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Assadi Khalil S, Kim GJ, Rand D. Comparison of Upper Extremity Function and Daily Use in Individuals with and without Post Stroke Depression. Neurorehabil Neural Repair 2024; 38:99-108. [PMID: 38078457 PMCID: PMC10874110 DOI: 10.1177/15459683231215332] [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: 02/18/2024]
Abstract
BACKGROUND Post-stroke depression (PSD) is a frequent psychiatric complication, however very few studies have investigated its relation to the affected upper extremity (UE) post-stroke. Objective. To compare the affected UE in terms of motor impairment, functional ability, and daily-use in individuals with and without PSD during the first 6 months post-stroke. METHODS This study analyzed data from a previous cohort; participants were assessed at rehabilitation admission (T1), 6 weeks (T2), and 6 months (T3) post-stroke. At each time point we compared between participants with and without PSD (Geriatric Depression Scale score ≥ 5). The Fugl-Meyer Motor Assessment assessed motor impairment, Action Research Arm Test assessed functional ability, and the Rating of Everyday Arm-Use in the Community and Home assessed daily-use. Independence in daily activities and cognition were also assessed. RESULTS A total of 116 participants were recruited, 38% had PSD at T1. No significant differences were found between groups at T1 and T2. However, significant differences (z = -5.23 to -2.66, p < .01) were found between groups for all UE measures at T3; participants with PSD had lower motor and functional ability and less daily hand-use than participants without PSD. At T3 participants with PSD were also less independent in daily-living. CONCLUSIONS PSD is associated with greater UE motor, functional, and daily-use disability at 6 months post-stroke. Our findings underscore the negative impact of PSD on UE during the crucial transition period when individuals return home and integrate back into the community. Further research is needed to delineate the effect of change in PSD status on UE outcomes post stroke.
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Affiliation(s)
- Samar Assadi Khalil
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Grace J. Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY, USA
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhao Z, Wu J, Fan M, Yin D, Tang C, Gong J, Xu G, Gao X, Yu Q, Yang H, Sun L, Jia J. Altered intra- and inter-network functional coupling of resting-state networks associated with motor dysfunction in stroke. Hum Brain Mapp 2018; 39:3388-3397. [PMID: 29691945 DOI: 10.1002/hbm.24183] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/20/2018] [Accepted: 04/06/2018] [Indexed: 12/18/2022] Open
Abstract
Motor functions are supported through functional integration across the extended motor system network. Individuals following stroke often show deficits on motor performance requiring coordination of multiple brain networks; however, the assessment of connectivity patterns after stroke was still unclear. This study aimed to investigate the changes in intra- and inter-network functional connectivity (FC) of multiple networks following stroke and further correlate FC with motor performance. Thirty-three left subcortical chronic stroke patients and 34 healthy controls underwent resting-state functional magnetic resonance imaging. Eleven resting-state networks were identified via independent component analysis (ICA). Compared with healthy controls, the stroke group showed abnormal FC within the motor network (MN), visual network (VN), dorsal attention network (DAN), and executive control network (ECN). Additionally, the FC values of the ipsilesional inferior parietal lobule (IPL) within the ECN were negatively correlated with the Fugl-Meyer Assessment (FMA) scores (hand + wrist). With respect to inter-network interactions, the ipsilesional frontoparietal network (FPN) decreased FC with the MN and DAN; the contralesional FPN decreased FC with the ECN, but it increased FC with the default mode network (DMN); and the posterior DMN decreased FC with the VN. In sum, this study demonstrated the coexistence of intra- and inter-network alterations associated with motor-visual attention and high-order cognitive control function in chronic stroke, which might provide insights into brain network plasticity following stroke.
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Affiliation(s)
- Zhiyong Zhao
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Jie Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Mingxia Fan
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Dazhi Yin
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Chaozheng Tang
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jiayu Gong
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Guojun Xu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Xinjie Gao
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Qiurong Yu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Hao Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, 200062, China
| | - Limin Sun
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jie Jia
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, 200040, China
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Subramanian SK, Chilingaryan G, Sveistrup H, Levin MF. Depressive symptoms influence use of feedback for motor learning and recovery in chronic stroke. Restor Neurol Neurosci 2016; 33:727-40. [PMID: 26444639 DOI: 10.3233/rnn-150508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Sensorimotor impairments and depressive symptoms (PSD) influence arm motor recovery post-stroke. Feedback provision improves upper limb motor learning in patients with chronic stroke but factors including PSD may affect ability to use feedback. We evaluated the influence of PSD on the ability to use auditory feedback for upper limb recovery and motor learning in patients with chronic stroke. METHODS Participants (n = 24) practiced 72 pointing movements/session (6 targets, 12 sessions, randomized) with auditory feedback on movement speed and trunk displacement. The presence of PSD (Beck's Depression Inventory; BDI-II) was assessed at pre-intervention (PRE). Arm motor impairment (Fugl-Meyer Assessment, shoulder horizontal adduction, shoulder flexion, elbow extension ranges, trunk displacement) and arm use (Motor Activity Log) were assessed at PRE, immediately after (POST) and retention (3 mos; RET). Participants were divided into two groups based on BDI-II scores: ≥ 14/63 (DEP group; n = 8; score: 20.5 ± 7.5) and ≤ 13/63 (no PSD (ND) group; n = 16; score: 5.0 ± 3.8). Changes in impairment and arm use levels were assessed (mixed-model ANOVAs). RESULTS All participants improved arm use. DEP had lower Fugl-Meyer scores, used more compensatory trunk displacement and had lower shoulder horizontal adduction range compared to ND. CONCLUSION The presence of PSD diminished the ability to use auditory feedback for arm motor recovery and motor learning.
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Affiliation(s)
- Sandeep K Subramanian
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Gevorg Chilingaryan
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Heidi Sveistrup
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.,Feil-Oberfeld Research Centre, Jewish Rehabilitation Hospital site of Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
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Mullick AA, Subramanian SK, Levin MF. Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: A meta-analysis. Restor Neurol Neurosci 2016; 33:389-403. [PMID: 26410581 PMCID: PMC4923759 DOI: 10.3233/rnn-150510] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: Motor and cognitive impairments are common and often coexist in patients with stroke. Although evidence is emerging about specific relationships between cognitive deficits and upper-limb motor recovery, the practical implication of these relationships for rehabilitation is unclear. Using a structured review and meta-analyses, we examined the nature and strength of the associations between cognitive deficits and upper-limb motor recovery in studies of patients with stroke. Methods: Motor recovery was defined using measures of upper limb motor impairment and/or activity limitations. Studies were included if they reported on at least one measure of cognitive function and one measure of upper limb motor impairment or function. Results: Six studies met the selection criteria. There was a moderate association (r = 0.43; confidence interval; CI:0.09– 0.68, p = 0.014) between cognition and overall arm motor recovery. Separate meta-analyses showed a moderately strong association between executive function and motor recovery (r = 0.48; CI:0.26– 0.65; p < 0.001), a weak positive correlation between attention and motor recovery (r = 0.25; CI:0.04– 0.45; p = 0.023), and no correlation between memory and motor recovery (r = 0.42; CI:0.16– 0.79; p = 0.14). Conclusion: These results imply that information on the presence of cognitive deficits should be considered while planning interventions for clients in order to design more personalized interventions tailored to the individual for maximizing upper-limb recovery.
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Affiliation(s)
- Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada
| | - Sandeep K Subramanian
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada.,Département de neurosciences, Université de Montréal, Montreal, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada.,Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Laval, Canada
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Arm and trunk movement kinematics during seated reaching within and beyond arm's length in people with stroke: a validity study. Phys Ther 2014; 94:845-56. [PMID: 24481598 DOI: 10.2522/ptj.20130101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Kinematic analysis is commonly used to objectively measure upper extremity movement performance after stroke. However, the concurrent validity and predictive validity of arm-trunk kinematics during reaching within and beyond arm's length have not been studied. OBJECTIVE The aim of this study was to estimate the concurrent validity of kinematic measures before and after treatment and the predictive validity for reaching within and beyond arm's length after stroke. DESIGN This was a secondary analysis study. METHODS Ninety-seven participants with stroke (mean age=55.9 years [SD=10.9]) received intensive treatment every weekday for 3 to 4 weeks. Kinematic reaching tasks and the Wolf Motor Function Test (WMFT) were used before and after treatment. The validity of the kinematic measures was estimated in relation to WMFT scores. RESULTS Of the 8 kinematic variables that were measured, index movement time before treatment (R2=.227-.362) and trunk movement time and trunk displacement after treatment (R2=.095-.346) had the strongest association with the WMFT at both reaching distances. Trunk movement time and trunk displacement before treatment explained 6.9% to 14.9% of the variance in the WMFT after treatment. Kinematic variables explained 6.9% to 49.3% and 9.4% to 38.7% of the variance in the WMFT during a task within arm's length and beyond arm's length, respectively. LIMITATIONS The study has limited generalizability. CONCLUSIONS Different kinematic variables may partially reflect motor function before and after treatment to a limited degree. Although the predictive validity was modest, trunk movement may be considered a prognostic determinant of motor function after treatment. A reaching task within arm's length may be a more suitable measure of kinematic performance for describing motor function than a reaching task beyond arm's length.
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