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Kim D, Ko SH, Han J, Kim YT, Kim YH, Chang WH, Shin YI. Correlations in abnormal synergies between the upper and lower extremities across various phases of stroke. J Neurophysiol 2024; 132:87-95. [PMID: 38748436 DOI: 10.1152/jn.00102.2024] [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: 03/13/2024] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024] Open
Abstract
The flexion synergy and extension synergy are a representative consequence of a stroke and appear in the upper extremity and the lower extremity. Since the ipsilesional corticospinal tract (CST) is the most influential neural pathway for both extremities in motor execution, damage by a stroke to this tract could lead to similar motor pathological features (e.g., abnormal synergies) in both extremities. However, less attention has been paid to the interlimb correlations in the flexion synergy and extension synergy across different recovery phases of a stroke. We used results of the Fugl-Meyer assessment (FMA) to characterize those correlations in a total of 512 participants with hemiparesis after stroke from the acute phase to 1 year. The FMA provides indirect indicators of the degrees of the flexion synergy and extension synergy after stroke. We found that, generally, strong interlimb correlations (r > 0.65 with all P values < 0.0001) between the flexion synergy and extension synergy appeared in the acute-to-subacute phase (<90 days). However, the correlations of the lower-extremity extension synergy with the upper-extremity flexion synergy and extension synergy decreased (down to r = 0.38) 360 days after stroke (P < 0.05). These results suggest that the preferential use of alternative neural pathways after damage by a stroke to the CST enhances the interlimb correlations between the flexion synergy and extension synergy. At the same time, the results imply that the recovery of CST integrity or/and the fragmentation (remodeling) of the alternative neural substrates in the chronic phase may contribute to diversity in neural pathways in motor execution, eventually leading to reduced interlimb correlations.NEW & NOTEWORTHY For the first time, this article addresses the asynchronous relationships in the strengths of flexion and extension synergy expressions between the paretic upper extremity and lower extremity across various phases of stroke.
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Affiliation(s)
- Dongwon Kim
- Shirley Ryan AbilityLab, Chicago, Illinois, United States
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois, United States
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois, United States
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon-si, Republic of Korea
| | - Young-Taek Kim
- Department of Preventive Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Yun-Hee Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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Kang NY, Ko SH, Shin YI, Min JH, Yun MS, Sohn MK, Lee J, Kim DY, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Kim YH, Chang WH. Association between Height and Functional Outcomes of Patients 6 Months after a Stroke: A Multicenter Prospective Observational Cohort Study. J Pers Med 2024; 14:610. [PMID: 38929831 PMCID: PMC11204573 DOI: 10.3390/jpm14060610] [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: 04/22/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Many physical factors influence post-stroke functional outcomes. However, few studies have examined the influence of height on these outcomes. Here, data from the Korean Stroke Cohort for Functioning and Rehabilitation were used and patients' height was categorized into three groups: short (lower 25%), middle (middle 50%), and tall (upper 25%). Differences in the modified Rankin scale (mRS), functional ambulatory category (FAC), and Korean-translated version of the Modified Barthel Index (K-MBI) scores were analyzed for each group at 6 months post-stroke. A subgroup analysis was conducted based on the initial Fugl-Meyer Assessment (FMA) score. We analyzed functional outcomes in 5296 patients at 6 months post-stroke, adjusting for age and body mass index. The short-height group exhibited higher mRS scores (1.88 ± 0.043), lower FAC scores (3.74 ± 0.045), and lower K-MBI scores (82.83 ± 0.748) than the other height groups (p < 0.05). In the subgroup analysis, except for the very severe FMA group, the short-height group also exhibited worse outcomes in terms of mRS, FAC, and K-MBI scores (p < 0.05). Taken together, the short-height group exhibited worse outcomes related to disability, gait function, and ADLs at 6 months post-stroke.
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Grants
- 2012: 3300-3334-300- 260-00, 2013: 2013-E33017-00, 2014: 2013E-33017-01, 2015: 2013E- 33017-02, 2016: 2016-E33003-00, 2017: 2016-E33003-01, 2018: 2016- E33003-02, 2019: 2019-E3202-00, 2020: 2019-E3202-01, 2021: 2019- E3202-02, 2022: 2022-11-006, 2023: 202 Korea Disease Control and Prevention Agency
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Affiliation(s)
- Nae Yoon Kang
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (N.Y.K.); (Y.-I.S.); (J.H.M.)
| | - Sung-Hwa Ko
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (N.Y.K.); (Y.-I.S.); (J.H.M.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (N.Y.K.); (Y.-I.S.); (J.H.M.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Ji Hong Min
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (N.Y.K.); (Y.-I.S.); (J.H.M.)
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
| | - Mi Sook Yun
- Division of Biostatistics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea;
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea;
| | - Jongmin Lee
- Department of Rehabilitation Medicine, School of Medicine, Konkuk University, Seoul 05029, Republic of Korea;
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea;
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - Yang Soo Lee
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, Republic of Korea;
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan 54538, Republic of Korea;
| | - So Young Lee
- Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju 63241, Republic of Korea;
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju 61469, Republic of Korea;
| | - Junhee Han
- Department of Statistics, Hallym University, Chuncheon 24252, Republic of Korea;
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul 03760, Republic of Korea;
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Republic of Korea;
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul 06351, Republic of Korea;
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Wouda NC, Knijff B, Punt M, Visser-Meily JMA, Pisters MF. Predicting Recovery of Independent Walking After Stroke: A Systematic Review. Am J Phys Med Rehabil 2024; 103:458-464. [PMID: 38363655 DOI: 10.1097/phm.0000000000002436] [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: 02/18/2024]
Abstract
ABSTRACT Patients recovering from a stroke experience reduced participation, especially when they are limited in daily activities involving walking. Understanding the recovery of independent walking, can be used by clinicians in the decision-making process during rehabilitation, resulting in more personalized stroke rehabilitation. Therefore, it is necessary to gain insight in predicting the recovery of independent walking in patients after stroke. This systematic review provided an overview of current evidence about prognostic models and its performance to predict recovery of independent walking after stroke. Therefore, MEDLINE, CINAHL, and Embase were searched for all relevant studies in English and Dutch. Descriptive statistics, study methods, and model performance were extracted and divided into two categories: subacute phase and chronic phase. This resulted in 16 articles that fulfilled all the search criteria, which included 30 prognostic models. Six prognostic models showed an excellent performance (area under the curve value and/or overall accuracy ≥0.90). The model of Smith et al. (2017) showed highest overall accuracy (100%) in predicting independent walking in the subacute phase after stroke ( Neurorehabil Neural Repair 2017;31(10-11):955-64.). Recovery of independent walking can be predicted in the subacute and chronic phase after stroke. However, proper external validation and the applicability in clinical practice of identified prognostic models are still lacking.
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Affiliation(s)
- Natasja Charon Wouda
- From the Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands (NCW, JMAV-M); De Hoogstraat Rehabilitation, Department of Neurorehabilitation, Utrecht, the Netherlands (NCW); Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, the Netherlands (BK, MP); Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (JMAV-M, MFP); Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, the Netherlands (MFP); and Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands (MFP)
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Bennett KJ, Leese J, Davis JC, Eng JJ, Liu-Ambrose T. Exploring the experience of cognitive changes among community-dwelling stroke survivors: a qualitative study. Disabil Rehabil 2024; 46:1870-1877. [PMID: 37212368 DOI: 10.1080/09638288.2023.2210309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Cognitive deficits are common among stroke survivors and impact their functional independence. Despite the prevalence of cognitive deficits after stroke, cognitive function is largely overlooked in post-stroke care. The aim of this qualitative study was to explore the experiences of individuals living with post-stroke cognitive changes to understand the impact of these changes on their daily lives. MATERIALS AND METHODS Semi-structured interviews were conducted with a purposeful sample of thirteen community-dwelling adults 50 years and older with chronic stroke who self-identified cognitive changes post-stroke. Interviews were transcribed and an inductive thematic analysis was completed. RESULTS Four key themes were identified: 1) inability to maintain everyday activities; 2) experiencing emotional responses to living with post-stroke cognitive changes; 3) a shrinking social world and; 4) seeking care for cognitive health post-stroke. CONCLUSIONS Post-stroke cognitive changes were described by participants as a driving force behind negative shifts in their daily lives, emotional health, and social connections after stroke. Despite seeking care for their post-stroke cognitive changes, many participants were unable to find support in mainstream healthcare. There is a demonstrated need to further elucidate the gaps in care for post-stroke cognitive deficits and implement community interventions targeting cognitive health post-stroke.
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Affiliation(s)
- Kimberly J Bennett
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Jenny Leese
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research at the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer C Davis
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Applied Health Economics Laboratory, Faculty of Management, University of British Columbia-Okanagan, Kelowna, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, G. F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
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Taga M, Hong YNG, Charalambous CC, Raju S, Hayes L, Lin J, Zhang Y, Shao Y, Houston M, Zhang Y, Mazzoni P, Roh J, Schambra HM. Corticospinal and corticoreticulospinal projections benefit motor behaviors in chronic stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.04.588112. [PMID: 38645144 PMCID: PMC11030245 DOI: 10.1101/2024.04.04.588112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
After corticospinal tract (CST) stroke, several motor deficits in the upper extremity (UE) emerge, including diminished muscle strength, motor control, and muscle individuation. Both the ipsilesional CST and contralesional corticoreticulospinal tract (CReST) innervate the paretic UE and may have different innervation patterns for the proximal and distal UE segments. These patterns may underpin distinct pathway relationships to separable motor behaviors. In this cross-sectional study of 15 chronic stroke patients and 28 healthy subjects, we examined two key questions: (1) whether segmental motor behaviors differentially relate to ipsilesional CST and contralesional CReST projection strengths, and (2) whether motor behaviors segmentally differ in the paretic UE. We measured strength, motor control, and muscle individuation in a proximal (biceps, BIC) and distal muscle (first dorsal interosseous, FDI) of the paretic UE. We measured the projection strengths of the ipsilesional CST and contralesional CReST to these muscles using transcranial magnetic stimulation (TMS). Stroke subjects had abnormal motor control and muscle individuation despite strength comparable to healthy subjects. In stroke subjects, stronger ipsilesional CST projections were linked to superior motor control in both UE segments, whereas stronger contralesional CReST projections were linked to superior muscle strength and individuation in both UE segments. Notably, both pathways also shared associations with behaviors in the proximal segment. Motor control deficits were segmentally comparable, but muscle individuation was worse for distal motor performance. These results suggest that each pathway has specialized contributions to chronic motor behaviors but also work together, with varying levels of success in supporting chronic deficits. Key points summary Individuals with chronic stroke typically have deficits in strength, motor control, and muscle individuation in their paretic upper extremity (UE). It remains unclear how these altered behaviors relate to descending motor pathways and whether they differ by proximal and distal UE segment.In this study, we used transcranial magnetic stimulation (TMS) to examine projection strengths of the ipsilesional corticospinal tract (CST) and contralesional corticoreticulospinal tract (CReST) with respect to quantitated motor behaviors in chronic stroke.We found that stronger ipsilesional CST projections were associated with better motor control in both UE segments, whereas stronger contralesional CReST projections were associated with better strength and individuation in both UE segments. In addition, projections of both pathways shared associations with motor behaviors in the proximal UE segment.We also found that deficits in strength and motor control were comparable across UE segments, but muscle individuation was worse with controlled movement in the distal UE segment.These results suggest that the CST and CReST have specialized contributions to chronic motor behaviors and also work together, although with different degrees of efficacy.
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Kim S, Jang S, Lee O. Single fiber curvature for muscle impairment assessment: Phase contrast imaging of stroke-induced animals. Microsc Res Tech 2024; 87:705-715. [PMID: 37983687 DOI: 10.1002/jemt.24459] [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: 05/28/2023] [Revised: 10/15/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
There are technical challenges in imaging studies that can three-dimensionally (3D) analyze a single fiber (SF) to observe the functionality of the entire muscle after stroke. This study proposes a 3D assessment technique that only segments the SF of the right stroke-induced soleus muscle of a gerbil using synchrotron radiation x-ray microcomputed tomography (SR-μCT), which is capable of muscle structure analysis. Curvature damage in the SF of the left soleus muscle (impaired) progressed at 7-day intervals after the stroke in the control; particularly on the 7 days (1 week) and 14 days (2 weeks), as observed through visualization analysis. At 2 weeks, the SF volume was significantly reduced in the control impaired group (p = .033), and was significantly less than that in the non-impaired group (p = .009). We expect that animal post-stroke studies will improve the basic field of rehabilitation therapy by diagnosing the degree of SF curvature. RESEARCH HIGHLIGHTS: Muscle evaluation after ischemic stroke using synchrotron radiation x-ray microcomputed tomography (SR-μCT). Curvature is measured by segmenting a single fiber (SF) in the muscle. Structural changes in the SF of impaired gerbils at 7-day intervals were assessed.
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Affiliation(s)
- Subok Kim
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
| | - Sanghun Jang
- Department of Physical Therapy, College of Health and Life Sciences, Korea National University of Transportation, Jeungpyeong-gun, Republic of Korea
| | - Onseok Lee
- Department of Software Convergence, Graduate School, Soonchunhyang University, Asan, Republic of Korea
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Asan, Republic of Korea
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:158-168. [PMID: 37824730 DOI: 10.1177/17474930231205207] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. METHODS Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. RESULTS Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. CONCLUSIONS The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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Coremans M, Carmeli E, De Bauw I, Essers B, Lemmens R, Verheyden G. Error Enhancement for Upper Limb Rehabilitation in the Chronic Phase after Stroke: A 5-Day Pre-Post Intervention Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:471. [PMID: 38257564 PMCID: PMC10820998 DOI: 10.3390/s24020471] [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: 12/12/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1-Q3)) in (1) UL Fugl-Meyer assessment (1.0 (0.8-3.0), p < 0.001) and action research arm test (2.0 (0.8-2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0-0.3), p < 0.001) and quality of use (0.1 (0.1-0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (-0.45 (-0.81-0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training.
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Affiliation(s)
- Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel;
| | - Ineke De Bauw
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, 3000 Leuven, Belgium;
- Department of Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
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Van Criekinge T, Heremans C, Burridge J, Deutsch JE, Hammerbeck U, Hollands K, Karthikbabu S, Mehrholz J, Moore JL, Salbach NM, Schröder J, Veerbeek JM, Weerdesteyn V, Borschmann K, Churilov L, Verheyden G, Kwakkel G. Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:41-51. [PMID: 37837351 DOI: 10.1177/15459683231209154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials. METHODS Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement. RESULTS Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used. CONCLUSIONS The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.
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Affiliation(s)
| | | | - Jane Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith E Deutsch
- RiVERS Lab, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers University, Newark, NJ, USA
| | - Ulrike Hammerbeck
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust and The Tamil Nadu Dr. M.G.R. Medical University, Coimbatore, India
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Jennifer L Moore
- Institute for Knowledge Translation, Carmel, IN, USA
- Southeastern Norway Regional Center for Knowledge Translation in Rehabilitation, Oslo, Norway
| | - Nancy M Salbach
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
| | | | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
| | - Karen Borschmann
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Medicine, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, The Netherlands
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10
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Levin MF, Berman S, Weiss N, Parmet Y, Baniña MC, Frenkel-Toledo S, Soroker N, Solomon JM, Liebermann DG. ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range. Sci Rep 2023; 13:22934. [PMID: 38129527 PMCID: PMC10739929 DOI: 10.1038/s41598-023-49974-6] [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: 01/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
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Affiliation(s)
- Mindy F Levin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada.
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Weiss
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melanie C Baniña
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel.
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11
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Zaidi KF, Harris-Love M. Upper extremity kinematics: development of a quantitative measure of impairment severity and dissimilarity after stroke. PeerJ 2023; 11:e16374. [PMID: 38089910 PMCID: PMC10712307 DOI: 10.7717/peerj.16374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background Strokes are a leading cause of disability worldwide, with many survivors experiencing difficulty in recovering upper extremity movement, particularly hand function and grasping ability. There is currently no objective measure of movement quality, and without it, rehabilitative interventions remain at best informed estimations of the underlying neural structures' response to produce movement. In this article, we utilize a novel modification to Procrustean distance to quantify curve dissimilarity and propose the Reach Severity and Dissimilarity Index (RSDI) as an objective measure of motor deficits. Methods All experiments took place at the Medstar National Rehabilitation Hospital; persons with stroke were recruited from the hospital patient population. Using Fugl-Meyer (FM) scores and reach capacities, stroke survivors were placed in either mild or severe impairment groups. Individuals completed sets of reach-to-target tasks to extrapolate kinematic metrics describing motor performance. The Procrustes method of statistical shape analysis was modified to identify reaching sub-movements that were congruous to able-bodied sub-movements. Findings Movement initiation proceeds comparably to the reference curve in both two- and three-dimensional representations of mild impairment movement. There were significant effects of the location of congruent segments between subject and reference curves, mean velocities, peak roll angle, and target error. These metrics were used to calculate a preliminary RSDI score with severity and dissimilarity sub-scores, and subjects were reclassified in terms of rehabilitation goals as Speed Emphasis, Strength Emphasis, and Combined Emphasis. Interpretation The modified Procrustes method shows promise in identifying disruptions in movement and monitoring recovery without adding to patient or clinician burden. The proposed RSDI score can be adapted and expanded to other functional movements and used as an objective clinical tool. By reducing the impact of stroke on disability, there is a significant potential to improve quality of life through individualized rehabilitation.
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Affiliation(s)
- Khadija F. Zaidi
- Department of Bioengineering, George Mason University, Fairfax, United States
| | - Michelle Harris-Love
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
- Medstar National Rehabilitation Hospital, Washington, District of Columbia, United States of America
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12
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Cheng HJ, Chin LF, Kanzler CM, Lehner R, Kuah CWK, Kager S, Josse E, Samkharadze T, Sidarta A, Gonzalez PC, Lie E, Zbytniewska-Mégret M, Wee SK, Liang P, Gassert R, Chua K, Lambercy O, Wenderoth N. Upper limb sensorimotor recovery in Asian stroke survivors: a study protocol for the development and implementation of a Technology-Assisted dIgitaL biOmaRker (TAILOR) platform. Front Neurol 2023; 14:1246888. [PMID: 38107648 PMCID: PMC10722087 DOI: 10.3389/fneur.2023.1246888] [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: 06/24/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background Stroke is a leading cause of lifelong disability worldwide, partially driven by a reduced ability to use the upper limb in daily life causing increased dependence on caregivers. However, post-stroke functional impairments have only been investigated using limited clinical scores, during short-term longitudinal studies in relatively small patient cohorts. With the addition of technology-based assessments, we propose to complement clinical assessments with more sensitive and objective measures that could more holistically inform on upper limb impairment recovery after stroke, its impact on upper limb use in daily life, and on overall quality of life. This paper describes a pragmatic, longitudinal, observational study protocol aiming to gather a uniquely rich multimodal database to comprehensively describe the time course of upper limb recovery in a representative cohort of 400 Asian adults after stroke. Particularly, we will characterize the longitudinal relationship between upper limb recovery, common post-stroke impairments, functional independence and quality of life. Methods Participants with stroke will be tested at up to eight time points, from within a month to 3 years post-stroke, to capture the influence of transitioning from hospital to community settings. We will perform a battery of established clinical assessments to describe the factors most likely to influence upper limb recovery. Further, we will gather digital health biomarkers from robotic or wearable sensing technology-assisted assessments to sensitively characterize motor and somatosensory impairments and upper limb use in daily life. We will also use both quantitative and qualitative measures to understand health-related quality of life. Lastly, we will describe neurophysiological motor status using transcranial magnetic stimulation. Statistics Descriptive analyses will be first performed to understand post-stroke upper limb impairments and recovery at various time points. The relationships between digital biomarkers and various domains will be explored to inform key aspects of upper limb recovery and its dynamics using correlation matrices. Multiple statistical models will be constructed to characterize the time course of upper limb recovery post-stroke. Subgroups of stroke survivors exhibiting distinct recovery profiles will be identified. Conclusion This is the first study complementing clinical assessments with technology-assisted digital biomarkers to investigate upper limb sensorimotor recovery in Asian stroke survivors. Overall, this study will yield a multimodal data set that longitudinally characterizes post-stroke upper limb recovery in functional impairments, daily-life upper limb use, and health-related quality of life in a large cohort of Asian stroke survivors. This data set generates valuable information on post-stroke upper limb recovery and potentially allows researchers to identify different recovery profiles of subgroups of Asian stroke survivors. This enables the comparisons between the characteristics and recovery profiles of stroke survivors in different regions. Thus, this study lays out the basis to identify early predictors for upper limb recovery, inform clinical decision-making in Asian stroke survivors and establish tailored therapy programs. Clinical trial registration ClinicalTrials.gov, identifier: NCT05322837.
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Affiliation(s)
- Hsiao-Ju Cheng
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Lay Fong Chin
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
| | - Christoph M Kanzler
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Rea Lehner
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Christopher W K Kuah
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Simone Kager
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Eva Josse
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Tengiz Samkharadze
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
| | - Ananda Sidarta
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Pablo Cruz Gonzalez
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Eloise Lie
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Seng Kwee Wee
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Singapore Institute of Technology (SIT), Singapore, Singapore
| | - Phyllis Liang
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Roger Gassert
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Karen Chua
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Institute of Rehabilitation Excellence (IREx), Tan Tock Seng Hospital Rehabilitation Centre, Singapore, Singapore
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Olivier Lambercy
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Nicole Wenderoth
- Singapore-ETH Centre, Future Health Technologies Programme, CREATE Campus, Singapore, Singapore
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
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13
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Franco J, Silva PFDS, Menezes AR, Brito SAFD, Faria CDCDM. Trunk biomechanical changes between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors. Disabil Rehabil 2023:1-8. [PMID: 37837316 DOI: 10.1080/09638288.2023.2268514] [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: 01/18/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE To compare the trunk biomechanical characteristics between the sit-to-stand and stand-to-sit performed at self-selected and fast speeds in stroke survivors and healthy-matched controls. METHODS Thirty individuals (15 stroke survivors and 15 healthy-matched controls) were included. The following biomechanical characteristics were determined: peak of trunk forward flexion and time until the peak of trunk forward flexion, total duration, phase I (sit-to-stand: time spent from the beginning to seat-off; stand-to-sit: time spent from the beginning to seat-on) and II durations (sit-to-stand: time spent from seat-off to the end of the task; stand-to-sit: time spent from the seat-on to the end of the task). Two-way repeated measures ANOVA was used (α = 5%). RESULTS The maximum angle of trunk forward flexion and time spent until the maximum angle of trunk forward flexion in both tasks were significantly higher in stroke survivors. For both groups and speeds, phase I duration and peak of trunk forward flexion of the stand-to-sit were significantly higher than that of the sit-to-stand (11.41≤F ≤ 33.60; 0.001 ≤ p ≤ 0.002) and, phase II duration was significantly higher during the sit-to-stand than that of the stand-to-sit (21.27 ≤ F ≤ 65.10; p ≤ 0.001). CONCLUSIONS These results confirm specific trunk biomechanical characteristics between sit-to-stand and stand-to-sit in stroke survivors and healthy-matched controls.
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Affiliation(s)
- Juliane Franco
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
| | | | - Alice Rausch Menezes
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil
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14
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Jovanovic LI, Jervis Rademeyer H, Pakosh M, Musselman KE, Popovic MR, Marquez-Chin C. Scoping Review on Brain-Computer Interface-Controlled Electrical Stimulation Interventions for Upper Limb Rehabilitation in Adults: A Look at Participants, Interventions, and Technology. Physiother Can 2023; 75:276-290. [PMID: 37736411 PMCID: PMC10510539 DOI: 10.3138/ptc-2021-0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/07/2021] [Accepted: 12/07/2021] [Indexed: 09/23/2023]
Abstract
Purpose While current rehabilitation practice for improving arm and hand function relies on physical/occupational therapy, a growing body of research evaluates the effects of technology-enhanced rehabilitation. We review interventions that combine a brain-computer interface (BCI) with electrical stimulation (ES) for upper limb movement rehabilitation to summarize the evidence on (1) populations of study participants, (2) BCI-ES interventions, and (3) the BCI-ES systems. Method After searching seven databases, two reviewers identified 23 eligible studies. We consolidated information on the study participants, interventions, and approaches used to develop integrated BCI-ES systems. The included studies investigated the use of BCI-ES interventions with stroke and spinal cord injury (SCI) populations. All studies used electroencephalography to collect brain signals for the BCI, and functional electrical stimulation was the most common type of ES. The BCI-ES interventions were typically conducted without a therapist, with sessions varying in both frequency and duration. Results Of the 23 eligible studies, only 3 studies involved the SCI population, compared to 20 involving individuals with stroke. Conclusions Future BCI-ES interventional studies could address this gap. Additionally, standardization of device and rehabilitation modalities, and study-appropriate involvement with therapists, can be considered to advance this intervention towards clinical implementation.
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Affiliation(s)
- Lazar I. Jovanovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
| | - Hope Jervis Rademeyer
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, Toronto, Canada
| | - Kristin E. Musselman
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Milos R. Popovic
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Cesar Marquez-Chin
- From the:
Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- The Center for Advancing Neurotechnological Innovation to Application (CRANIA), University Health Network, Toronto, Canada
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15
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Schröder J, Saeys W, Embrechts E, Hallemans A, Yperzeele L, Truijen S, Kwakkel G. Recovery of Quiet Standing Balance and Lower Limb Motor Impairment Early Poststroke: How Are They Related? Neurorehabil Neural Repair 2023; 37:530-544. [PMID: 37596887 DOI: 10.1177/15459683231186983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023]
Abstract
BACKGROUND Recovery of quiet standing balance early poststroke has been poorly investigated using repeated measurements. OBJECTIVE To investigate (1) the time course of steady-state balance in terms of postural stability and inter-limb symmetry, and (2) longitudinal associations with lower limb motor recovery in the first 3 months poststroke. METHODS Forty-eight hemiparetic subjects (age: 58.9 ± 16.1 years) were evaluated at weeks 3, 5, 8, and 12 poststroke. Motor impairments concerned the Fugl-Meyer assessment (FM-LE) and Motricity Index total score (MI-LE) or ankle item separately (MI-ankle). Postural stability during quiet 2-legged stance was calculated as the net center-of-pressure area (COPArea) and direction-dependent velocities (COPVel-ML and COPVel-AP). Dynamic control asymmetry (DCA) and weight-bearing asymmetry (WBA) estimated inter-limb symmetries in balance control and loading. Linear mixed models determined (1) time-dependent change and (2) the between- and within-subject associations between motor impairments and postural stability or inter-limb symmetry. RESULTS Time-dependent improvements were significant for FM-LE, MI-LE, MI-ankle, COPArea, COPVel-ML, and COPVel-AP, and tended to plateau by week 8. DCA and WBA did not exhibit significant change. Between-subject analyses yielded significant regression coefficients for FM-LE, MI-LE, and MI-ankle scores with COPArea, COPVel-ML, and COPVel-AP up until week 8, and with WBA until week 12. Within-subject regression coefficients of motor recovery with change in COPArea, COPVel-ML, COPVel-AP, DCA, or WBA were generally non-significant. CONCLUSIONS Postural stability improved significantly in the first 8 weeks poststroke, independent of lower limb motor recovery at the most affected side within subjects. Our findings suggest that subjects preferred to compensate with their less affected side, making metrics reflecting inter-limb asymmetries in balance invariant for change early poststroke.Clinical Trial Registration: Clinicaltrials.gov. unique identifier NCT03728036.
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Affiliation(s)
- Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Wim Saeys
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
- Department of Neurorehabilitation, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Elissa Embrechts
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Laetitia Yperzeele
- Neurovascular Center Antwerp and Stroke Unit, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- Research Group on Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Steven Truijen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerp, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- Amsterdam Rehabilitation Research Centre Reade, Amsterdam, The Netherlands
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16
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da Silva Jaques E, Figueiredo AI, Schiavo A, Loss BP, da Silveira GH, Sangalli VA, da Silva Melo DA, Xavier LL, Pinho MS, Mestriner RG. Conventional Mirror Therapy versus Immersive Virtual Reality Mirror Therapy: The Perceived Usability after Stroke. Stroke Res Treat 2023; 2023:5080699. [PMID: 37275507 PMCID: PMC10234727 DOI: 10.1155/2023/5080699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Background Stroke is a widespread and complex health issue, with many survivors requiring long-term rehabilitation due to upper-limb impairment. This study is aimed at comparing the perceived usability of two feedback-based stroke therapies: conventional mirror therapy (MT) and immersive virtual reality mirror therapy (VR). Methods The study involved 45 participants, divided into three groups: the stroke survivors (n = 15), stroke-free older adults (n = 15), and young controls (n = 15). Participants performed two tasks using both MT and VR in a semirandom sequence. Usability instruments (SUS and NASA-TLX) were applied at the end of the activities, along with two experience-related questions. Results The results indicated that both MT and VR had similar levels of perceived usability, with MT being more adaptable and causing less overall discomfort. Conversely, VR increased the perception of task difficulty and prevented participants from diverting their attention from the mirror-based feedback. Conclusion While VR was found to be less comfortable than MT, both systems exhibited similar perceived usability. The comfort levels of the goggles may play a crucial role in determining the usability of VR for upper limb rehabilitation after stroke.
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Affiliation(s)
- Eliana da Silva Jaques
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Anelise Ineu Figueiredo
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Bianca Pacheco Loss
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Gabriel Hoff da Silveira
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Vicenzo Abichequer Sangalli
- Pontifical Catholic University of Rio Grande do Sul (PUCRS), Polytechnic School, Virtual Reality Research Group, Porto Alegre, Brazil
| | - Denizar Alberto da Silva Melo
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Léder Leal Xavier
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Márcio Sarroglia Pinho
- Pontifical Catholic University of Rio Grande do Sul (PUCRS), Polytechnic School, Virtual Reality Research Group, Porto Alegre, Brazil
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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17
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Badawi AS, Mogharbel GH, Aljohani SA, Surrati AM. Predictive Factors and Interventional Modalities of Post-stroke Motor Recovery: An Overview. Cureus 2023; 15:e35971. [PMID: 37041905 PMCID: PMC10082951 DOI: 10.7759/cureus.35971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Stroke is the most common cause of motor impairment worldwide. Therefore, many factors are being investigated for their predictive and facilitatory effects on recovery of motor function after stroke. Motor recovery can be predicted through several factors, such as clinical assessment, clinical biomarkers, and gene-based variations. As for interventions, many methods are under experimental investigation that aim to improve motor recovery, including different types of pharmacological interventions, non-invasive stimulation, and rehabilitation training by inducing cortical reorganization, neuroplasticity, angiogenesis, changing the levels of neurotransmitters in the brain, and altering the inflammatory and apoptotic processes occurring after stroke. Studies have shown that clinical biomarkers combined with clinical assessment and gene-based variations are reliable factors for predicting motor recovery after stroke. Moreover, different types of interventions such as pharmacological agents (selective serotonin reuptake inhibitors {SSRI}, noradrenaline reuptake inhibitors {NARIs}, levodopa, and amphetamine), non-invasive stimulation, and rehabilitation training have shown significant results in improving functional and motor recovery.
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18
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Gait asymmetry in stroke patients with unilateral spatial neglect. Med Biol Eng Comput 2023; 61:651-659. [PMID: 36577925 DOI: 10.1007/s11517-022-02738-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
The recovery of independent gait represents one of the main functional goals of the rehabilitative interventions after stroke but it can be hindered by the presence of unilateral spatial neglect (USN). The aim of the paper is to study if the presence of USN in stroke patients affects lower limb gait parameters between the two body sides, differently from what could be expected by the motor impairment alone, and to explore whether USN is associated to specific gait asymmetry. Thirty-five stroke patients (right or left lesion and ischemic or hemorrhagic etiology) who regained independent gait were assessed for global cognitive functioning and USN. All patients underwent a gait analysis session by using a wearable inertial system, kinematic parameters were computed. Enrolled patients presented altered motion parameters. Stroke patients with USN showed specific asymmetries in the following parameters: stance phase, swing phase, and knee range of motion. No differences in the clinical scores were found as the presence of USN. The presence of USN was associated with a specific form of altered gait symmetry. These findings may help clinicians to develop more tailored rehabilitative training to enhance gait efficacy of patients with motor defects complicated by the presence of selected cognitive impairments. Overview of the experiment setup. The workflow shows: diagnosis of unilateral spatial neglect by the neuropsychologist, sensors placement, gait analysis protocol and evaluation of the gait asymmetry together with the statistically significant features.
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19
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Bacho Z, Khin NY, Ag Daud DM. Effect of Core Exercises on Motor Function Recovery in Stroke Survivors with Very Severe Motor Impairment. J Cardiovasc Dev Dis 2023; 10:jcdd10020050. [PMID: 36826546 PMCID: PMC9959809 DOI: 10.3390/jcdd10020050] [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: 12/02/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 02/03/2023] Open
Abstract
Paresis of the upper and lower limbs is a typical issue in stroke survivors. This study aims to determine whether core exercises help stroke survivors with very severe motor impairment recover their motor function. This study employed a within-subjects design. Eleven hemiparetic stroke patients with very severe motor impairment (FMA score < 35) and ages ranging from 24 to 52 years old were enrolled in this study. All participants engaged in supervised core exercise training twice a week for 12 weeks. The main outcome measures were Fugl-Meyer Assessment Lower Extremity (FMA-LE) and Fugl-Meyer Assessment Upper Extremity (FMA-UE), which were measured before training and at intervals of four weeks during training. Repeated measures ANOVA was used to analyze the effect of core exercises on motor function performance and lower extremity motor function and upper extremity motor function recovery. There were significant differences in the mean scores for motor function performance, lower extremity motor function, and upper extremity motor function throughout the four time points. A post-hoc pairwise comparison using the Bonferroni correction revealed that mean scores significantly increased and were statistically different between the initial assessment and follow-up assessments four, eight, and twelve weeks later. This study suggests that 12 weeks of core exercise training is effective for improving motor function recovery in patients with very severe motor impairment.
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Affiliation(s)
- Zuliana Bacho
- Sports Science Program, Faculty of Psychology and Education, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Nyein Yin Khin
- Department of Rehabilitation Medicine, Faculty of Medicine and Health, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - D Maryama Ag Daud
- HEAL Research Unit, Faculty of Medicine and Health, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
- Department of Biomedical Sciences, Faculty of Medicine and Health, University Malaysia Sabah, Kota Kinabalu 88400, Malaysia
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20
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Piscitelli D, Baniña MC, Lam TK, Chen JL, Levin MF. Psychometric Properties of a New Measure of Upper Limb Performance in Post-Stroke Individuals: Trunk-Based Index of Performance. Neurorehabil Neural Repair 2023; 37:66-75. [PMID: 36575955 PMCID: PMC9896540 DOI: 10.1177/15459683221143462] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several measures of upper limb (UL) motor tasks have been developed to characterize recovery. However, UL performance and movement quality measures in isolation may not provide a true profile of functional recovery. OBJECTIVE To investigate the measurement properties of a new trunk-based Index of Performance (IPt) of the UL combining endpoint performance (accuracy and speed) and movement quality (trunk displacement) in stroke. METHODS Participants with stroke (n = 25, mean time since stroke: 18.7 ± 17.2 months) performed a reaching task over 3 evaluation sessions. The IPt was computed based on Fitts' Law that incorporated endpoint accuracy and speed corrected by the amount of trunk displacement. Test-retest reliability was analyzed using intraclass correlation coefficient (ICC) and Bland-Altman plots. Standard error of measurement (SEM) and Minimal Detectable Change (MDC) were determined. Validity was investigated through the relationship between IPt, Fugl-Meyer Assessment (FMA-UE), and Action Research Arm Test (ARAT), as well as the ability of IPt to distinguish between levels of UL motor impairment severity. RESULTS Test-retest reliability was excellent (ICC = .908, 95% CI: 0.807-0.96). Bland-Altman did not show systematic differences. SEM and MDC95 were 14% and 39%, respectively. Construct validity was satisfactory. The IPt showed low-to-moderate relationships with FMA-UE (R2 ranged from .236 to .428) and ARAT (R2 ranged from .277 to .306). IPt scores distinguished between different levels of UL severity. CONCLUSIONS The IPt showed evidence of good reliability, and initial validity. The IPt may be a promising tool for research and clinical settings. Further research is warranted to investigate its validity with additional comparator instruments.
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Affiliation(s)
- Daniele Piscitelli
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada,Department of Kinesiology, University
of Connecticut, Storrs, CT, USA
| | - Melanie C. Baniña
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada
| | - Timothy K. Lam
- Canadian Partnership for Stroke
Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Toronto, ON, Canada
| | - Joyce L. Chen
- Canadian Partnership for Stroke
Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Toronto, ON, Canada,Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada
| | - Mindy F. Levin
- School of Physical and Occupational
Therapy, McGill University, Montreal, QC, Canada,Feil/Oberfeld Research Centre of the
Jewish Rehabilitation Hospital/Centre for Interdisciplinary Research in
Rehabilitation, Laval, QC, Canada,Mindy F. Levin, School of Physical and
Occupational Therapy, McGill University, 3654 Promenade Sir William Osler,
Montreal, QC H3G 1Y5, Canada.
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21
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Rojas-Sosa MDC, Zárate JA, de la Rosa-Peña N, Olvera-Gómez JL, Rojano-Mejía D, Delgado-García J, Garduño-Espinosa J. Aphasia improvement without logotherapy during motor neurorehabilitation of post-stroke hemiparesis using virtual reality or modified constraint-induced movement therapy: A retrospective cohort. NeuroRehabilitation 2023; 53:585-594. [PMID: 37927287 PMCID: PMC10789345 DOI: 10.3233/nre-230183] [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: 08/08/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Some research suggests that post-stroke aphasia can recover "on its own", however, there is evidence of a common neural substrate for motor and language systems. We hypothesize, that motor neurorehabilitation of hemiparesis could be related to simultaneous improvement in aphasia. OBJECTIVE To measure changes in post-stroke aphasia and its relation with hemiparesis treated with different therapies. METHODS Database information (n = 32) on post-stroke hemiparesis (Fugl-Meyer Scale evaluated) managed with virtual reality (VR) versus modified constraint-induced movement therapy (mCIMT) or regular therapy (rPT/OT) was analyzed. None received logotherapy (LT) by appointment at four months. INCLUSION CRITERIA < 3 months after the stroke, aphasia severe (Boston Aphasia Intensity Scale), and all three evaluations. RESULTS Twenty-one patient records met inclusion criteria (71,4% women and mean age 66,67±3,13 years) who received VR, mCIMT, or rPT/OT (n = 6, 8, and 7, respectively). There was continuous intra-groups improvement in aphasia (p < 0.05), but inter-groups the greater aphasia recovery (p = 0.05) and hemiparesis (p = 0.02) were in VR, with a high correlation in evolution between them (r = 0.73; p = 0.047). CONCLUSION High clinical correlation between aphasia, without LT, and hemiparesis evolution during motor neurorehabilitation would support common neural connections stimulation. We will conduct a clinical trial, with a larger sample size to contrast our hypothesis.
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Affiliation(s)
- María del Carmen Rojas-Sosa
- Rehabilitation Units and Services Division, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - José Antonio Zárate
- External Consultation Service, XXI Century Physical Medicine and Rehabilitation Unit, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Norma de la Rosa-Peña
- Psychology Department, XXI Century Physical Medicine and Rehabilitation Unit, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - José Luis Olvera-Gómez
- Planning and Institutional Liaison Directorate, South Delegation, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - David Rojano-Mejía
- Health Research Coordination, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - José Delgado-García
- Rehabilitation Units and Services Division, Mexican Institute of Social Security (IMSS), Mexico City, Mexico
| | - Juan Garduño-Espinosa
- Secretariat of Health, Federico Gómez Children’s Hospital of Mexico, Mexico City, Mexico
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22
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Bilateral Sensorimotor Cortical Communication Modulated by Multiple Hand Training in Stroke Participants: A Single Training Session Pilot Study. Bioengineering (Basel) 2022; 9:bioengineering9120727. [PMID: 36550934 PMCID: PMC9774770 DOI: 10.3390/bioengineering9120727] [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: 10/14/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022] Open
Abstract
Bi-manual therapy (BT), mirror therapy (MT), and robot-assisted rehabilitation have been conducted in hand training in a wide range of stages in stroke patients; however, the mechanisms of action during training remain unclear. In the present study, participants performed hand tasks under different intervention conditions to study bilateral sensorimotor cortical communication, and EEG was recorded. A multifactorial design of the experiment was used with the factors of manipulating objects (O), robot-assisted bimanual training (RT), and MT. The sum of spectral coherence was applied to analyze the C3 and C4 signals to measure the level of bilateral corticocortical communication. We included stroke patients with onset <6 months (n = 6), between 6 months and 1 year (n = 14), and onset >1 year (n = 20), and their Brunnstrom recovery stage ranged from 2 to 4. The results showed that stroke duration might influence the effects of hand rehabilitation in bilateral cortical corticocortical communication with significant main effects under different conditions in the alpha and beta bands. Therefore, stroke duration may influence the effects of hand rehabilitation on interhemispheric coherence.
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23
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Assessing the level of perceived social support among community-dwelling stroke survivors using the Multidimensional Scale of Perceived Social Support. Sci Rep 2022; 12:19318. [PMID: 36369351 PMCID: PMC9652448 DOI: 10.1038/s41598-022-23840-3] [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: 06/15/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
Social support has an important role in stroke rehabilitation. The Multidimensional Scale of Perceived Social Support (MSPSS) is an instrument examining the adequacy of perceived social support. However, the psychometric properties of the Chinese version of MSPSS (MSPSS-C) have not been examined in Chinese people with stroke. This study aimed at investigating the psychometric properties of the MSPSS-C, identifying the correlations between MSPSS-C scores and health-related measures of these people; and examining the differences in the levels of perceived social support between people with and without stroke in Hong Kong using a cohort of 57 community-dwelling people with stroke and 50 age-matched healthy controls. We found that the MSPSS-C subscales demonstrated excellent internal consistency, and a ceiling effect was observed for the family subscale of the MSPSS-C. The total MSPSS-C score had significant weak to moderate correlations with the scores of the concerned variables of interests. Exploratory factor analysis revealed a two-factor structure for the MSPSS-C. People with stroke had lower levels of perceived social support from friends and their significant other than those without stroke. The MSPSS-C is a valid tool for assessing perceived social support among chronic stroke survivors with moderate to very severe motor impairment.
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24
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Liu-Ambrose T, Falck RS, Dao E, Best JR, Davis JC, Bennett K, Hall PA, Hsiung GYR, Middleton LE, Goldsmith CH, Graf P, Eng JJ. Effect of Exercise Training or Complex Mental and Social Activities on Cognitive Function in Adults With Chronic Stroke: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2236510. [PMID: 36227593 PMCID: PMC9561961 DOI: 10.1001/jamanetworkopen.2022.36510] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A stroke doubles one's risk for dementia. How to promote cognitive function among persons with chronic stroke is unclear. OBJECTIVE To evaluate the effect of exercise (EX) or cognitive and social enrichment activities (ENRICH) on cognitive function in adults with chronic stroke. DESIGN, SETTING, AND PARTICIPANTS This was a 3-group parallel, single-blinded, single-site, proof-of-concept randomized clinical trial at a research center in Vancouver, British Columbia, Canada. Participants included community-dwelling adults with chronic stroke, aged 55 years and older, able to walk 6 meters, and without dementia. The trial included a 6-month intervention and a 6-month follow-up. Randomization occurred from June 6, 2014, to February 26, 2019. Measurement occurred at baseline, 6 months, and 12 months. Data were analyzed from January to November 2021. INTERVENTIONS Participants were randomly allocated to twice-weekly supervised classes of: (1) EX, a multicomponent exercise program; (2) ENRICH, a program of cognitive and social enrichment activities; or (3) balance and tone (BAT), a control group that included stretches and light-intensity exercises. MAIN OUTCOMES AND MEASURES The primary outcome was the Alzheimer Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus), which included the 13-item ADAS-Cog, Trail Making Test Parts A and B, Digit Span Forward and Backward, Animal Fluency, and Vegetable Fluency. RESULTS One-hundred and twenty participants, with a mean (range) of 1.2 (1-4) strokes, a mean (SD) of 66.5 (53.8) months since the most recent stroke, mean (SD) baseline age of 70 (8) years, mean (SD) baseline ADAS-Cog-Plus of 0.22 (0.81), and 74 (62%) male participants, were randomized to EX (34 participants), ENRICH (34 participants), or BAT (52 participants). Seventeen withdrew during the 6-month intervention and another 7 during the 6-month follow-up. Including all 120 participants, at the end of the 6-month intervention, EX significantly improved ADAS-Cog-Plus performance compared with BAT (estimated mean difference: -0.24; 95% CI, -0.43 to -0.04; P = .02). This difference did not persist at the 6-month follow-up (estimated mean difference: -0.08; 95% CI, -0.29 to 0.12; P = .43). For the 13-item ADAS-Cog, the EX group improved by 5.65 points over the 6-month intervention (95% CI, 2.74 to 8.57 points; P < .001), exceeding the minimally clinical difference of 3.0 points. CONCLUSIONS AND RELEVANCE These findings suggest that exercise can induce clinically important improvements in cognitive function in adults with chronic stroke. Future studies need to replicate current findings and to understand training parameters, moderators, and mediators to maximize benefits. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01916486.
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Affiliation(s)
- Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S. Falck
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Dao
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John R. Best
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jennifer C. Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Management, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kim Bennett
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Peter A. Hall
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
- Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura E. Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Charles H. Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Graf
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
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25
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Non-invasive brain stimulation as therapeutic approach for ischemic stroke: Insights into the (sub)cellular mechanisms. Pharmacol Ther 2022; 235:108160. [PMID: 35183592 DOI: 10.1016/j.pharmthera.2022.108160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/12/2023]
Abstract
Although spontaneous recovery can occur following ischemic stroke due to endogenous neuronal reorganization and neuroplastic events, the degree of functional improvement is highly variable, causing many patients to remain permanently impaired. In the last decades, non-invasive brain stimulation (NIBS) techniques have emerged as potential add-on interventions to the standard neurorehabilitation programs to improve post-stroke recovery. Due to their ability to modulate cortical excitability and to induce neuroreparative processes in the brain, multiple studies have assessed the safety, efficacy and (sub)cellular mechanisms of NIBS following ischemic stroke. In this review, an overview will be provided of the different NIBS techniques that are currently being investigated in (pre)clinical stroke studies. The NIBS therapies that will be discussed include transcranial magnetic stimulation, transcranial direct current stimulation and extremely low frequency electromagnetic stimulation. First, an overview will be given of the cellular mechanisms induced by NIBS that are associated with enhanced stroke outcome in preclinical models. Furthermore, the current knowledge on safety and efficacy of these NIBS techniques in stroke patients will be reviewed.
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26
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Lee HH, Sohn MK, Kim DY, Shin YI, Oh GJ, Lee YS, Joo MC, Lee SY, Song MK, Han J, Ahn J, Lee YH, Chang WH, Choi SM, Lee SK, Lee J, Kim YH. Understanding of the Lower Extremity Motor Recovery After First-Ever Ischemic Stroke. Stroke 2022; 53:3164-3172. [PMID: 35713003 DOI: 10.1161/strokeaha.121.038196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to verify the validity of the proportional recovery model for the lower extremity. METHODS We reviewed clinical data of patients enrolled in the Korean Stroke Cohort for Functioning and Rehabilitation between August 2012 and May 2015. Recovery proportion was calculated as the amount of motor recovery over initial motor impairment, measured as the Fugl-Meyer Assessment of Lower Extremity score. We used the logistic regression method to model the probability of achieving the full Fugl-Meyer Assessment of Lower Extremity score, whereby we considered the ceiling effect of the score. To show the difference in the prevalence of achieving the full Fugl-Meyer Assessment of Lower Extremity score between 3 and 6 months poststroke, we constructed a marginal model through the generalized estimating equation method. We also performed the propensity score matching analysis to show the dependency of recovery proportion on the initial motor deficit at 3 and 6 months poststroke. RESULTS We evaluated 1085 patients. The recovery proportions at 3 and 6 months poststroke were 0.67±0.42 and 0.75±0.39, respectively. A 1-unit decrease in the initial neurological impairment and the age at stroke onset increased the probability of achieving the full Fugl-Meyer Assessment of Lower Extremity score, which occurred at both 3 and 6 months poststroke. The prevalence of those who reach full lower limb motor recovery differs significantly between 3 and 6 months poststroke. We also found out that the recovery proportion at both 3 and 6 months poststroke is determined by the initial motor deficits of the lower limb. These results are not consistent with the proportional recovery model. CONCLUSIONS Our results demonstrated that the proportional recovery model for the lower limb is invalid.
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Affiliation(s)
- Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea (H.H.L., J.L.)
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University School of Medicine, Daejeon, South Korea (M.K.S.)
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea (D.Y.K.)
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, South Korea (Y.-I.S.)
| | - Gyung-Jae Oh
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (G.-J.O., Y.-H.L.)
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea (Y.-S.L.)
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (M.C.J.)
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju National University School of Medicine, South Korea (S.Y.L.)
| | - Min-Keun Song
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, South Korea (M.K.S.)
| | - Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, South Korea (J.H.)
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, South Korea (J.A.)
| | - Young-Hoon Lee
- Department of Preventive Medicine, Wonkwang University School of Medicine, Iksan, South Korea. (G.-J.O., Y.-H.L.)
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.H.C., Y.-H.K.)
| | - Soo Mi Choi
- Division of Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, South Korea (S.M.C., S.K.L.)
| | - Seon Kui Lee
- Division of Chronic Disease Prevention, Korea Disease Control and Prevention Agency, Cheongju, South Korea (S.M.C., S.K.L.)
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center and Konkuk University School of Medicine, Seoul, South Korea (H.H.L., J.L.)
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (W.H.C., Y.-H.K.).,Department of Health Science and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea (Y.-H.K.)
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27
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Yen SC, Wang X, Wang I, Corkery MB, Chui KK, Chou CA. Association Rule Mining to Examine Predictors for the Outcome of Gait Rehabilitation Programs in Stroke Survivors. Am J Phys Med Rehabil 2022; 101:609-614. [PMID: 34686633 PMCID: PMC9018884 DOI: 10.1097/phm.0000000000001912] [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] [Indexed: 11/27/2022]
Abstract
ABSTRACT This study presents a novel application of association rule data mining to determine the predictors of the response to locomotor training and home exercise for improving gait after stroke. The study was a secondary data analysis on the Locomotor Experience Applied Post Stroke Trial dataset. The association rule analysis was applied to analyze three interventions: (1) early locomotor training, (2) late locomotor training, and (3) home exercise program. The outcome variable was whether participants poststroke had greater than median improvement in the self-selected comfortable gait speed. Three types of predictors were investigated: (1) demographics, (2) behavioral and medical history, and (3) clinical assessments at baseline. Association rules were generated when they meet two criteria determined based on the data: 10% of support and 70% of confidence. The identified rules showed that the predictors of the response were different across the three interventions, which was inconsistent with the previous report based on traditional logistic regression. However, the rules were identified with high confidence but low support, indicating that they were reliable but did not appear often in the Locomotor Experience Applied Post Stroke Trial dataset. Further investigation of these rules with a larger sample size is warranted before applying them to clinical settings.
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Affiliation(s)
- Sheng-Che Yen
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA 02115
| | - Xiaofan Wang
- Department of Mechanical and Industrial Engineering, Northeastern University, Northeastern University, Boston MA 02115
| | - Inga Wang
- Rehabilitation Sciences and Technology, University of Wisconsin Milwaukee, Milwaukee WI 53211
| | - Marie B. Corkery
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, MA 02115
| | - Kevin K. Chui
- Department of Physical Therapy, Waldron College of Health and Human Services, Radford University, Roanoke, VA 24013
| | - Chun-An Chou
- Department of Mechanical and Industrial Engineering, Northeastern University, Northeastern University, Boston MA 02115
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Effects of Transcranial Direct Current Stimulation of Bilateral Supplementary Motor Area on the Lower Limb Motor Function in a Stroke Patient with Severe Motor Paralysis: A Case Study. Brain Sci 2022; 12:brainsci12040452. [PMID: 35447983 PMCID: PMC9029581 DOI: 10.3390/brainsci12040452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 02/04/2023] Open
Abstract
In patients with severe motor paralysis, increasing the excitability of the supplementary motor area (SMA) in the non-injured hemisphere contributes to the recovery of lower limb motor function. However, the contribution of transcranial direct current stimulation (tDCS) over the SMA of the non-injured hemisphere in the recovery of lower limb motor function is unclear. This study aimed to examine the effects of tDCS on bilateral hemispheric SMA combined with assisted gait training. A post-stroke patient with severe motor paralysis participated in a retrospective AB design. Assisted gait training was performed only in period A and tDCS to the SMA of the bilateral hemisphere combined with assisted gait training (bi-tDCS) was performed in period B. Additionally, three conditions were performed for 20 min each in the intervals between the two periods: (1) assisted gait training only, (2) assisted gait training combined with tDCS to the SMA of the injured hemisphere, and (3) bi-tDCS. Measurements were muscle activity and beta-band intermuscular coherence (reflecting corticospinal tract excitability) of the vastus medialis muscle. The bi-tDCS immediately and longitudinally increased muscle activity and intermuscular coherence. We consider that bi-tDCS may be effective in recovering lower limb motor function in a patient with severe motor paralysis.
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Lamberti N, Manfredini F, Nardi F, Baroni A, Piva G, Crepaldi A, Basaglia N, Casetta I, Straudi S. Cortical Oxygenation during a Motor Task to Evaluate Recovery in Subacute Stroke Patients: A Study with Near-Infrared Spectroscopy. Neurol Int 2022; 14:322-335. [PMID: 35466207 PMCID: PMC9036242 DOI: 10.3390/neurolint14020026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
In subacute stroke patients we studied cortical oxygenation changes by near-infrared spectroscopy (NIRS) during a motor task performed with the hemiparetic arm (15 s of reaching and grasping, 45 s of rest, repeated 6 times). Twenty-three subjects were included at baseline, compared with six healthy subjects, and restudied after 6 weeks of rehabilitation. Motor/premotor cortical changes in oxyhemoglobin detected by NIRS were quantified as the area under the curve (AUC) for the total cortex (TOT-AUC) and for both affected (AFF-AUC) and unaffected hemispheres (UN-AUC). The ratio between AUC and the number of task repetitions performed identified the cortical metabolic cost (CMC) or the oxygenation increase for a single movement. Fugl−Meyer assessment of the upper extremity (FMA-UE) was also performed. At baseline, both total and hemispheric CMC were significantly higher in stroke patients than in healthy subjects and inversely correlated with FMA-UE. After rehabilitation, changes in total-CMC and unaffected-CMC, but not Affected-CMC, were inversely correlated with variations in the FMA-UE score. A value > 5000 a.u. for the ratio baseline TOT-CMC/days since stroke was associated with not reaching the clinically important difference for FMA-UE after rehabilitation. In subacute stroke the CMC, a biomarker assessed by NIRS during a motor task with the hemiparetic arm, may describe cortical time/treatment reorganization and favor patient selection for rehabilitation.
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Affiliation(s)
- Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
- Correspondence: ; Tel.: +39-05322-36187
| | - Francesca Nardi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
| | - Andrea Baroni
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
| | - Giovanni Piva
- PhD Program in Environmental Sustainability and Wellbeing, University of Ferrara, Via Paradiso 12, 44121 Ferrara, Italy;
| | - Anna Crepaldi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- PhD Program in Biomedicine, Instituto Maimónides de Investigación Biomédica de Córdoba, 14005 Córdova, Spain
| | - Nino Basaglia
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
| | - Ilaria Casetta
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- Unit of Clinical Neurology, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy; (N.L.); (F.N.); (A.C.); (I.C.); (S.S.)
- Unit of Rehabilitation Medicine, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (N.B.)
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Sato C, Kamijo YI, Sakurai Y, Araki S, Sakata Y, Ishigame A, Murai K, Yoshioka I, Tajima F. Three-week exercise and protein intake immediately after exercise increases the 6-min walking distance with simultaneously improved plasma volume in patients with chronic cerebrovascular disease: a preliminary prospective study. BMC Sports Sci Med Rehabil 2022; 14:38. [PMID: 35292094 PMCID: PMC8922777 DOI: 10.1186/s13102-022-00429-x] [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: 09/24/2021] [Accepted: 03/02/2022] [Indexed: 05/31/2023]
Abstract
Background Blood volume (BV) is a critical factor for physical endurance in chronic stroke patients, while hypervolemia can worsen hypertension in these patients. This prospective study assessed whether rehabilitation combined with protein supplementation immediately after each exercise for 3 weeks would improve plasma volume (PV) and BV as well as physical endurance without worsening hypertension. Methods Ambulatory patients with chronic cerebrovascular disease who received a 3-week rehabilitation program with high protein jelly (intervention group [PG]; n = 8; 10-g protein) or protein-free jelly (control group [CG]; n = 8) consumed within 30 min after each exercise. PV and BV were assessed while measuring the 6-min walking distance (6MWD), peak oxygen consumption (VO2peak), strength of knee extension, and resting blood pressure before and after the intervention. Two-way ANOVA was used to determine whether there was an interaction of time × group. The difference between before and after intervention or between the groups by post-hoc test (Tukey’s test) at the level of P < 0.05. Results The 6MWD increased only in the PG (P = 0.001; an interaction of Group and Time, P = 0.037). PV and BV increased only in the PG (P < 0.05). VO2peak and strength of knee extension in the paralysed limb increased in both groups (P < 0.05). The resting blood pressure did not worsen after the intervention. Conclusions In chronic post-stroke patients, 3-week rehabilitation combined with protein intake immediately after exercise increased 6MWD simultaneously with increased PV and BV, but it did not increase resting blood pressure. The present regimen is acceptable and effective for ambulatory patients with chronic cerebrovascular disease. Name of the registry Examining effects of protein supplementation on functional improvement during rehabilitation intervention in chronic stroke patients Trial registration number UMIN000028009; date of registration: 30/06/2017. This study was registered prospectively. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-022-00429-x.
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Affiliation(s)
- Chika Sato
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan.,Department of Rehabilitation Medicine, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan. .,Institute of Sports Science and Environmental Physiology, Medical Centre for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033, Japan. .,Department of Rehabilitation Medicine, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
| | - Yuta Sakurai
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan
| | - Shohei Araki
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan
| | - Yuki Sakata
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan.,Department of Rehabilitation Medicine, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
| | - Ayana Ishigame
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan
| | - Kota Murai
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan.,Department of Rehabilitation Medicine, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan
| | - Izumi Yoshioka
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan
| | - Fumihiro Tajima
- Nachi-Katsuura Research Centre of Sports Medicine and Balneology, Nachi-Katsuura Balneologic Town Hospital, 1185-4 Tenma-Nachi-katuurachou, Higashimuro gun, 649-5331, Japan.,Department of Rehabilitation Medicine, School of Medicine, Wakayama Medical University, 811-1, Kimiidera, Wakayama, 641-8509, Japan.,Institute of Sports Science and Environmental Physiology, Medical Centre for Health Promotion and Sports Science, Wakayama Medical University, 2-1 Honmachi, Wakayama, 640-8033, Japan
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Schröder J, Saeys W, Yperzeele L, Kwakkel G, Truijen S. Time Course and Mechanisms Underlying Standing Balance Recovery Early After Stroke: Design of a Prospective Cohort Study With Repeated Measurements. Front Neurol 2022; 13:781416. [PMID: 35265023 PMCID: PMC8899509 DOI: 10.3389/fneur.2022.781416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Although most stroke survivors show some spontaneous neurological recovery from motor impairments of the most-affected leg, the contribution of this leg to standing balance control remains often poor. Consequently, it is unclear how spontaneous processes of neurological recovery contributes to early improvements in standing balance. Objective We aim to investigate (1) the time course of recovery of quiet stance balance control in the first 12 weeks poststroke and (2) how clinically observed improvements of lower limb motor impairments longitudinally relate to this limb's relative contribution to balance control. Methods and Analysis In this prospective longitudinal study, a cohort of 60 adults will be recruited within the first 3 weeks after a first-ever hemispheric stroke and mild-to-severe motor impairments. Individual recovery trajectories will be investigated by means of repeated measurements scheduled at 3, 5, 8, and 12 weeks poststroke. The Fugl-Meyer Motor Assessment and Motricity Index of the lower limb serve as clinical measures of motor impairments at the hemiplegic side. As soon as subjects are able to stand independently, bilateral posturography during quietly standing will be measured. First, the obtained center-of-pressure (COP) trajectories at each foot will be used for synchronization and contribution measures that establish (a-)symmetries between lower limbs. Second, the COP underneath both feet combined will be used to estimate overall stability. Random coefficient analyses will be used to model time-dependent changes in these measures and, subsequently, a hybrid model will be used to investigate longitudinal associations with improved motor impairments. Discussion The current study aims to investigate how stroke survivors "re-learn" to maintain standing balance as an integral part of daily life activities. The knowledge gained through this study may contribute to recommending treatment strategies for early stroke rehabilitation targeting behavioral restitution of the most-affected leg or learning to compensate with the less-affected leg.
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Affiliation(s)
- Jonas Schröder
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences, University of Antwerp, Wilrijk, Belgium.,M2OCEAN Lab, The Multidisciplinary Motor Centre Antwerp, Faculty of Health Sciences, University of Antwerp, Edegem, Belgium
| | - Wim Saeys
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences, University of Antwerp, Wilrijk, Belgium.,M2OCEAN Lab, The Multidisciplinary Motor Centre Antwerp, Faculty of Health Sciences, University of Antwerp, Edegem, Belgium.,RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Laetitia Yperzeele
- Department of Neurology, Neurovascular Reference Center, Antwerp University Hospital, Edegem, Belgium.,Research Group Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Gert Kwakkel
- Department of Rehabilitation Medicine and Amsterdam Neuroscience, Amsterdam Movement Sciences, Amsterdam University Medical Centre, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre, Reade, Amsterdam, Netherlands
| | - Steven Truijen
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Health Sciences, University of Antwerp, Wilrijk, Belgium.,M2OCEAN Lab, The Multidisciplinary Motor Centre Antwerp, Faculty of Health Sciences, University of Antwerp, Edegem, Belgium
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Saionz EL, Busza A, Huxlin KR. Rehabilitation of visual perception in cortical blindness. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:357-373. [PMID: 35034749 PMCID: PMC9682408 DOI: 10.1016/b978-0-12-819410-2.00030-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.
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Affiliation(s)
- Elizabeth L Saionz
- Medical Scientist Training Program, University of Rochester, Rochester, NY, United States
| | - Ania Busza
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Krystel R Huxlin
- Flaum Eye Institute, University of Rochester, Rochester, NY, United States.
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Longitudinal Changes in Temporospatial Gait Characteristics during the First Year Post-Stroke. Brain Sci 2021; 11:brainsci11121648. [PMID: 34942950 PMCID: PMC8699066 DOI: 10.3390/brainsci11121648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Given the paucity of longitudinal data in gait recovery after stroke, we compared temporospatial gait characteristics of stroke patients during subacute (<2 months post-onset, T0) and at approximately 6 and 12 months post-onset (T1 and T2, respectively) and explored the relationship between gait characteristics at T0 and the changes in gait speed from T0 to T1. Forty-six participants were assessed at T0 and a subsample of twenty-four participants were assessed at T2. Outcome measures included Fugl-Meyer lower-extremity motor score, 14 temporospatial gait parameters, and symmetry indices of 5 step parameters. Except for step width, all temporospatial parameters improved from T0 to T1 (p ≤ 0.0001). Additionally, significant improvements in symmetry were found for the initial double-support time and single-support time (p ≤ 0.0001). As a group, no significant differences were found between T1 and T2 in any of the temporospatial measures. However, the individual analysis revealed that 42% (10/24) of the subsample showed a significant increase in gait speed (Welch’s t-test, p ≤ 0.002). Yet, only 5/24 (21%) of the participants improved speed from T1 to T2 according to speed-based minimum detectable change criteria. The increase in gait speed from T0 to T1 was negatively correlated with gait speed and stride length and positively correlated with the symmetry indices of stance and single-support times at T0 (p ≤ 0.002). Temporospatial gait parameters and stance time symmetry improved over the first 6 months after stroke with an apparent plateau thereafter. A greater increase in gait speed during the first 6 months post-stroke is associated with initially slower walking, shorter stride length, and more pronounced asymmetry in stance and single-support times. The improvement in lower-extremity motor function and bilateral improvements in step parameters collectively suggest that gait changes over the first 6 months after stroke are likely due to a combination of neurological recovery, compensatory strategies, and physical therapy received during that time.
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. The effect of time spent in rehabilitation on activity limitation and impairment after stroke. Cochrane Database Syst Rev 2021; 10:CD012612. [PMID: 34695300 PMCID: PMC8545241 DOI: 10.1002/14651858.cd012612.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.e. days per week of rehabilitation), and duration (i.e. time period over which rehabilitation is provided). Effect of time spent in rehabilitation after stroke has been explored extensively in the literature, but findings are inconsistent. Previous systematic reviews with meta-analyses have included studies that differ not only in the amount provided, but also type of rehabilitation. OBJECTIVES To assess the effect of 1. more time spent in the same type of rehabilitation on activity measures in people with stroke; 2. difference in total rehabilitation time (in minutes) on recovery of activity in people with stroke; and 3. rehabilitation schedule on activity in terms of: a. average time (minutes) per week undergoing rehabilitation, b. frequency (number of sessions per week) of rehabilitation, and c. total duration of rehabilitation. SEARCH METHODS We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, eight other databases, and five trials registers to June 2021. We searched reference lists of identified studies, contacted key authors, and undertook reference searching using Web of Science Cited Reference Search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with stroke that compared different amounts of time spent, greater than zero, in rehabilitation (any non-pharmacological, non-surgical intervention aimed to improve activity after stroke). Studies varied only in the amount of time in rehabilitation between experimental and control conditions. Primary outcome was activities of daily living (ADLs); secondary outcomes were activity measures of upper and lower limbs, motor impairment measures of upper and lower limbs, and serious adverse events (SAE)/death. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data, assessed methodological quality using the Cochrane RoB 2 tool, and assessed certainty of the evidence using GRADE. For continuous outcomes using different scales, we calculated pooled standardised mean difference (SMDs) and 95% confidence intervals (CIs). We expressed dichotomous outcomes as risk ratios (RR) with 95% CIs. MAIN RESULTS The quantitative synthesis of this review comprised 21 parallel RCTs, involving analysed data from 1412 participants. Time in rehabilitation varied between studies. Minutes provided per week were 90 to 1288. Days per week of rehabilitation were three to seven. Duration of rehabilitation was two weeks to six months. Thirteen studies provided upper limb rehabilitation, five general rehabilitation, two mobilisation training, and one lower limb training. Sixteen studies examined participants in the first six months following stroke; the remaining five included participants more than six months poststroke. Comparison of stroke severity or level of impairment was limited due to variations in measurement. The risk of bias assessment suggests there were issues with the methodological quality of the included studies. There were 76 outcome-level risk of bias assessments: 15 low risk, 37 some concerns, and 24 high risk. When comparing groups that spent more time versus less time in rehabilitation immediately after intervention, we found no difference in rehabilitation for ADL outcomes (SMD 0.13, 95% CI -0.02 to 0.28; P = 0.09; I2 = 7%; 14 studies, 864 participants; very low-certainty evidence), activity measures of the upper limb (SMD 0.09, 95% CI -0.11 to 0.29; P = 0.36; I2 = 0%; 12 studies, 426 participants; very low-certainty evidence), and activity measures of the lower limb (SMD 0.25, 95% CI -0.03 to 0.53; P = 0.08; I2 = 48%; 5 studies, 425 participants; very low-certainty evidence). We found an effect in favour of more time in rehabilitation for motor impairment measures of the upper limb (SMD 0.32, 95% CI 0.06 to 0.58; P = 0.01; I2 = 10%; 9 studies, 287 participants; low-certainty evidence) and of the lower limb (SMD 0.71, 95% CI 0.15 to 1.28; P = 0.01; 1 study, 51 participants; very low-certainty evidence). There were no intervention-related SAEs. More time in rehabilitation did not affect the risk of SAEs/death (RR 1.20, 95% CI 0.51 to 2.85; P = 0.68; I2 = 0%; 2 studies, 379 participants; low-certainty evidence), but few studies measured these outcomes. Predefined subgroup analyses comparing studies with a larger difference of total time spent in rehabilitation between intervention groups to studies with a smaller difference found greater improvements for studies with a larger difference. This was statistically significant for ADL outcomes (P = 0.02) and activity measures of the upper limb (P = 0.04), but not for activity measures of the lower limb (P = 0.41) or motor impairment measures of the upper limb (P = 0.06). AUTHORS' CONCLUSIONS An increase in time spent in the same type of rehabilitation after stroke results in little to no difference in meaningful activities such as activities of daily living and activities of the upper and lower limb but a small benefit in measures of motor impairment (low- to very low-certainty evidence for all findings). If the increase in time spent in rehabilitation exceeds a threshold, this may lead to improved outcomes. There is currently insufficient evidence to recommend a minimum beneficial daily amount in clinical practice. The findings of this study are limited by a lack of studies with a significant contrast in amount of additional rehabilitation provided between control and intervention groups. Large, well-designed, high-quality RCTs that measure time spent in all rehabilitation activities (not just interventional) and provide a large contrast (minimum of 1000 minutes) in amount of rehabilitation between groups would provide further evidence for effect of time spent in rehabilitation.
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Affiliation(s)
- Beth Clark
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jane Burridge
- Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Miller T, Ying MTC, Chung RCK, Pang MYC. Convergent Validity and Test-Retest Reliability of Multimodal Ultrasonography and Related Clinical Measures in People With Chronic Stroke. Arch Phys Med Rehabil 2021; 103:459-472.e4. [PMID: 34695388 DOI: 10.1016/j.apmr.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the test-retest reliability of diagnostic ultrasonography measurements of the bilateral biceps brachii (BB), brachial artery, medial gastrocnemius (MG), and popliteal artery in survivors of stroke and their convergent validity with related clinical comparators. DESIGN Cross-sectional study. SETTING All procedures were conducted in a university laboratory. PARTICIPANTS Sixty-five community dwelling adults (N=65; 26 women, 39 men) with an average age of 60.9±7.7 years and stroke duration of 5.7±3.9 years participated in this study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Measures of muscle structure (ie, thickness, cross-sectional area, fascicle length, pennation angle), stiffness, and intramuscular blood perfusion were conducted using B-mode, elastography and color flow Doppler ultrasonography modes, respectively. Convergent validity was assessed by examining correlations between ultrasonography measures and assessments of related constructs (ie, dynamic stiffness, isometric peak torque, spasticity, and systemic vascular function using myotonometry, dynamometry, the Composite Spasticity Scale, and the Ankle-Brachial Index, respectively). A 2-way random-effects intraclass correlation coefficient (ICC) model (ICC2,3) was used to determine agreement between intersession measures among a smaller cohort of participants with stroke (n=20). RESULTS ICC estimates ranged from moderate to excellent for muscle stiffness (paretic: ICC=0.74-0.89; nonparetic: ICC=0.66-0.88), structure (paretic: ICC=0.87-0.99; nonparetic: ICC=0.81-0.98), and blood perfusion measures (paretic: ICC=0.74-0.84; nonparetic: ICC=0.73-0.88). Weak to moderate associations were found between myotonometry and elastography measures of the bilateral BB (r=0.29-0.52, P≤.05) and MG muscles (r=0.31-0.69, P≤.05). The correlations between elastography measures and spasticity scores for the paretic upper (r=0.35-0.63, P≤.05) and lower limbs (r=0.25-0.37, P≤.05) were also weak to moderate. CONCLUSIONS Elastography demonstrated mostly weak to moderate correlation with measures of stiffness using myotonometry as well as scores of paretic upper and lower limb spasticity. The results also indicate acceptable intersession reliability for muscle and vascular measures using several ultrasonography modalities among individuals with chronic stroke.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom
| | - Michael T C Ying
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom.
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36
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Ishibashi K, Yoshikawa K, Koseki K, Aoyama T, Ishii D, Yamamoto S, Matsuda T, Tomita K, Mutsuzaki H, Kohno Y. Gait Training after Stroke with a Wearable Robotic Device: A Case Report of Further Improvements in Walking Ability after a Recovery Plateau. Prog Rehabil Med 2021; 6:20210037. [PMID: 34595360 PMCID: PMC8441009 DOI: 10.2490/prm.20210037] [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: 05/11/2021] [Accepted: 08/25/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Conventional rehabilitation is known to improve walking ability after stoke, but its effectiveness is often limited. Recent studies have shown that gait training combining conventional rehabilitation and robotic devices in stroke patients provides better results than conventional rehabilitation alone, suggesting that gait training with a robotic device may lead to further improvements in the walking ability recovered by conventional rehabilitation. Therefore, the aim of this report was to highlight the changes in kinematic and electromyographic data recorded during walking before and after gait training with the Honda Walking Assist Device® (HWAT) in a male patient whose walking speed had reached a recovery plateau under conventional rehabilitation. Case: The patient was a 42-year-old man with severe hemiplegia caused by right putaminal hemorrhage. He underwent conventional rehabilitation for 20 weeks following the onset of stroke, after which his walking speed reached a recovery plateau. Subsequently, we added robotic rehabilitation using HWAT to his regular rehabilitation regimen, which resulted in improved step length symmetry and gait endurance. We also noted changes in muscle activity patterns during walking. Discussion: HWAT further improved the walking ability of a patient who had recovered with conventional rehabilitation; this improvement was accompanied by changes in muscle activity patterns during walking. The improvement in gait endurance exceeded the smallest meaningful change in stroke patients, suggesting that this improvement represented a noticeable enhancement in the quality of life in relation to mobility in the community. Further clinical trials are needed to confirm the results of the present case study.
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Affiliation(s)
- Kiyoshige Ishibashi
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kazunori Koseki
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Toshiyuki Aoyama
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Daisuke Ishii
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan.,Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Satoshi Yamamoto
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Tomoyuki Matsuda
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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37
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Chin LF, Hayward KS, Chai ALM, Brauer SG. A Self-Empowered Upper Limb Repetitive Engagement Program to Improve Upper Limb Recovery Early Post-Stroke: Phase II Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2021; 35:836-848. [PMID: 34281405 DOI: 10.1177/15459683211032967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Time outside therapy provides an opportunity to increase upper limb (UL) use during post-stroke hospitalization. Objective. To determine if a self-directed UL program outside therapy (Self-Empowered UL Repetitive Engagement, SURE) was feasible and to explore the potential effect of the SURE program on UL use and recovery. Methods. Twenty-three patients from an inpatient rehabilitation center who were ≤21 days post-stroke and had a Fugl Meyer UL (FMUL) score ≤50 and a positive motor evoked potential (MEP+) response were randomized (stratified by impairment) to either experimental group (SURE: individualized, UL self-exercise and use outside therapy for 6 hours/week for 4 weeks) or control group (education booklet). Feasibility was evaluated by program adherence, dropout rate, adverse events, and satisfaction. Potential effect was measured by paretic UL use via accelerometry weekly during the intervention, FMUL and Action Research Arm Test (ARAT) at baseline (Week 0), post-intervention (Week 4), and follow-up (Week 8 and Week 16). Results. Adherence to SURE was high: 87% program completion (mean 313±75 repetitions/day). There were no dropouts, no adverse events related to SURE, and patient satisfaction averaged 7.8/10. Experimental participants achieved an additional hour of UL use daily (range: .3-1.2 hours/day) compared to control. Significant improvements in FMUL and ARAT were observed in both groups from Week 0 to Week 4 and to Week 8 (P ≤ .002), which were maintained to Week 16. There were no differences between groups (P ≥ .119). Conclusions. SURE was a feasible self-directed program that increased UL use in MEP+ individuals with moderate-severe impairment early post-stroke. Further studies with larger sample sizes and potentially higher dose are required to determine efficacy.
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Affiliation(s)
- Lay Fong Chin
- Rehabilitation Centre, Tan Tock Seng Hospital, Singapore, Singapore.,Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Kathryn S Hayward
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia.,Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Parkville, VIC, Australia.,Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia.,NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | | | - Sandra G Brauer
- Physiotherapy, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Gogia AS, Martin Del Campo-Vera R, Chen KH, Sebastian R, Nune G, Kramer DR, Lee MB, Tafreshi AR, Barbaro MF, Liu CY, Kellis S, Lee B. Gamma-band modulation in the human amygdala during reaching movements. Neurosurg Focus 2021; 49:E4. [PMID: 32610288 PMCID: PMC9651147 DOI: 10.3171/2020.4.focus20179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/14/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Motor brain-computer interface (BCI) represents a new frontier in neurological surgery that could provide significant benefits for patients living with motor deficits. Both the primary motor cortex and posterior parietal cortex have successfully been used as a neural source for human motor BCI, leading to interest in exploring other brain areas involved in motor control. The amygdala is one area that has been shown to have functional connectivity to the motor system; however, its role in movement execution is not well studied. Gamma oscillations (30-200 Hz) are known to be prokinetic in the human cortex, but their role is poorly understood in subcortical structures. Here, the authors use direct electrophysiological recordings and the classic "center-out" direct-reach experiment to study amygdaloid gamma-band modulation in 8 patients with medically refractory epilepsy. METHODS The study population consisted of 8 epilepsy patients (2 men; age range 21-62 years) who underwent implantation of micro-macro depth electrodes for seizure localization and EEG monitoring. Data from the macro contacts sampled at 2000 Hz were used for analysis. The classic center-out direct-reach experiment was used, which consists of an intertrial interval phase, a fixation phase, and a response phase. The authors assessed the statistical significance of neural modulation by inspecting for nonoverlapping areas in the 95% confidence intervals of spectral power for the response and fixation phases. RESULTS In 5 of the 8 patients, power spectral analysis showed a statistically significant increase in power within regions of the gamma band during the response phase compared with the fixation phase. In these 5 patients, the 95% bootstrapped confidence intervals of trial-averaged power in contiguous frequencies of the gamma band during the response phase were above, and did not overlap with, the confidence intervals of trial-averaged power during the fixation phase. CONCLUSIONS To the authors' knowledge, this is the first time that direct neural recordings have been used to show gamma-band modulation in the human amygdala during the execution of voluntary movement. This work indicates that gamma-band modulation in the amygdala could be a contributing source of neural signals for use in a motor BCI system.
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Affiliation(s)
| | | | | | | | - George Nune
- 2Neurology and.,3USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles; and
| | - Daniel R Kramer
- Departments of1Neurological Surgery and.,3USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles; and
| | | | | | | | - Charles Y Liu
- Departments of1Neurological Surgery and.,3USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles; and.,4Department of Biology and Biological Engineering and
| | - Spencer Kellis
- Departments of1Neurological Surgery and.,3USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles; and.,4Department of Biology and Biological Engineering and.,5Tianqiao and Chrissy Chen Brain-Machine Interface Center, Chen Institute for Neuroscience, California Institute of Technology, Pasadena, California
| | - Brian Lee
- Departments of1Neurological Surgery and.,3USC Neurorestoration Center, Keck School of Medicine of USC, Los Angeles; and.,4Department of Biology and Biological Engineering and
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The Effects of 4 Weeks of Chiropractic Spinal Adjustments on Motor Function in People with Stroke: A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11060676. [PMID: 34064209 PMCID: PMC8224305 DOI: 10.3390/brainsci11060676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Chiropractic spinal adjustments have been shown to result in short-term increases in muscle strength in chronic stroke patients, however, the effect of longer-term chiropractic spinal adjustments on people with chronic stroke is unknown. This exploratory study assessed whether 4 weeks of chiropractic spinal adjustments, combined with physical therapy (chiro + PT), had a greater impact than sham chiropractic with physical therapy (sham + PT) did on motor function (Fugl Meyer Assessment, FMA) in 63 subacute or chronic stroke patients. Secondary outcomes included health-related quality of life and other measures of functional mobility and disability. Outcomes were assessed at baseline, 4 weeks (post-intervention), and 8 weeks (follow-up). Data were analyzed using linear mixed-effects models or generalized linear mixed models. A post-hoc responder analysis was performed to investigate the clinical significance of findings. At 4 weeks, there was a larger effect of chiro + PT, compared with sham + PT, on the FMA (difference = 6.1, p = 0.04). The responder analysis suggested the improvements in motor function seen following chiropractic spinal adjustments may have been clinically significant. There was also a robust improvement in both groups in most measures from baseline to the 4- and 8-week assessments, but between-group differences were no longer significant at the 8-week assessment. Four weeks of chiro + PT resulted in statistically significant improvements in motor function, compared with sham + PT, in people with subacute or chronic stroke. These improvements appear to be clinically important. Further trials, involving larger group sizes and longer follow-up and intervention periods, are required to corroborate these findings and further investigate the impacts of chiropractic spinal adjustments on motor function in post-stroke survivors. ClinicalTrials.gov Identifier NCT03849794.
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40
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Ghai S, Maso FD, Ogourtsova T, Porxas AX, Villeneuve M, Penhune V, Boudrias MH, Baillet S, Lamontagne A. Neurophysiological Changes Induced by Music-Supported Therapy for Recovering Upper Extremity Function after Stroke: A Case Series. Brain Sci 2021; 11:brainsci11050666. [PMID: 34065395 PMCID: PMC8161385 DOI: 10.3390/brainsci11050666] [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: 03/29/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 12/30/2022] Open
Abstract
Music-supported therapy (MST) follows the best practice principles of stroke rehabilitation and has been proven to instigate meaningful enhancements in motor recovery post-stroke. The existing literature has established that the efficacy and specificity of MST relies on the reinforcement of auditory-motor functional connectivity in related brain networks. However, to date, no study has attempted to evaluate the underlying cortical network nodes that are key to the efficacy of MST post-stroke. In this case series, we evaluated changes in connectivity within the auditory-motor network and changes in upper extremity function following a 3-week intensive piano training in two stroke survivors presenting different levels of motor impairment. Connectivity was assessed pre- and post-training in the α- and the β-bands within the auditory-motor network using magnetoencephalography while participants were passively listening to a standardized melody. Changes in manual dexterity, grip strength, movement coordination, and use of the upper extremity were also documented in both stroke survivors. After training, an increase in the clinical measures was accompanied by enhancements in connectivity between the auditory and motor network nodes for both the α- and the β-bands, especially in the affected hemisphere. These neurophysiological changes associated with the positive effects of post-stroke MST on motor outcomes delineate a path for a larger scale clinical trial.
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Affiliation(s)
- Shashank Ghai
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
- Correspondence:
| | - Fabien Dal Maso
- Laboratory of Simulation and Movement Modelling, School of Kinesiology and Physical Activity, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre Interdisciplinaire de Recherche sur le Cerveau et l’Apprentissage, Montréal, QC H7N 0A5, Canada
| | - Tatiana Ogourtsova
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
| | - Alba-Xifra Porxas
- Graduate Program in Biological and Biomedical Engineering, McGill University, Montreal, QC H3A 0C3, Canada;
| | - Myriam Villeneuve
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
| | - Virginia Penhune
- Department of Psychology, Concordia University, Montreal, QC H3G 1M8, Canada;
- Laboratory for Brain Music and Sound (BRAMS), Centre for Research in Brain, Language and Music, Montreal, QC H2V 2S9, Canada
| | - Marie-Hélène Boudrias
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada;
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC H3G 1Y5, Canada; (T.O.); (M.-H.B.); (A.L.)
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital–CISSS Laval, A Research Site of the Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC H7V 1R2, Canada;
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Lackritz H, Parmet Y, Frenkel-Toledo S, Baniña MC, Soroker N, Solomon JM, Liebermann DG, Levin MF, Berman S. Effect of post-stroke spasticity on voluntary movement of the upper limb. J Neuroeng Rehabil 2021; 18:81. [PMID: 33985543 PMCID: PMC8117272 DOI: 10.1186/s12984-021-00876-6] [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: 01/20/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.
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Affiliation(s)
- Hadar Lackritz
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Silvi Frenkel-Toledo
- Faculty of Health Sciences, Department of Physical Therapy, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel
| | - Melanie C Baniña
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Hospital, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mindy F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Dragunas AC, Cornwell T, Lopez-Rosado R, Gordon KE. Post-Stroke Adaptation of Lateral Foot Placement Coordination in Variable Environments. IEEE Trans Neural Syst Rehabil Eng 2021; 29:731-739. [PMID: 33835919 PMCID: PMC8115208 DOI: 10.1109/tnsre.2021.3072252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Individuals with stroke often have difficulty modulating their lateral foot placement during gait, a primary strategy for maintaining lateral stability. Our purpose was to understand how individuals with and without stroke adapt their lateral foot placement when walking in an environment that alters center of mass (COM) dynamics and the mechanical requirement to maintain lateral stability. The treadmill walking environments included: 1) a Null Field – where no forces were applied, and 2) a Damping Field – where external forces opposed lateral COM velocity. To evaluate the response to the changes in environment, we quantified the correlation between lateral COM state and lateral foot placement (FP), as well as step width mean and variability. We hypothesized the Damping Field would produce a stabilizing effect and reduce both the COM-FP correlation strength and step width compared to the Null Field. We also hypothesized that individuals with stroke would have a significantly weaker COM-FP correlation than individuals without stroke. Surprisingly, we found no differences in COM-FP correlations between the Damping and Null Fields. We also found that compared to individuals without stroke in the Null Field, individuals with stroke had weaker COM-FP correlations (Paretic < Control: p = 0.001, Non-Paretic < Control: p = 0.007) and wider step widths (p = 0.001). Our results suggest that there is a post-stroke shift towards a non-specific lateral stabilization strategy that relies on wide steps that are less correlated to COM dynamics than in individuals without stroke.
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Hamaguchi T, Yamada N, Hada T, Abo M. Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data. Front Neurol 2020; 11:581186. [PMID: 33193036 PMCID: PMC7606467 DOI: 10.3389/fneur.2020.581186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/03/2020] [Indexed: 01/03/2023] Open
Abstract
Recovery from motor paralysis is facilitated by affected patients' recognition of the need for and practice of their own exercise goals. Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified. If an expected score for the neurorehabilitation effect can be calculated using the Fugl-Meyer Motor Assessment (FMA), a global assessment index, before neurorehabilitation, such a score will be useful for optimizing the treatment application criteria and for setting a goal to enhance the treatment effect. Therefore, this study verified whether the responsiveness to a treatment method, the NovEl intervention using repetitive transcranial magnetic stimulation and occupational therapy (NEURO), in patients with post-stroke upper extremity (UE) motor paralysis could be predicted by the pretreatment FMA score. No control group was established in this study for NEURO treatment. To analyze the recovery of the motor function in the UE, delta-FMA was calculated from the pre- and post-FMA scores obtained during NEURO treatment. The probability of three levels of treatment responsiveness was evaluated in association with delta-FMA score (<5, 5 ≤ delta-FMA <10, and ≥10 as non-responders; responders; and hyper-responders, respectively) according to the reported minimal clinically important difference (MCID). The association of the initial FMA scores with post-FMA scores, from the status of the treatment responsiveness, was determined by multinomial logistic regression analysis. Finally, 1,254 patients with stroke, stratified by FMA scores were analyzed. About 45% of the patients who had FMA scores ranging from 30 to 40 before treatment showed improvement over the MCID by NEURO treatment (odds ratio = 0.93, 95% CI = 0.92–0.95). Furthermore, more than 25% of the patients with more severe initial values, ranging from 26 to 30, improved beyond the MCID calculated in the acute phase (odds ratio = 0.87, 95% CI = 0.85–0.89). These results suggest that the evaluated motor function score of the UE before NEURO treatment can be used to estimate the possibility of a patient recovering beyond MCID in the chronic phase. This study provided clinical data to estimate the effect of NEURO treatment by the pretreatment FMA-UE score.
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Affiliation(s)
- Toyohiro Hamaguchi
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Rehabilitation, Graduate School of Health Sciences, Saitama Prefectural University, Koshigaya, Japan
| | - Naoki Yamada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takuya Hada
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Nedergård H, Schelin L, Frykberg GE, Häger CK. Inclination angles of the ankle and head relative to the centre of mass identify gait deviations post-stroke. Gait Posture 2020; 82:181-188. [PMID: 32937270 DOI: 10.1016/j.gaitpost.2020.08.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 06/26/2020] [Accepted: 08/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whole-body movement adjustments during gait are common post-stroke, but comprehensive ways of quantifying and evaluating gait from a whole-body perspective are lacking. RESEARCH QUESTION Can novel kinematic variables related to Center of Mass (CoM) position discriminate side asymmetries as well as coordination between the upper and lower body during gait within persons post-stroke and compared to non-disabled controls? METHODS Thirty-one persons post-stroke and 41 age-matched non-disabled controls walking at their self-selected speed were recorded by 3D motion capture. The Ankle-CoM Inclination Angle (A-CoMIA) and the Head-CoM Inclination Angle (H-CoMIA) defined the angle between the CoM and the ankle and the head, respectively, in the frontal plane. These angles and their angular velocities were compared between groups, and with regard to motor impairment severity during all phases of the gait cycle (GC) using a functional interval-wise testing analysis suitable for curve data. Upper and lower body coordination was assessed using cross- correlation. RESULTS The A-CoMIA was symmetrical between body sides in persons post-stroke but larger compared to controls. The angular velocity of A-CoMIA also differed when compared to controls. The H-CoMIA was consistently asymmetrical in persons post-stroke and larger than in controls throughout the stance phase. There were only minor group differences in the angular velocity of H-CoMIA, with some side asymmetry in persons post-stroke. The A-CoMIA of the non-affected side, and the H- CoMIA, discriminated between persons with more severe impairments compared to those with milder impairments post-stroke. The variables showed strong cross- correlations in both groups. SIGNIFICANCE The A-CoMIA and Head-CoMIA discriminated post-stroke gait from non-disabled, as well as motor impairment severity. These variables with the advantageous curve analysis during the entire GC add valuable whole-body information to existing parameters of post-stroke gait analysis through assessment of symmetry and upper and lower body coordination.
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Affiliation(s)
- Heidi Nedergård
- Dept. of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden.
| | - Lina Schelin
- Dept. of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Sweden
| | - Gunilla E Frykberg
- Dept. of Neuroscience, Rehabilitation Medicine, Uppsala University, Sweden
| | - Charlotte K Häger
- Dept. of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Sweden
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Chen J, Sun D, Zhang S, Shi Y, Qiao F, Zhou Y, Liu J, Ren C. Effects of home-based telerehabilitation in patients with stroke. Neurology 2020; 95:e2318-e2330. [DOI: 10.1212/wnl.0000000000010821] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 05/08/2020] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo determine the effects of a 12-week home-based motor training telerehabilitation program in patients with subcortical stroke by combining motor function assessments and multimodality MRI analysis methods.MethodsFifty-two patients with stroke and hemiplegia were randomly assigned to either a home-based motor training telerehabilitation (TR) group or a conventional rehabilitation (CR) group for 12 weeks. The Fugl-Meyer assessment (FMA) for upper and lower extremities and the modified Barthel Index were used as primary outcomes. The secondary outcomes included resting-state functional connectivity (rsFC) between the bilateral M1 areas, gray matter volumes of the primary motor cortex (M1) areas, and white matter integrity of the corticospinal tract. Analysis of covariance was applied to examine the effects of the home-based motor training TR program on neural function recovery and brain plasticity.ResultsCompared with the CR group, the TR group showed significant improvement in the FMA (p = 0.011) and significantly increased M1-M1 rsFC (p = 0.031) at the end of the rehabilitation. The M1-M1 rsFC change was significantly positively correlated with the FMA change in the TR group (p = 0.018).ConclusionThis study showed a beneficial effect of the home-based motor training telerehabilitation program on motor function in patients with stroke, which was accompanied by enhanced interhemispheric functional connectivity of the M1 areas. We inferred that it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home. The combined use of imaging biomarkers should be encouraged in motor training clinical studies in patients with stroke.Classification of evidenceThis study provides Class II evidence that for patients with stroke with hemiplegia, home-based telerehabilitation compared to conventional rehabilitation significantly improves some motor function tests.
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Lee J, Kim H, Kim J, Lee HJ, Chang WH, Kim YH. Differential early predictive factors for upper and lower extremity motor recovery after ischaemic stroke. Eur J Neurol 2020; 28:132-140. [PMID: 32881176 DOI: 10.1111/ene.14494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Various clinical and neuroimaging predictive factors have been identified for the recovery of upper extremity (UE) motor function after stroke. However, few studies have addressed factors related to the recovery of lower extremity (LE) motor function after stroke or performed direct comparisons of UE and LE motor recovery in the same set of patients. In this study, predictive factors for UE and LE motor recovery after stroke were investigated using clinical and neuroimaging characteristics. METHODS Forty-two subacute ischaemic stroke patients underwent structural and functional magnetic resonance imaging data acquisition and cognitive/behavioral assessments using the Fugl-Meyer assessment, the National Institutes of Health Stroke Scale (NIHSS) and the Mini-Mental State Examination (MMSE) 2 weeks after stroke onset. Neuroimaging factors, including corticospinal tract (CST) fractional anisotropy, lesion volume, CST lesion load and interhemispheric homotopic functional connectivity, were extracted. The outcome of motor function was assessed by Fugl-Meyer assessment scores 3 months after onset. RESULTS Early clinical and neuroimaging factors for predicting motor recovery were noticeably different for UE and LE. UE motor function recovery was related to age, NIHSS, MMSE, CST lesion load, lesion volume, ipsilesional CST integrity and interhemispheric homotopic functional connectivity. In contrast, LE motor recovery was related to ipsilesional and contralesional CST integrity and MMSE. Specifically, LE recovery showed a strong relationship to the preservation of cognitive function compared with motor impairment. CONCLUSIONS Our results indicate that different mechanisms underlie UE and LE motor recovery after stroke. LE motor recovery seems to be more intensively modulated by cognitive functions than UE.
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Affiliation(s)
- J Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - H Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - J Kim
- Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - H-J Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - W H Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y-H Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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Wang YL, Cheng JC, Chang CP, Su FC, Chen CC. Individualized Running Wheel System with a Dynamically Adjustable Exercise Area and Speed for Rats Following Ischemic Stroke. Med Sci Monit 2020; 26:e924411. [PMID: 32886655 PMCID: PMC7491243 DOI: 10.12659/msm.924411] [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] [Indexed: 11/24/2022] Open
Abstract
Background An innovative animal running wheel with an individualized design was implemented for the rehabilitation of rats following ischemic stroke. Material/Methods The design of the running wheel platform included the running wheel and a side plate for exercise area adjustments. A U-curve with a width of 2 cm was drawn on the lower half of the side plate for the dynamic adjustments of five infrared (IR) sensors based on the physical fitness of the rats. The individualized training process for this running wheel consisted of 2 days of free training to record their average and maximum speeds, 3 days of progressive training to determine their exercise areas, and 2 weeks of normal training based on their average speeds, maximum speeds, and exercise areas. Blood samples were obtained from the tail veins of all rats before the operations and on Days 14, 21, and 28 postsurgery to measure cortisol levels. The motor function tests were performed on Days 7 and 28 postsurgery. On Day 28 postsurgery, the rats were sacrificed under anesthesia, and their brains were removed for Nissl and H&E staining. Results On Day 28 after surgery, the motor function, lesion volume, and cell damage of the DEARW and control groups differed significantly, indicating that this device is effective for stroke rehabilitation. Conclusions The outcomes of the rats that were rehabilitated using the newly designed training system were better than those of their control-group counterparts, indicating the advantages of this designed system.
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Affiliation(s)
- Yu-Lin Wang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.,Center of General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jui-Chi Cheng
- Department of Electronic Engineering, National Chin-Yi University of Technology, Taichung, Taiwan
| | - Ching-Ping Chang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chi-Chun Chen
- Department of Electronic Engineering, National Chin-Yi University of Technology, Taichung, Taiwan
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Deficits in corticospinal control of stretch reflex thresholds in stroke: Implications for motor impairment. Clin Neurophysiol 2020; 131:2067-2078. [DOI: 10.1016/j.clinph.2020.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/24/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
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Martino Cinnera A, Bonnì S, Pellicciari MC, Giorgi F, Caltagirone C, Koch G. Health-related quality of life (HRQoL) after stroke: Positive relationship between lower extremity and balance recovery. Top Stroke Rehabil 2020; 27:534-540. [PMID: 32041495 DOI: 10.1080/10749357.2020.1726070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Stroke survivors have poor long-term quality of life (QoL), especially in the dimensions of mobility and daily activities. Objectives: We aimed to investigate how clinical variables influence QoL during subacute stroke rehabilitation. Methods: We assessed the evolution of the health-related QoL (HRQoL), the balance skills, the sensory-motor functions, and the ability in the activity of daily living in 25 hospitalized patients (60.6 ± 11.14 years old; 32% female) during a period of 2 months of stroke rehabilitation. We used the Stroke-Specific Quality of Life scale (SSQoL) to assess the HRQoL; the Berg Balance Scale to assess gait and balance functions; the Fugl-Meyer Assessment scale for sensory-motor functions of upper (UE) and lower limb (LE); and the Barthel Index for activity of daily living. All data have been investigated with the repeated-measures analysis of variance before and after normalization. Multiple Regression Analysis (MRA) has been performed on the normalized data and between the normalized data and the demographic characteristics (Gender; Age; Lesion side). Results: A significant improvement was found in all the assessed scales during the time of observation. MRA shows a positive regression between HRQoL and the motor recovery of LE and between HRQoL and the balance skills in 60 days from the stroke (MR = 0.88; respectively: p = 0.004 and p = 0.02). Conclusions: Our result shows that LE motor recovery impacts the QoL more than motor recovery of UE after 60 days of neurorehabilitation. This finding is strengthened by a positive regression between balance skills and QoL.
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Affiliation(s)
- Alex Martino Cinnera
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Sonia Bonnì
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | | | - Francesco Giorgi
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Carlo Caltagirone
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit (NIBSU), IRCCS Santa Lucia Foundation , Rome, Italy.,Department of Psychology, "eCampus" University , Novedrate, Italy
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Curuk E, Lee Y, Aruin AS. Individuals with stroke improve anticipatory postural adjustments after a single session of targeted exercises. Hum Mov Sci 2020; 69:102559. [DOI: 10.1016/j.humov.2019.102559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 10/25/2022]
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