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Subramanian SK, Margolese G, Turolla A, Saposnik G, Levin MF. Responsiveness of the Reaching Performance Scale for Stroke. Arch Phys Med Rehabil 2023; 104:1588-1595. [PMID: 37178950 DOI: 10.1016/j.apmr.2023.04.020] [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: 10/02/2022] [Revised: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The objective of the study was to estimate the internal and external responsiveness of the Reaching Performance Scale for Stroke (RPSS) in individuals with stroke. DESIGN Retrospective analysis of data from 4 randomized controlled trials. SETTING Recruitment locations spanning rehabilitation centers and hospitals in Canada, Italy, Argentina, Peru, and Thailand. PARTICIPANTS Data from 567 participants (acute to chronic stroke; N=567) were available. INTERVENTIONS All 4 studies involved training using virtual reality for upper limb rehabilitation. MAIN OUTCOME MEASURES RPSS and upper extremity Fugl-Meyer Assessment (FMA-UE) scores. Responsiveness was quantified for all data and across different stages of stroke. Internal responsiveness of the RPSS was quantified as effect-sizes calculated using post and preintervention change data. External responsiveness was quantified using orthogonal regressions between FMA-UE and RPSS scores. The area under the Receiver Operating Characteristic curve (AUC) was quantified based on the ability of RPSS scores to detect change above FMA-UE minimal clinically important different values across different stages of stroke. RESULTS The RPSS had high internal responsiveness overall and across the acute or subacute and chronic stages of stroke. For external responsiveness, orthogonal regression analyses indicated that change in FMA-UE scores had positive moderate correlations with both RPSS Close and Far Target scores for all data and across the acute or subacute and chronic stages of stroke (0.6 CONCLUSIONS In addition to being reliable and valid, the RPSS is also responsive. Along with the FMA-UE, using RPSS scores can help present a more comprehensive picture of motor compensations to characterize poststroke upper limb motor improvement.
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Affiliation(s)
- Sandeep K Subramanian
- Departments of Physical Therapy, Physician Assistant Studies and Rehabilitation Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Gita Margolese
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; Laboratory of Rehabilitation Technologies, Hospital San Camillo IRCCS, Venice, Italy
| | - Gustavo Saposnik
- Stroke Outcomes and Decision Neuroscience Unit, Unity Health Toronto, University of Toronto, Toronto, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
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Scano A, Guanziroli E, Brambilla C, Amendola C, Pirovano I, Gasperini G, Molteni F, Spinelli L, Molinari Tosatti L, Rizzo G, Re R, Mastropietro A. A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation. Healthcare (Basel) 2023; 11:2282. [PMID: 37628480 PMCID: PMC10454517 DOI: 10.3390/healthcare11162282] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.
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Affiliation(s)
- Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Cristina Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Caterina Amendola
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
| | - Ileana Pirovano
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Lorenzo Spinelli
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Giovanna Rizzo
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Rebecca Re
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Alfonso Mastropietro
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
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Liu LY, Sangani S, Patterson KK, Fung J, Lamontagne A. Instantaneous effect of real-time avatar visual feedback on interlimb coordination during walking post-stroke. Clin Biomech (Bristol, Avon) 2022; 100:105821. [PMID: 36435074 DOI: 10.1016/j.clinbiomech.2022.105821] [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] [Received: 07/14/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gait asymmetry, which is common after stroke, is typically characterized using spatiotemporal parameters of gait that do not consider the aspect of movement coordination. In this manuscript, we examined whether an avatar-based feedback provided as a single-session intervention to improve gait symmetry also improved inter-limb coordination among people with stroke and we examined the relationship between changes in coordination and step length symmetry. METHODS Twelve stroke participants walked on a self-paced treadmill with and without a self-avatar that replicated their locomotor movements in real time. Continuous relative phase and angular coefficient of correspondence calculated using bilateral sagittal hip movements were used to quantify temporal and spatial interlimb coordination, respectively. Spatial gait symmetry, previously shown to improve with the avatar feedback, was quantified using step length ratio between both limbs, with the largest value as numerator. FINDINGS Participants who improved their spatial symmetry during avatar exposure also improved their temporal coordination, while spatial coordination remained unchanged. Overall, improvements in spatial symmetry correlated positively with improvements in temporal coordination. The non-paretic hip and paretic ankle angle excursion in the sagittal plane also significantly increased during avatar exposure. INTERPRETATION Improvements in gait symmetry may be explained by changes in interlimb coordination. Current data and existing literature further suggest that such improvements are largely driven by adaptations in non-paretic leg movements, notably at the hip. By providing real-time information on walking movements not affordable in other ways, avatar-based feedback shows great potential to improve gait symmetry and interlimb coordination post-stroke.
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Affiliation(s)
- Le Yu Liu
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
| | - Samir Sangani
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada
| | - Kara K Patterson
- Department of Physical Therapy of University of Toronto, 160-500 University Ave, Toronto M5G 1V7, Canada; KITE-University Health Network, 550 University Ave #12-165, Toronto M5G 2A2, Canada.
| | - Joyce Fung
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy of McGill University, 3654 Promenade Sir-William-Osler, Montreal H3G1Y5, Canada; Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval and research site of the Montreal Centre for Interdisciplinary Research in Rehabilitation (CRIR), 3205 Pl. Alton-Goldbloom, Laval H7V 1R2, Canada.
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Ganguly K, Khanna P, Morecraft R, Lin DJ. Modulation of neural co-firing to enhance network transmission and improve motor function after stroke. Neuron 2022; 110:2363-2385. [PMID: 35926452 PMCID: PMC9366919 DOI: 10.1016/j.neuron.2022.06.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/15/2022] [Accepted: 06/28/2022] [Indexed: 01/28/2023]
Abstract
Stroke is a leading cause of disability. While neurotechnology has shown promise for improving upper limb recovery after stroke, efficacy in clinical trials has been variable. Our central thesis is that to improve clinical translation, we need to develop a common neurophysiological framework for understanding how neurotechnology alters network activity. Our perspective discusses principles for how motor networks, both healthy and those recovering from stroke, subserve reach-to-grasp movements. We focus on neural processing at the resolution of single movements, the timescale at which neurotechnologies are applied, and discuss how this activity might drive long-term plasticity. We propose that future studies should focus on cross-area communication and bridging our understanding of timescales ranging from single trials within a session to across multiple sessions. We hope that this perspective establishes a combined path forward for preclinical and clinical research with the goal of more robust clinical translation of neurotechnology.
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Affiliation(s)
- Karunesh Ganguly
- Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA,Neurology Service, SFVAHCS, San Francisco, CA, USA,
| | - Preeya Khanna
- Department of Neurology, Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA,Neurology Service, SFVAHCS, San Francisco, CA, USA
| | - Robert Morecraft
- Laboratory of Neurological Sciences, Division of Basic Biomedical Sciences, Sanford School of Medicine, The University of South Dakota, Vermillion, SD, 57069 USA
| | - David J. Lin
- Center for Neurotechnology and Neurorecovery, Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA,Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Providence VA Medical Center, Providence, RI
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Maistrello L, Rimini D, Cheung VCK, Pregnolato G, Turolla A. Muscle Synergies and Clinical Outcome Measures Describe Different Factors of Upper Limb Motor Function in Stroke Survivors Undergoing Rehabilitation in a Virtual Reality Environment. SENSORS 2021; 21:s21238002. [PMID: 34884003 PMCID: PMC8659727 DOI: 10.3390/s21238002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
Recent studies have investigated muscle synergies as biomarkers for stroke, but it remains controversial if muscle synergies and clinical observation convey the same information on motor impairment. We aim to identify whether muscle synergies and clinical scales convey the same information or not. Post-stroke patients were administered an upper limb treatment. Before (T0) and after (T1) treatment, we assessed motor performance with clinical scales and motor output with EMG-derived muscle synergies. We implemented an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) to identify the underlying relationships among all variables, at T0 and T1, and a general linear regression model to infer any relationships between the similarity between the affected and unaffected synergies (Median-sp) and clinical outcomes at T0. Clinical variables improved with rehabilitation whereas muscle-synergy parameters did not show any significant change. EFA and CFA showed that clinical variables and muscle-synergy parameters (except Median-sp) were grouped into different factors. Regression model showed that Median-sp could be well predicted by clinical scales. The information underlying clinical scales and muscle synergies are therefore different. However, clinical scales well predicted the similarity between the affected and unaffected synergies. Our results may have implications on personalizing rehabilitation protocols.
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Affiliation(s)
- Lorenza Maistrello
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy; (L.M.); (G.P.); (A.T.)
| | - Daniele Rimini
- Medical Physics Department—Clinical Engineering, Salford Care Organisation, Salford M6 8HD, UK
- Correspondence: ; Tel.: +44-61620 (ext. 64859)
| | - Vincent C. K. Cheung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, China;
| | - Giorgia Pregnolato
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy; (L.M.); (G.P.); (A.T.)
| | - Andrea Turolla
- Laboratory of Rehabilitation Technologies, IRCCS San Camillo Hospital, 30126 Venice, Italy; (L.M.); (G.P.); (A.T.)
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Bavikatte G, Subramanian G, Ashford S, Allison R, Hicklin D. Early Identification, Intervention and Management of Post-stroke Spasticity: Expert Consensus Recommendations. J Cent Nerv Syst Dis 2021; 13:11795735211036576. [PMID: 34566442 PMCID: PMC8461119 DOI: 10.1177/11795735211036576] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/27/2021] [Accepted: 07/09/2021] [Indexed: 11/16/2022] Open
Abstract
Stroke patients with spasticity usually require long-lasting care and interventions but frequently report that outpatient and community treatment is limited, reflecting a significant unmet need in health and social care provision. Rehabilitation and spasticity management services are essential for patient recovery, with improvements in both activity and participation reducing the burden on patients, family and society. Current clinical guidance provides scope for improvements in both post-stroke management and spasticity prevention. However, access to specialist services can be limited and the patient journey does not always match national recommendations. Identification of spasticity and its predictors and lack of subsequent referral to rehabilitation or specialist spasticity services are key issues in the management of post-stroke spasticity. Implementation of a traffic light classification system prioritises patients at an increased risk of spasticity and promotes early and consistent management across the spectrum of primary and secondary care. The proposed system is based on clinical evidence, expert consensus and recent clinical guidelines. It provides simple and straightforward criteria for management, multidisciplinary consultation and referral to specialist spasticity services, with patients allocated by monitoring requirements and a low (green/periodic monitoring), medium (amber/routine referral) or high risk (red/urgent referral) of spasticity.
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Affiliation(s)
- Ganesh Bavikatte
- Neuro-Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ganesh Subramanian
- Department of Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Stephen Ashford
- Regional Hyper-acute Rehabilitation Unit, London North West University Healthcare NHS Trust; King’s College London & Centre for Nursing Midwifery and Allied Health Research, University College London Hospitals/University College London, London, UK
| | - Rhoda Allison
- Torbay and South Devon NHS Foundation Trust, Torbay, Devon, UK
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Su P, Zhou JL, Liu F, Zhang Y. Application of Image Registration to Analyze the Clavicular Rotation of Normal Upper Limb Motion in the Sagittal Plane. Orthop Surg 2021; 13:493-500. [PMID: 33569907 PMCID: PMC7957416 DOI: 10.1111/os.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To use image registration techniques to study the clavicular rotation of the shoulders in the sagittal plane. METHODS From 28 April 2019 to 20 May 2019, 13 healthy adults (7 males and 6 females) with no history of shoulder trauma surgery or chronic pain were recruited. Patients' ages ranged from 22 to 42 years, with a mean age of 26.5 years. Three-dimensional composite images of the sternum-clavicle-humerus were taken using CT images of upper limb movement in the sagittal plane in the 13 healthy adults. Four different postures were registered: (i) anatomical supine position; (ii) elbow joints lifted anteriorly in the supine position; (iii) posterosuperior hyperextension of the elbow joints in the prone position; and (iv) posteroinferior hyperextension of the elbow joints in the prone position. Image data from the humerus and clavicle in three of the postures were processed to calculate Euler angles for movements in the sagittal plane. SPSS 19 was used to perform statistical analyses. RESULTS There was no significant difference in the angles of change in the clavicle and humerus between the dominant and non-dominant sides under different movement patterns. For upper limb movements in the sagittal plane, the clavicle displayed different Euler angles in different postures. The rotation angle from the anatomical to the horizontal position was the smallest angle, with an average value of 7.1°, whereas the rotation angle from horizontal to posterosuperior hyperextension was the largest, with an average value of 37.2°. When the upper limb moved from anterior protraction to a posterosuperior extension, the intrinsic rotation angle of the clavicle reached its maximum, with an average value of 27.9°; when moved from the anatomical to the horizontal position, 9.1% of the sagittal rotation was executed by the clavicle. During rotation from the horizontal position to posterosuperior hyperextension and from the anatomical to posterior extension, the clavicle showed relatively higher weights at 29.5% and 37.0%, respectively. CONCLUSION Our results showed that dominance was not a consideration when studying clavicular rotation. Image registration is an effective method that can be used to study upper limb scapular movements. Through comparing and analyzing the data, two postures had relatively large changes in the rotation angle. This can help improve indicators of clavicular rotational function during physical examinations and postoperative functional evaluations.
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Affiliation(s)
- Peng Su
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Department of Orthopaedics, Beijing Shijingshan Hospital, Capital Medical University, Beijing, China
| | - Jun-Lin Zhou
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Feng Liu
- Department of Orthopaedics, Beijing Shijingshan Hospital, Capital Medical University, Beijing, China
| | - Yi Zhang
- Department of Orthopaedics, Beijing Shijingshan Hospital, Capital Medical University, Beijing, China
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