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Dexheimer B, Sainburg R, Sharp S, Philip BA. Roles of Handedness and Hemispheric Lateralization: Implications for Rehabilitation of the Central and Peripheral Nervous Systems: A Rapid Review. Am J Occup Ther 2024; 78:7802180120. [PMID: 38305818 PMCID: PMC11017742 DOI: 10.5014/ajot.2024.050398] [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: 02/03/2024] Open
Abstract
IMPORTANCE Handedness and motor asymmetry are important features of occupational performance. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. OBJECTIVE To review the basic neural mechanisms behind handedness and their implications for central and peripheral nervous system injury. DATA SOURCES Relevant published literature obtained via MEDLINE. FINDINGS Handedness, along with performance asymmetries observed between the dominant and nondominant hands, may be due to hemispheric specializations for motor control. These specializations contribute to predictable motor control deficits that are dependent on which hemisphere or limb has been affected. Clinical practice recommendations for occupational therapists and other rehabilitation specialists are presented. CONCLUSIONS AND RELEVANCE It is vital that occupational therapists and other rehabilitation specialists consider handedness and hemispheric lateralization during evaluation and treatment. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. Plain-Language Summary: The goal of this narrative review is to increase clinicians' understanding of the basic neural mechanisms related to handedness (the tendency to select one hand over the other for specific tasks) and their implications for central and peripheral nervous system injury and rehabilitation. An enhanced understanding of these mechanisms may allow clinicians to better tailor neurorehabilitation interventions to address motor deficits and promote functional independence.
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Affiliation(s)
- Brooke Dexheimer
- Brooke Dexheimer, PhD, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond;
| | - Robert Sainburg
- Robert Sainburg, PhD, OTR, is Professor and Huck Institutes Distinguished Chair, Department of Kinesiology, Pennsylvania State University, University Park, and Department of Neurology, Pennsylvania State College of Medicine, Hershey
| | - Sydney Sharp
- Sydney Sharp, is Occupational Therapy Doctoral Student, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Department of Neurology and Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Smith DB, Scott SH, Semrau JA, Dukelow SP. Impairments of the ipsilesional upper-extremity in the first 6-months post-stroke. J Neuroeng Rehabil 2023; 20:106. [PMID: 37580751 PMCID: PMC10424459 DOI: 10.1186/s12984-023-01230-8] [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: 05/12/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Ipsilesional motor impairments of the arm are common after stroke. Previous studies have suggested that severity of contralesional arm impairment and/or hemisphere of lesion may predict the severity of ipsilesional arm impairments. Historically, these impairments have been assessed using clinical scales, which are less sensitive than robot-based measures of sensorimotor performance. Therefore, the objective of this study was to characterize progression of ipsilesional arm motor impairments using a robot-based assessment of motor function over the first 6-months post-stroke and quantify their relationship to (1) contralesional arm impairment severity and (2) stroke-lesioned hemisphere. METHODS A total of 106 participants with first-time, unilateral stroke completed a unilateral assessment of arm motor impairment (visually guided reaching task) using the Kinarm Exoskeleton. Participants completed the assessment along with a battery of clinical measures with both ipsilesional and contralesional arms at 1-, 6-, 12-, and 26-weeks post-stroke. RESULTS Robotic assessment of arm motor function revealed a higher incidence of ipsilesional arm impairment than clinical measures immediately post-stroke. The incidence of ipsilesional arm impairments decreased from 47 to 14% across the study period. Kolmogorov-Smirnov tests revealed that ipsilesional arm impairment severity, as measured by our task, was not related to which hemisphere was lesioned. The severity of ipsilesional arm impairments was variable but displayed moderate significant relationships to contralesional arm impairment severity with some robot-based parameters. CONCLUSIONS Ipsilesional arm impairments were variable. They displayed relationships of varying strength with contralesional impairments and were not well predicted by lesioned hemisphere. With standard clinical care, 86% of ipsilesional impairments recovered by 6-months post-stroke.
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Affiliation(s)
- Donovan B Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th Street NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer A Semrau
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th Street NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada.
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Mota DMS, Moraes ÍAP, Papa DCR, Fernani DCGL, Almeida CS, Tezza MHS, Dantas MTAP, Fernandes SMS, Ré AHN, Silva TD, Monteiro CBM. Bilateral Transfer of Performance between Real and Non-Immersive Virtual Environments in Post-Stroke Individuals: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3301. [PMID: 36834000 PMCID: PMC9963577 DOI: 10.3390/ijerph20043301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Post-stroke presents motor function deficits, and one interesting possibility for practicing skills is the concept of bilateral transfer. Additionally, there is evidence that the use of virtual reality is beneficial in improving upper limb function. We aimed to evaluate the transfer of motor performance of post-stroke and control groups in two different environments (real and virtual), as well as bilateral transfer, by changing the practice between paretic and non-paretic upper limbs. (2) Methods: We used a coincident timing task with a virtual (Kinect) or a real device (touch screen) in post-stroke and control groups; both groups practiced with bilateral transference. (3) Results: Were included 136 participants, 82 post-stroke and 54 controls. The control group presented better performance during most parts of the protocol; however, it was more evident when compared with the post-stroke paretic upper limb. We found bilateral transference mainly in Practice 2, with the paretic upper limb using the real interface method (touch screen), but only after Practice 1 with the virtual interface (Kinect), using the non-paretic upper limb. (4) Conclusions: The task with the greatest motor and cognitive demand (virtual-Kinect) provided transfer into the real interface, and bilateral transfer was observed in individuals post-stroke. However, this is more strongly observed when the virtual task was performed using the non-paretic upper limb first.
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Affiliation(s)
- Deise M. S. Mota
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Íbis A. P. Moraes
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Denise C. R. Papa
- Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Deborah C. G. L. Fernani
- Department of Physiotherapy, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Caroline S. Almeida
- Department of Physiotherapy, University of Medical Sciences of Santa Casa of São Paulo, São Paulo 01224-001, Brazil
| | - Maria H. S. Tezza
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Maria T. A. P. Dantas
- Department of Physiotherapy, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Susi M. S. Fernandes
- Department of Physiotherapy, Mackenzie Presbyterian University (UPM), São Paulo 01302-907, Brazil
| | - Alessandro H. N. Ré
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Talita D. Silva
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
- Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Carlos B. M. Monteiro
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
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Liu X, Li F, Song W. Impact of cognition on test-retest reliability and concurrent validity of n-back for Chinese stroke patients. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36152340 DOI: 10.1080/23279095.2022.2121211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The objective of this study was the measurement of the test-retest reliability of n-back in Chinese stroke patients. METHODS Seventy-five sub-acute stroke patients performed n-back twice in three days. The test-retest reliability of n-back was analyzed by correlation coefficient. RESULTS The n-back had excellent test-retest reliability in stroke patients. Pearson or Spearman coefficients ranged from 0.81 to 0.88. The intra-class correlation coefficients ranged from 0.72 to 0.87. The Chinese version of Montreal Cognitive Assessment-Basic (MoCA-BC) score was significantly correlated with the performance of n-back. MoCA-BC and n-back accuracy were significantly related in the Mild Cognitive Impairment (MCI) group (r = 0.60 in 1-back, p = .002; r = 0.43 in 2-back, p = .040). However, MoCA-BC was correlated with reaction time (RT) in the Cognitively Normal (CN) group (r = -0.44 in 1-back, p = .003; r = -0.36 in 2-back, p = .018). The test-retest reliability of CN group was mostly higher than that of MCI group RT: 0.71-0.76 in MCI, 0.80-0.88 in CN; accuracy: 0.80-0.85 in MCI, 0.75-0.86 in CN). The practice effect was observed in the CN group instead of the MCI group. CONCLUSIONS This study indicated that the test-retest reliability of n-back was high in stroke patients. N-back was correlated with cognition. It was preferable to conduct subgroup analyses according to the level of cognitive assessment of patients with stroke.
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Affiliation(s)
- Xiuzhen Liu
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Fang Li
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing, China
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Jochumsen M, Niazi IK, Zia ur Rehman M, Amjad I, Shafique M, Gilani SO, Waris A. Decoding Attempted Hand Movements in Stroke Patients Using Surface Electromyography. SENSORS 2020; 20:s20236763. [PMID: 33256073 PMCID: PMC7730601 DOI: 10.3390/s20236763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022]
Abstract
Brain- and muscle-triggered exoskeletons have been proposed as a means for motor training after a stroke. With the possibility of performing different movement types with an exoskeleton, it is possible to introduce task variability in training. It is difficult to decode different movement types simultaneously from brain activity, but it may be possible from residual muscle activity that many patients have or quickly regain. This study investigates whether nine different motion classes of the hand and forearm could be decoded from forearm EMG in 15 stroke patients. This study also evaluates the test-retest reliability of a classical, but simple, classifier (linear discriminant analysis) and advanced, but more computationally intensive, classifiers (autoencoders and convolutional neural networks). Moreover, the association between the level of motor impairment and classification accuracy was tested. Three channels of surface EMG were recorded during the following motion classes: Hand Close, Hand Open, Wrist Extension, Wrist Flexion, Supination, Pronation, Lateral Grasp, Pinch Grasp, and Rest. Six repetitions of each motion class were performed on two different days. Hudgins time-domain features were extracted and classified using linear discriminant analysis and autoencoders, and raw EMG was classified with convolutional neural networks. On average, 79 ± 12% and 80 ± 12% (autoencoders) of the movements were correctly classified for days 1 and 2, respectively, with an intraclass correlation coefficient of 0.88. No association was found between the level of motor impairment and classification accuracy (Spearman correlation: 0.24). It was shown that nine motion classes could be decoded from residual EMG, with autoencoders being the best classification approach, and that the results were reliable across days; this may have implications for the development of EMG-controlled exoskeletons for training in the patient’s home.
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Affiliation(s)
- Mads Jochumsen
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg Øst, Denmark;
- Correspondence:
| | - Imran Khan Niazi
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg Øst, Denmark;
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand;
- Health and Rehabilitation Research Institute, AUT University, Auckland 1010, New Zealand
| | - Muhammad Zia ur Rehman
- Faculty of Rehabilitation and Allied Sciences & Faculty of Engineering and Applied Sciences, Riphah International University, Islamabad 44000, Pakistan; (M.Z.u.R.); (M.S.)
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand;
- Faculty of Rehabilitation and Allied Sciences & Faculty of Engineering and Applied Sciences, Riphah International University, Islamabad 44000, Pakistan; (M.Z.u.R.); (M.S.)
| | - Muhammad Shafique
- Faculty of Rehabilitation and Allied Sciences & Faculty of Engineering and Applied Sciences, Riphah International University, Islamabad 44000, Pakistan; (M.Z.u.R.); (M.S.)
| | - Syed Omer Gilani
- Department of Biomedical Engineering & Sciences, School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (S.O.G.); (A.W.)
| | - Asim Waris
- Department of Biomedical Engineering & Sciences, School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 44000, Pakistan; (S.O.G.); (A.W.)
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Kwon Y, Shin JY, Son SM. Deficit of Motor Skill Acquisition on the Upper Limb Ipsilesional to the Injured Hemisphere in Individuals with Stroke. Med Sci Monit 2019; 25:5062-5067. [PMID: 31283752 PMCID: PMC6636404 DOI: 10.12659/msm.916484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Movement deficits in limbs ipsilesional to the damaged hemisphere in individuals with stroke have been established through various motor tasks. Nevertheless, there has been little evidence regarding hindrance of motor skill acquisition on the ipsilesional limb in patients with stroke. Therefore, we attempted to demonstrate whether the characteristics of ipsilesional deficits involved motor learning insufficiency in stroke survivors with unilateral brain damage. Material/Methods Thirty-six participants (18 patients with stroke and 18 normal individuals) were recruited. Patients with stroke performed a visuo-spatial tracking task in the upper limb ipsilesional to the injured hemisphere, and normal participants did the same task with the upper limb matched for the same side. The participants were required to track a target sine wave as accurately as possible while the wave was displayed on the computer screen for 15 seconds. An accuracy index was calculated for each of the trials. Results We found that motor skill learning improved in both stroke and normal groups with repetitive practice. However, the normal group exhibited greater motor skill acquisition than in comparison the stroke group for motor skill improvement. Statistical analyses revealed significant differences in time effects and time x group interactions. Conclusions Our findings provide evidence that individuals with stroke might have difficulty in performing visuo-spatial movements and acquiring motor skills with the ipsilateral upper limb. Improvement of ipsilesional limb function increases self-care activity in daily life. Therefore, we recommend that clinicians adopt remedial strategies for ipsilesional limbs.
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Affiliation(s)
- Yonghyun Kwon
- Department of Physical Therapy, Yeungnam University College, Daegu, South Korea
| | - Ju Yong Shin
- Department of Physical Therapy, Gumi University, Gumi, Gyeongsangbuk-do, South Korea
| | - Sung Min Son
- Department of Physical Therapy, Cheongju University, Cheongju, Chungcheongbuk-do, South Korea
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