1
|
Cheng S, Liu Y, Gao Y, Dong Z. "As if it were my own hand": inducing the rubber hand illusion through virtual reality for motor imagery enhancement. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:7086-7096. [PMID: 39250394 DOI: 10.1109/tvcg.2024.3456147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Brain-computer interfaces (BCI) are widely used in the field of disability assistance and rehabilitation, and virtual reality (VR) is increasingly used for visual guidance of BCI-MI (motor imagery). Therefore, how to improve the quality of electroencephalogram (EEG) signals for MI in VR has emerged as a critical issue. People can perform MI more easily when they visualize the hand used for visual guidance as their own, and the Rubber Hand Illusion (RHI) can increase people's ownership of the prosthetic hand. We proposed to induce RHI in VR to enhance participants' MI ability and designed five methods of inducing RHI, namely active movement, haptic stimulation, passive movement, active movement mixed with haptic stimulation, and passive movement mixed with haptic stimulation, respectively. We constructed a first-person training scenario to train participants' MI ability through the five induction methods. The experimental results showed that through the training, the participants' feeling of ownership of the virtual hand in VR was enhanced, and the MI ability was improved. Among them, the method of mixing active movement and tactile stimulation proved to have a good effect on enhancing MI. Finally, we developed a BCI system in VR utilizing the above training method, and the performance of the participants improved after the training. This also suggests that our proposed method is promising for future application in BCI rehabilitation systems.
Collapse
|
2
|
Beovich A, Boose J, Patel R, Wolf SL. Vagus Nerve Stimulation Paired With Rehabilitation for Chronic Stroke: Characterizing Responders. J Neurol Phys Ther 2024; 48:217-223. [PMID: 39028576 DOI: 10.1097/npt.0000000000000488] [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: 07/21/2024]
Abstract
BACKGROUND AND PURPOSE Implantable vagus nerve stimulation (VNS) paired with volitional upper extremity rehabilitation can improve impairment and function among moderately to severely impaired, chronic stroke survivors. This study is a retrospective analysis of the in-clinic rehabilitation phase of the blinded, placebo-controlled, randomized pivotal VNS-REHAB trial to determine whether dosing parameters during in-clinic paired VNS therapy were associated with responder status and whether covariates might impact that determination. METHODS Data were limited to 53 participants in the active VNS group who had received VNS implants prior to undergoing 6 weeks of in-clinic rehabilitation paired with VNS. Tasks were standardized across all participants. Dosing parameters included number of stimulations and task time. The primary outcome was the Fugl-Meyer Upper Extremity Assessment (FMA-UE), evaluated at the end of 6 weeks (Post-1). Participants were classified a priori as responders based on an improvement of ≥6 points on the FMA-UE from baseline to Post-1. RESULTS Dosing parameters were not associated with FMA-UE responder status at the end of 6 weeks. Covariates including age, gender, paretic hand, baseline severity, and chronicity of stroke were also not significant associations of response. DISCUSSION AND CONCLUSIONS While responders to VNS could be defined, therapy dosing and participant attributes did not provide greater specification for association of responder status. Limitations of this study include small sample size and non-linearity of the FMA-UE. Future studies will include reassessing responder categorization using more linear scales and examining stroke lesion characteristics to determine whether these measures are more sensitive to dosing parameters. VIDEO ABSTRACT AVAILABLE for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://www.w3.org/1999/xlink ).
Collapse
Affiliation(s)
- Alexa Beovich
- Emory Neurologic Physical Therapy Residency Program (A.B., R.P.), Doctor of Physical Therapy Program, Department of Rehabilitation Medicine (J.B.), Emory University, Atlanta, Georgia; Division of Physical Therapy, Department of Rehabilitation Medicine (S.L.W.), Emory University, School of Medicine, Atlanta, Georgia; Departments of Cell Biology and Medicine (S.L.W.), Woodruff School of Nursing, Emory University, Atlanta, Georgia; Atlanta VA Center for Visual and Neurocognitive Rehabilitation (S.L.W.), Decatur, Georgia
| | | | | | | |
Collapse
|
3
|
Canlı K, Van Oijen J, Van Oosterwijck J, Meeus M, Van Oosterwijck S, De Meulemeester K. Influence of sensory retraining on cortical reorganization in peripheral neuropathy: A systematic review. PM R 2024; 16:888-907. [PMID: 38155585 DOI: 10.1002/pmrj.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/19/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE This study systematically reviewed the literature about sensory retraining effect in comparison to other rehabilitative techniques on cortical reorganization in patients with peripheral neuropathic pain. TYPE: Systematic review. LITERATURE SURVEY After an electronic search of PubMed, Web of Science, and Embase, risk of bias was assessed using the revised Cochrane risk of bias tool for randomized controlled trials and the ROBINS-1 (Risk of bias in non-randomized studies-of interventions) for non-randomized studies of intervention. METHODOLOGY The strength of conclusion was determined using the evidence-based guideline development approach. SYNTHESIS Limited evidence indicates a higher increase in cortical inhibition and a higher reduction in cortical activation during a motor task of the affected hemisphere after graded motor imagery compared to wait-list. Higher reductions in map volume (total excitability of the cortical representation) of the affected hemisphere after peripheral electrical stimulation (PES) were observed when compared to transcranial direct current stimulation (tDCS) or to sham treatment with limited evidence. No other differences in cortical excitability and representation of the affected and non-affected hemisphere were observed when comparing mirror therapy with sham therapy or tDCS, PES with sham therapy or tDCS, and graded motor imagery with wait-list. CONCLUSIONS Graded motor imagery and PES result in higher cortical excitability reductions of the affected hemisphere compared to wait-list, tDCS and sham treatment, respectively.
Collapse
Affiliation(s)
- Kübra Canlı
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Türkiye
| | - Joris Van Oijen
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
| | - Jessica Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Antwerpen, Belgium
| | - Sophie Van Oosterwijck
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
- Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Kayleigh De Meulemeester
- Department of Rehabilitation Sciences, Spine, Pain and Head Research Unit Ghent, Ghent University, Ghent, Belgium
- Pain in Motion International Research Group, Brussels, Belgium
| |
Collapse
|
4
|
Du L, He X, Xiong X, Zhang X, Jian Z, Yang Z. Vagus nerve stimulation in cerebral stroke: biological mechanisms, therapeutic modalities, clinical applications, and future directions. Neural Regen Res 2024; 19:1707-1717. [PMID: 38103236 PMCID: PMC10960277 DOI: 10.4103/1673-5374.389365] [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: 06/11/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 12/18/2023] Open
Abstract
Stroke is a major disorder of the central nervous system that poses a serious threat to human life and quality of life. Many stroke victims are left with long-term neurological dysfunction, which adversely affects the well-being of the individual and the broader socioeconomic impact. Currently, post-stroke brain dysfunction is a major and difficult area of treatment. Vagus nerve stimulation is a Food and Drug Administration-approved exploratory treatment option for autism, refractory depression, epilepsy, and Alzheimer's disease. It is expected to be a novel therapeutic technique for the treatment of stroke owing to its association with multiple mechanisms such as altering neurotransmitters and the plasticity of central neurons. In animal models of acute ischemic stroke, vagus nerve stimulation has been shown to reduce infarct size, reduce post-stroke neurological damage, and improve learning and memory capacity in rats with stroke by reducing the inflammatory response, regulating blood-brain barrier permeability, and promoting angiogenesis and neurogenesis. At present, vagus nerve stimulation includes both invasive and non-invasive vagus nerve stimulation. Clinical studies have found that invasive vagus nerve stimulation combined with rehabilitation therapy is effective in improving upper limb motor and cognitive abilities in stroke patients. Further clinical studies have shown that non-invasive vagus nerve stimulation, including ear/cervical vagus nerve stimulation, can stimulate vagal projections to the central nervous system similarly to invasive vagus nerve stimulation and can have the same effect. In this paper, we first describe the multiple effects of vagus nerve stimulation in stroke, and then discuss in depth its neuroprotective mechanisms in ischemic stroke. We go on to outline the results of the current major clinical applications of invasive and non-invasive vagus nerve stimulation. Finally, we provide a more comprehensive evaluation of the advantages and disadvantages of different types of vagus nerve stimulation in the treatment of cerebral ischemia and provide an outlook on the developmental trends. We believe that vagus nerve stimulation, as an effective treatment for stroke, will be widely used in clinical practice to promote the recovery of stroke patients and reduce the incidence of disability.
Collapse
Affiliation(s)
- Li Du
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xuan He
- Department of Anesthesiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoxing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xu Zhang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zhenxing Yang
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| |
Collapse
|
5
|
Liu CL, Tu YW, Li MW, Chang KC, Chang CH, Chen CK, Wu CY. Electroencephalogram Alpha Oscillations in Stroke Recovery: Insights into Neural Mechanisms from Combined Transcranial Direct Current Stimulation and Mirror Therapy in Relation to Activities of Daily Life. Bioengineering (Basel) 2024; 11:717. [PMID: 39061800 PMCID: PMC11273914 DOI: 10.3390/bioengineering11070717] [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: 06/18/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
The goal of stroke rehabilitation is to establish a robust protocol for patients to live independently in community. Firstly, we examined the impact of 3 hybridized transcranial direct current stimulation (tDCS)-mirror therapy interventions on activities of daily life (ADL) in stroke patients. Secondly, we explored the underlying therapeutic mechanisms with theory-driven electroencephalography (EEG) indexes in the alpha band. This was achieved by identifying the unique contributions of alpha power in motor production to ADL in relation to the premotor cortex (PMC), primary cortex (M1), and Sham tDCS with mirror therapy. The results showed that, although post-intervention ADL improvement was comparable among the three tDCS groups, one of the EEG indexes differentiated the interventions. Neural-behavioral correlation analyses revealed that different types of ADL improvements consistently corresponded with alpha power in the temporal lobe exclusively in the PMC tDCS group (all rs > 0.39). By contrast, alterations in alpha power in the central-frontal region were found to vary, with ADL primarily in the M1 tDCS group (r = -0.6 or 0.7), with the benefit depending on the complexity of the ADL. In conclusion, this research suggested two potential therapeutic mechanisms and demonstrated the additive benefits of introducing theory-driven neural indexes in explaining ADL.
Collapse
Affiliation(s)
- Chia-Lun Liu
- Department of Occupational Therapy, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Ya-Wen Tu
- Department of Physical Medicine and Rehabilitation, Sijhih Cathay General Hospital, New Taipei 221, Taiwan; (Y.-W.T.); (M.-W.L.)
| | - Ming-Wei Li
- Department of Physical Medicine and Rehabilitation, Sijhih Cathay General Hospital, New Taipei 221, Taiwan; (Y.-W.T.); (M.-W.L.)
| | - Ku-Chou Chang
- Division of Cerebrovascular Diseases, Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80756, Taiwan;
- Long-Term Care Service Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 80756, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
| | - Chih-Hung Chang
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108, USA;
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63130, USA
| | - Chih-Kuang Chen
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 33302, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy, Chang Gung University, Taoyuan 33302, Taiwan;
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 333, Taiwan
| |
Collapse
|
6
|
Raciti L, Raciti G, Ammendolia A, de Sire A, Onesta MP, Calabrò RS. Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches. Brain Sci 2024; 14:631. [PMID: 39061372 PMCID: PMC11274891 DOI: 10.3390/brainsci14070631] [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: 05/10/2024] [Revised: 06/11/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs.
Collapse
Affiliation(s)
- Loredana Raciti
- Unità Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy; (L.R.); (M.P.O.)
| | - Gianfranco Raciti
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (G.R.); (A.A.); (A.d.S.)
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (G.R.); (A.A.); (A.d.S.)
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (G.R.); (A.A.); (A.d.S.)
| | - Maria Pia Onesta
- Unità Spinale Unipolare, AO Cannizzaro, 98102 Catania, Italy; (L.R.); (M.P.O.)
| | | |
Collapse
|
7
|
Zhang Y, Zhang X, Cheng C, Huang S, Hua Y, Hu J, Wang Y, Zhang W, Yang Y, Liu Y, Jia J, Gou P, Zhang P, Zhou F, Wei X, Bai Y. Mirror therapy combined with contralaterally controlled functional electrical stimulation for the upper limb motor function after stroke: a randomized controlled trial. Disabil Rehabil 2024; 46:2528-2534. [PMID: 37341447 DOI: 10.1080/09638288.2023.2225878] [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: 10/22/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE In this study, we investigated the effects of mirror therapy (MT) combined with contralaterally controlled functional electrical stimulation (CCFES) on upper limb motor function, activities of daily life, and corticospinal excitability in post-stroke patients. METHODS Sixty post-stroke patients were randomly divided into four groups: CCFES, MT, MT combined with CCFES, and control. All the patients underwent routine rehabilitation. Those in the MT, CCFES, MT combined with CCFES, and control groups received MT, CCFES, MT combined with CCFES, and routine rehabilitation alone, respectively. Upper limb motor function, activities of daily living, and corticospinal excitability were evaluated before and after a 3-week intervention period. RESULTS MT combined with CCFES demonstrated a significantly greater therapeutic effect on motor function of the paretic wrist than CCFES, MT, or routine rehabilitation alone. However, there was no significant difference in the overall motor function of the affected upper limb, activities of daily life, or corticospinal excitability between the MT combined with CCFES group and the other three groups. CONCLUSION MT combined with CCFES may be a potential adjuvant therapy to promote motor function in paretic wrist after stroke.
Collapse
Affiliation(s)
- Yuqian Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xingnan Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Cancan Cheng
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Songhua Huang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yan Hua
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyuan Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Weizhou Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Yi Yang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Yafeng Liu
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Jian Jia
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Pingping Gou
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Pei Zhang
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Feng Zhou
- Department of Neurosurgery, Baoji Central Hospital, Baoji, China
| | - Xiaoli Wei
- Department of Rehabilitation Medicine, Baoji Central Hospital, Baoji, China
| | - Yulong Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Ma ZZ, Wu JJ, Cao Z, Hua XY, Zheng MX, Xing XX, Ma J, Xu JG. Motor imagery-based brain-computer interface rehabilitation programs enhance upper extremity performance and cortical activation in stroke patients. J Neuroeng Rehabil 2024; 21:91. [PMID: 38812014 PMCID: PMC11134735 DOI: 10.1186/s12984-024-01387-w] [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: 08/25/2023] [Accepted: 05/18/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The most challenging aspect of rehabilitation is the repurposing of residual functional plasticity in stroke patients. To achieve this, numerous plasticity-based clinical rehabilitation programs have been developed. This study aimed to investigate the effects of motor imagery (MI)-based brain-computer interface (BCI) rehabilitation programs on upper extremity hand function in patients with chronic hemiplegia. DESIGN A 2010 Consolidated Standards for Test Reports (CONSORT)-compliant randomized controlled trial. METHODS Forty-six eligible stroke patients with upper limb motor dysfunction participated in the study, six of whom dropped out. The patients were randomly divided into a BCI group and a control group. The BCI group received BCI therapy and conventional rehabilitation therapy, while the control group received conventional rehabilitation only. The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) score was used as the primary outcome to evaluate upper extremity motor function. Additionally, functional magnetic resonance imaging (fMRI) scans were performed on all patients before and after treatment, in both the resting and task states. We measured the amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), z conversion of ALFF (zALFF), and z conversion of ReHo (ReHo) in the resting state. The task state was divided into four tasks: left-hand grasping, right-hand grasping, imagining left-hand grasping, and imagining right-hand grasping. Finally, meaningful differences were assessed using correlation analysis of the clinical assessments and functional measures. RESULTS A total of 40 patients completed the study, 20 in the BCI group and 20 in the control group. Task-related blood-oxygen-level-dependent (BOLD) analysis showed that when performing the motor grasping task with the affected hand, the BCI group exhibited significant activation in the ipsilateral middle cingulate gyrus, precuneus, inferior parietal gyrus, postcentral gyrus, middle frontal gyrus, superior temporal gyrus, and contralateral middle cingulate gyrus. When imagining a grasping task with the affected hand, the BCI group exhibited greater activation in the ipsilateral superior frontal gyrus (medial) and middle frontal gyrus after treatment. However, the activation of the contralateral superior frontal gyrus decreased in the BCI group relative to the control group. Resting-state fMRI revealed increased zALFF in multiple cerebral regions, including the contralateral precentral gyrus and calcarine and the ipsilateral middle occipital gyrus and cuneus, and decreased zALFF in the ipsilateral superior temporal gyrus in the BCI group relative to the control group. Increased zReHo in the ipsilateral cuneus and contralateral calcarine and decreased zReHo in the contralateral middle temporal gyrus, temporal pole, and superior temporal gyrus were observed post-intervention. According to the subsequent correlation analysis, the increase in the FMA-UE score showed a positive correlation with the mean zALFF of the contralateral precentral gyrus (r = 0.425, P < 0.05), the mean zReHo of the right cuneus (r = 0.399, P < 0.05). CONCLUSION In conclusion, BCI therapy is effective and safe for arm rehabilitation after severe poststroke hemiparesis. The correlation of the zALFF of the contralateral precentral gyrus and the zReHo of the ipsilateral cuneus with motor improvements suggested that these values can be used as prognostic measures for BCI-based stroke rehabilitation. We found that motor function was related to visual and spatial processing, suggesting potential avenues for refining treatment strategies for stroke patients. TRIAL REGISTRATION The trial is registered in the Chinese Clinical Trial Registry (number ChiCTR2000034848, registered July 21, 2020).
Collapse
Affiliation(s)
- Zhen-Zhen Ma
- Department of Rehabilitation Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Zhi Cao
- Department of Tuina, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Department of Trauma and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Trauma and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Rehabilitation Center, Qilu Hospital of Shandong University, Jinan, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Jian-Guang Xu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China.
| |
Collapse
|
9
|
Martín Pérez SE, Rodríguez JD, Kalitovics A, de Miguel Rodríguez P, Bortolussi Cegarra DS, Rodríguez Villanueva I, García Molina Á, Ruiz Rodríguez I, Montaño Ocaña J, Martín Pérez IM, Sosa Reina MD, Villafañe JH, Alonso Pérez JL. Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial. J Clin Med 2024; 13:1490. [PMID: 38592311 PMCID: PMC10934708 DOI: 10.3390/jcm13051490] [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: 02/01/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.
Collapse
Affiliation(s)
- Sebastián Eustaquio Martín Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - Jhoselyn Delgado Rodríguez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
| | - Alejandro Kalitovics
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
| | - Pablo de Miguel Rodríguez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
| | - Daniela Sabrina Bortolussi Cegarra
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Iremar Rodríguez Villanueva
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Álvaro García Molina
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Iván Ruiz Rodríguez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Juan Montaño Ocaña
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
| | - Isidro Miguel Martín Pérez
- Departamento de Medicina Física y Farmacología, Área de Radiología y Medicina Física, Facultad de Ciencias de la Salud, Universidad de la Laguna, 38200 Santa Cruz de Tenerife, Spain
- Escuela de Doctorado y Estudios de Posgrado, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| | - María Dolores Sosa Reina
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Jorge Hugo Villafañe
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - José Luis Alonso Pérez
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Canarias, 38300 Santa Cruz de Tenerife, Spain; (J.D.R.); (A.K.); (P.d.M.R.); (J.L.A.P.)
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain; (D.S.B.C.); (I.R.V.); (Á.G.M.); (I.R.R.); (J.M.O.); (M.D.S.R.); (J.H.V.)
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| |
Collapse
|
10
|
Zhang K, Ding L, Wang X, Zhuang J, Tong S, Jia J, Guo X. Evidence of mirror therapy for recruitment of ipsilateral motor pathways in stroke recovery: A resting fMRI study. Neurotherapeutics 2024; 21:e00320. [PMID: 38262102 DOI: 10.1016/j.neurot.2024.e00320] [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: 11/21/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
Mirror therapy (MT) has been proposed to promote motor recovery post-stroke through activation of mirror neuron system, recruitment of ipsilateral motor pathways, or/and increasing attention toward the affected limb. However, neuroimaging evidence for these mechanisms is still lacking. To uncover the underlying mechanisms, we designed a randomized controlled study and used a voxel-based whole-brain analysis of resting-state fMRI to explore the brain reorganizations induced by MT. Thirty-five stroke patients were randomized to an MT group (n = 16) and a conventional therapy (CT) group (n = 19) for a 4-week intervention. Before and after the intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) and resting-state fMRI were collected. A healthy cohort (n = 16) was established for fMRI comparison. The changes in fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity were analyzed to investigate the impact of intervention. Results showed that greater FMA-UL improvement in the MT group was associated with the compensatory increase of fALFF in the contralesional precentral gyrus (M1) region and the re-establishment of functional connectivity between the bilateral M1 regions, which facilitate motor signals transmission via the ipsilateral motor pathways from the ipsilesional M1, contralesional M1, to the affected limb. A step-wise linear regression model revealed these two brain reorganization patterns collaboratively contributed to FMA-UL improvement. In conclusion, MT achieved motor rehabilitation primarily by recruitment of the ipsilateral motor pathways. Trial Registration Information: http://www.chictr.org.cn. Unique Identifier. ChiCTR-INR-17013644, submitted on December 2, 2017.
Collapse
Affiliation(s)
- Kexu Zhang
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Xu Wang
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Jinyang Zhuang
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Shanbao Tong
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China.
| | - Xiaoli Guo
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China.
| |
Collapse
|
11
|
Allen JR, Karri SR, Yang C, Stoykov ME. Spinal Cord Stimulation for Poststroke Hemiparesis: A Scoping Review. Am J Occup Ther 2024; 78:7802180220. [PMID: 38477681 PMCID: PMC11017736 DOI: 10.5014/ajot.2024.050533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
IMPORTANCE Spinal cord stimulation (SCS) is a neuromodulation technique that can improve paresis in individuals with spinal cord injury. SCS is emerging as a technique that can address upper and lower limb hemiparesis. Little is understood about its effectiveness with the poststroke population. OBJECTIVE To summarize the evidence for SCS after stroke and any changes in upper extremity and lower extremity motor function. DATA SOURCES PubMed, Web of Science, Embase, and CINAHL. The reviewers used hand searches and reference searches of retrieved articles. There were no limitations regarding publication year. STUDY SELECTION AND DATA COLLECTION This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The inclusion and exclusion criteria included a broad range of study characteristics. Studies were excluded if the intervention did not meet the definition of SCS intervention, used only animals or healthy participants, did not address upper or lower limb motor function, or examined neurological conditions other than stroke. FINDINGS Fourteen articles met the criteria for this review. Seven studies found a significant improvement in motor function in groups receiving SCS. CONCLUSIONS AND RELEVANCE Results indicate that SCS may provide an alternative means to improve motor function in the poststroke population. Plain-Language Summary: The results of this study show that spinal cord stimulation may provide an alternative way to improve motor function after stroke. Previous neuromodulation methods have targeted the impaired supraspinal circuitry after stroke. Although downregulated, spinal cord circuitry is largely intact and offers new possibilities for motor recovery.
Collapse
Affiliation(s)
- Jonathan R Allen
- Jonathan R. Allen, OTD, OTR/L, is Occupational Therapist, Corewell Health, Grand Rapids, MI. At the time of the study, Allen was Doctoral Student, Department of Occupational Therapy, College of Health Sciences, University of Michigan-Flint;
| | - Swathi R Karri
- Swathi R. Karri, is Osteopathic Medical Student II, Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL
| | - Chen Yang
- Chen Yang, PhD, is Postdoctoral Fellow, Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, and Postdoctoral Fellow, Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mary Ellen Stoykov
- Mary Ellen Stoykov, PhD, OTR/L, is Research Scientist, Arms + Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, and Research Associate Professor, Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
12
|
Pan H, Liu TW, Ng SSM, Chen PM, Chung RCK, Lam SSL, Li CSK, Chan CCC, Lai CWK, Ng WWL, Tang MWS, Hui E, Woo J. Effects of mirror therapy with electrical stimulation for upper limb recovery in people with stroke: a systematic review and meta-analysis. Disabil Rehabil 2024:1-16. [PMID: 38334111 DOI: 10.1080/09638288.2024.2310757] [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: 06/21/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. METHODS Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. RESULTS A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52-2.26]) and ES alone (SMD, 0.42 [0.11-0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04-0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92-11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. CONCLUSION MT with ES may be effective in improving upper limb motor recovery in people with stroke.
Collapse
Affiliation(s)
- Hong Pan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Tai Wa Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China (SAR)
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Pei Ming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Stefanie S L Lam
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Carol S K Li
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Charles C C Chan
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Charles W K Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Winnie W L Ng
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China (SAR)
| | - Maria W S Tang
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China (SAR)
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China (SAR)
| | - Jean Woo
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (SAR)
| |
Collapse
|
13
|
Lee MT, Chen CC, Lu HL, Hsieh YW. Comparisons of three different modes of digital mirror therapy for post-stroke rehabilitation: Preliminary results of randomized controlled trial. Digit Health 2024; 10:20552076241260536. [PMID: 38846366 PMCID: PMC11155361 DOI: 10.1177/20552076241260536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Objective Technologically adapted mirror therapy shows promising results in improving motor function for stroke survivors. The treatment effects of a newly developed multi-mode stroke rehabilitation system offering multiple training modes in digital mirror therapy remain unknown. This study aimed to examine the effects of unilateral mirror visual feedback (MVF) with unimanual training (UM-UT), unilateral MVF with bimanual training (UM-BT), and bilateral MVF with bimanual training (BM-BT) on clinical outcomes in stroke survivors, compared to classical mirror therapy (CMT). Methods Thirty-five participants were randomly assigned to one of four groups receiving fifteen 60-minute training sessions for 3-4 weeks. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Chedoke Arm and Hand Activity Inventory (CAHAI), Revised Nottingham Sensory Assessment (rNSA), Motor Activity Log (MAL), and EQ-5D-5L were administered at pre- and post-intervention and at 1-month follow-up. Results After intervention and follow-up, significant within-group treatment efficacies were found on most primary outcomes of the FMA-UE and CAHAI scores in all four groups. Significant within-group improvements in the secondary outcomes were found on the MAL and EQ-5D-5L index in the UM-BT group, and the rNSA tactile sensation and MAL quality of movement subscales in the BM-BT group. No significant between-group treatment efficacies were found. Conclusions UM-UT, UM-BT, BM-BT, and CMT led to similar clinical effects on the FMA-UE and can be considered effective alternative interventions for post-stroke upper-limb motor rehabilitation. UM-BT and BM-BT showed within-group improvements in functional performance in the patients' affected upper limbs in real-life activities.
Collapse
Affiliation(s)
- Meng-Ta Lee
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsuan-Lun Lu
- Department of Biomedical Engineering, Da-Yeh University, Changhua County, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| |
Collapse
|
14
|
Muñoz-Gómez E, Inglés M, Aguilar-Rodríguez M, Sempere-Rubio N, Mollà-Casanova S, Serra-Añó P. Effects of mirror therapy on spasticity and sensory impairment after stroke: Systematic review and meta-analysis. PM R 2023; 15:1478-1492. [PMID: 36787183 DOI: 10.1002/pmrj.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/09/2023] [Accepted: 01/25/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To review and synthesize existing evidence on the effectiveness of mirror therapy (MT) compared to active exercise-based interventions (ie, cross-training and conventional exercise) for reducing spasticity and sensory impairment in stroke survivors. TYPE: Systematic Review and Metanalysis. LITERATURE SURVEY Pubmed/MEDLINE, Cochrane, Embase, CINAHL, and Physiotherapy Evidence Database (PEDro), were searched. METHODOLOGY Randomized controlled trials (RCTs) that investigated MT effectiveness in improving spasticity and sensory impairment in stroke survivors compared to a control group. SYNTHESIS Fifteen RCTs (653 volunteers) were included. Spasticity improvements achieved with MT were similar to those obtained with cross-training (standard mean difference [SMD]: 0.12, 95% confidence interval [CI]: -0.43 to 0.68). In addition, when further combined with conventional exercise, spasticity improved similarly in both groups (SMD: 0.10, 95% CI: -0.16, 0.36). Lastly, when MT plus exercise was compared to exercise alone, spasticity decreased in both groups (SMD: 0.16, 95% CI: -0.16 to 0.48). Nevertheless, none of the Interventions seem effective on sensory impairment (SMD: 0.27, 95% CI: -0.28 to 0.81). CONCLUSIONS MT is equally effective as other exercise therapies, such as cross-training and conventional exercise, for improving spasticity in stroke survivors, whereas none of the explored interventions yielded beneficial effects on sensory impairment. Further well-designed RCTs are needed to confirm the results.
Collapse
Affiliation(s)
- Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| |
Collapse
|
15
|
Paolucci T, Agostini F, Mussomeli E, Cazzolla S, Conti M, Sarno F, Bernetti A, Paoloni M, Mangone M. A rehabilitative approach beyond the acute stroke event: a scoping review about functional recovery perspectives in the chronic hemiplegic patient. Front Neurol 2023; 14:1234205. [PMID: 37789885 PMCID: PMC10542412 DOI: 10.3389/fneur.2023.1234205] [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: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 10/05/2023] Open
Abstract
Background Stroke is a main cause of disability worldwide and its neuro-rehabilitative management is not limited to the acute phase but requires continuity in the rehabilitation approach especially in the chronic phase. The aim of this scoping review was to highlight the different treatment opportunities available in neurorehabilitation, effective for patients with chronic stroke sequelae, not only in terms of maintaining motor function but also improving it. Methods The literature search was conducted using the following databases: MEDLINE (PubMed), PEDro, Scopus, Web of Science (WOS), Cochrane from 2012 to February 2023. We selected Randomized Clinical Trials in English dealing with neurorehabilitation strategies in chronic hemiplegic patients after stroke focusing on motor function, muscular strength, gait, postural balance, spasticity, and quality of life. Results According to the inclusion criteria, 47 articles were selected for our review. All of them were analyzed following the primary outcome and the rehabilitation technique used. Despite the different protocols used within the same technique and despite the chronicity of the disease, all studies report an improvement after the rehabilitation treatment of motor function and quality of life. Conclusion The literature analyzed invites us to reflect respect to neurorehabilitation approach to the patient with chronic stroke sequelae often considered to have as its objective the maintenance of the present motor function and contain disability: instead, the review reports how, even in chronicity, the patient always reports margins of statistically and clinically significant improvement. The chronic stroke rehabilitation over 6 months has been proved effective in obtaining recovery in different settings.
Collapse
Affiliation(s)
- Teresa Paolucci
- Department of Medical, Oral and Biotechnological Science (DSMOB), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Francesco Agostini
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Elena Mussomeli
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Sara Cazzolla
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Conti
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Francescapia Sarno
- Department of Medical, Oral and Biotechnological Science (DSMOB), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Andrea Bernetti
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Marco Paoloni
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomy, Histology Forensic Medicine and Orthopedics, Sapienza University, Rome, Italy
| |
Collapse
|
16
|
BORAN HE, KILINÇ H, CENGİZ B. Mirror neuron activity depending on the content and stage of the observed action: a TMS study. Turk J Med Sci 2023; 53:1428-1437. [PMID: 38813024 PMCID: PMC10763779 DOI: 10.55730/1300-0144.5710] [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: 12/15/2022] [Revised: 10/26/2023] [Accepted: 08/11/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The firing rate of the mirror neuron system in monkeys decreases systematically with more repetitions. The aim of this study is to investigate whether the activity of the mirror neuron system varies based on the observed movement and the contents of the action, as well as whether there is inhibition in the mirror neuron system when humans observe repeated actions. If inhibition is present, the second question of the study is whether it is related to the organization of the observed action. Materials and methods Fourteen healthy volunteers participated in the study. Transcranial magnetic stimulation was applied to the left primary motor cortex and motor evoked potentials (MEPs) were recorded from the right first dorsal interosseous and abductor pollicis brevis muscles while the participants were watching videos specially prepared for the study. Results There were no significant changes in MEP amplitudes compared to baseline MEPs while observing aimless action. However, while participants watched the repeated action video, the mean MEP amplitude increased at the beginning of the movement, but neither facilitation nor inhibition was detected when the participants watched the phase of grasping the object of the action compared to the baseline MEP amplitude. On the other hand, while participants were watching different activities, an increased MEP amplitude was observed at the beginning of the movement and in the grasping of the object of the action. Additionally, there was no significant reduction in MEP amplitude during any movement stages while observing the repeated action video. Conclusion The findings of this study suggest that the activation of the mirror neuron system in humans depends on the content and stages of the observed movement. Additionally, there was no inhibition or systematic reduction in MEP amplitudes while watching a repeated action.
Collapse
Affiliation(s)
- H. Evren BORAN
- Department of Neurology and Division of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara,
Turkiye
- Neuropsychiatry Center, Gazi University, Ankara,
Turkiye
- Neuroscience and Neurotechnology Center of Excellence, Ankara,
Turkiye
| | - Hasan KILINÇ
- Neuropsychiatry Center, Gazi University, Ankara,
Turkiye
- Neuroscience and Neurotechnology Center of Excellence, Ankara,
Turkiye
| | - Bülent CENGİZ
- Department of Neurology and Division of Clinical Neurophysiology, Faculty of Medicine, Gazi University, Ankara,
Turkiye
- Neuropsychiatry Center, Gazi University, Ankara,
Turkiye
- Neuroscience and Neurotechnology Center of Excellence, Ankara,
Turkiye
| |
Collapse
|
17
|
Dagenais F, Neville C, Desmet L, Martineau S. Measuring the Potential Effects of Mirror Therapy Added to the Gold Standard Facial Neuromuscular Retraining in Patients With Chronic Peripheral Facial Palsy: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47709. [PMID: 37418307 PMCID: PMC10362495 DOI: 10.2196/47709] [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: 03/29/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Facial neuromuscular retraining (fNMR) is a noninvasive physical therapy widely used to treat peripheral facial palsies. It consists of different intervention methods that aim to reduce the debilitating sequelae of the disease. Recently, the use of mirror therapy in the acute facial palsy and postsurgical rehabilitation contexts has shown promising results, suggesting its use as an adjunct to fNMR in treating patients with later stages of paralysis, such as the paretic, early, or chronic synkinetic. OBJECTIVE The main aim of this study is to compare the efficacy of an added mirror therapy component with fNMR in patients with peripheral facial palsy (PFP) sequelae in 3 different stages. The specific objectives of this study are to measure the effects of combined therapy compared to fNMR alone on (1) participants' facial symmetry and synkinesis, (2) quality of life and psychological aspects of the participants, (3) motivation and treatment adherence, and (4) different stages of facial palsies. METHODS This study is a randomized controlled trial that compares the effect of fNMR combined with mirror therapy (experimental group: n=45) with fNMR alone (control group: n=45) in 90 patients with peripheral facial palsy presenting with sequelae 3-12 months after onset. Both groups will receive 6 months of rehabilitation training. Facial symmetry and synkinesis; participants' quality of life; and their psychological factors, motivation, and compliance will be assessed at baseline (T0), 3 months (T1), 6 months (T2), and 12 months (T3) postintervention. Outcome measures are (1) changes in facial symmetry and synkinesis assessed with facial grading tools, (2) quality of life changes with patient questionnaires, and (3) therapy motivation with a standardized scale, as well as adherence to treatment with metadata. Changes in facial symmetry and synkinesis will be judged by 3 assessors blinded to group assignment. Mixed models and Kruskal-Wallis, chi-square, and multilevel analyses will be conducted according to the appropriate variable type. RESULTS Inclusion will start in 2024 and is anticipated to be completed in 2027. The 12-month follow-up will be completed with the last patient in 2028. We expect patients included in this study to experience improvement in facial symmetry, synkinesis, and quality of life, regardless of group assignments. A potential benefit of mirror therapy for facial symmetry and synkinesis could be noted for patients in the paretic phase. We hypothesize better motivation and adherence to treatment for the mirror therapy group. CONCLUSIONS The results of this trial may provide new guidelines for PFP rehabilitation with patients dealing with long-term sequelae. It also fills the need for robust evidence-based data in behavioral facial rehabilitation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47709.
Collapse
Affiliation(s)
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Liesbet Desmet
- Department of Health and Care, Artevelde University of Applied Sciences, Gent, Belgium
- European Institute for Otorhinolaryngology - Head & Neck Surgery, Sint-Augustinus GZA Hospital, Antwerp, Belgium
| | - Sarah Martineau
- Centre de Recherche de l'Hôpital Maisonneuve-Rosemont, École d'Orthophonie et d'Audiologie, Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
18
|
Li RY, Chen KY, Wang XR, Yu Q, Xu L. Comparison of Different Rehabilitation Techniques of Traditional Chinese and Western Medicine in the Treatment of Motor Dysfunction After Stroke Based on Frequency Method: A Network Meta-analysis. Am J Phys Med Rehabil 2023; 102:504-512. [PMID: 36731006 PMCID: PMC10184820 DOI: 10.1097/phm.0000000000002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the effect of different traditional Chinese and western medicine rehabilitation techniques on motor dysfunction after stroke using a network meta-analysis. METHODS CNKI, Wanfang, PubMed, Embase, and Cochrane databases were searched from inception to September 2022. We independently searched and screened randomized controlled trials of rehabilitation techniques for poststroke motor dysfunction treatment, evaluated the quality, and analyzed the data using Stata 14.0. RESULTS Seventy-four randomized controlled trials involving nine rehabilitation techniques and 5128 patients were included. The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl-Meyer Assessment, Action Research Arm Test, and Berg Balance Scale: biofeedback therapy > mirror therapy > repetitive transcranial magnetic stimulation > acupuncture therapy > transcranial direct current stimulation > Taichi > common therapy, virtual reality > transcranial direct current stimulation > repetitive transcranial magnetic stimulation > mirror therapy > common therapy, and acupuncture therapy > virtual reality > neuromuscular electrical stimulation > mirror therapy > common therapy > transcranial direct current stimulation, respectively. CONCLUSIONS Biofeedback therapy had the best comprehensive effect, while virtual reality was the best intervention for improving the index of action research arm test and Fugl-Meyer Assessment-lower extremity. Acupuncture therapy improved lower limb balance function.
Collapse
|
19
|
Tesio L, Caronni A, Russo C, Felisari G, Banco E, Simone A, Scarano S, Bolognini N. Reversed Mirror Therapy (REMIT) after Stroke-A Proof-of-Concept Study. Brain Sci 2023; 13:847. [PMID: 37371327 DOI: 10.3390/brainsci13060847] [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: 04/27/2023] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
In mirror training (MIT), stroke patients strive to move their hands while looking at the reflected image of the unaffected one. The recruitment of the mirror neurons and visual-proprioceptive conflict are expected to facilitate the paretic voluntary movement. Here, a reversed MIT (REMIT) is presented, which requires moving hands while looking at the reflected image of the paretic one, giving the illusion of being unable to move the unimpaired hand. This study compares MIT and REMIT on post-stroke upper-limb recovery to gain clues on the mechanism of action of mirror therapies. Eight chronic stroke patients underwent two weeks of MIT and REMIT (five sessions each) in a crossover design. Upper-limb Fugl-Meyer, Box and Block and handgrip strength tests were administered at baseline and treatments end. The strength of the mirror illusion was evaluated after each session. MIT induced a larger illusory effect. The Fugl-Meyer score improved to the same extent after both treatments. No changes occurred in the Box and Block and the handgrip tests. REMIT and MIT were equally effective on upper-limb dexterity, challenging the exclusive role of mirror neurons. Contrasting learned nonuse through an intersensory conflict might provide the rationale for both forms of mirror-based rehabilitation after stroke.
Collapse
Affiliation(s)
- Luigi Tesio
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Antonio Caronni
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Cristina Russo
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | - Giorgio Felisari
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
| | - Elisabetta Banco
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
| | - Anna Simone
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Neuropsychological Laboratory, Istituto Auxologico Italiano, IRCCS, 20122 Milano, Italy
| |
Collapse
|
20
|
Ruf SP, Hetterich L, Mazurak N, Rometsch C, Jurjut AM, Ott S, Herrmann-Werner A, Zipfel S, Stengel A. Mirror Therapy in Patients with Somatoform Pain Disorders-A Pilot Study. Behav Sci (Basel) 2023; 13:432. [PMID: 37232669 PMCID: PMC10215185 DOI: 10.3390/bs13050432] [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: 03/29/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
Patients with chronic pain report reduced quality of life and high symptom burden while often responding insufficiently to treatment options. Mirror therapy has been proven to be effective in treating phantom limb pain and other conditions such as CRPS. This study was designed to investigate the efficacy of mirror therapy in patients with somatoform pain disorders on symptom severity and associated physiological parameters. Fifteen patients with persistent somatoform pain disorder (F45.40) or chronic pain disorder with somatic and psychological factors (F45.41) participated and received four weeks of tablet-based mirror therapy. Symptom severity was measured with established questionnaires, and their thermal detection, pain thresholds, and heart rate variability (HRV) were also assessed. After mirror therapy, pain intensity was reduced (z = -2.878, p = 0.004), and pain thresholds for cold stimuli were also diminished, i.e., the subjects became more sensitive to cold stimuli (z = -2.040, p = 0.041). In addition, a reduction of absolute power in the low-frequency band of HRV (t(13) = 2.536, p = 0.025) was detected. These findings indicate that this intervention may reduce pain intensity and modulate associated physiological parameters. As these results are limited by several factors, e.g., a small sample size and no control group, they should be validated in further studies investigating this novel intervention in these patients.
Collapse
Affiliation(s)
- Steffen Philipp Ruf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Larissa Hetterich
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Firenze, Italy
| | - Anna-Maria Jurjut
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Stephan Ott
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
- Institute of Occupational, Social and Environmental Medicine with Outpatient Clinic, Friedrich-Alexander-Universität Erlangen-Nürnberg, Henkestr. 9-11, 91054 Erlangen, Germany
| | - Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
- TIME (Tübingen Institute for Medical Education), Medical Faculty Tübingen, Elfriede-Aulhorn-Str. 10, 72076 Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Osianderstr. 5, 72076 Tübingen, Germany
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 12203 Berlin, Germany
| |
Collapse
|
21
|
Matsuda S, Osumi M. Perception of Heaviness Induced by Sensorimotor Incongruence Is Associated with Pain Prognosis: A Pilot Study. Pain Res Manag 2023; 2023:9906268. [PMID: 37056450 PMCID: PMC10089778 DOI: 10.1155/2023/9906268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/15/2022] [Accepted: 02/10/2023] [Indexed: 04/07/2023]
Abstract
Background. Patients with chronic musculoskeletal pain experience not only pain but also abnormal body perception. Such abnormal body perception has been reported to be caused by incongruence between motor intentions and sensory feedback (i.e., sensorimotor incongruence). However, the influence of abnormal body perception with sensorimotor incongruence on pain prognosis in musculoskeletal pain patients has not been investigated. Objective. We aimed at clarifying the influence of abnormal body perception on pain prognosis using an experimental procedure for inducing sensorimotor incongruence in patients with musculoskeletal pain. Methods. We recruited 18 patients within 2 months after limb fracture or ligament injury. In the experiment, patients sat with the intact upper or lower limb reflected in a large mirror aligned with the sagittal plane. A motor task was performed for 20 seconds in each of the congruent and incongruent conditions. In the congruent condition, patients were asked to perform flexion-extension movements with the intact and affected limbs in-phase, while observing the intact limb in the mirror. In the incongruent condition, patients were asked to perform flexion-extension movements antiphase, while observing the intact limb in the mirror. After performing the congruent and incongruent conditions, patients were asked to complete a questionnaire about abnormal body perception. These procedures were conducted within 2 months after the fracture (first), 2 weeks after the first measurement (second), and 4 weeks (third) after the first measurement. Results. Pain, heaviness, and peculiarity were more likely to be experienced in incongruent conditions. Additionally, structural equation modeling indicated that heaviness at the first time point predicted the pain intensity at the second and third time points. Conclusions. Heaviness caused by sensorimotor incongruence may predict pain prognosis in patients with musculoskeletal pain after one month.
Collapse
Affiliation(s)
- Soichiro Matsuda
- Graduate School of Health Science, Kio University, 4-2-2 Umaminaka, Kitakatsuragigun, Nara 635-0832, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| |
Collapse
|
22
|
Katai S, Maeda M, Katsuyama S, Maruyama Y, Midorikawa M, Okushima T, Yoshida K. Cortical reorganization correlates with motor recovery after low-frequency repetitive transcranial magnetic stimulation combined with occupational therapy in chronic subcortical stroke patients. NEUROIMAGE: REPORTS 2023. [DOI: 10.1016/j.ynirp.2023.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
23
|
Westlake K, Akinlosotu R, Udo J, Goldstein Shipper A, Waller SM, Whitall J. Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis. Front Neurol 2023; 14:1035256. [PMID: 36816549 PMCID: PMC9932529 DOI: 10.3389/fneur.2023.1035256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input. Objectives To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs. Data sources We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched. Eligibility criteria Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes. Data collection and analysis Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool. Main results We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis. Limitations By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias. Conclusions and implications There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.
Collapse
Affiliation(s)
- Kelly Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Ruth Akinlosotu
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Jean Udo
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Andrea Goldstein Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States
| | - Sandy McCombe Waller
- Division of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD, United States
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| |
Collapse
|
24
|
The Effectiveness of Rehabilitation Interventions on Pain and Disability for Complex Regional Pain Syndrome: A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:91-105. [PMID: 36650605 DOI: 10.1097/ajp.0000000000001089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To summarize and critically appraise the body of evidence on conservative management of complex regional pain syndrome (CRPS), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). METHODS We conducted a literature search from inception to November 2021 in the following databases: Embase, Medline, CINAHL, Google Scholar, PEDRO, and Psychinfo. Two independent reviewers conducted risk of bias and quality assessment. Qualitative synthesis and meta-analysis were the methods for summarizing the findings of the RCTs. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to rate the overall quality and certainty of the evidence on each treatment outcome. RESULT Through a database search, 751 records were found, and 33 RCTs were eligible for inclusion. Studies were published between 1995 and 2021. The overall risk of bias for 2 studies was low, 8 studies were unclear, and 23 studies were high.Low-quality evidence suggests that mirror therapy (as an addition to conventional stroke rehabilitation interventions) and graded motor imagery program (compared with routine rehabilitation interventions) may result in a large improvement in pain and disability up to 6-month follow-up in poststroke CRPS-1 patients. Low-quality evidence suggests that pain exposure therapy and aerobic exercises as an additive treatment to physical therapy interventions may result in a large improvement in pain up to a 6-month follow-up. The evidence is very uncertain about the effect of all other targeted interventions over conventional physical therapy or sham treatments on pain and disability. DISCUSSION There is an ongoing need for high-quality studies to inform conservative management choices in CRPS.
Collapse
|
25
|
Compagnat M, Daviet JC, Hermand E, Billot M, Salle JY, Perrochon A. Impact of a dual task on the energy cost of walking in individuals with subacute phase stroke. Brain Inj 2023; 37:114-121. [PMID: 36625007 DOI: 10.1080/02699052.2023.2165153] [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: 01/11/2023]
Abstract
OBJECTIVE To assess the impact of cognitive Dual Task (DT) during walking on the energy cost of walking (Cw) in individuals with subacute stroke. The secondary objective was to determine whether there is an association between the Cw and cortical activity of the prefrontal area. METHODS Any individual with stroke localized in the temporal-parietal regions and able to walk without human assistance was included. Cw and prefrontal cortical activity, recorded by fNIRS, were measured during simple task walking activity and cognitive dual task during walking. RESULTS Nineteen individuals with stroke (age = 67.7 ± 9.6 yrs) were included. The cognitive DT during walking resulted in an increase in Cw of 23.1%; 95%CI [13.1%; 34.5%]. The increase in Cw in cognitive DT was correlated with the Cw for the single task walking activity (r = 0.48, p < 0.01) as well as the predominance of cortical activity of the prefrontal area in the contralesional hemisphere (r = -0.33, p < 0.01). CONCLUSION There is an increase in Cw during the cognitive DT. This increase is even more significant, as the Cw of the single task walking activity is high, and the cortical activity of the prefrontal areas predominates in the contralesional hemisphere.
Collapse
Affiliation(s)
- Maxence Compagnat
- HAVAE UR 20217 (Handicap, Aging, Autonomy, Environment), IFRH, University of Limoges, Limoges, France.,Department of Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation in the University Hospital Center of Limoges, Limoges, France
| | - Jean Christophe Daviet
- HAVAE UR 20217 (Handicap, Aging, Autonomy, Environment), IFRH, University of Limoges, Limoges, France.,Department of Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation in the University Hospital Center of Limoges, Limoges, France
| | - Eric Hermand
- URePSSS ULR 7369 (Unité de Recherche Pluridisciplinaire Sport, Santé, Société), Université du Littoral Côte d'Opale, Dunkerque, France
| | - Maxime Billot
- PRISMATICS Laboratory (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Jean Yves Salle
- HAVAE UR 20217 (Handicap, Aging, Autonomy, Environment), IFRH, University of Limoges, Limoges, France.,Department of Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation in the University Hospital Center of Limoges, Limoges, France
| | - Anaick Perrochon
- HAVAE UR 20217 (Handicap, Aging, Autonomy, Environment), IFRH, University of Limoges, Limoges, France
| |
Collapse
|
26
|
Ding L, Sun Q, Jiang N, He J, Jia J. The instant effect of embodiment via mirror visual feedback on electroencephalogram-based brain connectivity changes: A pilot study. Front Neurosci 2023; 17:1138406. [PMID: 37021135 PMCID: PMC10067600 DOI: 10.3389/fnins.2023.1138406] [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: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
The therapeutic efficacy of mirror visual feedback (MVF) is attributed to the perception of embodiment. This study intends to investigate the instantaneous effect of embodiment on brain connectivity. Twelve healthy subjects were required to clench and open their non-dominant hands and keep the dominant hands still during two experimental sessions. In the first session, the dominant hand was covered and no MVF was applied, named the sham-MVF condition. Random vibrotactile stimulations were applied to the non-dominant hand with MVF in the subsequent session. Subjects were asked to pedal while having embodiment perception during motor tasks. As suggested by previous findings, trials of no vibration and continuous vibration were selected for this study, named the condition of MVF and vt-MVF. EEG signals were recorded and the alterations in brain connectivity were analyzed. The average node degrees of sham-MVF, MVF, and vt-MVF conditions were largely different in the alpha band (9.94, 11.19, and 17.37, respectively). Further analyses showed the MVF and vt-MVF had more nodes with a significantly large degree, which mainly occurred in the central and the visual stream involved regions. Results of network metrics showed a significant increment of local and global efficiency, and a reduction of characteristic path length for the vt-MVF condition in the alpha and beta bands compared to sham-MVF, and in the alpha band compared to MVF. Similar trends were found for MVF condition in the beta band compared to sham-MVF. Moreover, significant leftward asymmetry of global efficiency and rightward asymmetry of characteristic path length was reported in the vt-MVF condition in the beta band. These results indicated a positive impact of embodiment on network connectivity and neural communication efficiency, which reflected the potential mechanisms of MVF for new insight into neural modulation.
Collapse
Affiliation(s)
- Li Ding
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Sun
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
- Med-X Center for Manufacturing, Sichuan University, Sichuan, China
| | - Ning Jiang
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
- Med-X Center for Manufacturing, Sichuan University, Sichuan, China
| | - Jiayuan He
- National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
- Med-X Center for Manufacturing, Sichuan University, Sichuan, China
- Jiayuan He,
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jie Jia,
| |
Collapse
|
27
|
Therapeutic Role of Additional Mirror Therapy on the Recovery of Upper Extremity Motor Function after Stroke: A Single-Blind, Randomized Controlled Trial. Neural Plast 2022; 2022:8966920. [PMID: 36624743 PMCID: PMC9825233 DOI: 10.1155/2022/8966920] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/02/2023] Open
Abstract
Background Rehabilitation of upper extremity hemiplegia after stroke remains a great clinical challenge, with only 20% of patients achieving a basic return to normal hand function. How to promote the recovery of motor function at an early stage is crucial to the life of the patient. Objectives To invest the effects of additional mirror therapy in improving upper limb motor function and activities of daily living in acute and subacute stroke patients, and further explore the effects of other factors on the efficacy of MT. Methods Participants who presented with unilateral upper extremity paralysis due to a first ischemic or hemorrhagic stroke were included in the study. They were randomly allocated to the experimental or control group. Patients in the control group received occupational therapy for 30 minutes each session, six times a week, for three weeks, while patients in the experimental group received 30 minutes of additional mirror therapy based on occupational therapy. The primary outcome measures were Fugl-Meyer Assessment-upper extremity (FMA-UE), Action Research Arm Test (ARAT), and Instrumental Activity of Daily Living (IADL) which were evaluated by two independent occupational therapists before treatment and after 3-week treatment. A paired t-test was used to compare the values between pretreatment and posttreatment within an individual group. Two-sample t-test was utilized to compare the changes (baseline to postintervention) between the two groups. Results A total of 52 stroke patients with unilateral upper extremity motor dysfunction who were able to actively cooperate with the training were included in this study. At baseline, no significant differences were found between groups regarding demographic and clinical characteristics (P > 0.05 for all). Upper limb motor function and ability to perform activities of daily living of the patients were statistically improved in both groups towards the third week (P < 0.05). In addition, statistical analyses showed more significant improvements in the score changes of FMA-UE and IADL in the experimental group compared to the control group after treatment (P < 0.05), but no significant difference was observed in the ARAT score changes between the two groups (P > 0.05). The subgroup analysis showed that no significant heterogeneity was observed in age, stroke type, lesion side, and clinical stage (P > 0.05). Conclusion In conclusion, some positive changes in aspects of upper limb motor function and the ability to perform instrumental activities of daily living compared with routine occupational therapy were observed in additional mirror therapy. Therefore, the application of additional mirror therapy training should be reconsidered to improve upper extremity motor in stroke patients.
Collapse
|
28
|
Soares JF, Abreu R, Lima AC, Sousa L, Batista S, Castelo-Branco M, Duarte JV. Task-based functional MRI challenges in clinical neuroscience: Choice of the best head motion correction approach in multiple sclerosis. Front Neurosci 2022; 16:1017211. [PMID: 36570849 PMCID: PMC9768441 DOI: 10.3389/fnins.2022.1017211] [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: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Functional MRI (fMRI) is commonly used for understanding brain organization and connectivity abnormalities in neurological conditions, and in particular in multiple sclerosis (MS). However, head motion degrades fMRI data quality and influences all image-derived metrics. Persistent controversies regarding the best correction strategy motivates a systematic comparison, including methods such as scrubbing and volume interpolation, to find optimal correction models, particularly in studies with clinical populations prone to characterize by high motion. Moreover, strategies for correction of motion effects gain more relevance in task-based designs, which are less explored compared to resting-state, have usually lower sample sizes, and may have a crucial role in describing the functioning of the brain and highlighting specific connectivity changes. Methods We acquired fMRI data from 17 early MS patients and 14 matched healthy controls (HC) during performance of a visual task, characterized motion in both groups, and quantitatively compared the most used and easy to implement methods for correction of motion effects. We compared task-activation metrics obtained from: (i) models containing 6 or 24 motion parameters (MPs) as nuisance regressors; (ii) models containing nuisance regressors for 6 or 24 MPs and motion outliers (scrubbing) detected with Framewise Displacement or Derivative or root mean square VARiance over voxelS; and (iii) models with 6 or 24 MPs and motion outliers corrected through volume interpolation. To our knowledge, volume interpolation has not been systematically compared with scrubbing, nor investigated in task fMRI clinical studies in MS. Results No differences in motion were found between groups, suggesting that recently diagnosed MS patients may not present problematic motion. In general, models with 6 MPs perform better than models with 24 MPs, suggesting the 6 MPs as the best trade-off between correction of motion effects and preservation of valuable information. Parsimonious models with 6 MPs and volume interpolation were the best combination for correcting motion in both groups, surpassing the scrubbing methods. A joint analysis regardless of the group further highlighted the value of volume interpolation. Discussion Volume interpolation of motion outliers is an easy to implement technique, which may be an alternative to other methods and may improve the accuracy of fMRI analyses, crucially in clinical studies in MS and other neurological populations.
Collapse
Affiliation(s)
- Júlia F. Soares
- Coimbra Institute for Biomedical Imaging and Translational Research, Institute for Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
| | - Rodolfo Abreu
- Coimbra Institute for Biomedical Imaging and Translational Research, Institute for Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
| | - Ana Cláudia Lima
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lívia Sousa
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sónia Batista
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research, Institute for Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - João Valente Duarte
- Coimbra Institute for Biomedical Imaging and Translational Research, Institute for Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal,Faculty of Medicine, University of Coimbra, Coimbra, Portugal,*Correspondence: João Valente Duarte,
| |
Collapse
|
29
|
Immediate Effects of Fine-Motor Training on Coordination and Dexterity of the Non-Dominant Hand in Healthy Adults: A Randomized Controlled Trial. Behav Sci (Basel) 2022; 12:bs12110446. [PMID: 36421742 PMCID: PMC9687507 DOI: 10.3390/bs12110446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/30/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Several studies have demonstrated the beneficial effects of mirror training; however, only a few studies in Eastern countries have investigated fine-motor exercises using chopsticks, which have numerous advantages. We aimed to compare changes in coordination and dexterity of the non-dominant hand in healthy adults after conducting fine-motor training with the dominant hand using a mirror. We divided 100 healthy adults (age: 20−40 years) into experimental and control groups (each n = 50). The experimental group placed the non-dominant hand in a mirror box and indirectly imitated the fine-motor exercises conducted with the dominant hand using chopsticks. The control group performed the task with the non-dominant hand using chopsticks. We conducted the Chopsticks Manipulation Test and the Purdue Pegboard Test to assess the pre- and post-intervention coordination and dexterity of the non-dominant hand. Both groups showed a significant post-intervention improvement in coordination and dexterity (p < 0.01). There was no significant between-group difference in the functional improvement of coordination and dexterity (p > 0.05). Fine-motor training using mirrors and chopsticks significantly improved coordination and dexterity of the non-dominant hand. This training could be used to improve activity in brain regions associated with the non-dominant hand in healthy adults.
Collapse
|
30
|
Geller D, Nilsen DM, Quinn L, Van Lew S, Bayona C, Gillen G. Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke. Disabil Rehabil 2022; 44:6766-6774. [PMID: 34538193 DOI: 10.1080/09638288.2021.1973121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. CONCLUSIONS All participants, regardless of home-based program, adhered to the prescribed dosage and significantly improved over time. Despite no between-group differences, effect size and 95% confidence interval data suggest that UMT may be more beneficial for individuals with moderate-to-severe arm impairment as compared to BMT or TOT. ClinicalTrials.gov: #NCT02780440Implications for RehabilitationHome-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke.Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.
Collapse
Affiliation(s)
- Daniel Geller
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lori Quinn
- Department of Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Stephen Van Lew
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Claribell Bayona
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Glen Gillen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
31
|
Alashram AR, Padua E, Annino G. Virtual reality for balance and mobility rehabilitation following traumatic brain injury: A systematic review of randomized controlled trials. J Clin Neurosci 2022; 105:115-121. [PMID: 36182811 DOI: 10.1016/j.jocn.2022.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/11/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Balance and mobility deficits are most prevalent impairments in patients with traumatic brain injury (TBI). The evidence has proposed that rehabilitation plays an important role in improving balance and mobility post-TBI. Virtual reality (VR) is a computer technology that provides immersed users to generate feedback such as visual, audio, and haptic. OBJECTIVE This review aimed to examine the effects of the VR treatment intervention on balance and mobility in patients with TBI and to define the most effective VR treatment protocol. METHODS SCOPUS, PEDro, PubMed, REHABDATA, EMBASE, and the web of science were searched for experimental trials examining the impacts of VR training on balance and mobility in patients with TBI from inception until July 2022. Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the selected studies. RESULTS Five randomized controlled trials (RCTs) met the inclusion criteria. The PEDro scores ranged from 6 to 8, with a median of 6. A total of 157 patients with TBI were included in this review, 31.2% of whom were females. The findings showed that VR intervention is not superior to traditional physiotherapy interventions in improving balance and mobility post- TBI. CONCLUSIONS The preliminary findings showed that the influence of VR on the balance and mobility ability in patients with TBI is promising. Combining VR with other concurrent rehabilitation interventions may show more significant improvements in balance and mobility compared to VR interventions alone. The optimal VR treatment protocol remains unclear. Further randomized controlled trials are strongly needed.
Collapse
Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan; Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
| | - Elvira Padua
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Giuseppe Annino
- Department of Medicine Systems, University of Rome "Tor Vergata", Italy
| |
Collapse
|
32
|
Song M, Jeong H, Kim J, Jang SH, Kim J. An EEG-based asynchronous MI-BCI system to reduce false positives with a small number of channels for neurorehabilitation: A pilot study. Front Neurorobot 2022; 16:971547. [PMID: 36172602 PMCID: PMC9510756 DOI: 10.3389/fnbot.2022.971547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/08/2022] [Indexed: 11/22/2022] Open
Abstract
Many studies have used motor imagery-based brain–computer interface (MI-BCI) systems for stroke rehabilitation to induce brain plasticity. However, they mainly focused on detecting motor imagery but did not consider the effect of false positive (FP) detection. The FP could be a threat to patients with stroke as it can induce wrong-directed brain plasticity that would result in adverse effects. In this study, we proposed a rehabilitative MI-BCI system that focuses on rejecting the FP. To this end, we first identified numerous electroencephalogram (EEG) signals as the causes of the FP, and based on the characteristics of the signals, we designed a novel two-phase classifier using a small number of EEG channels, including the source of the FP. Through experiments with eight healthy participants and nine patients with stroke, our proposed MI-BCI system showed 71.76% selectivity and 13.70% FP rate by using only four EEG channels in the patient group with stroke. Moreover, our system can compensate for day-to-day variations for prolonged session intervals by recalibration. The results suggest that our proposed system, a practical approach for the clinical setting, could improve the therapeutic effect of MI-BCI by reducing the adverse effect of the FP.
Collapse
Affiliation(s)
- Minsu Song
- Department of Medical Device, Korea Institute of Machinery and Materials, Daegu, South Korea
| | - Hojun Jeong
- School of Mechanical Engineering, Sungkyunkwan University, Gyeonggi-do, South Korea
| | - Jongbum Kim
- Department of Robotics Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, South Korea
| | - Sung-Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - Jonghyun Kim
- School of Mechanical Engineering, Sungkyunkwan University, Gyeonggi-do, South Korea
- *Correspondence: Jonghyun Kim
| |
Collapse
|
33
|
Toh SFM, Chia PF, Fong KNK. Effectiveness of home-based upper limb rehabilitation in stroke survivors: A systematic review and meta-analysis. Front Neurol 2022; 13:964196. [PMID: 36188398 PMCID: PMC9521568 DOI: 10.3389/fneur.2022.964196] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Home-based training is an alternative option to provide intensive rehabilitation without costly supervised therapy. Though several studies support the effectiveness of home-based rehabilitation in improving hemiparetic upper limb function in stroke survivors, a collective evaluation of the evidence remains scarce. Objectives This study aims to determine the effects of home-based upper limb rehabilitation for hemiparetic upper limb recovery in stroke survivors. Methods The databases of the Cochrane Library, MEDLINE, CINAHL, and Web of Science were systematically searched from January 2000 to September 2020. Only randomized, controlled, and cross-over trials that evaluated the effects of home-based upper limb interventions were selected. The Pedro scale was used to assess the methodological quality of the studies. A meta-analysis of the upper limb function outcomes was performed by calculating the mean difference/standardized mean difference using a fixed/random effect model. Results An initial search yielded 1,049 articles. Twenty-six articles were included in the review. The pooled evidence of the meta-analysis showed that home-based upper limb intervention was more effective in improving upper limb function [SMD: 0.28, 95% CI (0.12, 0.44), I2 = 0%, p < 0.001, fixed effect model] than conventional therapy. When comparing two types of home-based interventions, subgroup analysis revealed that home-based technology treatment—electrical stimulation—provided more significant improvement in upper limb function than treatment without the use of technology (SMD: 0.64, 95% CI (0.21, 1.07), I2 = 0%, p = 0.003, random effect model). Conclusion The beneficial effects of home-based upper limb interventions were superior to conventional therapy in improving function and perceived use of the hemiparetic upper limb in daily activities. Among the home-based interventions, home-based electrical stimulation seemed to provide the most optimal benefits.
Collapse
Affiliation(s)
- Sharon Fong Mei Toh
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Rehabilitation, Yishun Community Hospital, Singapore, Singapore
| | - Pei Fen Chia
- Department of Occupational Therapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kenneth N. K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- *Correspondence: Kenneth N. K. Fong
| |
Collapse
|
34
|
Schrader M, Sterr A, Kettlitz R, Wohlmeiner A, Buschfort R, Dohle C, Bamborschke S. The effect of mirror therapy can be improved by simultaneous robotic assistance. Restor Neurol Neurosci 2022; 40:185-194. [PMID: 35848045 PMCID: PMC9484120 DOI: 10.3233/rnn-221263] [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] [Indexed: 12/04/2022]
Abstract
Background: Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could be a solution to provide visual and somatosensory feedback simultaneously. Objective: The study compares the treatment effects of MT with a version of robot-assisted MT where the affected arm movement was delivered through a robotic glove (RMT). Methods: This is a parallel, randomized trial, including patients with severe arm paresis after stroke or traumatic brain injury with a Fugl-Meyer subscore hand/finger < 4. Participants received either RMT or MT in individual 30 minute sessions (15 sessions within 5 weeks). Main outcome parameter was the improvement in the Fugl-Meyer Assessment upper extremity (FMA-UE) motor score. Additionally, the Motricity Index (MI) and the FMA-UE sensation test as well as a pain scale were recorded. Furthermore, patients’ and therapists’ experiences with RMT were captured through qualitative tools. Results: 24 patients completed the study. Comparison of the FMA-UE motor score difference values between the two groups revealed a significantly greater therapy effect in the RMT group than the MT group (p = 0.006). There were no significant differences for the MI (p = 0.108), the FMA-UE surface sensibility subscore (p = 0.403) as well as the FMA-UE position sense subscore (p = 0.192). In both groups the levels of pain remained stable throughout the intervention. No other adverse effects were observed. The RMT training was well accepted by patients and therapists. Conclusions: The study provides evidence that bilateral RMT achieves greater treatment benefit on motor function than conventional MT. The use of robotics seems to be a good method to implement passive co-movement in clinical practice. Our study further demonstrates that this form of training can feasibly and effectively be delivered in an inpatient setting.
Collapse
Affiliation(s)
- Mareike Schrader
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Fürst-Donnersmarck-Stiftung zu Berlin, Berlin, Germany
| | - Annette Sterr
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Fürst-Donnersmarck-Stiftung zu Berlin, Berlin, Germany
- School of Psychology, University of Surrey, Guildford, UK
| | - Robyn Kettlitz
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Fürst-Donnersmarck-Stiftung zu Berlin, Berlin, Germany
| | | | | | - Christian Dohle
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Fürst-Donnersmarck-Stiftung zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité – University Medicine Berlin, Berlin, Germany
| | - Stephan Bamborschke
- P.A.N. Zentrum für Post-Akute Neurorehabilitation, Fürst-Donnersmarck-Stiftung zu Berlin, Berlin, Germany
| |
Collapse
|
35
|
He K, Wu L, Ni F, Li X, Liang K, Ma R. Efficacy and Safety of Mirror Therapy for Post-stroke Dysphagia: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:874994. [PMID: 35860492 PMCID: PMC9289191 DOI: 10.3389/fneur.2022.874994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Post-stroke dysphagia is a common symptom after stroke and one of the most frequent and severe complications of stroke. Over the recent years, mirror therapy has generated significant research interest as a non-invasive therapeutic and rehabilitative intervention for post-stroke dysphagia and has been investigated in several randomized controlled trials in single center. Objective In this study, we aimed to evaluate the efficacy and safety of mirror therapy for post-stroke dysphagia. Methods A total of seven databases were searched comprehensively from inception to the 31 December 2021, including PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wan-fang database, and the Chinese Scientific Journals Database (VIP) from inception to 31 December 2021. The primary outcome measure was efficacy, as measured by clinical effectiveness rate. Secondary outcomes included the water swallowing test and the incidence of pneumonia. In addition, we applied the Cochrane Risk of Bias Tool to investigate the risk of bias. Potential publication bias was evaluated by applying Egger's bias indicator test and by assessing the symmetry of data when visualized as funnel plots. Results A total of five randomized controlled trials (135 subjects in the experimental group and control group) were found to report the application of mirror therapy for post-stroke dysphagia and were included in this study. No publication bias was detected. Meta-analysis revealed that mirror therapy had a positive effect on the rate of clinical efficacy [odds ratio (OR) = 4.22; 95% confidence interval (CI): 2.3–7.73] and the water swallowing test [mean difference (MD) = −0.76; 95% CI = −1.29 to −0.22]. Moreover, mirror therapy reduced the incidence of pneumonia (OR = 0.13; 95% CI = 0.03–0.49). Subgroup analyses indicated that mirror therapy during the acute phase was robust but was unstable during the convalescent phase. Sensitivity analysis revealed that the results generated by our meta-analysis were robust and stable. Conclusions Available evidence appears to suggest that mirror therapy may have a role in the management of post-stroke dysphagia but has yet to be fully confirmed. Existing evidence from clinical trials suggests that evidence relating to the safety of mirror therapy for patients with post-stroke dysphagia is not yet sufficient. Systematic Review Registration Identifier: CRD42022302733.
Collapse
Affiliation(s)
- Kelin He
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Wu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Fengjia Ni
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Xinyun Li
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Kang Liang
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruijie Ma
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Ruijie Ma
| |
Collapse
|
36
|
A Pilot Randomized Controlled Trial of Botulinum Toxin Treatment Combined with Robot-Assisted Therapy, Mirror Therapy, or Active Control Treatment in Patients with Spasticity Following Stroke. Toxins (Basel) 2022; 14:toxins14060415. [PMID: 35737076 PMCID: PMC9228472 DOI: 10.3390/toxins14060415] [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: 05/26/2022] [Revised: 06/12/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Effects of the combined task-oriented trainings with botulinum toxin A (BoNT-A) injection on improving motor functions and reducing spasticity remains unclear. This study aims to investigate effects of 3 task-oriented trainings (robot-assisted therapy (RT), mirror therapy (MT), and active control treatment (AC)) in patients with stroke after BoNT-A injection. Thirty-seven patients with chronic spastic hemiplegic stroke were randomly assigned to receive RT, MT, or AC following BoNT-A injection over spastic upper extremity muscles. Each session of RT, MT, and AC was 75 min, 3 times weekly, for 8 weeks. Outcome measures were assessed at pretreatment, post-treatment, and 3-month follow-up, involving the Fugl-Meyer Assessment (FMA), Modified Ashworth Scale (MAS), Motor Activity Log (MAL), including amount of use (AOU) and quality of movement (QOM), and arm activity level. All 3 combined treatments improved FMA, MAS, and MAL. The AC induced a greater effect on QOM in MAL at the 3-month follow-up than RT or MT. All 3 combined trainings induced minimal effect on arm activity level. Our findings suggest that for patients with stroke who received BoNT-A injection over spastic UE muscles, the RT, MT, or AC UE training that followed was effective in improving motor functions, reducing spasticity, and enhancing daily function.
Collapse
|
37
|
Cui W, Huang L, Tian Y, Luo H, Chen S, Yang Y, Li Y, Fu J, Yu Q, Xu L. Effect and mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke: A fMRI study. NeuroRehabilitation 2022; 51:65-77. [PMID: 35311718 DOI: 10.3233/nre-210307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mirror therapy has been gradually adopted for lower limb rehabilitation, but its efficacy and neural mechanism are not well understood. OBJECTIVE This study aims to investigate the effect and neural mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke by using resting state functional magnetic resonance imaging (rs-fMRI). METHODS A single-blind and randomized controlled pilot study was conducted. 32 patients with ischemic stroke were included in this study and randomly divided into two groups - the control group (CT, n = 16) and the mirror therapy group (MT, n = 16). Both the CT and MT groups received medication and routine rehabilitation training. In addition, mirror therapy was added to the MT group 5 times a week for 30 minutes each time over a period of 3 weeks. Patients' motor functions, functional connectivity (FC), regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF) were analyzed both before and immediately after the treatment. RESULTS Patients' motor functions showed significant improvement in both groups compared to those before treatment (p < 0.01). Moreover, the MT group showed significantly better improvement than the CT group after the treatment (p < 0.05). FC, ReHo and fALFF indicated enhanced neuronal activities in motor function-related brain regions in the MT group compared to the CT group. CONCLUSION Mirror therapy promotes the recovery of lower limb motor functions in patients with ischemic stroke. Through the comparative rs-fMRI analysis, it is found that the mirror therapy promotes the functional reorganization of the injured brain.
Collapse
Affiliation(s)
- Wei Cui
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Lin Huang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yang Tian
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Hong Luo
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Shuang Chen
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yan Yang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yamei Li
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Jing Fu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Qian Yu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Li Xu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| |
Collapse
|
38
|
Proulx CE, Louis Jean MT, Higgins J, Gagnon DH, Dancause N. Somesthetic, Visual, and Auditory Feedback and Their Interactions Applied to Upper Limb Neurorehabilitation Technology: A Narrative Review to Facilitate Contextualization of Knowledge. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:789479. [PMID: 36188924 PMCID: PMC9397809 DOI: 10.3389/fresc.2022.789479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022]
Abstract
Reduced hand dexterity is a common component of sensorimotor impairments for individuals after stroke. To improve hand function, innovative rehabilitation interventions are constantly developed and tested. In this context, technology-based interventions for hand rehabilitation have been emerging rapidly. This paper offers an overview of basic knowledge on post lesion plasticity and sensorimotor integration processes in the context of augmented feedback and new rehabilitation technologies, in particular virtual reality and soft robotic gloves. We also discuss some factors to consider related to the incorporation of augmented feedback in the development of technology-based interventions in rehabilitation. This includes factors related to feedback delivery parameter design, task complexity and heterogeneity of sensory deficits in individuals affected by a stroke. In spite of the current limitations in our understanding of the mechanisms involved when using new rehabilitation technologies, the multimodal augmented feedback approach appears promising and may provide meaningful ways to optimize recovery after stroke. Moving forward, we argue that comparative studies allowing stratification of the augmented feedback delivery parameters based upon different biomarkers, lesion characteristics or impairments should be advocated (e.g., injured hemisphere, lesion location, lesion volume, sensorimotor impairments). Ultimately, we envision that treatment design should combine augmented feedback of multiple modalities, carefully adapted to the specific condition of the individuals affected by a stroke and that evolves along with recovery. This would better align with the new trend in stroke rehabilitation which challenges the popular idea of the existence of an ultimate good-for-all intervention.
Collapse
Affiliation(s)
- Camille E. Proulx
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal – Site Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
- *Correspondence: Camille E. Proulx
| | | | - Johanne Higgins
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal – Site Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Dany H. Gagnon
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal – Site Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Numa Dancause
- Department of Neurosciences, Faculty of Medecine, Université de Montréal, Montreal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montreal, QC, Canada
| |
Collapse
|
39
|
Jo S, Kim H, Song C. A Novel Approach to Increase Attention during Mirror Therapy among Stroke Patients: A Video-Based Behavioral Analysis. Brain Sci 2022; 12:brainsci12030297. [PMID: 35326254 PMCID: PMC8946785 DOI: 10.3390/brainsci12030297] [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: 02/03/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Stroke is a major cause of disability and an evident rehabilitation strategy is crucial. Mirror therapy (MT) is one of the popular rehabilitation methods that is known to be effective as the patients benefit from the mirror illusion. However, the patient’s attention to the mirror illusion during treatment is unclear. Therefore, the present study assesses the duration and frequency of the mirror gaze, distraction, and preparation of sixteen stroke patients during two MT methods using a behavioral coding software. During the 30 min treatment, the total mirror gaze duration during conventional bilateral MT (BMT) was 564.04 s, while it was 1482.45 s in unilateral MT using a screen (UMT). The total distracted time was 945.61 s in BMT, while it was only 162.03 s in UMT. The total preparatory duration was 290.35 s in BMT and 155.53 s in UMT. The total number of distracted bouts were 136.45 in BMT, while it was 73.38 in UMT. The total number of preparatory bouts were 18.42 in BMT and 9.56 in UMT. The average times of gaze duration per bout were 5.52 s in BMT and 21.81 s in UMT. The average times of distraction per bout were 9.22 s in BMT and 3.00 s in UMT. The total number of mirror gaze bouts and average time of preparation per bout did not present a statistical significance in the comparisons of the two methods. This study assesses two methods of MT using observational coding software to evaluate the duration and frequency of the mirror gaze during treatment. The results suggest that UMT may be an alternative option to provide MT for stroke patients to increase their attention towards the mirror.
Collapse
|
40
|
Varalta V, Munari D, Fonte C, Evangelista E, Picelli A, Smania N. Rehabilitation of somatic sensation and related deficit of motor control by Mirror Box Therapy: a case report. Neurocase 2022; 28:42-47. [PMID: 34983309 DOI: 10.1080/13554794.2021.2023193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Somatosensory disorders are often present after cerebral stroke. These deficits are associated with patients' disability. Therefore, their rehabilitation takes an importance in recovery program. However, the treatment of sensation remains poorly considered during neurorehabilitation and evidence for active sensory training is limited. Mirror Box Therapy is a simple training used to treat upper extremity motor deficits and pain also in patients with stroke. However, the effects of Mirror Box Therapy on somatosensory impairments in post-stroke patients are not deeply investigated and often exclusively motor exercises are provided during therapy.The aim of the present study was to investigate the effects of Mirror Box Therapy sensory training on somatosensory deficits in a stroke patient presenting upper limb impairment.The patient underwent to four weeks of training, five days a week. Before, during and after the Mirror Box Therapy treatment, the patient was assessed by Rivermead Assessment of Somatosensory Performance. Before and after training also upper limb motor function and performance in activities of daily living were assessed.After training patient showed an improvement in somatosensory performance. The gain was maintained at follow-up.This case report shows the effects of Mirror Box Therapy sensory training on the upper extremity for the improvement of sensation and movement in a patient with a thalamo-capsular hemorrhagic stroke during the subacute phase.
Collapse
Affiliation(s)
- Valentina Varalta
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Daniele Munari
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Cristina Fonte
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Evangelista
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| | - Nicola Smania
- Neuromotor and Cognitive Rehabilitation Research Center - Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.,Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy
| |
Collapse
|
41
|
Kim DH, Lee KD, Bulea TC, Park HS. Increasing motor cortex activation during grasping via novel robotic mirror hand therapy: a pilot fNIRS study. J Neuroeng Rehabil 2022; 19:8. [PMID: 35073933 PMCID: PMC8785601 DOI: 10.1186/s12984-022-00988-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Mirror therapy (MT) has been used for functional recovery of the affected hand by providing the mirrored image of the unaffected hand movement, which induces neural activation of the cortical hemisphere contralateral to the affected hand. Recently, many wearable robots assisting the movement of the hand have been developed, and several studies have proposed robotic mirror therapy (RMT) that uses a robot to provide mirrored movements of the unaffected hand to the affected hand with the robot controlled by measuring electromyography or posture of the unaffected hand. In some cases of RMT a mirror is placed to allow the person to observe only the unaffected hand but in others users simply observe the robotically assisted hand performing the mirrored movements, as was the case in this study. There have been limited evaluations of the cortical activity during RMT compared to MT and robotic therapy (RT) providing passive movements despite the difference in the modality of sensory feedback and the involvement of motor intention, respectively. Methods This paper analyzes bilateral motor cortex activation in nine healthy subjects and five chronic stroke survivors during a pinching task performed in MT, RT, and RMT conditions using functional near infrared spectroscopy (fNIRS). In the MT condition, the person moved the unaffected hand and observed it in a mirror while the affected hand remained still. In RT condition passive movements were provided to the affected hand with a cable-driven soft robotic glove, while, in RMT condition, the posture of the unaffected hand was measured by a sensing glove and the soft robotic glove mirrored its movement on the affected hand. Results For both groups, the RMT condition showed the greatest mean cortical activation on the motor cortex contralateral to the affected (non-dominant for the healthy group) hand compared to other conditions. Individual results indicate that RMT induces similar or greater neural activation on the motor cortex compared to MT and RT conditions. The interhemispheric activations of both groups were balanced in RMT condition. In MT condition, significantly greater activation was shown on the hemisphere ipsilateral to the affected (dominant for the healthy group) hand for both subject groups, while the contralateral side showed significantly greater activation for the healthy group in RT condition. Conclusion The experimental results indicate that combining visual feedback, somatosensory feedback, and motor intention are important for greater stimulation on the contralateral motor cortex of the affected hand. RMT that includes these factors is hypothesized to achieve a more effective functional rehabilitation due to greater and more balanced cortical activation.
Collapse
|
42
|
Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities. Rehabil Res Pract 2022; 2021:9487319. [PMID: 35003808 PMCID: PMC8741383 DOI: 10.1155/2021/9487319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mirror therapy (MT) has been used as a treatment for various neurological disorders. Recent application of electroencephalogram (EEG) to the MT study allows researchers to gain insight into the changes in brain activity during the therapy. Objective This scoping review is aimed at mapping existing evidence and identifying knowledge gaps about the effects of MT on upper limb recovery and its application for individuals with chronic stroke. Methods and Materials A scoping review through a systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. Twenty articles published between 2010 and 2020 met the inclusion criteria. The efficacy of MT on upper limb recovery and brain activity during MT were discussed according to the International Classification of Functioning, Disability and Health (ICF). Results A majority of the studies indicated positive effects of MT on upper limb recovery from the body structure/functional domain. All studies used EEG to indicate brain activation during MT. Conclusion MT is a promising intervention for improving upper limb function for individuals with chronic stroke. This review also highlights the need to incorporate EEG into the MT study to capture brain activity and understand the mechanism underlying the therapy.
Collapse
|
43
|
Vinehout K, Tynes K, Sotelo MR, Hyngstrom AS, McGuire JR, Schmit BD. Changes in Cortical Activity in Stroke Survivors Undergoing Botulinum Neurotoxin Therapy for Treatment of Focal Spasticity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:735819. [PMID: 36188774 PMCID: PMC9397708 DOI: 10.3389/fresc.2021.735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Background: Botulinum NeuroToxin-A (BoNT-A) relieves muscle spasticity and increases range of motion necessary for stroke rehabilitation. Determining the effects of BoNT-A therapy on brain neuroplasticity could help physicians customize its use and predict its outcome. Objective: The purpose of this study was to investigate the effects of Botulinum Toxin-A therapy for treatment of focal spasticity on brain activation and functional connectivity. Design: We used functional Magnetic Resonance Imaging (fMRI) to track changes in blood oxygen-level dependent (BOLD) activation and functional connectivity associated with BoNT-A therapy in nine chronic stroke participants, and eight age-matched controls. Scans were acquired before BoNT-A injections (W0) and 6 weeks after the injections (W6). The task fMRI scan consisted of a block design of alternating mass finger flexion and extension. The voxel-level changes in BOLD activation, and pairwise changes in functional connectivity were analyzed for BoNT-A treatment (stroke W0 vs. W6). Results: BoNT-A injection therapy resulted in significant increases in brain activation in the contralesional premotor cortex, cingulate gyrus, thalamus, superior cerebellum, and in the ipsilesional sensory integration area. Lastly, cerebellar connectivity correlated with the Fugl-Meyer assessment of motor impairment before injection, while premotor connectivity correlated with the Fugl-Meyer score after injection. Conclusion: BoNT-A therapy for treatment of focal spasticity resulted in increased brain activation in areas associated with motor control, and cerebellar connectivity correlated with motor impairment before injection. These results suggest that neuroplastic effects might take place in response to improvements in focal spasticity.
Collapse
Affiliation(s)
- Kaleb Vinehout
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kelsey Tynes
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miguel R. Sotelo
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison S. Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - John R. McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Schmit
| |
Collapse
|
44
|
De Marco D, Scalona E, Bazzini MC, Nuara A, Taglione E, Lopomo NF, Rizzolatti G, Fabbri-Destro M, Avanzini P. Observation of others' actions during limb immobilization prevents the subsequent decay of motor performance. Proc Natl Acad Sci U S A 2021; 118:e2025979118. [PMID: 34782480 PMCID: PMC8617512 DOI: 10.1073/pnas.2025979118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/18/2022] Open
Abstract
There is rich clinical evidence that observing normally executed actions promotes the recovery of the corresponding action execution in patients with motor deficits. In this study, we assessed the ability of action observation to prevent the decay of healthy individuals' motor abilities following upper-limb immobilization. To this end, upper-limb kinematics was recorded in healthy participants while they performed three reach-to-grasp movements before immobilization and the same movements after 16 h of immobilization. The participants were subdivided into two groups; the experimental group observed, during the immobilization, the same reach-to-grasp movements they had performed before immobilization, whereas the control group observed natural scenarios. After bandage removal, motor impairment in performing reach-to-grasp movements was milder in the experimental group. These findings support the hypothesis that action observation, via the mirror mechanism, plays a protective role against the decline of motor performance induced by limb nonuse. From this perspective, action observation therapy is a promising tool for anticipating rehabilitation onset in clinical conditions involving limb nonuse, thus reducing the burden of further rehabilitation.
Collapse
Affiliation(s)
- Doriana De Marco
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy;
| | - Emilia Scalona
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy
| | - Maria Chiara Bazzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma 43125, Italy
| | - Arturo Nuara
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy
| | - Elisa Taglione
- Centro di Riabilitazione Motoria di Volterra, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro (INAIL), Volterra 56048, Italy
| | - Nicola Francesco Lopomo
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy
- Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia 25121, Italy
| | - Giacomo Rizzolatti
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy;
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma 43125, Italy
| | | | - Pietro Avanzini
- Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Parma 43125, Italy
- Humanitas Clinical and Research Center - IRCCS, Rozzano 20089, Italy
| |
Collapse
|
45
|
Sinha AM, Nair VA, Prabhakaran V. Brain-Computer Interface Training With Functional Electrical Stimulation: Facilitating Changes in Interhemispheric Functional Connectivity and Motor Outcomes Post-stroke. Front Neurosci 2021; 15:670953. [PMID: 34646112 PMCID: PMC8503522 DOI: 10.3389/fnins.2021.670953] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
While most survivors of stroke experience some spontaneous recovery and receive treatment in the subacute setting, they are often left with persistent impairments in upper limb sensorimotor function which impact autonomy in daily life. Brain-Computer Interface (BCI) technology has shown promise as a form of rehabilitation that can facilitate motor recovery after stroke, however, we have a limited understanding of the changes in functional connectivity and behavioral outcomes associated with its use. Here, we investigate the effects of EEG-based BCI intervention with functional electrical stimulation (FES) on resting-state functional connectivity (rsFC) and motor outcomes in stroke recovery. 23 patients post-stroke with upper limb motor impairment completed BCI intervention with FES. Resting-state functional magnetic resonance imaging (rs-fMRI) scans and behavioral data were collected prior to intervention, post- and 1-month post-intervention. Changes in rsFC within the motor network and behavioral measures were investigated to identify brain-behavior correlations. At the group-level, there were significant increases in interhemispheric and network rsFC in the motor network after BCI intervention, and patients significantly improved on the Action Research Arm Test (ARAT) and SIS domains. Notably, changes in interhemispheric rsFC from pre- to both post- and 1 month post-intervention correlated with behavioral improvements across several motor-related domains. These findings suggest that BCI intervention with FES can facilitate interhemispheric connectivity changes and upper limb motor recovery in patients after stroke.
Collapse
Affiliation(s)
- Anita M Sinha
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States.,Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| |
Collapse
|
46
|
Bello UM, Chan CCH, Winser SJ. Task Complexity and Image Clarity Facilitate Motor and Visuo-Motor Activities in Mirror Therapy in Post-stroke Patients. Front Neurol 2021; 12:722846. [PMID: 34630297 PMCID: PMC8493295 DOI: 10.3389/fneur.2021.722846] [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: 06/12/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Mirror therapy is effective in the recovery of upper-limb function among post-stroke patients. An important component of mirror therapy is imagining finger movements. This study aimed to determine the influence of finger movement complexity and mirror image clarity on facilitating motor and visuo-motor activities in post-stroke patients. Methods: Fifteen post-stroke patients and 18 right-handed healthy participants performed simple or complex finger tapping while viewing mirror images of these movements at varying levels of clarity. The physical setup was identical to typical mirror therapy. Functional near infrared spectroscopy (fNIRS) was used to capture the brain activities elicited in the bilateral primary motor cortices (M1) and the precuneus using a block experimental design. Results: In both study groups, the “complex finger-tapping task with blurred mirror image” condition resulted in lower intensity (p < 0.01) and authenticity (p < 0.01) of the kinesthetic mirror illusion, and higher levels of perceived effort in generating the illusion (p < 0.01), relative to the “simple finger-tapping with clear mirror image” condition. Greater changes in the oxygenated hemoglobin (HbO) concentration were recorded at the ipsilesional and ipsilateral M1 in the “complex finger-tapping task with blurred mirror image” condition relative to that recorded in the “simple finger-tapping task with clear mirror image” condition (p = 0.03). These HbO concentration changes were not significant in the precuneus. Post-stroke patients showed greater changes than their healthy counterparts at the ipsilesional M1 (F = 5.08; p = 0.03; partial eta squared = 0.14) and the precuneus (F = 7.71; p < 0.01; partial eta squared = 0.20). Conclusion: The complexity and image clarity of the finger movements increased the neural activities in the ipsilesional motor cortex in the post-stroke patients. These findings suggest plausible roles for top-down attention and working memory in the treatment effects of mirror therapy. Future research can aim to corroborate these findings by using a longitudinal design to examine the use of mirror therapy to promote upper limb motor recovery in post-stroke patients.
Collapse
Affiliation(s)
- Umar Muhammad Bello
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China.,Department of Physiotherapy, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | - Chetwyn C H Chan
- Department of Psychology, The Education University of Hong Kong, Tai Po, Hong Kong, SAR China
| | - Stanley John Winser
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong, SAR China
| |
Collapse
|
47
|
Nogueira NGDHM, Parma JO, Leão SESDA, Sales IDS, Macedo LC, Galvão ACDR, de Oliveira DC, Murça TM, Fernandes LA, Junqueira C, Lage GM, Ferreira BDP. Mirror therapy in upper limb motor recovery and activities of daily living, and its neural correlates in stroke individuals: A systematic review and meta-analysis. Brain Res Bull 2021; 177:217-238. [PMID: 34626693 DOI: 10.1016/j.brainresbull.2021.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Available literature indicates that 30-66% of stroke survivors present persistent upper limb impairment. Considering the importance of upper limb function for activities of daily living, it is necessary to investigate neurorehabilitation therapies that could improve the upper limb function. Among stroke complementary therapies, mirror therapy has shown promising results. Thus, the aim of this systematic review and meta-analyses was to review and synthesize clinical evidence on the use of mirror therapy on motor recovery of the upper limb and activities of daily living, and its neural correlates in stroke patients. The literature search was carried out in PubMed, ISI Web of Science, and Scopus databases. Twenty-nine studies met all the inclusion criteria. Two meta-analyses were conducted to compare mirror therapy with sham therapy on two general measures, upper limb assessment and activities of daily living. Results suggest that mirror therapy was better than sham therapy, mainly in the subacute phase, but the meta-analyses were nonsignificant. In addition, mirror therapy and cortical reorganization showed potential neural correlates, such as the primary motor cortex, precuneus, and posterior cingulate cortex.
Collapse
Affiliation(s)
| | | | | | - Izabella de Souza Sales
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lilian Carla Macedo
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Dalva Cadeu de Oliveira
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; School of Kinesiology, Auburn University, Auburn, USA; Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Department of Physical Education, Universidade Federal de Juiz de Fora, Governador Valadares, MG, Brazil
| | - Tatiane Moisés Murça
- Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Cristiani Junqueira
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Guilherme Menezes Lage
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Bárbara de Paula Ferreira
- School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| |
Collapse
|
48
|
Roberts M, Lietz NH, Portelli NA, Huang MH. Implementing technology enhanced real-time action observation therapy in persons with chronic stroke: A pilot study. Physiother Theory Pract 2021; 38:2665-2676. [PMID: 34503381 DOI: 10.1080/09593985.2021.1978120] [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: 10/20/2022]
Abstract
This pilot study examined a novel technology-enhanced real-time action observation therapy (TERTAOT) of symmetrical bilateral movements in survivors of chronic stroke regardless of their ability to move their paretic limb(s). The TERTAOT used a Kinect XBox One to project mirror images of non-paretic limbs as participants performed symmetrical bilateral motor tasks involving whole-body movements in sitting or standing. The participants received eight weeks of treatment consisting of 30-minutes of conventional physical therapy (balance training, gait training, neuromuscular reeducation, and generalized strength training) and 30-minutes of the TERTAOT protocol per session (three sessions per week for a total of 24 sessions). Ten Meter Walk Test (10MWT), Five Times Sit-to-Stand (5TSTS), Timed Up and Go (TUG), Motor Activity Log - Quality of Movement (QOM) and Amount of Use (AOU) were administered at baseline (pretest), 4 weeks (posttest 1) and 8 weeks (posttest 2) post-TERTAOT, and 3 months after TERTAOT ended (retention). A General Linear Model Repeated Measures (parametric test) or the Friedman Test (non-parametric test) was used to compare outcomes across time points, depending on the normality of data distribution. Bonferroni post-hoc corrections were applied. Seventeen participants completed >80% of TERTAOT sessions without adverse events. The effect of time was significant for 10MWT (p = .001), 5TSTS (p = .001), TUG (p = .005), QOM (p = .001), and AOU (p = .017). TERTAOT may be feasible to be implemented in an outpatient setting. Improvements in functional outcomes including gait, balance, and use of upper limbs were observed after eight weeks of conventional therapy and TERTAOT protocol in survivors of chronic stroke.
Collapse
Affiliation(s)
- Mary Roberts
- Ambulatory Rehabilitation and Speech Language Pathology, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Canton, MI, United States of America
| | - Ncs Hendrika Lietz
- Ambulatory Rehabilitation and Speech Language Pathology, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Canton, MI, United States of America
| | - Ncs Alyssa Portelli
- Ambulatory Rehabilitation and Speech Language Pathology, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Canton, MI, United States of America
| | - Min Hui Huang
- Physical Therapy Department, College of Health Sciences, University of Michigan-Flint, Flint, Mi, United States of America
| |
Collapse
|
49
|
Chin K, Lambert S. Revision total elbow replacement. J Clin Orthop Trauma 2021; 20:101495. [PMID: 34277345 PMCID: PMC8271158 DOI: 10.1016/j.jcot.2021.101495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The range of general and specific adverse event in total elbow arthroplasty is similar in principle and practice to all other revision prosthetic arthroplasty but with three particular challenges: loss of humeral and ulnar bone stock; insufficiency of the extensor 'mechanism'; and the management of the ulnar nerve. Total elbow replacement is presently performed for the management of complex non-reconstructable distal humeral fractures in osteoporotic bone, for post-traumatic arthropathy, and for medically managed inflammatory arthritides in which metaphyseal bone architecture is often preserved while the articular surface is degenerate. In all these conditions the patient often presents for revision total elbow arthroplasty with relevant co-morbidities and relevant musculoskeletal dysfunction (for example: ipsilateral shoulder, wrist, thumb or hand dysfunction). Infection is a universal concern for revision arthroplasty but where the soft tissue 'envelope' is compromised and already limited, as in the proximal forearm, it is difficult to eradicate, particularly in immunocompromised patients. Bone loss compromises subsequent implantation of a revision prosthesis, while failure to restore the working lengths of the humerus and ulna reduces the strength of the flexor and extensor compartment muscles for elbow motion. Failure to restore the continuity of the triceps aponeurosis - antebrachial fascia and triceps medial head-olecranon components of the extensor 'mechanism' also compromises extensor power. Prior triceps-dividing surgical approaches will determine the elasticity, and therefore pliability, of the extensor 'mechanism': this will have a role in determining how much gain in length of the humeral side can be safely achieved. The ulnar nerve, and its management during elbow arthroplasty, is a source of frequent concern, particularly for revision of an elbow arthroplasty undertaken for distal non-reconstructable humeral articular fractures or post-traumatic arthropathy, in which the position of the ulnar nerve is never anatomic. For these reasons revision total elbow replacement (RTER) is challenging: it requires experience with surgical exposures of the elbow including the major nerve trunks, familiarity with the restoration of bone stock, a range of prostheses and techniques for prosthetic implantation, the ability to achieve adequate soft tissue cover and primary closure, and a logical approach to individualised rehabilitation.
Collapse
|
50
|
Rong J, Ding L, Xiong L, Zhang W, Wang W, Deng M, Wang Y, Chen Z, Jia J. Mirror Visual Feedback Prior to Robot-Assisted Training Facilitates Rehabilitation After Stroke: A Randomized Controlled Study. Front Neurol 2021; 12:683703. [PMID: 34305792 PMCID: PMC8297738 DOI: 10.3389/fneur.2021.683703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Robot-assisted training has been widely used in neurorehabilitation, but its effect on facilitating recovery after stroke remains controversial. One possible reason might be lacking consideration of the role of embodiment in robotic systems. Mirror visual feedback is an ideal method to approach embodiment. Thus, we hypothesized that mirror visual feedback priming with subsequent robot-assisted training might provide additional treatment benefits in rehabilitation. Method: This is a prospective, assessor-blinded, randomized, controlled study. Forty subacute stroke patients were randomly assigned into an experimental group (N = 20) or a control group (N = 20). They received either mirror visual feedback or sham-mirror visual feedback prior to robot-assisted training for 1.5 h/day, 5 days/week for 4 weeks. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale, the Functional Independence Measure, the modified Barthel Index, and grip strength were measured. Scores of four specified games were recorded pre and post one-time mirror visual feedback priming before intervention in the experimental group. Results: All measurements improved significantly in both groups following interventions. Moreover, the Fugl-Meyer Assessment Upper Limb subscale, self-care subscale of the Functional Independence Measure, and the grip strength were improved significantly in the experimental group after a 4-week intervention, compared with the control group. Significantly higher scores of two games were revealed after one-time priming. Conclusions: Mirror visual feedback prior to robot-assisted training could prompt motor recovery, increase ability of self-care, and potentially enhance grip strength in stroke patients, compared to control treatment. Moreover, mirror visual feedback priming might have the capability to improve the patient's performance and engagement during robot-assisted training, which could prompt the design and development of robotic systems. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: ChiCTR1900023356.
Collapse
Affiliation(s)
- Jifeng Rong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Li Ding
- The Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Xiong
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Wen Zhang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Weining Wang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Meikui Deng
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Yana Wang
- The Center of Rehabilitation Therapy, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Zhen Chen
- The Neurorehabilitation Centre, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Jie Jia
- The Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.,The National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|