1
|
Goubier JN, Battiston B, Casanas J, Quick T. Adult traumatic brachial plexus injuries: advances and current updates. J Hand Surg Eur Vol 2024; 49:734-746. [PMID: 38366385 DOI: 10.1177/17531934241229201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Nerve grafting, tendon transfer and joint fusion are routinely used to improve the upper limb function in patients with brachial plexus palsies. Newer techniques have been developed that provide additional options for reconstruction. Nerve transfer is a tool for restoring upper limb function in total root avulsions where nerve grafting is not possible. In partial brachial plexus injuries, nerve transfers can greatly improve shoulder, elbow, wrist and hand function. Intraoperative electrical stimulation can be used to diagnose precisely which nerve is injured and to choose which nerve fascicles should be transferred. Finally, measuring the postoperative outcome can improve the evaluation of our techniques. The aim of this article was to present the current techniques used to treat patients with brachial plexus injury.
Collapse
Affiliation(s)
- Jean-Noel Goubier
- Brachial Plexus and Nerve Surgery Institute, Paris, France
- Hôpital Privé Paul d'Égine, Clinique la Francilienne, Champigny sur Marne, France
- Institut de la Main, Clinique Bizet, Paris, France
| | - Bruno Battiston
- UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Tom Quick
- Institute of Orthopaedics and Musculoskeletal Science, University College London, London, UK
- Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK
- Centre for Nerve Engineering, University College London, London, UK
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Pennington A, Ramakrishnan V, Scronce G, Coupland K, Vatinno AA, Seo NJ. Effect of Using TheraBracelet on Grasping versus Reaching in Poststroke Rehabilitation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023; 43:702-709. [PMID: 36757086 PMCID: PMC10409869 DOI: 10.1177/15394492231151887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A peripheral sensory stimulation named TheraBracelet has recently been shown to have a potential to improve gross manual dexterity following stroke. Upper limb function requires both reach and grasp. It is unknown whether TheraBracelet affects one more than other. The objective of this study was to determine whether TheraBracelet improves reaching versus grasping. In a pilot randomized controlled trial, persons with stroke received TheraBracelet (treatment) or no stimulation (control) during task practice therapy (n = 6/group). Effects of TheraBracelet on reaching versus grasping were determined using breakdown of movement times in the Box and Block Test video recordings. Improvements in movement times for the treatment compared with control group were more pronounced for grasping than for reaching at both post and follow-up time points. TheraBracelet may be beneficial for persons with grasping deficits. This knowledge can guide clinicians for targeted use of TheraBracelet, resulting in effective implementation of the new treatment.
Collapse
Affiliation(s)
- Allison Pennington
- Division of Occupational Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Gabrielle Scronce
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Kristen Coupland
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Amanda A. Vatinno
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Na Jin Seo
- Division of Occupational Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Ralph H. Johnson VA Medical Center, Charleston, SC
| |
Collapse
|
4
|
Baker A, Schranz C, Seo NJ. Associating Functional Neural Connectivity and Specific Aspects of Sensorimotor Control in Chronic Stroke. SENSORS (BASEL, SWITZERLAND) 2023; 23:5398. [PMID: 37420566 DOI: 10.3390/s23125398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
Hand sensorimotor deficits often result from stroke, limiting the ability to perform daily living activities. Sensorimotor deficits are heterogeneous among stroke survivors. Previous work suggests a cause of hand deficits is altered neural connectivity. However, the relationships between neural connectivity and specific aspects of sensorimotor control have seldom been explored. Understanding these relationships is important for developing personalized rehabilitation strategies to improve individual patients' specific sensorimotor deficits and, thus, rehabilitation outcomes. Here, we investigated the hypothesis that specific aspects of sensorimotor control will be associated with distinct neural connectivity in chronic stroke survivors. Twelve chronic stroke survivors performed a paretic hand grip-and-relax task while EEG was collected. Four aspects of hand sensorimotor grip control were extracted, including reaction time, relaxation time, force magnitude control, and force direction control. EEG source connectivity in the bilateral sensorimotor regions was calculated in α and β frequency bands during grip preparation and execution. Each of the four hand grip measures was significantly associated with a distinct connectivity measure. These results support further investigations into functional neural connectivity signatures that explain various aspects of sensorimotor control, to assist the development of personalized rehabilitation that targets the specific brain networks responsible for the individuals' distinct sensorimotor deficits.
Collapse
Affiliation(s)
- Adam Baker
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St., Charleston, SC 29425, USA
| | - Christian Schranz
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St., Charleston, SC 29425, USA
| | - Na Jin Seo
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President St., Charleston, SC 29425, USA
- Division of Occupational Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, 151B Rutledge Ave., Charleston, SC 29425, USA
- Ralph H. Johnson VA Health Care System, 109 Bee St., Charleston, SC 29425, USA
| |
Collapse
|
5
|
Judy LM, Morrow C, Seo NJ. Development and evaluation of an efficient training program to facilitate the adoption of a novel neurorehabilitation device. J Rehabil Assist Technol Eng 2023; 10:20556683231158552. [PMID: 36818163 PMCID: PMC9932764 DOI: 10.1177/20556683231158552] [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: 10/14/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
Many rehabilitation devices are not adopted by therapists in practice. One major barrier is therapists' limited time and resources to get training. The objective of this study was to develop/evaluate an efficient training program for a novel rehabilitation device. The program was developed based on structured interviews with seven therapists for training preference and composed of asynchronous and in-person trainings following efficient teaching methods. The training program was evaluated for six occupational therapy doctoral students and six licensed therapists in neurorehabilitation practice. Training effectiveness was evaluated in a simulated treatment session in which 3 trainees shifted their roles among therapist applying the device, client, and peer assessor. In results, 11 of the 12 trainees passed the assessment of using the device in simulated treatment sessions. One trainee did not pass because s/he did not plug in the device to charge at the end. The in-person training fit within 1-h lunch break. All trainees perceived that they could effectively use the device in their practice and both asynchronous and in-person training easily fit into their schedule. This project serves as an example for development of an efficient and effective training program for a novel rehabilitation device to facilitate clinical adoption.
Collapse
Affiliation(s)
- Laura M Judy
- Division of Occupational Therapy,
Department of Rehabilitation Sciences, Medical University of South
Carolina, Charleston, SC, USA
| | - Corey Morrow
- Department of Health Sciences and
Research, College of Health Professions, Medical University of South
Carolina, Charleston, SC, USA
| | - Na Jin Seo
- Division of Occupational Therapy,
Department of Rehabilitation Sciences, Medical University of South
Carolina, Charleston, SC, USA,Department of Health Sciences and
Research, College of Health Professions, Medical University of South
Carolina, Charleston, SC, USA,Ralph H. Johnson VA Health Care
System, Charleston, SC, USA,Na J Seo, Division of Occupational Therapy,
Department of Rehabilitation Sciences, Medical University of South Carolina, 77
President Street, Charleston, SC 29425, USA.
| |
Collapse
|
6
|
Osumi M, Sumitani M, Otake Y, Nishi Y, Nobusako S, Morioka S. Influence of vibrotactile random noise on the smoothness of the grasp movement in patients with chemotherapy-induced peripheral neuropathy. Exp Brain Res 2023; 241:407-415. [PMID: 36565342 DOI: 10.1007/s00221-022-06532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/12/2022] [Indexed: 12/25/2022]
Abstract
Patients with chemotherapy-induced peripheral neuropathy (CIPN) often suffer from sensorimotor dysfunction of the distal portion of the extremities (e.g., loss of somatosensory sensation, numbness/tingling, difficulty typing on a keyboard, or difficulty buttoning/unbuttoning a shirt). The present study aimed to reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor dysfunction in CIPN patients without exacerbating symptoms. Twenty-five patients with CIPN and 28 age-matched healthy adults participated in this study. To reveal the effects of subthreshold vibrotactile random noise stimulation on sensorimotor function, participants were asked to perform a tactile detection task and a grasp movement task during random noise stimulation delivered to the volar and dorsal wrist. We set three intensity conditions of the vibrotactile random noise: 0, 60, and 120% of the sensory threshold (Noise 0%, Noise 60%, and Noise 120% conditions). In the tactile detection task, a Semmes-Weinstein monofilament was applied to the volar surface of the tip of the index finger using standard testing measures. In the grasp movement task, the distance between the thumb and index finger was recorded while the participant attempted to grasp a target object, and the smoothness of the grasp movement was quantified by calculating normalized jerk in each experimental condition. The experimental data were compared using two-way repeated-measures analyses of variance with two factors: experimental condition (Noise 0, 60, 120%) × group (Healthy controls, CIPN patients). The tactile detection threshold and the smoothness of the grasp movement were only improved in the Noise 60% condition without exacerbating numbness/tingling in CIPN patients and healthy controls. The current study suggested that the development of treatment devices using stochastic resonance can improve sensorimotor function for CIPN patients.
Collapse
Affiliation(s)
- Michihiro Osumi
- Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan. .,Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Kitakatsuragi-Gun, Nara, 635-0832, Japan.
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yuko Otake
- Department of Physical Therapy, Faculty of Human Care at Makuhari, Tohto University, 1-3 Nakase, Mihamaku, Chiba, 261-850, Japan
| | - Yuki Nishi
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Kitakatsuragi-Gun, Nara, 635-0832, Japan
| | - Satoshi Nobusako
- Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan.,Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Kitakatsuragi-Gun, Nara, 635-0832, Japan
| | - Shu Morioka
- Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Koryo-Cho, Kitakatsuragi-Gun, Nara, 635-0832, Japan.,Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Kitakatsuragi-Gun, Nara, 635-0832, Japan
| |
Collapse
|
7
|
Scronce G, Ramakrishnan V, Vatinno AA, Seo NJ. Effect of Self-Directed Home Therapy Adherence Combined with TheraBracelet on Poststroke Hand Recovery: A Pilot Study. Stroke Res Treat 2023; 2023:3682898. [PMID: 36936523 PMCID: PMC10017223 DOI: 10.1155/2023/3682898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/26/2023] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
Hand impairment is a common consequence of stroke, resulting in long-term disability and reduced quality of life. Recovery may be augmented through self-directed therapy activities at home, complemented by the use of rehabilitation devices such as peripheral sensory stimulation. The objective of this study was to determine the effect of adherence to self-directed therapy and the use of TheraBracelet (subsensory random-frequency vibratory stimulation) on hand function for stroke survivors. In a double-blind, randomized controlled pilot trial, 12 chronic stroke survivors were assigned to a treatment or control group (n = 6/group). All participants were instructed to perform 200 repetitions of therapeutic hand tasks 5 days/week while wearing a wrist-worn device 8 hours/day for 4 weeks. The treatment group received TheraBracelet vibration from the device, while the control group received no vibration. Home task repetition adherence and device wear logs, as well as hand function assessment (Stroke Impact Scale Hand domain), were obtained weekly. Repetition adherence was comparable between groups but varied among participants. Participants wore the device to a greater extent than adhering to completing repetitions. A linear mixed model analysis showed a significant interaction between repetition and group (p = 0.01), with greater adherence resulting in greater hand function change for the treatment group (r = 0.94; R 2 = 0.88), but not for the control group. Secondary analysis revealed that repetition adherence was greater for those with lower motor capacity and greater self-efficacy at baseline. This pilot study suggests that adherence to self-directed therapy at home combined with subsensory stimulation may affect recovery outcomes in stroke survivors. This trial is registered with NCT04026399.
Collapse
Affiliation(s)
- Gabrielle Scronce
- 1Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- 2Ralph H. Johnson VA Health Care System, Charleston, SC, USA
| | - Viswanathan Ramakrishnan
- 3Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda A. Vatinno
- 1Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Na Jin Seo
- 1Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- 2Ralph H. Johnson VA Health Care System, Charleston, SC, USA
- 4Division of Occupational Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
8
|
Blaschke J, Vatinno A, Scronce G, Ramakrishnan V, Seo NJ. Effect of Sensory Impairment on Hand Functional Improvement with Therapy and Sensory Stimulation. NEUROLOGY AND NEUROREHABILITATION 2022; 4:1-4. [PMID: 36780248 PMCID: PMC9918228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Sensory impairment may impact individual stroke survivors' motor recovery as well as their response to peripheral sensory stimulation treatment. The objective of this study was to determine the effect of sensory impairment level of individual stroke survivors on motor improvement with therapy and peripheral sensory stimulation. A secondary analysis of a pilot triple-blind randomized controlled trial was used. Twelve chronic stroke survivors were randomly assigned to the treatment group receiving peripheral sensory stimulation or the control group receiving no stimulation during 2-week hand task practice therapy. Sensory impairment level was quantified as the pre-intervention sensory threshold. Motor improvement was assessed as change in the Box and Block Test score from pre- to post-intervention. The association between sensory impairment level and motor improvement was examined using a regression analysis, accounting for groups. This study found that participants with better sensation (i.e., with lower sensory threshold) had better motor improvement than patients with worse sensation (i.e., with higher sensory threshold). Sensory impairment level did not alter the effect of peripheral sensory stimulation. These findings suggest that the level of sensory impairment may predict recovery potentials and direct rehabilitation treatment for stroke survivors.
Collapse
Affiliation(s)
- Jenna Blaschke
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Amanda Vatinno
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Gabrielle Scronce
- Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA
| | | | - Na Jin Seo
- Department of Rehabilitation Sciences, Medical University of South Carolina, Charleston, SC, USA,Department of Health Science and Research, Medical University of South Carolina, Charleston, SC, USA,Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| |
Collapse
|