30
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Alwhaibi RM, Mahmoud NF, Zakaria HM, Ragab WM, Al Awaji NN, Elserougy HR. Effect of compressive therapy on sensorimotor function of the more affected upper extremity in chronic stroke patients: A randomized clinical trial. Medicine (Baltimore) 2022; 101:e30657. [PMID: 36197197 PMCID: PMC9509044 DOI: 10.1097/md.0000000000030657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Common upper extremity (UE) physical impairments after stroke include paresis, abnormal muscle tone, and somatosensory affection. This study evaluated the effect of passive somatosensory stimulation using compressive therapy on sensorimotor function of the more affected UE in chronic stroke patients. METHODS Forty chronic stroke patients were enrolled in this study. They were randomized into 2 groups: Gr1 and Gr2. Three patients dropped out leaving us with a total of 37 patients completing the study. Gr1 received UE motor program for the more affected UE along with sham electrical stimulation while Gr2 had the same UE motor program along with passive somatosensory stimulation. The session duration in both groups was 85 min. Gr1 and Gr2 received a total of 36 sessions for 6 successive weeks. UE function in Gr1 and Gr2 was examined, before and after treatment using Box and Block test (BBT) and Perdue Pegboard test (PPBT) as measures of motor of both the more affected and less affected UE while the Nottingham sensory assessment (NSA) scale was used as a measure of sensory function of the more affected UE. RESULTS There were significant improvements in motor and sensory function of the more affected UE compared to the less affected UE in both groups, measured by the BBT, PPBT, and NSA scales post-treatment (P < .05). However, the comparison between both groups regarding improvement revealed no significant change (P > .05). CONCLUSION Upper extremity motor and passive somatosensory stimulation techniques are effective in improving sensorimotor function of the more affected UE, but none of them had the advantage over the other, in terms of improving motor and sensory function in chronic stroke patients.
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Affiliation(s)
- Reem M Alwhaibi
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Noha F Mahmoud
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Hoda M Zakaria
- Department of Neuromuscular Disorders and its Surgery, College of Physical Therapy, Cairo University, Cairo 12613, Egypt
| | - Walaa M Ragab
- Department of Neuromuscular Disorders and its Surgery, College of Physical Therapy, Cairo University, Cairo 12613, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia
| | - Nisreen N Al Awaji
- Health Communication Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi, Arabia
| | - Hager R Elserougy
- Department of Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza 77, Egypt
- * Correspondence: Hager R. Elserougy, Department of Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza 77, Egypt (e-mail: )
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31
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Pan L, Xu D, Wang W, Rong J, Xu J, Ferland A, Adams R, Han J, Zhu Y. Assessing bilateral ankle proprioceptive acuity in stroke survivors: An exploratory study. Front Neurol 2022; 13:929310. [PMID: 36034305 PMCID: PMC9410727 DOI: 10.3389/fneur.2022.929310] [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: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Bilateral proprioception deficits were reported in stroke survivors. However, whether bilateral proprioception deficits exist in the ankle joint after stroke was unclear. Ankle proprioception is a significant predictor of balance dysfunction after stroke, and previous studies to date are lacking appropriate evaluation methods. Objectives We want to determine whether the active movement extent discrimination apparatus (AMEDA) is a reliable tool for assessing ankle proprioceptive acuity in stroke survivors and the presence of deficits in ankle proprioception on the affected and unaffected sides in patients after stroke. Methods Bilateral ankle proprioception was assessed in 20 stroke patients and 20 age-matched healthy controls using AMEDA. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Results The ICC in the affected and unaffected sides was 0.713 and 0.74, respectively. Analysis of variance revealed significant deficits in ankle proprioception in subacute stroke survivors vs. healthy controls (F = 2.719, p = 0.045). However, there were no significant differences in proprioception acuity scores between the affected and unaffected sides in patients after stroke (F = 1.14, p = 0.331). Conclusions Stroke survivors had bilateral deficits in ankle proprioceptive acuity during active movements compared with age-matched healthy controls, underscoring the need to evaluate these deficits on both sides of the body and develop effective sensorimotor rehabilitation methods for this patient population. The AMEDA can reliably determine bilateral ankle proprioceptive acuity in stroke survivors.
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Affiliation(s)
- Li Pan
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Dongyan Xu
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Weining Wang
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Jifeng Rong
- The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jinyao Xu
- Research Institute for Sport and Exercise, University of Canberra, Canberra, NSW, Australia
| | - Amanda Ferland
- USC Division of Biokinesiology and Physical Therapy, Orthopedic Physical Therapy Residency, and Spine Rehabilitation Fellowship, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Roger Adams
- Research Institute for Sport and Exercise, University of Canberra, Canberra, NSW, Australia
| | - Jia Han
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- Research Institute for Sport and Exercise, University of Canberra, Canberra, NSW, Australia
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
- *Correspondence: Jia Han
| | - Yulian Zhu
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
- Yulian Zhu
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32
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Lv Q, Zhang J, Pan Y, Liu X, Miao L, Peng J, Song L, Zou Y, Chen X. Somatosensory Deficits After Stroke: Insights From MRI Studies. Front Neurol 2022; 13:891283. [PMID: 35911919 PMCID: PMC9328992 DOI: 10.3389/fneur.2022.891283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022] Open
Abstract
Somatosensory deficits after stroke are a major health problem, which can impair patients' health status and quality of life. With the developments in human brain mapping techniques, particularly magnetic resonance imaging (MRI), many studies have applied those techniques to unravel neural substrates linked to apoplexy sequelae. Multi-parametric MRI is a vital method for the measurement of stroke and has been applied to diagnose stroke severity, predict outcome and visualize changes in activation patterns during stroke recovery. However, relatively little is known about the somatosensory deficits after stroke and their recovery. This review aims to highlight the utility and importance of MRI techniques in the field of somatosensory deficits and synthesizes corresponding articles to elucidate the mechanisms underlying the occurrence and recovery of somatosensory symptoms. Here, we start by reviewing the anatomic and functional features of the somatosensory system. And then, we provide a discussion of MRI techniques and analysis methods. Meanwhile, we present the application of those techniques and methods in clinical studies, focusing on recent research advances and the potential for clinical translation. Finally, we identify some limitations and open questions of current imaging studies that need to be addressed in future research.
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Affiliation(s)
- Qiuyi Lv
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Junning Zhang
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Yuxing Pan
- Institute of Neuroscience, Chinese Academy of Science, Shanghai, China
| | - Xiaodong Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | | | - Jing Peng
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Lei Song
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yihuai Zou
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xing Chen
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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33
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Sasaki R, Watanabe H, Onishi H. Therapeutic benefits of noninvasive somatosensory cortex stimulation on cortical plasticity and somatosensory function: a systematic review. Eur J Neurosci 2022; 56:4669-4698. [PMID: 35804487 DOI: 10.1111/ejn.15767] [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: 12/20/2021] [Revised: 05/23/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022]
Abstract
Optimal limb coordination requires efficient transmission of somatosensory information to the sensorimotor cortex. The primary somatosensory cortex (S1) is frequently damaged by stroke, resulting in both somatosensory and motor impairments. Noninvasive brain stimulation (NIBS) to the primary motor cortex is thought to induce neural plasticity that facilitates neurorehabilitation. Several studies have also examined if NIBS to the S1 can enhance somatosensory processing as assessed by somatosensory-evoked potentials (SEPs) and improve behavioral task performance, but it remains uncertain if NIBS can reliably modulate S1 plasticity or even whether SEPs can reflect this plasticity. This systematic review revealed that NIBS has relatively minor effects on SEPs or somatosensory task performance, but larger early SEP changes after NIBS can still predict improved performance. Similarly, decreased paired-pulse inhibition in S1 post-NIBS is associated with improved somatosensory performance. However, several studies still debate the role of inhibitory function in somatosensory performance after NIBS in terms of the direction of the change (that, disinhibition or inhibition). Altogether, early SEP and paired-pulse inhibition (particularly inter-stimulus intervals of 30-100 ms) may become useful biomarkers for somatosensory deficits, but improved NIBS protocols are required for therapeutic applications.
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Affiliation(s)
- Ryoki Sasaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Discipline of Physiology, School of Biomedicine, The University of Adelaide, Adelaide, Australia
| | - Hiraku Watanabe
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Hideaki Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan.,Department of Physical Therapy, Niigata University of Health and Welfare, Niigata, Japan
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34
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Huang Y, Jiao J, Hu J, Hsing C, Lai Z, Yang Y, Li Z, Hu X. Electroencephalographic Measurement on Post-stroke Sensory Deficiency in Response to Non-painful Cold Stimulation. Front Aging Neurosci 2022; 14:866272. [PMID: 35645770 PMCID: PMC9131028 DOI: 10.3389/fnagi.2022.866272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Reduced elementary somatosensation is common after stroke. However, the measurement of elementary sensation is frequently overlooked in traditional clinical assessments, and has not been evaluated objectively at the cortical level. This study designed a new configuration for the measurement of post-stroke elementary thermal sensation by non-painful cold stimulation (NPCS). The post-stroke cortical responses were then investigated during elementary NPCS on sensory deficiency via electroencephalography (EEG) when compared with unimpaired persons. Method Twelve individuals with chronic stroke and fifteen unimpaired controls were recruited. A 64-channel EEG system was used to investigate the post-stroke cortical responses objectively during the NPCS. A subjective questionnaire of cold sensory intensity was also administered via a numeric visual analog scale (VAS). Three water samples with different temperatures (i.e., 25, 10, and 0°C) were applied to the skin surface of the ventral forearm for 3 s via glass beaker, with a randomized sequence on either the left or right forearm of a participant. EEG relative spectral power (RSP) and topography were used to evaluate the neural responses toward NPCS with respect to the independent factors of stimulation side and temperature. Results For unimpaired controls, NPCS initiated significant RSP variations, mainly located in the theta band with the highest discriminative resolution on the different temperatures (P < 0.001). For stroke participants, the distribution of significant RSP spread across all EEG frequency bands and the temperature discrimination was lower than that observed in unimpaired participants (P < 0.05). EEG topography showed that the NPCS could activate extensive and bilateral sensory cortical areas after stroke. Significant group differences on RSP intensities were obtained in each EEG band (P < 0.05). Meanwhile, significant asymmetry cortical responses in RSP toward different upper limbs were observed during the NPCS in both unimpaired controls and participants with stroke (P < 0.05). No difference was found between the groups in the VAS ratings of the different temperatures (P > 0.05). Conclusion The post-stroke cortical responses during NPCS on sensory deficiency were characterized by the wide distribution of representative RSP bands, lowered resolution toward different temperatures, and extensive activated sensory cortical areas.
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Affiliation(s)
- Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Jiao Jiao
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Junyan Hu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Chihchia Hsing
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Zhangqi Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yang Yang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Centre for Rehabilitation Technical Aids Beijing, Beijing, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- Research Institute for Smart Ageing (RISA), The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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35
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Evaluation of Post-Stroke Impairment in Fine Tactile Sensation by Electroencephalography (EEG)-Based Machine Learning. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094796] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Electroencephalography (EEG)-based measurements of fine tactile sensation produce large amounts of data, with high costs for manual evaluation. In this study, an EEG-based machine-learning (ML) model with support vector machine (SVM) was established to automatically evaluate post-stroke impairments in fine tactile sensation. Stroke survivors (n = 12, stroke group) and unimpaired participants (n = 15, control group) received stimulations with cotton, nylon, and wool fabrics to the different upper limbs of a stroke participant and the dominant side of the control. The average and maximal values of relative spectral power (RSP) of EEG in the stimulations were used as the inputs to the SVM-ML model, which was first optimized for classification accuracies for different limb sides through hyperparameter selection (γ, C) in radial basis function (RBF) kernel and cross-validation during cotton stimulation. Model generalization was investigated by comparing accuracies during stimulations with different fabrics to different limbs. The highest accuracies were achieved with (γ = 21, C = 23) for the RBF kernel (76.8%) and six-fold cross-validation (75.4%), respectively, in the gamma band for cotton stimulation; these were selected as optimal parameters for the SVM-ML model. In model generalization, significant differences in the post-stroke fabric stimulation accuracies were shifted to higher (beta/gamma) bands. The EEG-based SVM-ML model generated results similar to manual evaluation of cortical responses to fabric stimulations; this may aid automatic assessments of post-stroke fine tactile sensations.
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36
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de Freitas Zanona A, Romeiro da Silva AC, do Rego Maciel AB, Gomes do Nascimento LS, Bezerra da Silva A, Bolognini N, Monte-Silva K. Somatosensory Cortex Repetitive Transcranial Magnetic Stimulation and Associative Sensory Stimulation of Peripheral Nerves Could Assist Motor and Sensory Recovery After Stroke. Front Hum Neurosci 2022; 16:860965. [PMID: 35479184 PMCID: PMC9036089 DOI: 10.3389/fnhum.2022.860965] [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: 01/24/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background We investigated whether transcranial magnetic stimulation (rTMS) over the primary somatosensory cortex (S1) and sensory stimulation (SS) could promote upper limb recovery in participants with subacute stroke. Methods Participants were randomized into four groups: rTMS/Sham SS, Sham rTMS/SS, rTMS/SS, and control group (Sham rTMS/Sham SS). Participants underwent ten sessions of sham or active rTMS over S1 (10 Hz, 1,500 pulses, 120% of resting motor threshold, 20 min), followed by sham or active SS. The SS involved active sensory training (exploring features of objects and graphesthesia, proprioception exercises), mirror therapy, and Transcutaneous electrical nerve stimulation (TENS) in the region of the median nerve in the wrist (stimulation intensity as the minimum intensity at which the participants reported paresthesia; five electrical pulses of 1 ms duration each at 10 Hz were delivered every second over 45 min). Sham stimulations occurred as follows: Sham rTMS, coil was held while disconnected from the stimulator, and rTMS noise was presented with computer loudspeakers with recorded sound from a real stimulation. The Sham SS received therapy in the unaffected upper limb, did not use the mirror and received TENS stimulation for only 60 seconds. The primary outcome was the Body Structure/Function: Fugl-Meyer Assessment (FMA) and Nottingham Sensory Assessment (NSA); the secondary outcome was the Activity/Participation domains, assessed with Box and Block Test, Motor Activity Log scale, Jebsen-Taylor Test, and Functional Independence Measure. Results Forty participants with stroke ischemic (n = 38) and hemorrhagic (n = 2), men (n = 19) and women (n = 21), in the subacute stage (10.6 ± 6 weeks) had a mean age of 62.2 ± 9.6 years, were equally divided into four groups (10 participants in each group). Significant somatosensory improvements were found in participants receiving active rTMS and active SS, compared with those in the control group (sham rTMS with sham SS). Motor function improved only in participants who received active rTMS, with greater effects when active rTMS was combined with active SS. Conclusion The combined use of SS with rTMS over S1 represents a more effective therapy for increasing sensory and motor recovery, as well as functional independence, in participants with subacute stroke. Clinical Trial Registration [clinicaltrials.gov], identifier [NCT03329807].
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Affiliation(s)
| | | | | | | | | | - Nadia Bolognini
- Department of Psychology, University of Milano Bicocca, Milan, Italy
- Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Katia Monte-Silva
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Brazil
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Lee KW, Kang SH, Lim SC. Simple and Reliable Position Sense Assessment under Different External Torques: Toward Developing a Post-stroke Proprioception Evaluation Device. IEEE Trans Neural Syst Rehabil Eng 2022; 30:823-832. [PMID: 35324443 DOI: 10.1109/tnsre.2022.3161948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of position sense post-stroke is essential for rehabilitation. Position sense may be an output of a process needing position information, external torque, and the sense of effort. Even for healthy individuals, it is unclear whether external torque affects position sense. Thus, evaluation of position sense under different external torques in clinical settings is strongly needed. However, simple devices for measuring position sense under different external torques in clinical settings are lacking. Technologically advanced devices that may evaluate the elbow position sense under different torques were reported to be infeasible clinically because of device complexity and the need for technical experts when analyzing data. To address the unmet need, in this study, a simple and light elbow position sense measurement device was developed that allows clinicians to measure elbow position sense under different external torques in the form of position matching error objectively without any technical difficulties. The feasibility of the device, including intra-session intra-rater reliability and test-retest reliability over two consecutive days, was verified to be clinically applicable using tests with 25 healthy subjects. Thanks to its ease of use, high reliability, and ease of data analysis, it is expected that the device can help to evaluate the position sense post-stroke comprehensively.
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Carlsson H, Lindgren I, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063636. [PMID: 35329318 PMCID: PMC8955037 DOI: 10.3390/ijerph19063636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023]
Abstract
Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme ‘Sensory relearning was meaningful and led to improved ability to perform daily hand activities’ and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended.
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Affiliation(s)
- Håkan Carlsson
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
- Correspondence:
| | - Ingrid Lindgren
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
| | - Birgitta Rosén
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden;
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
- Department of Clinical Sciences, Lund University, 221 00 Lund, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
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Salgueiro C, Urrútia G, Cabanas-Valdés R. Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial. NeuroRehabilitation 2022; 51:91-99. [PMID: 35311721 DOI: 10.3233/nre-210332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Telerehabilitation has been proposed as an effective strategy to deliver post-stroke specific exercise. OBJECTIVE To assess the effectiveness and feasibility of core stability exercises guided by a telerehabilitation App after hospital discharge. METHODS Extension of a prospective controlled trial. Subacute stage stroke survivors were included at the time of hospital discharge where they had participated in a previous 5-week randomized controlled trial comparing conventional physiotherapy versus core stability exercises. After discharge, patients from the experimental group were offered access to telerehabilitation to perform core stability exercises at home (AppG), while those from the control group were subject to usual care (CG). The Spanish-version of the Trunk Impairment Scale 2.0 (S-TIS 2.0), Function in Sitting Test (S-FIST), Berg Balance Scale (BBS), Spanish-version of Postural Assessment for Stroke Patients (S-PASS), the number of falls, Brunel Balance Assessment (BBA) and Gait were assessed before and after 3 months intervention. RESULTS A total of 49 subjects were recruited. AppG showed greater improvement in balance in both sitting and standing position and gait compared with CG, although no statistically significant differences were obtained. CONCLUSION Core stability exercises Telerehabilitation as a home-based guide appears to improve balance in post-stroke stage. Future studies are necessary to confirm the effects as well as identifying strategies to increase telerehabilitation adherence.
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Affiliation(s)
- Carina Salgueiro
- Health Science PHD program, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gerard Urrútia
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBERESP, Madrid, Spain
| | - Rosa Cabanas-Valdés
- Department of Physiotherapy, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
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Lee EY, Na Y, Cho M, Hwang YM, Noh JS, Kwon HK, Pyun SB. Clinical Factors Associated With Balance Function in the Early Subacute Phase After Stroke. Am J Phys Med Rehabil 2022; 101:203-210. [PMID: 34320561 DOI: 10.1097/phm.0000000000001856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the key factors of balance function in the early subacute phase after stroke. DESIGN Ninety-four stroke patients were included. Multiple variables were evaluated, including demographic factors, clinical variables (stroke type; lesion site; Mini-Mental State Examination; motor strength of the hip, knee, and ankle joints; Fugl-Meyer Assessment of lower extremity), neurophysiological variables (amplitude ratio of somatosensory evoked potential of the tibial nerves), and laterality index of fractional anisotropy of the corticospinal tract using diffusion tensor imaging. Balance function was measured using the Berg Balance Scale. RESULTS The Berg Balance Scale score was significantly negatively correlated with age and laterality index of fractional anisotropy and positively correlated with Mini-Mental State Examination; Fugl-Meyer Assessment of lower extremity; motor strength of the affected hip, knee, and ankle joint; and somatosensory evoked potential amplitude ratio (P < 0.05). The abnormal somatosensory evoked potential group and poor integrity of the corticospinal tract group showed significantly decreased Berg Balance Scale scores. In multivariable logistic regression analysis, age, Fugl-Meyer Assessment of lower extremity score, and ankle plantar flexion strength were significantly associated with balance function (odds ratios = 0.919, 1.181, and 15.244, respectively, P < 0.05). CONCLUSIONS Higher age, severe initial motor impairment, and strength of the affected lower limb muscles, especially the ankle plantar flexor, are strongly associated with poor balance function early after stroke. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Enhance ability to evaluate motor and balance function of stroke patients by learning common assessment tools including clinical tests, neurophysiological and neuroimaging studies; (2) Explain the important factors associated with balance function impairment in early subacute stroke patients; and (3) Enhance planning rehabilitation strategies for improvement of balance function according to recovery stage after stroke. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Eun Young Lee
- From the Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Republic of Korea (EYL, JSN, H-KK, S-BP); Brain Convergence Research Center, Korea University, Seoul, Republic of Korea (YN, MC, YMH, S-BP); and Department of Biomedical Sciences, Korea University, Seoul, Republic of Korea (YN, MC, S-BP)
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Neuromuscular electrical stimulation restores upper limb sensory-motor functions and body representations in chronic stroke survivors. MED 2022; 3:58-74.e10. [DOI: 10.1016/j.medj.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/08/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
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Russo C, Spandri V, Gallucci M, Halligan P, Bolognini N, Vallar G. Rivermead assessment of somatosensory performance: Italian normative data. Neurol Sci 2021; 42:5149-5156. [PMID: 33783659 PMCID: PMC8642335 DOI: 10.1007/s10072-021-05210-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/19/2021] [Indexed: 11/25/2022]
Abstract
The Rivermead assessment of somatosensory performance (RASP) provides a quantitative assessment of somatosensory processing, suitable for brain-damaged patients suffering from stroke. It consists of seven subcomponents: Subtest 1 (sharp/dull discrimination), Subtest 2 (surface pressure touch), Subtest 3 (surface localization), Subtest 4 (sensory extinction), Subtest 5 (2-point discrimination), Subtest 6 (temperature discrimination), and Subtest 7 (proprioception). Overall, the RASP assesses 5 bilateral body regions: face (cheek), hand (palm and back), and foot (sole and back). This study aimed at providing normative data and cut-off scores for RASP subtests, for each body region, in a large Italian population sample. We present results from 300 healthy Italian individuals aged 19 to 98 years. Data represent a comprehensive set of norms that cover each subtest and each body region tested. Performance in Subtests 1, 5, and 6 decreased, for some body regions, with increasing age. Based on these results, norms were stratified for age (seven groups), with the pathological/non-pathological cut-off coinciding with the 5th percentile. Conversely, other results were not influenced by age; in such cases, a single error, in each body region, has to be considered indicative of pathological performance. This independent investigation of all subcomponents of the somatosensory system, for each body region, further confirms RASP's potential in clinical practice, for neurological assessment, as well as in research settings.
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Affiliation(s)
- Cristina Russo
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Building U6, 20126, Milan, Italy.
- Neurology-Stroke Unit, Manzoni Hospital, Lecco, Italy.
| | - Viviana Spandri
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Building U6, 20126, Milan, Italy
- Neurology-Stroke Unit, Manzoni Hospital, Lecco, Italy
| | - Marcello Gallucci
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Building U6, 20126, Milan, Italy
| | | | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Building U6, 20126, Milan, Italy
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Giuseppe Vallar
- Department of Psychology and Milan Center for Neuroscience-NeuroMi, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Building U6, 20126, Milan, Italy.
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.
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Soto-Vidal C, Calvo-Fuente V, Muriel-García A, Gallego-Izquierdo T, González-Alted C, Pacheco-da-Costa S. Responsiveness of the Spanish Version of Newcastle Stroke-Specific Quality of Life Measure (NEWSQOL). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10034. [PMID: 34639337 PMCID: PMC8507955 DOI: 10.3390/ijerph181910034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the responsiveness of the Spanish version of the Newcastle Stroke-specific Quality of Life measure (NEWSQOL) to assess quality of life in Spanish people after suffering a stroke. DESIGN A prospective observational study was conducted to assess the responsiveness of the Spanish version of NEWSQOL. The sample contained 128 patients who filled in the questionnaires before and after a physical therapy intervention. The responsiveness was assessed with p-values using the effect size (ES) and the standardized response means (SRMs) of the change. Besides, two other external criteria were used to distinguish patients who improved with the treatment from those who remained stable. This classification was based on one functional independence measure (the Barthel Index) and one disability measure (the modified Rankin Scale). RESULTS There was a statistically significant correlation (Spearman's coefficient = p < 0.01) between the domains of the Spanish version of NEWSQOL in relation to the Barthel Index and the modified Rankin Scale. All domains showed between marked-to-mild change responsiveness except sleep and relationships; mobility (ES 0.66 and SRM 0.92) and activities of daily living (ES 0.75 and SRM 0.87) were markedly responsive; communication (ES 0.38 and SRM 0.61) was moderately responsive; and pain, vision, cognition, feelings, emotions and fatigue were mildly responsive (ES 0.21-0.41 and SRM 0.23-0.44). CONCLUSION The Spanish version of NEWSQOL shows between marked and mild responsiveness to measure the perception of QoL in post-stroke patients. Therefore, its use can be suitable for evaluation studies, clinical trials and clinical practice.
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Affiliation(s)
- Concepción Soto-Vidal
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Victoria Calvo-Fuente
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Alfonso Muriel-García
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | - Tomás Gallego-Izquierdo
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
| | | | - Soraya Pacheco-da-Costa
- Department of Nursing and Physiotherapy, Universidad de Alcalá, 28871 Madrid, Spain; (C.S.-V.); (A.M.-G.); (T.G.-I.); (S.P.-d.-C.)
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Zhang YH, Wang YC, Hu GW, Ding XQ, Shen XH, Yang H, Rong JF, Wang XQ. The Effects of Gender, Functional Condition, and ADL on Pressure Pain Threshold in Stroke Patients. Front Neurosci 2021; 15:705516. [PMID: 34408626 PMCID: PMC8366776 DOI: 10.3389/fnins.2021.705516] [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: 05/05/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background Somatosensory impairments and pain are common symptoms following stroke. However, the condition of perception and pain threshold for pressure stimuli and the factors that can influence this in individuals with stroke are still unclear. This study aimed to investigate the gender differences in pressure pain threshold (PPT) and positive somatosensory signs for pressure stimuli, and explore the effects of joint pain, motor function, and activities of daily living (ADL) on pain threshold in post-stroke patients. Design A cross-sectional study. Methods A total of 60 participants with stroke were recruited, and their pain condition, motor functions, and ADL were evaluated by the Fugl-Meyer assessment of joint pain scale, motor function scale, and Barthel index, respectively. PPTs in eight tested points at the affected and unaffected sides were assessed. Results Significant differences in PPTs were found between male and female patients in all measured muscles (p < 0.05). Positive somatosensory signs for pressure stimuli, including hypoalgesia and hyperalgesia, were frequently found at the affected side, particularly in the extremity muscles, but such signs were not significantly influenced by gender (p > 0.05). More equal PPTs between both sides and relatively lower PPTs at the affected side in the trunk and medial gastrocnemius muscles (p < 0.05) were observed in patients with less pain, better motor functions, and ADL. Conclusion Gender differences widely exist in post-stroke survivors either at the affected or unaffected side, which are multifactorial. Sensory loss and central and/or peripheral sensitization, such as hypoalgesia and hyperalgesia for pressure stimuli, caused by a brain lesion are common signs in male and female stroke patients. Moreover, patients who are in a better condition show a more symmetrical pain sensitivity between both sides in the trunk and in female lower extremities, indicating the bidirectional improvement of somatosensory abnormalities caused by a possible neural plasticity.
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Affiliation(s)
- Yong-Hui Zhang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Chen Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Gong-Wei Hu
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xiao-Qin Ding
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xiao-Hua Shen
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Hui Yang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ji-Feng Rong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Department of Rehabilitation Medicine, Shanghai Shangti Orthopaedic Hospital, Shanghai, China
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Carlsson H, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. SENSory re-learning of the UPPer limb (SENSUPP) after stroke: development and description of a novel intervention using the TIDieR checklist. Trials 2021; 22:430. [PMID: 34225764 PMCID: PMC8259306 DOI: 10.1186/s13063-021-05375-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention “SENSory re-learning of the UPPer limb after stroke (SENSUPP)” that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke. Methods The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used. Results The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks. Conclusion Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training. Trial registration ClinicalTrials.govNCT03336749. Registered on 8 November 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05375-6.
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Affiliation(s)
- Håkan Carlsson
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden. .,Department of Health Sciences, Lund University, Lund, Sweden.
| | - Birgitta Rosén
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anders Björkman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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Body temperature and esthesia in individuals with stroke. Sci Rep 2021; 11:10106. [PMID: 33980917 PMCID: PMC8115134 DOI: 10.1038/s41598-021-89543-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/26/2021] [Indexed: 12/29/2022] Open
Abstract
Patients with sequelae of stroke commonly report somatosensory losses. It is believed that body temperature may be associated with tactile sensibility and sensorimotor recovery of these patients. Demonstrate the associations among tactile sensibility, cutaneous temperature, subjective temperature perception, and sensorimotor recovery of patients with stroke sequelae. 86 patients with stroke sequelae were included. Patients had standardized regions of interest (ROIs) assessed with infrared thermography (FLIR T650SC) and monofilaments esthesiometry, and global motor recovery was evaluated with Fugl-Meyer Assessment (FMA). The presence of self-reported perception of temperature difference was used to divide the participants into two groups of 43 patients, and correlation tests were applied to establish correlations among variables. There is no clinically relevant association between tactile sensibility and cutaneous temperature of the foot, regardless of the subjective sensation of temperature changes. Sensorimotor recovery evaluated by FMA is associated with the difference of sensibility between both sides of the body (p < 0.001), as well as with the difference of tactile sensibility (p < 0.001). A clinically significant association between the difference of cutaneous temperature and tactile sensibility was not found, regardless of the presence or absence of subjective perception of such temperature difference. However, sensorimotor recovery is correlated with cutaneous temperature differences and tactile sensibility.
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Kessner SS, Schlemm E, Gerloff C, Thomalla G, Cheng B. Grey and white matter network disruption is associated with sensory deficits after stroke. NEUROIMAGE-CLINICAL 2021; 31:102698. [PMID: 34023668 PMCID: PMC8163991 DOI: 10.1016/j.nicl.2021.102698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/04/2022]
Abstract
Somatosensory deficits occur in about 60% of patients after ischaemic stroke. Clinical and imaging data of 101 ischaemic stroke patients were analysed. Stroke lesions may disrupt grey (GM) and/or white matter (WM) network. Lesion volume explains 23% of sensory deficit variance; GM / WM disruption adds 14% Subnetwork of postcentral, supramarginal, transverse temporal gyri involved.
Somatosensory deficits after ischaemic stroke are common and can occur in patients with lesions in the anterior parietal cortex and subcortical nuclei. It is less clear to what extent damage to white matter tracts within the somatosensory system may contribute to somatosensory deficits after stroke. We compared the roles of cortical damage and disruption of subcortical white matter tracts as correlates of somatosensory deficit after ischaemic stroke. Clinical and imaging data were assessed in incident stroke patients. Somatosensory deficits were measured using a standardized somatosensory test. Remote effects were quantified by projecting the MRI-based segmented stroke lesions onto a predefined atlas of white matter connectivity. Direct ischaemic damage to grey matter was computed by lesion overlap with grey matter areas. The association between lesion impact scores and sensory deficit was assessed statistically. In 101 patients, median sensory score was 188/193 (97.4%). Lesion volume was associated with somatosensory deficit, explaining 23.3% of variance. Beyond this, the stroke-induced grey and white matter disruption within a subnetwork of the postcentral, supramarginal, and transverse temporal gyri explained an additional 14% of the somatosensory outcome variability. On mutual comparison, white matter network disruption was a stronger predictor than grey matter damage. Ischaemic damage to both grey and white matter are structural correlates of acute somatosensory disturbance after ischaemic stroke. Our data suggest that white matter integrity of a somatosensory network of primary and secondary cortex is a prerequisite for normal processing of somatosensory inputs and might be considered as an additional parameter for stroke outcome prediction in the future.
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Affiliation(s)
- Simon S Kessner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Effects of a robot-aided somatosensory training on proprioception and motor function in stroke survivors. J Neuroeng Rehabil 2021; 18:77. [PMID: 33971912 PMCID: PMC8112068 DOI: 10.1186/s12984-021-00871-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Proprioceptive deficits after stroke are associated with poor upper limb function, slower motor recovery, and decreased self-care ability. Improving proprioception should enhance motor control in stroke survivors, but current evidence is inconclusive. Thus, this study examined whether a robot-aided somatosensory-based training requiring increasingly accurate active wrist movements improves proprioceptive acuity as well as motor performance in chronic stroke. Methods Twelve adults with chronic stroke completed a 2-day training (age range: 42–74 years; median time-after-stroke: 12 months; median Fugl–Meyer UE: 65). Retention was assessed at Day 5. Grasping the handle of a wrist-robotic exoskeleton, participants trained to roll a virtual ball to a target through continuous wrist adduction/abduction movements. During training vision was occluded, but participants received real-time, vibro-tactile feedback on their forearm about ball position and speed. Primary outcome was the just-noticeable-difference (JND) wrist position sense threshold as a measure of proprioceptive acuity. Secondary outcomes were spatial error in an untrained wrist tracing task and somatosensory-evoked potentials (SEP) as a neural correlate of proprioceptive function. Ten neurologically-intact adults were recruited to serve as non-stroke controls for matched age, gender and hand dominance (age range: 44 to 79 years; 6 women, 4 men). Results Participants significantly reduced JND thresholds at posttest and retention (Stroke group: pretest: mean: 1.77° [SD: 0.54°] to posttest mean: 1.38° [0.34°]; Control group: 1.50° [0.46°] to posttest mean: 1.45° [SD: 0.54°]; F[2,37] = 4.54, p = 0.017, ηp2 = 0.20) in both groups. A higher pretest JND threshold was associated with a higher threshold reduction at posttest and retention (r = − 0.86, − 0.90, p ≤ 0.001) among the stroke participants. Error in the untrained tracing task was reduced by 22 % at posttest, yielding an effect size of w = 0.13. Stroke participants exhibited significantly reduced P27-N30 peak-to-peak SEP amplitude at pretest (U = 11, p = 0.03) compared to the non-stroke group. SEP measures did not change systematically with training. Conclusions This study provides proof-of-concept that non-visual, proprioceptive training can induce fast, measurable improvements in proprioceptive function in chronic stroke survivors. There is encouraging but inconclusive evidence that such somatosensory learning transfers to untrained motor tasks. Trial registration Clinicaltrials.gov; Registration ID: NCT02565407; Date of registration: 01/10/2015; URL: https://clinicaltrials.gov/ct2/show/NCT02565407.
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Bernard-Espina J, Beraneck M, Maier MA, Tagliabue M. Multisensory Integration in Stroke Patients: A Theoretical Approach to Reinterpret Upper-Limb Proprioceptive Deficits and Visual Compensation. Front Neurosci 2021; 15:646698. [PMID: 33897359 PMCID: PMC8058201 DOI: 10.3389/fnins.2021.646698] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/04/2021] [Indexed: 11/29/2022] Open
Abstract
For reaching and grasping, as well as for manipulating objects, optimal hand motor control arises from the integration of multiple sources of sensory information, such as proprioception and vision. For this reason, proprioceptive deficits often observed in stroke patients have a significant impact on the integrity of motor functions. The present targeted review attempts to reanalyze previous findings about proprioceptive upper-limb deficits in stroke patients, as well as their ability to compensate for these deficits using vision. Our theoretical approach is based on two concepts: first, the description of multi-sensory integration using statistical optimization models; second, on the insight that sensory information is not only encoded in the reference frame of origin (e.g., retinal and joint space for vision and proprioception, respectively), but also in higher-order sensory spaces. Combining these two concepts within a single framework appears to account for the heterogeneity of experimental findings reported in the literature. The present analysis suggests that functional upper limb post-stroke deficits could not only be due to an impairment of the proprioceptive system per se, but also due to deficiencies of cross-references processing; that is of the ability to encode proprioceptive information in a non-joint space. The distinction between purely proprioceptive or cross-reference-related deficits can account for two experimental observations: first, one and the same patient can perform differently depending on specific proprioceptive assessments; and a given behavioral assessment results in large variability across patients. The distinction between sensory and cross-reference deficits is also supported by a targeted literature review on the relation between cerebral structure and proprioceptive function. This theoretical framework has the potential to lead to a new stratification of patients with proprioceptive deficits, and may offer a novel approach to post-stroke rehabilitation.
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Affiliation(s)
| | | | - Marc A Maier
- Université de Paris, INCC UMR 8002, CNRS, Paris, France
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Spencer J, Wolf SL, Kesar TM. Biofeedback for Post-stroke Gait Retraining: A Review of Current Evidence and Future Research Directions in the Context of Emerging Technologies. Front Neurol 2021; 12:637199. [PMID: 33859607 PMCID: PMC8042129 DOI: 10.3389/fneur.2021.637199] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/05/2021] [Indexed: 12/26/2022] Open
Abstract
Real-time gait biofeedback is a promising rehabilitation strategy for improving biomechanical deficits in walking patterns of post-stroke individuals. Because wearable sensor technologies are creating avenues for novel applications of gait biofeedback, including use in tele-health, there is a need to evaluate the state of the current evidence regarding the effectiveness of biofeedback for post-stroke gait training. The objectives of this review are to: (1) evaluate the current state of biofeedback literature pertaining to post-stroke gait training; and (2) determine future research directions related to gait biofeedback in context of evolving technologies. Our overall goal was to determine whether gait biofeedback is effective at improving stroke gait deficits while also probing why and for whom gait biofeedback may be an efficacious treatment modality. Our literature review showed that the effects of gait biofeedback on post-stroke walking dysfunction are promising but are inconsistent in methodology and therefore results. We summarize sources of methodological heterogeneity in previous literature, such as inconsistencies in feedback target, feedback mode, dosage, practice structure, feedback structure, and patient characteristics. There is a need for larger-sample studies that directly compare different feedback parameters, employ more uniform experimental designs, and evaluate characteristics of potential responders. However, as these uncertainties in existing literature are resolved, the application of gait biofeedback has potential to extend neurorehabilitation clinicians' cues to individuals with post-stroke gait deficits during ambulation in clinical, home, and community settings, thereby increasing the quantity and quality of skilled repetitions during task-oriented stepping training. In addition to identifying gaps in previous research, we posit that future research directions should comprise an amalgam of mechanism-focused and clinical research studies, to develop evidence-informed decision-making guidelines for gait biofeedback strategies that are tailored to individual-specific gait and sensorimotor impairments. Wearable sensor technologies have the potential to transform gait biofeedback and provide greater access and wider array of options for clinicians while lowering rehabilitation costs. Novel sensing technologies will be particularly valuable for telehealth and home-based stepping exercise programs. In summary, gait biofeedback is a promising intervention strategy that can enhance efficacy of post-stroke gait rehabilitation in both clinical and tele-rehabilitation settings and warrants more in-depth research.
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Affiliation(s)
- Jacob Spencer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Steven L. Wolf
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Cell Biology, Emory University School of Medicine, Atlanta, GA, United States
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, GA, United States
| | - Trisha M. Kesar
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
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