1
|
Chen S, Mao M, Zhu G, Chen Y, Qiu Y, Ye B, Xu D. Cortical activity in patients with high-functioning ischemic stroke during the Purdue Pegboard Test: insights into bimanual coordinated fine motor skills with functional near-infrared spectroscopy. Neural Regen Res 2024; 19:1098-1104. [PMID: 37862214 PMCID: PMC10749618 DOI: 10.4103/1673-5374.385312] [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: 03/08/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 10/22/2023] Open
Abstract
After stroke, even high-functioning individuals may experience compromised bimanual coordination and fine motor dexterity, leading to reduced functional independence. Bilateral arm training has been proposed as a promising intervention to address these deficits. However, the neural basis of the impairment of functional fine motor skills and their relationship to bimanual coordination performance in stroke patients remains unclear, limiting the development of more targeted interventions. To address this gap, our study employed functional near-infrared spectroscopy to investigate cortical responses in patients after stroke as they perform functional tasks that engage fine motor control and coordination. Twenty-four high-functioning patients with ischemic stroke (7 women, 17 men; mean age 64.75 ± 10.84 years) participated in this cross-sectional observational study and completed four subtasks from the Purdue Pegboard Test, which measures unimanual and bimanual finger and hand dexterity. We found significant bilateral activation of the sensorimotor cortices during all Purdue Pegboard Test subtasks, with bimanual tasks inducing higher cortical activation than the assembly subtask. Importantly, patients with better bimanual coordination exhibited lower cortical activation during the other three Purdue Pegboard Test subtasks. Notably, the observed neural response patterns varied depending on the specific subtask. In the unaffected hand task, the differences were primarily observed in the ipsilesional hemisphere. In contrast, the bilateral sensorimotor cortices and the contralesional hemisphere played a more prominent role in the bimanual task and assembly task, respectively. While significant correlations were found between cortical activation and unimanual tasks, no significant correlations were observed with bimanual tasks. This study provides insights into the neural basis of bimanual coordination and fine motor skills in high-functioning patients after stroke, highlighting task-dependent neural responses. The findings also suggest that patients who exhibit better bimanual performance demonstrate more efficient cortical activation. Therefore, incorporating bilateral arm training in post-stroke rehabilitation is important for better outcomes. The combination of functional near-infrared spectroscopy with functional motor paradigms is valuable for assessing skills and developing targeted interventions in stroke rehabilitation.
Collapse
Affiliation(s)
- Siyun Chen
- The Second Rehabilitation Hospital of Shanghai, Shanghai, China
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Mengchai Mao
- The Second Rehabilitation Hospital of Shanghai, Shanghai, China
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Guangyue Zhu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yufeng Chen
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuqi Qiu
- School of Statistics, East China Normal University, Shanghai, China
| | - Bin Ye
- The Third Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Dongsheng Xu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Tongji University, Shanghai, China
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
2
|
Bhat SG, Shin AY, Kaufman KR. Upper extremity asymmetry due to nerve injuries or central neurologic conditions: a scoping review. J Neuroeng Rehabil 2023; 20:151. [PMID: 37940959 PMCID: PMC10634143 DOI: 10.1186/s12984-023-01277-7] [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: 10/21/2022] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions. METHOD An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles. RESULTS Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period. CONCLUSION Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.
Collapse
Affiliation(s)
- Sandesh G Bhat
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alexander Y Shin
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kenton R Kaufman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
- Motion Analysis Laboratory, Mayo Clinic, DAHLC 4-214A, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
3
|
Johnson T, Ridgeway G, Luchmee D, Jacob J, Kantak S. Bimanual coordination during reach-to-grasp actions is sensitive to task goal with distinctions between left- and right-hemispheric stroke. Exp Brain Res 2022; 240:2359-2373. [PMID: 35869986 PMCID: PMC10077867 DOI: 10.1007/s00221-022-06419-2] [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: 10/19/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
The perceptual feature of a task such as how a task goal is perceived influences performance and coordination of bimanual actions in neurotypical adults. To assess how bimanual task goal modifies paretic and non-paretic arm performance and bimanual coordination in individuals with stroke affecting left and right hemispheres, 30 participants with hemispheric stroke (15 right-hemisphere damage-RHD); 15 left-hemisphere damage-LHD) and 10 age-matched controls performed reach-to-grasp and pick-up actions under bimanual common-goal (i.e., two physically coupled dowels), bimanual independent-goal (two physically uncoupled dowels), and unimanual conditions. Reach-to-grasp time and peak grasp aperture indexed motor performance, while time lags between peak reach velocities, peak grasp apertures, and peak pick-up velocities of the two hands characterized reach, grasp, and pick-up coordination, respectively. Compared to unimanual actions, bimanual actions significantly slowed non-paretic arm speed to match paretic arm speed, thus affording no benefit to paretic arm performance. Detriments in non-paretic arm performance during bimanual actions was more pronounced in the RHD group. Under common-goal conditions, movements were faster with smaller peak grasp apertures compared to independent-goal conditions for all groups. Compared to controls, individuals with stroke demonstrated poor grasp and pick-up coordination. Of the patient groups, patients with LHD showed more pronounced deficits in grasp coordination between hands. Finally, grasp coordination deficits related to paretic arm motor deficits (upper extremity Fugl-Meyer score) for LHD group, and to Trail-Making Test performance for RHD group. Findings suggest that task goal and distinct clinical deficits influence bimanual performance and coordination in patients with left- and right-hemispheric stroke.
Collapse
Affiliation(s)
- Tessa Johnson
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Gordon Ridgeway
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Dustin Luchmee
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Joshua Jacob
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Shailesh Kantak
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA.
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
| |
Collapse
|
4
|
Object-centered sensorimotor bias of torque control in the chronic stage following stroke. Sci Rep 2022; 12:14539. [PMID: 36008561 PMCID: PMC9411611 DOI: 10.1038/s41598-022-18754-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022] Open
Abstract
When lifting objects whose center of mass (CoM) are not centered below the handle one must compensate for arising external torques already at lift-off to avoid object tilt. Previous studies showed that finger force scaling during object lifting may be impaired at both hands following stroke. However, torque control in object manipulation has not yet been studied in patients with stroke. In this pilot study, thirteen patients with chronic stage left hemispheric stroke (SL), nine patients with right hemispheric stroke (SR) and hand-matched controls had to grasp and lift an object with the fingertips of their ipsilesional hand at a handle while preventing object tilt. Object CoM and therewith the external torque was varied by either relocating a covert weight or the handle. The compensatory torque at lift-off (Tcom) is the sum of the torque resulting from (1) grip force being produced at different vertical finger positions (∆CoP × GF) and (2) different vertical load forces on both sides of the handle (∆Fy × w/2). When having to rely on sensorimotor memories, ∆CoP × GF was elevated when the object CoM was on the ipsilesional-, but decreased when CoM was on the contralesional side in SL, whereas ∆Fy × w/2 was biased in the opposite direction, resulting in normal Tcom. SR patients applied a smaller ∆CoP × GF when the CoM was on the contralesional side. Torques were not altered when geometric cues were available. Our findings provide evidence for an object-centered spatial bias of manual sensorimotor torque control with the ipsilesional hand following stroke reminiscent of premotor neglect. Both intact finger force-to-position coordination and visuomotor control may compensate for the spatial sensorimotor bias in most stroke patients. Future studies will have to confirm the found bias and evaluate the association with premotor neglect.
Collapse
|
5
|
Johnson BP, Whitall J, McCombe Waller S, Westlake KP. Development and Psychometric Testing of the Bimanual Assessment Measure for People With Chronic Stroke. Am J Occup Ther 2022; 76:23287. [PMID: 35671509 DOI: 10.5014/ajot.2022.048995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Few tools are available to assess bimanual deficits after stroke. OBJECTIVE To develop the Bimanual Assessment Measure (BAM), which assesses a person's hand coordination in both preferred and prestroke roles (i.e., stabilizer or manipulator). DESIGN Development and psychometric testing of the BAM. SETTING Research laboratory. PARTICIPANTS People with chronic stroke (n = 24), age-matched controls (n = 23), and occupational therapists (n = 40). OUTCOMES AND MEASURES We assessed the BAM's internal consistency, reliability, and face and known-groups validity. RESULTS Items were selected as meaningful tasks that represented a range of bimanual coordination requirements (e.g., symmetrical forces and timing, asymmetrical forces and timing, time-limited reactive movement). Focus groups of people with stroke and occupational therapists provided input into BAM development. The BAM was found to have excellent reliability and internal consistency and face and known-groups validity. CONCLUSIONS AND RELEVANCE The BAM is a valid, reliable measure for people with chronic stroke that identifies bimanual coordination deficits beyond unimanual impairments and the potential capacity for people to return to prestroke hand roles (i.e., as a manipulator). What This Article Adds: This article introduces the BAM as a new assessment measure of bimanual functioning with the potential capacity to restore prestroke hand roles as either a manipulator or a stabilizer among people with chronic stroke.
Collapse
Affiliation(s)
- Brian P Johnson
- Brian P. Johnson, PhD, OTR/L, is Postdoctoral Fellow, Human Cortical Physiology and Neurorehabilitation Section, National Institute on Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jill Whitall
- Jill Whitall, PhD, is Professor Emerita, Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore
| | - Sandy McCombe Waller
- Sandy McCombe Waller, PhD, PT, is Associate Vice President and Dean of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD
| | - Kelly P Westlake
- Kelly P. Westlake, PhD, PT, is Associate Professor, Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore;
| |
Collapse
|
6
|
Liu J, Wang C, Cheng J, Miao P, Li Z. Dynamic Relationship Between Interhemispheric Functional Connectivity and Corticospinal Tract Changing Pattern After Subcortical Stroke. Front Aging Neurosci 2022; 14:870718. [PMID: 35601612 PMCID: PMC9120434 DOI: 10.3389/fnagi.2022.870718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeIncreased interhemispheric resting-state functional connectivity (rsFC) between the bilateral primary motor cortex (M1) compensates for corticospinal tract (CST) impairment, which facilitates motor recovery in chronic subcortical stroke. However, there is a lack of data on the evolution patterns and correlations between M1–M1 rsFC and diffusion indices of CSTs with different origins after subcortical stroke and their relations with long-term motor outcomes.MethodsA total of 44 patients with subcortical stroke underwent longitudinal structural and functional magnetic resonance imaging (MRI) examinations and clinical assessments at four time points. Diffusion tensor imaging was used to extract fractional anisotropy (FA) values of the affected CSTs with different origins. Resting-state functional MRI was used to calculate the M1–M1 rsFC. Longitudinal patterns of functional and anatomic changes in connections were explored using a linear mixed-effects model. Dynamic relationships between M1–M1 rsFC and FA values of the affected specific CSTs and the impact of these variations on the long-term motor outcomes were analyzed in patients with subcortical stroke.ResultsStroke patients showed a significantly decreased FA in the affected specific CSTs and a gradually increasing M1–M1 rsFC from the acute to the chronic stage. The FA of the affected M1 fiber was negatively correlated with the M1–M1 rsFC from the subacute to the chronic stage, FA of the affected supplementary motor area fiber was negatively correlated with the M1–M1 rsFC in the subacute stage, and FA of the affected M1 fiber in the acute stage was correlated with the long-term motor recovery after subcortical stroke.ConclusionOur findings show that the FA of the affected M1 fiber in the acute stage had the most significant correlation with long-term motor recovery and may be used as an imaging biomarker for predicting motor outcomes after stroke. The compensatory role of the M1–M1 rsFC enhancement may start from the subacute stage in stroke patients with CST impairment.
Collapse
Affiliation(s)
- Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
- Jingchun Liu
| | - Caihong Wang
- Department of MRI, Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Caihong Wang
| | - Jingliang Cheng
- Department of MRI, Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Peifang Miao
- Department of MRI, Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhen Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
7
|
Liu J, Wang C. Microstructure and Genetic Polymorphisms: Role in Motor Rehabilitation After Subcortical Stroke. Front Aging Neurosci 2022; 14:813756. [PMID: 35177977 PMCID: PMC8843845 DOI: 10.3389/fnagi.2022.813756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/07/2022] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose: Motor deficits are the most common disability after stroke, and early prediction of motor outcomes is critical for guiding the choice of early interventions. Two main factors that may impact the response to rehabilitation are variations in the microstructure of the affected corticospinal tract (CST) and genetic polymorphisms in brain-derived neurotrophic factor (BDNF). The purpose of this article was to review the role of these factors in stroke recovery, which will be useful for constructing a predictive model of rehabilitation outcomes.Summary of Review: We review the microstructure of the CST, including its origins in the primary motor area (M1), primary sensory area (S1), premotor cortex (PMC), and supplementary motor area (SMA). Damage to these fibers is disease-causing and can directly affect rehabilitation after subcortical stroke. BDNF polymorphisms are not disease-causing but can indirectly affect neuroplasticity and thus motor recovery. Both factors are known to be correlated with motor recovery. Further work is needed using large longitudinal patient samples and animal experiments to better establish the role of these two factors in stroke rehabilitation.Conclusions: Microstructure and genetic polymorphisms should be considered possible predictors or covariates in studies investigating motor recovery after subcortical stroke. Future predictive models of stroke recovery will likely include a combination of structural and genetic factors to allow precise individualization of stroke rehabilitation strategies.
Collapse
Affiliation(s)
- Jingchun Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Caihong Wang
- Department of MRI, Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Caihong Wang
| |
Collapse
|