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King EC, Pedi E, Stoykov ME, Corcos DM, Urday S. Combining high dose therapy, bilateral motor priming, and vagus nerve stimulation to treat the hemiparetic upper limb in chronic stroke survivors: a perspective on enhancing recovery. Front Neurol 2023; 14:1182561. [PMID: 37448744 PMCID: PMC10336216 DOI: 10.3389/fneur.2023.1182561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Stroke is a leading cause of disability worldwide and upper limb hemiparesis is the most common post-stroke disability. Recent studies suggest that clinically significant motor recovery is possible in chronic stroke survivors with severe impairment of the upper limb. Three promising strategies that have been investigated are (1) high dose rehabilitation therapy (2) bilateral motor priming and (3) vagus nerve stimulation. We propose that the future of effective and efficient upper limb rehabilitation will likely require a combination of these approaches.
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Affiliation(s)
- Erin C. King
- Northwestern University, Evanston, IL, United States
| | - Elizabeth Pedi
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Mary Ellen Stoykov
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Daniel M. Corcos
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sebastian Urday
- The Ken & Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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2
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Stoykov ME, Biller OM, Wax A, King E, Schauer JM, Fogg LF, Corcos DM. Bilateral upper extremity motor priming (BUMP) plus task-specific training for severe, chronic upper limb hemiparesis: study protocol for a randomized clinical trial. Trials 2022; 23:523. [PMID: 35733202 PMCID: PMC9214193 DOI: 10.1186/s13063-022-06465-9] [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: 12/03/2021] [Accepted: 06/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various priming techniques to enhance neuroplasticity have been examined in stroke rehabilitation research. Most priming techniques are costly and approved only for research. Here, we describe a priming technique that is cost-effective and has potential to significantly change clinical practice. Bilateral motor priming uses the Exsurgo priming device (Exsurgo Rehabilitation, Auckland, NZ) so that the less affected limb drives the more affected limb in bilateral symmetrical wrist flexion and extension. The aim of this study is to determine the effects of a 5-week protocol of bilateral motor priming in combination with task-specific training on motor impairment of the affected limb, bimanual motor function, and interhemispheric inhibition in moderate to severely impaired people with stroke. METHODS Seventy-six participants will be randomized to receive either 15, 2-h sessions, 3 times per week for 5 weeks (30 h of intervention) of bilateral motor priming and task-specific training (experimental group) or the same dose of control priming plus the task-specific training protocol. The experimental group performs bilateral symmetrical arm movements via the Exsurgo priming device which allows both wrists to move in rhythmic, symmetrical wrist flexion and extension for 15 min. The goal is one cycle (wrist flexion and wrist extension) per second. The control priming group receives transcutaneous electrical stimulation below sensory threshold for 15 min prior to the same 45 min of task-specific training. Outcome measures are collected at pre-intervention, post-intervention, and follow-up (8 weeks post-intervention). The primary outcome measure is the Fugl-Meyer Test of Upper Extremity Function. The secondary outcome is the Chedoke Arm and Hand Activity Index-Nine, an assessment of bimanual functional tasks. DISCUSSION To date, there are only 6 studies documenting the efficacy of priming using bilateral movements, 4 of which are pilot or feasibility studies. This is the first large-scale clinical trial of bilateral priming plus task-specific training. We have previously completed a feasibility intervention study of bilateral motor priming plus task-specific training and have considerable experience using this protocol. TRIAL REGISTRATION ClinicalTrials.gov NCT03517657 . Retrospectively registered on May 7, 2018.
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Affiliation(s)
- Mary Ellen Stoykov
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Olivia M Biller
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexandra Wax
- Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA.,Think & Speak Lab, Arms & Hands Lab, Shirley Ryan AbilityLab, Chicago, USA
| | - Erin King
- Interdepartmental Institution of Neuroscience, Northwestern University, Chicago, USA
| | - Jacob M Schauer
- Department of Preventive Medicine - Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Louis F Fogg
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
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Proprioceptive Training with Visual Feedback Improves Upper Limb Function in Stroke Patients: A Pilot Study. Neural Plast 2022; 2022:1588090. [PMID: 35075359 PMCID: PMC8783730 DOI: 10.1155/2022/1588090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/30/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Proprioceptive deficit is one of the common sensory impairments following stroke and has a negative impact on motor performance. However, evidence-based training procedures and cost-efficient training setups for patients with poststroke are still limited. We compared the effects of proprioceptive training versus nonspecific sensory stimulation on upper limb proprioception and motor function rehabilitation. In this multicenter, single-blind, randomized controlled trial, 40 participants with poststroke hemiparesis were enrolled from 3 hospitals in China. Participants were assigned randomly to receive proprioceptive training involving passive and active movements with visual feedback (proprioceptive training group [PG]; n = 20) or nonspecific sensory stimulation (control group [CG]; n = 20) 20 times in four weeks. Each session lasted 30 minutes. A clinical assessor blinded to group assignment evaluated patients before and after the intervention. The primary outcome was the change in the motor subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-M). Secondary outcomes were changes in box and block test (BBT), thumb localization test (TLT), the sensory subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-S), and Barthel Index (BI). The results showed that the mean change scores of FMA-UE were significantly greater in the PG than in the CG (p = 0.010 for FMA-UE-M, p = 0.033 for FMA-UE-S). The PG group was improved significantly in TLT (p = 0.010) and BBT (p = 0.027), while there was no significant improvement in TLT (p = 0.083) and BBT (p = 0.107) for the CG group. The results showed that proprioceptive training was effective in improving proprioception and motor function of the upper extremity in patients with poststroke. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2000037808).
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Bell A, Grampurohit N, Marino RJ, Duff S, Kaplan G, Calhoun Thielen C, Mulcahey M. Home Activity-based Interventions for the Neurologically Impaired Upper Extremity: A Scoping Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/1084822320953836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Activity-based therapy (ABT) for the upper extremity (UE) enables neurologic recovery with tasks that are functional, intense, and highly repetitive. A large proportion of rehabilitation occurs in the home and there is a gap in literature on the application of ABT within the home. The objective of this scoping review was to describe ABT in the home-setting for the neurologically-impaired UE. Methods: A systematic scoping review included searches of: MEDLINE, CINAHL, Cochrane, and OTSeeker. Results: A systematic search yielded 51 final studies. About 61% of ABT studies were exclusively within the home, others included outpatient visits (37%). Telerehabilitation was used in 37% of the studies with live-video and store forward techniques equally represented. ABT supported by technology was used in 61% of studies. Dosing of intervention ranged from 7 to 120 hours, with a mean of 34.5 hours of practice. Adherence with intended dosing was reported in 27% of studies and subjects completed a mean of 86% of the intended practice time. Sixty-seven percent of studies reported some degree of practice without therapist supervision. Conclusions: The results showed wide variability in the intervention methods, dosing and technology used in homebased settings. The high rate of adherence with dosing is encouraging for the application of homebased neurologic UE interventions. This scoping review highlights feasibility of UE ABT within the home and need for further research.
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Affiliation(s)
- Alison Bell
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | - Gary Kaplan
- Thomas Jefferson University, Philadelphia, PA, USA
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Stoykov ME, King E, David FJ, Vatinno A, Fogg L, Corcos DM. Bilateral motor priming for post stroke upper extremity hemiparesis: A randomized pilot study. Restor Neurol Neurosci 2021; 38:11-22. [PMID: 31609714 DOI: 10.3233/rnn-190943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bilateral priming, device assisted bilateral symmetrical wrist flexion/extension, is a noninvasive neuromodulation technique that can be used in the clinic. OBJECTIVE We examined the additive effect of bilateral motor priming and task specific training in individuals with severe upper limb hemiparesis. METHODS This is a parallel assignment, single-masked, randomized exploratory pilot study with three timepoints (pre-/post-intervention and follow up). Participants received either bilateral motor priming or health care education followed by task specific training. Sixteen participants who were at least 6 months post-stroke and had a Fugl Meyer Upper Extremity (FMUE) score between 23 and 38 were randomized. Our primary and secondary measures were Chedoke Arm & Hand Activity Index 9 (CAHAI-9) and the FMUE respectively. We determined changes in interhemispheric inhibition using transcranial magnetic stimulation. We hypothesized that improvement in the priming group would persist at follow up. RESULTS There was no between-group difference in the CAHAI. The improvement in the FMUE was significantly greater in the experimental group at follow up (t = 2.241, p = 0.045). CONCLUSIONS Both groups improved in the CAHAI. There was a significant between-group difference in the secondary outcome measure (FMUE) where the bilateral priming group had an average increase of 10 points from pre-intervention to follow up.
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Affiliation(s)
- Mary Ellen Stoykov
- Shirley Ryan Ability Lab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Erin King
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA
| | - Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Amanda Vatinno
- Department of Health Sciences and Research, Medical College of South Carolina, Charleston, SC, USA
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Daniel M Corcos
- Interdepartmental Neuroscience Program, Northwestern University, Chicago, IL, USA.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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Hung CS, Lin KC, Chang WY, Huang WC, Chang YJ, Chen CL, Grace Yao K, Lee YY. Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019; 100:2225-2232. [PMID: 31421096 DOI: 10.1016/j.apmr.2019.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. DESIGN A single-blind, randomized controlled trial. SETTING Four hospitals. PARTICIPANTS Outpatients with chronic stroke and mild to moderate motor impairment (N=44). INTERVENTION UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. MAIN OUTCOME MEASURES Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. RESULTS The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01). CONCLUSIONS BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.
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Affiliation(s)
- Chung-Shan Hung
- Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wan-Ying Chang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wen-Chih Huang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Miaoli General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan
| | - Ya-Ju Chang
- Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kaiping Grace Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Arrebola LS, Yi LC, de Oliveira VGC. The use of video games combined with conventional physical therapy in children with upper limb fractures: An exploratory study. J Pediatr Rehabil Med 2019; 12:65-70. [PMID: 30883369 DOI: 10.3233/prm-170529] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To determine the effect of rehabilitation using video games combined with conventional therapy in children with loss of range of motion (ROM) after conservative or surgical treatment of upper limb fractures. METHODS This retrospective observational study included 12 children (9 boys, 3 girls; mean age: 6.75 ± 2.83 y) treated with combined video game and conventional physical therapy following upper limb fracture. Children completed 60 minutes of combined therapy (20 minutes of game therapy and 40 minutes of physical therapy) two times per week until therapy was no longer warranted. The flexion and extension ROM of the elbow and wrist, pronation and supination of the forearm, and pain during rest and effort were measured at the beginning and end of treatment. RESULTS Children experienced significantly increased extension (p< 0.001) and flexion (p< 0.01) ROM of the elbow, increased flexion ROM of the wrist (p< 0.05), and reduced pain during effort (p< 0.05) after an average of 6 weeks of combined treatment. CONCLUSION The use of video games with conventional therapy was effective in reducing pain and recovering ROM in children with upper limb fractures.
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Affiliation(s)
- Lucas Simões Arrebola
- Human Movement Sciences Department, Universidade Federal de São Paulo, Baixada Santista Campus, Santos, São Paulo, Brazil.,Physical Therapy Department, Institute of Medical Assistance to the State Public Servant, São Paulo, Brazil
| | - Liu Chiao Yi
- Human Movement Sciences Department, Universidade Federal de São Paulo, Baixada Santista Campus, Santos, São Paulo, Brazil
| | - Vanessa Gonçalves Coutinho de Oliveira
- Human Movement Sciences Department, Universidade Federal de São Paulo, Baixada Santista Campus, Santos, São Paulo, Brazil.,Physical Therapy Department, Institute of Medical Assistance to the State Public Servant, São Paulo, Brazil
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Hoermann S, Ferreira Dos Santos L, Morkisch N, Jettkowski K, Sillis M, Devan H, Kanagasabai PS, Schmidt H, Krüger J, Dohle C, Regenbrecht H, Hale L, Cutfield NJ. Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy. Disabil Rehabil 2017; 39:1503-1514. [PMID: 28478736 DOI: 10.1080/09638288.2017.1291765] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. METHOD We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals. RESULTS The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. CONCLUSIONS Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation.
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Affiliation(s)
- Simon Hoermann
- a Department of Medicine (DSM) , University of Otago , Dunedin , New Zealand.,b Department of Information Science , University of Otago , Dunedin , New Zealand.,i School of Electrical & Information Engineering , The University of Sydney , Sydney , Australia
| | - Luara Ferreira Dos Santos
- c Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Industrial Automation Technology , Technische Universität Berlin , Berlin , Germany
| | - Nadine Morkisch
- e Center for Stroke Research Berlin , Charité - University Medicine Berlin , Berlin , Germany.,f MEDIAN Klinik Berlin-Kladow , Berlin , Germany
| | - Katrin Jettkowski
- e Center for Stroke Research Berlin , Charité - University Medicine Berlin , Berlin , Germany.,f MEDIAN Klinik Berlin-Kladow , Berlin , Germany
| | - Moran Sillis
- f MEDIAN Klinik Berlin-Kladow , Berlin , Germany.,g Department of Sport Medicine & Sport Orthopaedics , University of Potsdam , Potsdam , Germany
| | - Hemakumar Devan
- h School of Physiotherapy, Centre for Health , Activity and Rehabilitation Research (CHARR), University of Otago , Dunedin , New Zealand
| | - Parimala S Kanagasabai
- h School of Physiotherapy, Centre for Health , Activity and Rehabilitation Research (CHARR), University of Otago , Dunedin , New Zealand
| | - Henning Schmidt
- d Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Automation Technology , Fraunhofer IPK , Berlin , Germany
| | - Jörg Krüger
- c Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Industrial Automation Technology , Technische Universität Berlin , Berlin , Germany.,d Rehabilitation Robotics Group (TU Berlin/Fraunhofer IPK), Department of Automation Technology , Fraunhofer IPK , Berlin , Germany
| | - Christian Dohle
- e Center for Stroke Research Berlin , Charité - University Medicine Berlin , Berlin , Germany.,f MEDIAN Klinik Berlin-Kladow , Berlin , Germany
| | - Holger Regenbrecht
- b Department of Information Science , University of Otago , Dunedin , New Zealand
| | - Leigh Hale
- h School of Physiotherapy, Centre for Health , Activity and Rehabilitation Research (CHARR), University of Otago , Dunedin , New Zealand
| | - Nicholas J Cutfield
- a Department of Medicine (DSM) , University of Otago , Dunedin , New Zealand
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Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke. Am J Phys Med Rehabil 2017; 96:146-151. [DOI: 10.1097/phm.0000000000000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Stoykov ME, Corcos DM, Madhavan S. Movement-Based Priming: Clinical Applications and Neural Mechanisms. J Mot Behav 2017; 49:88-97. [PMID: 28277966 DOI: 10.1080/00222895.2016.1250716] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Priming can be described as behavior change generated by preceding stimuli. Although various types of priming have been long studied in the field of psychology, priming that targets motor cortex is a relatively new topic of research in the fields of motor control and rehabilitation. In reference to a rehabilitation intervention, priming is categorized as a restorative approach. There are a myriad of possible priming approaches including noninvasive brain stimulation, motor imagery, and sensory-based priming, to name a few. The authors report on movement-based priming which, compared to other priming types, is less frequently examined and under reported. Movement-based priming includes, but is not limited to, bilateral motor priming, unilateral priming, and aerobic exercise. Clinical and neural mechanistic aspects of movement-based priming techniques are explored.
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Affiliation(s)
| | - Daniel Montie Corcos
- b Department of Physical Therapy & Human Movement Sciences , Northwestern University , Chicago , Illinois
| | - Sangeetha Madhavan
- c Department of Physical Therapy , University of Illinois at Chicago , Chicago , Illinois
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Trinh T, Shiner CT, Thompson-Butel AG, McNulty PA. Targeted upper-limb Wii-based Movement Therapy also improves lower-limb muscle activation and functional movement in chronic stroke. Disabil Rehabil 2016; 39:1939-1949. [DOI: 10.1080/09638288.2016.1213892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Terry Trinh
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Christine T. Shiner
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Angelica G. Thompson-Butel
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Penelope A. McNulty
- Neuroscience Research Australia, Sydney, NSW, Australia
- Faculty of Medicine, School of Medical Sciences, University of New South Wales, Sydney, Australia
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12
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Hsieh YW, Wu CY, Wang WE, Lin KC, Chang KC, Chen CC, Liu CT. Bilateral robotic priming before task-oriented approach in subacute stroke rehabilitation: a pilot randomized controlled trial. Clin Rehabil 2016; 31:225-233. [PMID: 26893457 DOI: 10.1177/0269215516633275] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the treatment effects of bilateral robotic priming combined with the task-oriented approach on motor impairment, disability, daily function, and quality of life in patients with subacute stroke. DESIGN A randomized controlled trial. SETTING Occupational therapy clinics in medical centers. SUBJECTS Thirty-one subacute stroke patients were recruited. INTERVENTIONS Participants were randomly assigned to receive bilateral priming combined with the task-oriented approach (i.e., primed group) or to the task-oriented approach alone (i.e., unprimed group) for 90 minutes/day, 5 days/week for 4 weeks. The primed group began with the bilateral priming technique by using a bimanual robot-aided device. MAIN MEASURES Motor impairments were assessed by the Fugal-Meyer Assessment, grip strength, and the Box and Block Test. Disability and daily function were measured by the modified Rankin Scale, the Functional Independence Measure, and actigraphy. Quality of life was examined by the Stroke Impact Scale. RESULTS The primed and unprimed groups improved significantly on most outcomes over time. The primed group demonstrated significantly better improvement on the Stroke Impact Scale strength subscale ( p = 0.012) and a trend for greater improvement on the modified Rankin Scale ( p = 0.065) than the unprimed group. CONCLUSION Bilateral priming combined with the task-oriented approach elicited more improvements in self-reported strength and disability degrees than the task-oriented approach by itself. Further large-scale research with at least 31 participants in each intervention group is suggested to confirm the study findings.
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Affiliation(s)
- Yu-Wei Hsieh
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yi Wu
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,2 Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Wei-En Wang
- 1 Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Keh-Chung Lin
- 3 School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,4 Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ku-Chou Chang
- 5 Division of Cerebrovascular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,6 Department of Senior Citizen Service Management, Yuh-Ing Junior College, Kaohsiung, Taiwan.,7 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chi Chen
- 7 Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,8 Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Ting Liu
- 9 Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
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13
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Shiner CT, Pierce KD, Thompson-Butel AG, Trinh T, Schofield PR, McNulty PA. BDNF Genotype Interacts with Motor Function to Influence Rehabilitation Responsiveness Poststroke. Front Neurol 2016; 7:69. [PMID: 27242654 PMCID: PMC4868962 DOI: 10.3389/fneur.2016.00069] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/25/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Persistent motor impairment is common but highly heterogeneous poststroke. Genetic polymorphisms, including those identified on the brain-derived neurotrophic factor (BDNF) and apolipoprotein E (APOE) genes, may contribute to this variability by limiting the capacity for use-dependent neuroplasticity, and hence rehabilitation responsiveness. OBJECTIVE To determine whether BDNF and APOE genotypes influence motor improvement facilitated by poststroke upper-limb rehabilitation. METHODS BDNF-Val66Met and APOE isoform genotypes were determined using leukocyte DNA for 55 community-dwelling patients 2-123 months poststroke. All patients completed a dose-matched upper-limb rehabilitation program of either Wii-based Movement Therapy or Constraint-induced Movement Therapy. Upper-limb motor function was assessed pre- and post-therapy using a suite of functional measures. RESULTS Motor function improved for all patients post-therapy, with no difference between therapy groups. In the pooled data, there was no significant effect of BDNF or APOE genotype on motor function at baseline, or following the intervention. However, a significant interaction between the level of residual motor function and BDNF genotype was identified (p = 0.029), whereby post-therapy improvement was significantly less for Met allele carriers with moderate and high, but not low motor function. There was no significant association between APOE genotype and therapy outcomes. CONCLUSION This study identified a novel interaction between the BDNF-Val66Met polymorphism, motor-function status, and the magnitude of improvement with rehabilitation in chronic stroke. This polymorphism does not preclude, but may reduce, the magnitude of motor improvement with therapy, particularly for patients with higher, but not lower residual motor function. BDNF genotype should be considered in the design and interpretation of clinical trials.
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Affiliation(s)
- Christine T Shiner
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | | | - Angelica G Thompson-Butel
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Terry Trinh
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Penelope A McNulty
- Neuroscience Research Australia, Sydney, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
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Trinh T, Scheuer SE, Thompson-Butel AG, Shiner CT, McNulty PA. Cardiovascular fitness is improved post-stroke with upper-limb Wii-based Movement Therapy but not dose-matched constraint therapy. Top Stroke Rehabil 2016; 23:208-16. [DOI: 10.1080/10749357.2016.1138672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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