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Khan Z, Noohu MM, Parveen S, Usmani M, Khan F, Alsobhi MG, Manzar MD, Sehgal CA. Effect of Mirror Therapy on Upper Limb Function in Children and Adolescents with Hemiplegic Cerebral Palsy: A Systematic Review and Meta-Analysis. Dev Neurorehabil 2024; 27:106-115. [PMID: 38712882 DOI: 10.1080/17518423.2024.2349676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND This review aimed to explore the effect of mirror therapy (MT) on upper limb function in children and adolescents with hemiplegic cerebral palsy (HCP). METHODS MEDLINE, CENTRAL, Scopus, PEDro, and Web of Science were systematically searched. PEDro scale was used for the quality assessment of included trials. Risk of Bias assessment was done using Cochrane Risk-of-bias tool version 2. Meta-analysis was performed on four of the seven studies included. RESULTS & CONCLUSION The majority of the trials included in this review found MT efficacious in improving motor function in HCP. Quantitative analysis of the included trials using QUEST scores for evaluation of quality of upper extremity function revealed positive but non-significant difference between the groups (MD = -0.12; 95% CI = -2.57,2.33; Z = 0.09, p = .92). Pooled analysis of the included trials using BBT, however, favored control (MD = 4.98; 95% CI = 2.32,7.63; Z = 3.67, p = .0002).
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Affiliation(s)
- Zubina Khan
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Majumi M Noohu
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Sarah Parveen
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Maria Usmani
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael Ghazi Alsobhi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Chhavi Arora Sehgal
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
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Mollà-Casanova S, Muñoz-Gómez E, Sempere-Rubio N, Inglés M, Aguilar-Rodríguez M, Page Á, López-Pascual J, Serra-Añó P. Effect of virtual running with exercise on functionality in pre-frail and frail elderly people: randomized clinical trial. Aging Clin Exp Res 2023:10.1007/s40520-023-02414-x. [PMID: 37188994 DOI: 10.1007/s40520-023-02414-x] [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: 02/07/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Virtual mirror therapies could increase the results of exercise, since the mirror neuron system produces an activation of motor execution cortical areas by observing actions performed by others. In this way, pre-frail and frail people could use this system to reach an exercise capacity threshold and obtain health benefits. AIM The aim of this study is to evaluate the effects of a virtual running (VR) treatment combined with specific physical gait exercise (PE) compared to placebo VR treatment combined with PE on functionality, pain, and muscular tone in pre-frail and frail older persons. METHODS A single blinded, two-arm, randomised controlled trial design was employed. Thirty-eight participants were divided into two intervention arms: Experimental Intervention (EI) group, in which VR and gait-specific physical exercises were administered and Control Intervention (CI) group, in which a placebo virtual gait and the same exercise programme was administered. Functionality, pain, and tone were assessed. RESULTS EI group improved in aerobic capacity, functional lower-limb strength, reaction time, and pain, while CI group remained the same. Regarding static balance and muscle tone, no differences were found for either group. Further analysis is needed to asses VR effectiveness for improving gait, stand-up and sit-down performance and velocity. CONCLUSIONS Virtual running therapy appears to enhance capacities related with voluntary movements (i.e., aerobic capacity, functional lower-limb strength, and reaction time) and reduce pain.
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Affiliation(s)
- Sara Mollà-Casanova
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Elena Muñoz-Gómez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain.
| | - Marta Inglés
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
| | - Álvaro Page
- Instituto Universitario de Ingeniería Mecánica y Biomecánica, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica de Valencia, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Pilar Serra-Añó
- UBIC Research Group, Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag, 5, Valencia, Spain
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Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment. Rehabil Nurs 2022; 47:202-209. [PMID: 36210496 DOI: 10.1097/rnj.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors (p < .001). CONCLUSION Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE Balance training combined with containing mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.
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Effects of Meaningful Action Observation Therapy on Occupational Performance, Upper Limb Function, and Corticospinal Excitability Poststroke: A Double-Blind Randomized Control Trial. Neural Plast 2022; 2022:5284044. [PMID: 36160327 PMCID: PMC9507745 DOI: 10.1155/2022/5284044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes. Method A randomized control trial was designed to compare between experimental (n = 13) and control groups (n = 14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects. Result Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p ≤ 0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p = 0.03) and satisfaction (p = 0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p ≥ 0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p = 0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments. Conclusion Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.
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Patel RD, Mans KB. Review: Effect of Supplemental Activities on Motor and Nonmotor Outcomes in the Parkinson’s Population. AMERICAN JOURNAL OF DANCE THERAPY 2022. [DOI: 10.1007/s10465-022-09367-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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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.
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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
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Jiang LH, Zhao LJ, Liu Y, Zhang H, Zhang SC, Cong WQ, Qi R. Effectiveness of Tai Chi Yunshou motor imagery training for hemiplegic upper extremity motor function in poststroke patients: study protocol for a randomized clinical trial. Trials 2022; 23:329. [PMID: 35449109 PMCID: PMC9022298 DOI: 10.1186/s13063-022-06283-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/05/2022] [Indexed: 11/18/2022] Open
Abstract
Background Evidence concerning the effect of Tai Chi Yunshou motor imagery training (TCY-MIT) on upper extremity motor function (UE-MF) recovery in poststroke patients is lacking, and few studies have examined the neural mechanisms of MIT. The study was designed to assess the effectiveness of TCY-MIT and its possible neural mechanisms. Methods/design The study is an assessor-blinded, parallel, superiority, randomized clinical trial. A total of 78 eligible participants will be randomly assigned to 2 groups in a 1:1 ratio. Participants in the control group will receive (conventional rehabilitation therapies) CRTs for 40 min per day, 6 days per week, for 3 weeks. Participants in the intervention group will receive CRTs combined with TCY-MIT (30 min per day, 6 days per week, for 3 weeks). The primary outcome measure is the Fugl-Meyer Assessment of Upper Extremity. Secondary outcome measures are the Box and Block Test, muscle strength test, modified Barthel index, and Pearson correlation coefficients. All outcomes will be assessed at baseline, after completion of the intervention (1, 2, and 3 weeks), and at the end of follow-up (2 months). The outcome assessor will be blinded to the group allocation of the participants. Discussion We expect this assessor-blinded, parallel, superiority, randomized clinical trial to explore the effectiveness of TCY-MIT combined with CRTs compared with CRTs alone for UE-MF in poststroke patients. Trial registration Chinese Clinical Trial Registry ID: ChiCTR2100048868. Registered on 19 July 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06283-z.
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Affiliation(s)
- Lin Hong Jiang
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China.,Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Li Juan Zhao
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Yang Liu
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Hong Zhang
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Si Cong Zhang
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Wei Qin Cong
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China
| | - Rui Qi
- Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai, 200437, China.
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Nasrallah FA, Mohamed AZ, Yap HK, Lai HS, Yeow CH, Lim JH. Effect of proprioceptive stimulation using a soft robotic glove on motor activation and brain connectivity in stroke survivors. J Neural Eng 2021; 18:066049. [PMID: 34933283 DOI: 10.1088/1741-2552/ac456c] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Soft-robotic-assisted training may improve motor function during post-stroke recovery, but the underlying physiological changes are not clearly understood. We applied a single-session of intensive proprioceptive stimulation to stroke survivors using a soft robotic glove to delineate its short-term influence on brain functional activity and connectivity. APPROACH In this study, we utilized task-based and resting-state functional magnetic resonance imaging (fMRI) to characterize the changes in different brain networks following a soft robotic intervention. Nine stroke patients with hemiplegic upper limb engaged in resting-state and motor-task fMRI. The motor tasks comprised two conditions: active movement of fingers (active task) and glove-assisted active movement using a robotic glove (glove-assisted task), both with visual instruction. Each task was performed using bilateral hands simultaneously or the affected hand only. The same set of experiments was repeated following a 30-minute treatment of continuous passive motion (CPM) using a robotic glove. MAIN RESULTS On simultaneous bimanual movement, increased activation of supplementary motor area (SMA) and primary motor area (M1) were observed after CPM treatment compared to the pre-treatment condition, both in active and glove-assisted task. However, when performing the tasks solely using the affected hand, the phenomena of increased activity were not observed either in active or glove-assisted task. The comparison of the resting-state fMRI between before and after CPM showed the connectivity of the supramarginal gyrus and SMA was increased in the somatosensory network and salience network. SIGNIFICANCE This study demonstrates how passive motion exercise activates M1 and SMA in the post-stroke brain. The effective proprioceptive motor integration seen in bimanual exercise in contrast to the unilateral affected hand exercise suggests that the unaffected hemisphere might reconfigure connectivity to supplement damaged neural networks in the affected hemisphere. The somatosensory modulation rendered by the intense proprioceptive stimulation would affect the motor learning process in stroke survivors.
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Affiliation(s)
- Fatima A Nasrallah
- The University of Queensland Queensland Brain Institute, The University of Queensland, Brisbane, Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Abdalla Z Mohamed
- The University of Queensland Queensland Brain Institute, The University of Queensland, Brisbane, Australia., Saint Lucia, Queensland, 4072, AUSTRALIA
| | - Hong Kai Yap
- Roceso Technologies, 83 Science Park Dr #04-01, Singapore, 118258, SINGAPORE
| | - Hwa Sen Lai
- National University of Singapore, Biomedical Engineering, Singapore, 119260, SINGAPORE
| | - Chen-Hua Yeow
- National University of Singapore, Biomedical Engineering, Singapore, 119260, SINGAPORE
| | - Jeong Hoon Lim
- School of Medicine, Medicine, National University of Singapore, NUHS Tower block level 10 1E, Kent Ridge Road, Singapore, Singapore, 119228, SINGAPORE
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Raciti L, Calabrò RS. Neurological complications of COVID-19: from pathophysiology to rehabilitation. An overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021317. [PMID: 34487099 PMCID: PMC8477084 DOI: 10.23750/abm.v92i4.10620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate how the SARS-COV2 is able to affect the nervous system, the main neurological manifestation, and the treatment used, including neurorehabilitation. METHODS Studies performed during the current year that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "Covid 19," "rehabilitation/treatment," and "neurological complications." RESULTS The exact route by which SARS-CoV-2 can penetrate the CNS is still unknown, although a possible retrograde transynaptic pathway from peripheral nerve endings, and/or through the olfactory bulb, have been suggested. An early management of COVID-19 by a multiprofessional team is fundamental to avoid long term sequaele. Rehabilitation is recommended to improve respiratory and cardiac function, as well as to avoid long term neurological complications. CONCLUSIONS As no specific conclusions in term of prognosis and treatment could be done, research and consensus paper are needed to provide NeuroCovid patients with the best treatment options, including neurorehabilitation.
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Maggio MG, Naro A, Manuli A, Maresca G, Balletta T, Latella D, De Luca R, Calabrò RS. Effects of Robotic Neurorehabilitation on Body Representation in Individuals with Stroke: A Preliminary Study Focusing on an EEG-Based Approach. Brain Topogr 2021; 34:348-362. [PMID: 33661430 DOI: 10.1007/s10548-021-00825-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
Patients with stroke can experience a drastic change in their body representation (BR), beyond the physical and psychological consequences of stroke itself. Noteworthy, the misperception of BR could affect patients' motor performance even more. Our study aimed at evaluating the usefulness of a robot-aided gait training (RAGT) equipped with augmented visuomotor feedback, expected to target BR (RAGT + VR) in improving lower limb sensorimotor function, gait performance (using Fugl-Meyer Assessment scale for lower extremities, FMA-LE), and BR (using the Body Esteem Scale-BES- and the Body Uneasiness Test-BUT), as compared to RAGT - VR. We also assessed the neurophysiologic basis putatively subtending the BR-based motor function recovery, using EEG recording during RAGT. Forty-five patients with stroke were enrolled in this study and randomized with a 1:2 ratio into either the RAGT + VR (n = 30) or the RAGT - VR (n = 15) group. The former group carried out rehabilitation training with the Lokomat©Pro; whereas, the latter used the Lokomat©Nanos. The rehabilitation protocol consisted of 40 one-hour training sessions. At the end of the training, the RAGT + VR improved in FMA-LE (p < 0.001) and BR (as per BES, (p < 0.001), and BUT, (p < 0.001)) more than the RAGT- did (p < 0.001). These differences in clinical outcomes were paralleled by a greater strengthening of visuomotor connectivity and corticomotor excitability (as detected at the EEG analyses) in the RAGT + VR than in the RAGT - VR (all comparisons p < 0.001), corresponding to an improved motor programming and execution in the former group.We may argue that BR recovery was important concerning functional motor improvement by its integration with the motor control system. This likely occurred through the activation of the Mirror Neuron System secondary to the visuomotor feedback provision, resembling virtual reality. Last, our data further confirm the important role of visuomotor feedback in post-stroke rehabilitation, which can achieve better patient-tailored improvement in functional gait by means of RAGT + VR targeting BR.
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Affiliation(s)
- Maria Grazia Maggio
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Antonino Naro
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Alfredo Manuli
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Giuseppa Maresca
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Tina Balletta
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Desirèe Latella
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Rosaria De Luca
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino Pulejo - Piemonte, via Palermo, SS113, Ctr. Casazza, 98124, Messina, Italy.
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Mekbib DB, Debeli DK, Zhang L, Fang S, Shao Y, Yang W, Han J, Jiang H, Zhu J, Zhao Z, Cheng R, Ye X, Zhang J, Xu D. A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke. Ann N Y Acad Sci 2021; 1493:75-89. [PMID: 33442915 DOI: 10.1111/nyas.14554] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Given the rising incidence of stroke, several technology-driven methods for rehabilitation have recently been developed. Virtual reality (VR) is a promising therapeutic technology among them. We recently developed a neuroscientifically grounded VR system to aid recovery of motor function poststroke. The developed system provides unilateral and bilateral upper extremity (UE) training in a fully immersive virtual environment that may stimulate and activate mirror neurons (MNs) in the brain necessary for UE rehabilitation. Twenty-three participants were randomized to a VR group (n = 12) to receive VR intervention (8 h within 2 weeks) plus 8-h occupational therapy (OT) or a control group (n = 11) to receive time-matched OT alone. Treatment effects on motor recovery and cortical reorganization were investigated using the Barthel Index (BI), Fugl-Meyer Upper Extremity (FM-UE), and resting-state fMRI. Both groups significantly improved BI (P < 0.05), reflecting the recovery of UE motor function. The VR group revealed significant improvements on FM-UE scores (P < 0.05) than the control group. Neural activity increased after the intervention, particularly in the brain areas implicating MNs, such as in the primary motor cortex. Overall, results suggested that using a neuroscientifically grounded VR system might offer additional benefits for UE rehabilitation in patients receiving OT.
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Affiliation(s)
- Destaw B Mekbib
- Interdisciplinary Institute of Neuroscience and Technology (ZIINT), College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Dereje Kebebew Debeli
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shan Fang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuling Shao
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wei Yang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiawei Han
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongjie Jiang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Junming Zhu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhao
- MOE & Shanghai Key Laboratory of Brain Functional Genomics (East China Normal University), Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Shanghai Key Laboratory of Magnetic Resonance, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Ruidong Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jianmin Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York City, New York
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Wang CC, Chao JK, Wang ML, Yang YP, Chien CS, Lai WY, Yang YC, Chang YH, Chou CL, Kao CL. Care for Patients with Stroke During the COVID-19 Pandemic: Physical Therapy and Rehabilitation Suggestions for Preventing Secondary Stroke. J Stroke Cerebrovasc Dis 2020; 29:105182. [PMID: 33066878 PMCID: PMC7375317 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105182] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/17/2020] [Accepted: 07/18/2020] [Indexed: 12/14/2022] Open
Abstract
Infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the development of the novel 2019 coronavirus disease (COVID-19) and associated clinical symptoms, which typically presents as an upper respiratory syndrome such as pneumonia. Growing evidence indicates an increased prevalence of neurological involvement (e.g., in the form of stroke) during virus infection. COVID-19 has been suggested to be more than a lung infection because it affects the vasculature of the lungs and other organs and increases the risk of thrombosis. Patients with stroke are vulnerable to secondary events as a result not only of their poor vascular condition but also of their lack of access to rehabilitation resources. Herein, we review current knowledge regarding the pathophysiology of COVID-19, its possible association with neurological involvement, and current drug therapies. Suggestions are also offered regarding the potential for current neurorehabilitation therapies to be taught and practiced at home.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jian-Kang Chao
- Department of Social Work, National Pingtung University of Science & Technology, Pingtung, Taiwan; Department of psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
| | - Mong-Lien Wang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Ping Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Chien-Shiu Chien
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Wei-Yi Lai
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Research, Taipei Veterans General Hospital, Taiwan
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan; Department of physical medicine and rehabilitation, School of medicine, National Yang Ming university; Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan.
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Mekbib DB, Zhao Z, Wang J, Xu B, Zhang L, Cheng R, Fang S, Shao Y, Yang W, Han J, Jiang H, Zhu J, Ye X, Zhang J, Xu D. Proactive Motor Functional Recovery Following Immersive Virtual Reality-Based Limb Mirroring Therapy in Patients with Subacute Stroke. Neurotherapeutics 2020; 17:1919-1930. [PMID: 32671578 PMCID: PMC7851292 DOI: 10.1007/s13311-020-00882-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Virtual reality (VR) is considered to be a promising therapeutic technology for the rehabilitation of upper extremities (UEs) post-stroke. Recently, we designed and then implemented a neuroscientifically grounded VR protocol for the rehabilitation of patients with stroke. The system provides unilateral and bilateral limb mirroring exercises in a fully immersive virtual environment that may stimulate and activate the mirror neuron system in the brain to help patients for their rehabilitation. Twelve patients with subacute stroke underwent the newly implemented VR treatment in addition to conventional rehabilitation for 8 consecutive weekdays. The treatment effect on brain reorganization and motor function was investigated using resting-state fMRI (rs-fMRI) and the Fugl-Meyer assessment for Upper Extremity (FM-UE), respectively. Fifteen healthy controls (HCs) also underwent rs-fMRI scanning one time. The study finally obtained usable data from 8 patients and 13 HCs. After the intervention, patients demonstrated significant improvement in their FM-UE scores (p values < 0.042). Voxel-wise functional connectivity (FC) analysis based on the rs-fMRI data found that HCs showed widespread bilateral FC patterns associated with the dominant hemispheric primary motor cortex (M1). However, the FC patterns in patients revealed intra-hemispheric association with the ipsilesional M1 seed and this association became visible in the contra-hemisphere after the intervention. Moreover, the change of FC values between the bilateral M1 was significantly correlated with the changes in FM-UE scores (p values < 0.037). We conclude that unilateral and bilateral limb mirroring exercise in an immersive virtual environment may enhance cortical reorganization and lead to improved motor function.
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Affiliation(s)
- Destaw B Mekbib
- Interdisciplinary Institute of Neuroscience and Technology, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310000, China
| | - Zhiyong Zhao
- Shanghai Key Laboratory of Magnetic Resonance, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, 200064, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, China
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Jianbao Wang
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310029, China
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology,, Zhejiang University School of Medicine, Hangzhou, 310029, China
| | - Bin Xu
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310029, China
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Ruiding Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Shan Fang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Yuling Shao
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Wei Yang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Jiawei Han
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Hongjie Jiang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Junming Zhu
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology,, Zhejiang University School of Medicine, Hangzhou, 310029, China.
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China.
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Jianmin Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY, 10032, USA.
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14
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Farina E, Borgnis F, Pozzo T. Mirror neurons and their relationship with neurodegenerative disorders. J Neurosci Res 2020; 98:1070-1094. [DOI: 10.1002/jnr.24579] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022]
Affiliation(s)
| | | | - Thierry Pozzo
- INSERM UMR1093‐CAPS, Université Bourgogne Franche‐Comté Dijon France
- IT@UniFe Center for Translational Neurophysiology Istituto Italiano di Tecnologia Ferrara Italy
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15
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Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study. Behav Neurol 2020; 2020:6250524. [PMID: 32377266 PMCID: PMC7199557 DOI: 10.1155/2020/6250524] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background Action observation therapy and mirror therapy, two promising rehabilitation strategies, are aimed at enhancing the motor learning and functional improvement of stroke patients through different patterns of visual feedback and observation. Objective This study investigated and compared the treatment effects of the action observation therapy, mirror therapy, and active control intervention on motor and functional outcomes of stroke patients. Methods Twenty-one patients with subacute stroke were recruited in this study. All patients were randomly assigned to the action observation therapy, mirror therapy, or active control intervention for 3 weeks. Outcome measures were conducted at baseline, immediately after treatment, and at 3-month follow-up. The primary outcome was the Fugl-Meyer Assessment, and secondary outcomes included the Box and Block Test, Functional Independence Measure, and Stroke Impact Scale. Descriptive analyses and the number of patients whose change score achieved minimal clinically important difference were reported. Results Both the action observation therapy and active control intervention showed similar improvements on the Fugl-Meyer Assessment, Box and Block Test, and Stroke Impact Scale. Moreover, the action observation therapy had a greater improvement on the Functional Independence Measure than the other 2 groups did. However, the mirror therapy group gained the least improvements on the outcomes. Conclusion The preliminary results found that the patients in the action observation therapy and active control intervention groups had comparable benefits, suggesting that the 2 treatments might be used as an alternative to each other. A further large-scale study with at least 20 patients in each group to validate the study findings is needed. This trial is registered with NCT02871700.
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Laffont I, Froger J, Jourdan C, Bakhti K, van Dokkum LEH, Gouaich A, Bonnin HY, Armingaud P, Jaussent A, Picot MC, Le Bars E, Dupeyron A, Arquizan C, Gelis A, Mottet D. Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial. Ann Phys Rehabil Med 2019; 63:173-180. [PMID: 31830535 DOI: 10.1016/j.rehab.2019.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few rehabilitation methods have proven their efficacy in increasing sensori-motor recovery and/or function of the upper limb (UL) after stroke. Video games (VGs) are promising tools in this indication. OBJECTIVE To compare UL rehabilitation by using VGs and conventional rehabilitation (CR) in patients with sub-acute stroke. DESIGN Single-blind, multicentric trial, with central randomization and stratification by center. SETTING Physical and rehabilitation medicine departments of 2 university hospitals. PARTICIPANTS Adults within 3 months after a first vascular cerebral accident, with UL Fugl Meyer Score (UL-FMS)<30/66 and without major cognitive impairment. INTERVENTION A 45-min additional session of conventional occupational therapy (OT) or a VG-based OT session as add-on therapy to usual rehabilitation programs, 5 days/week for 6 weeks. MAIN OUTCOME MEASURES Primary outcome: UL-FMS. Secondary outcome: Box and Block Test (BBT), Wolf Motor Function test (WMFT), Motor Activity Log (MAL), Barthel Index and quality of life (SF-36). RESULTS We included 51 patients (20 women) at a mean (SD) of 27.2 (19.4) days post-stroke (mean age 58 years [range 24-83]), 26 in the CR group and 25 in the VG group (23 in each group at 6-month follow-up). The mean duration of the additional rehabilitation session was similar in both groups: 29.3 (4.3) vs 28.0 (4.4) min in CR and VG groups. Shoulder pain occurred in 4 patients in the VG group versus 7 in the CR group. At day 45, gain in UL-FMS did not significantly differ between the groups (CR mean 17.8 [14.6] vs VG 24.1 [14.8]; P=0.10), whereas gain in BBT was doubled in the VG group (CR 7.4 [12.2] vs VG 15.7 [16.3]; P=0.02). At 6-month follow-up, the study was inconclusive about between-group differences in UL-FMS, BBT and other criteria. Post-hoc analysis showed that gains in UL-FMS or BBT were significantly higher in the VG than CR group for patients included within 30 days post-stroke. CONCLUSION In general, we cannot conclude that video gaming and conventional OT led to different long-term sensorimotor recovery of the UL after sub-acute stroke. However, when applied within the first month after stroke, video gaming was more efficient than conventional rehabilitation on both sensorimotor recovery and gross grasping function. TRIAL REGISTRATION ClinicalTrials.gov (NCT01554449).
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Affiliation(s)
- Isabelle Laffont
- PRM Department, University of Montpellier, Hôpital Lapeyronie, Montpellier University Hospital, 191, boulevard du Doyen-Gaston-Giraud, 34291 Montpellier cedex 05, France; IFRH, Euromov, University of Montpellier, Montpellier, France.
| | - Jerome Froger
- IFRH, Euromov, University of Montpellier, Montpellier, France; PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Claire Jourdan
- PRM Department, University of Montpellier, Hôpital Lapeyronie, Montpellier University Hospital, 191, boulevard du Doyen-Gaston-Giraud, 34291 Montpellier cedex 05, France; IFRH, Euromov, University of Montpellier, Montpellier, France
| | - Karima Bakhti
- PRM Department, University of Montpellier, Hôpital Lapeyronie, Montpellier University Hospital, 191, boulevard du Doyen-Gaston-Giraud, 34291 Montpellier cedex 05, France; IFRH, Euromov, University of Montpellier, Montpellier, France
| | - Liesjet E H van Dokkum
- Neuro Imagery Department, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | | | - Huei Yune Bonnin
- PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Philippe Armingaud
- PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Audrey Jaussent
- Inserm, Clinical Research and Epidemiology Unit, University of Montpellier, Montpellier, France
| | - Marie Christine Picot
- Inserm, Clinical Research and Epidemiology Unit, University of Montpellier, Montpellier, France
| | - Emmanuelle Le Bars
- CNRS, L2C, University of Montpellier, Montpellier, France; Neuro Imagery Department, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Arnaud Dupeyron
- IFRH, Euromov, University of Montpellier, Montpellier, France; PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Caroline Arquizan
- Neurology Department, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Anthony Gelis
- PRM Department, Propara Center, Montpellier, France; Epsylon, Paul Valery University, Montpellier, France
| | - Denis Mottet
- IFRH, Euromov, University of Montpellier, Montpellier, France
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17
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Hosni SM, Deligani RJ, Zisk A, McLinden J, Borgheai SB, Shahriari Y. An exploration of neural dynamics of motor imagery for people with amyotrophic lateral sclerosis. J Neural Eng 2019; 17:016005. [PMID: 31597125 DOI: 10.1088/1741-2552/ab4c75] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Studies of the neuropathological effects of amyotrophic lateral sclerosis (ALS) on the underlying motor system have investigated abnormalities in the magnitude and timing of the event-related desynchronization (ERD) and synchronization (ERS) during motor execution (ME). However, the spatio-spectral-temporal dynamics of these sensorimotor oscillations during motor imagery (MI) have not been fully explored for these patients. This study explores the neural dynamics of sensorimotor oscillations for ALS patients during MI by quantifying ERD/ERS features in frequency, time, and space. APPROACH Electroencephalogram (EEG) data were recorded from six patients with ALS and 11 age-matched healthy controls (HC) while performing a MI task. ERD/ERS features were extracted using wavelet-based time-frequency analysis and compared between the two groups to quantify the abnormal neural dynamics of ALS in terms of both time and frequency. Topographic correlation analysis was conducted to compare the localization of MI activity between groups and to identify subject-specific frequencies in the µ and β frequency bands. MAIN RESULTS Overall, reduced and delayed ERD was observed for ALS patients, particularly during right-hand MI. ERD features were also correlated with ALS clinical scores, specifically disease duration, bulbar, and cognitive functions. SIGNIFICANCE The analyses in this study quantify abnormalities in the magnitude and timing of sensorimotor oscillations for ALS patients during MI tasks. Our findings reveal notable differences between MI and existing results on ME in ALS. The observed alterations are speculated to reflect disruptions in the underlying cortical networks involved in MI functions. Quantifying the neural dynamics of MI plays an important role in the study of EEG-based cortical markers for ALS.
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Affiliation(s)
- Sarah M Hosni
- Department of Electrical, Computer and Biomedical Engineering, University of Rhode Island, Kingston, RI, United States of America
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18
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Costa-García Á, Ozaki KI, Yamasaki H, Itkonen M, S FA, Okajima S, Tanimoto M, Kondo I, Shimoda S. Model for prompt and effective classification of motion recovery after stroke considering muscle strength and coordination factors. J Neuroeng Rehabil 2019; 16:130. [PMID: 31684980 PMCID: PMC6829968 DOI: 10.1186/s12984-019-0611-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
Background Muscle synergies are now widely discussed as a method for evaluating the existence of redundant neural networks that can be activated to enhance stroke rehabilitation. However, this approach was initially conceived to study muscle coordination during learned motions in healthy individuals. After brain damage, there are several neural adaptations that contribute to the recovery of motor strength, with muscle coordination being one of them. In this study, a model is proposed that assesses motion based on surface electromyography (sEMG) according to two main factors closely related to the neural adaptations underlying motor recovery: (1) the correct coordination of the muscles involved in a particular motion and (2) the ability to tune the effective strength of each muscle through muscle fiber contractions. These two factors are hypothesized to be affected differently by brain damage. Therefore, their independent evaluation will play an important role in understanding the origin of stroke-related motor impairments. Results The model proposed was validated by analyzing sEMG data from 18 stroke patients with different paralysis levels and 30 healthy subjects. While the factors necessary to describe motion were stable across heathy subjects, there was an increasing disassociation for stroke patients with severe motor impairment. Conclusions The clear dissociation between the coordination of muscles and the tuning of their strength demonstrates the importance of evaluating these factors in order to choose appropriate rehabilitation therapies. The model described in this research provides an efficient approach to promptly evaluate these factors through the use of two intuitive indexes.
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Affiliation(s)
- Álvaro Costa-García
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan.
| | - Ken-Ichi Ozaki
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Hiroshi Yamasaki
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Matti Itkonen
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Fady Alnajjar S
- Intelligent Robot Interaction Lab, College of Information Technology, United Arab Emirates University, Abu Dhabi, 15551, United Arab Emirates
| | - Shotaro Okajima
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
| | - Masanori Tanimoto
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Izumi Kondo
- National Center for Geriatrics and Gerontology, 7-430, Morioka cho, Aichi-ken, Ohbu, 474-8511, Japan
| | - Shingo Shimoda
- Intelligent Behaviour Control Unit, RIKEN Center of Brain Science, CBS-Toyota Collaboration Center in the Nagoya Science Park Research and Development Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Aichi-ken, Nagoya, 463-0003, Japan
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Zhang B, Kan L, Dong A, Zhang J, Bai Z, Xie Y, Liu Q, Peng Y. The effects of action observation training on improving upper limb motor functions in people with stroke: A systematic review and meta-analysis. PLoS One 2019; 14:e0221166. [PMID: 31469840 PMCID: PMC6716645 DOI: 10.1371/journal.pone.0221166] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Action observation training (AOT) has been used as a new intervention for improving upper limb motor functions in people with stroke. This systematic review and meta-analysis aims to investigate the effects of AOT on improving upper limb motor functions in people with stroke. METHODS We searched ten electronic databases to identify randomized controlled trials (RCTs) about the effects of AOT on upper limb motor functions in stroke survivors. Methodological quality of included studies was assessed by the Risk of Bias Tool in the Cochrane Handbook for Systematic Reviews of Interventions. A random-effects meta-analysis was performed by pooling the standardized mean difference (SMD) of upper limb motor outcomes. RESULTS Seven studies of 276 participants with stroke were included. Meta-analysis showed a significant effect favoring AOT on improving upper limb motor functions in patients with stroke [SMD = 0.35, 95% confidence interval [CI], 0.10 to 0.61, I2 = 10.14%, p = 0.007]. CONCLUSIONS AOT appears to be an effective intervention for improving the upper limb motor functions in people after stroke. Further studies need to investigate the neural mechanism underlying the effects of AOT.
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Affiliation(s)
- Bingbing Zhang
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Laidi Kan
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Anqin Dong
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- * E-mail:
| | - Jiaqi Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Occupational Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Shanghai, China
| | - Yi Xie
- Department of Rehabilitation Engineering, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qianhao Liu
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yuzhong Peng
- Department of Rehabilitation Medicine, Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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20
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Ehrensberger M, Simpson D, Broderick P, Blake C, Horgan F, Hickey P, OʼReilly J, Monaghan K. Unilateral Strength Training and Mirror Therapy in Patients With Chronic Stroke: A Pilot Randomized Trial. Am J Phys Med Rehabil 2019; 98:657-665. [PMID: 31318745 DOI: 10.1097/phm.0000000000001162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The aim of the study was to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared with cross-education alone in poststroke upper limb recovery. DESIGN A pilot randomized controlled parallel group study was carried out. Thirty-two patients with chronic stroke followed a 4-wk isometric strength training program performed with the less-affected upper limb three times per week. Participants in the mirror and strength training group observed the reflection of the exercising arm in the mirror. Participants in the strength training only group exercised without a mirror entirely. Participant compliance, adverse effects, and suitability of outcome measures assessed feasibility. Effectiveness outcomes included maximal isometric strength measured with the Biodex Dynamometer, the Modified Ashworth Scale, and the Chedoke Arm and Hand Activity Inventory. RESULTS Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (P > 0.05) in patients with chronic stroke when training isometrically. CONCLUSIONS This pilot trial established the feasibility of a randomized controlled trial comparing mirror-aided cross-education with cross-education alone for poststroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate that the combination of interventions should be investigated further applying an altered training protocol.
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Affiliation(s)
- Monika Ehrensberger
- From the Clinical Health & Nutrition Centre (CHANCE), Department of Life Sciences, Institute of Technology, Sligo, Ireland (ME, DS, PB, KM); Physiotherapy & Population Science, University College Dublin, Dublin, Ireland (CB); Faculty of Medicine & Health Sciences, Royal College of Surgeons Ireland, Dublin, Ireland (FH); and University Hospital, Sligo, Ireland (PH, JO)
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21
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Simpson D, Ehrensberger M, Horgan F, Blake C, Roberts D, Broderick P, Monaghan K. Unilateral dorsiflexor strengthening with mirror therapy to improve motor function after stroke: A pilot randomized study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 24:e1792. [PMID: 31264770 DOI: 10.1002/pri.1792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/27/2019] [Accepted: 05/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting. OBJECTIVES This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke. METHODS Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining. RESULTS Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity. CONCLUSION Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.
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Affiliation(s)
- Daniel Simpson
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Monika Ehrensberger
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Frances Horgan
- School of Physiotherapy, RCSI (Royal College of Surgeons in Ireland), Dublin, Ireland
| | - Catherine Blake
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - David Roberts
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Patrick Broderick
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
| | - Kenneth Monaghan
- Clinical Health & Nutrition Centre (CHANCE), School of Science, Institute of Technology, Sligo, Ireland
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Lim H, Ku J. Multiple-command single-frequency SSVEP-based BCI system using flickering action video. J Neurosci Methods 2019; 314:21-27. [PMID: 30659844 DOI: 10.1016/j.jneumeth.2019.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The number of commands in a brain-computer interface (BCI) system is important. This study proposes a new BCI technique to increase the number of commands in a single BCI system without loss of accuracy. NEW METHOD We expected that a flickering action video with left and right elbow movements could simultaneously activate the different pattern of event-related desynchronization (ERD) according to the video contents (e.g., left or right) and steady-state visually evoked potential (SSVEP). The classification accuracy to discriminate left, right, and rest states was compared under the three following feature combinations: SSVEP power (19-21 Hz), Mu power (8-13 Hz), and simultaneous SSVEP and Mu power. RESULTS The SSVEP feature could discriminate the stimulus condition, regardless of left or right, from the rest condition, while the Mu feature discriminated left or right, but was relatively poor in discriminating stimulus from rest. However, combining the SSVEP and Mu features, which were evoked by the stimulus with a single frequency, showed superior performance for discriminating all the stimuli among rest, left, or right. COMPARISON WITH THE EXISTING METHOD The video contents could activate the ERD differently, and the flickering component increased its accuracy, such that it revealed a better performance to discriminate when considering together. CONCLUSIONS This paradigm showed possibility of increasing performance in terms of accuracy and number of commands with a single frequency by applying flickering action video paradigm and applicability to rehabilitation systems used by patients to facilitate their mirror neuron systems while training.
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Affiliation(s)
- Hyunmi Lim
- Department of Biomedical Engineering, College of Medicine, Keimyung University, South Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, South Korea.
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Multimodal Rehabilitation Program Promotes Motor Function Recovery of Rats After Ischemic Stroke by Upregulating Expressions of GAP-43, SYN, HSP70, and C-MYC. J Stroke Cerebrovasc Dis 2018; 27:2829-2839. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/30/2018] [Accepted: 06/14/2018] [Indexed: 11/21/2022] Open
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Broderick P, Horgan F, Blake C, Hickey P, O'Reilly J, Ehrensberger M, Simpson D, Roberts D, Monaghan K. Mirror therapy and treadmill training for a patient with chronic stroke: A case report. Physiother Theory Pract 2018; 35:478-488. [PMID: 29589777 DOI: 10.1080/09593985.2018.1453903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both mirror therapy and treadmill training have been shown to improve aspects of lower limb functioning in patients with stroke. This case report examined whether a new combination of both interventions would lead to improvements in lower limb functional disability for a patient with chronic stroke. CASE DESCRIPTION The participant was a 50-year-old female who had a left middle cerebral artery infarction (47 months' post stroke). Due to hemiparesis, she had lower limb motor impairment and gait deficits. INTERVENTION The participant engaged in a combination of mirror therapy and treadmill training for 30 minutes per day, 3 days per week, for 4 weeks. OUTCOMES Modified Ashworth Scale, Fugl-Meyer Assessment-Lower Extremity and the 10 m Walk Test demonstrated clinically meaningful change. The 6 Minute Walk Test did not demonstrate meaningful change. DISCUSSION The positive outcomes from this new combination therapy for this participant are encouraging given the relatively small dose of training and indicate the potential benefit of mirror therapy as an adjunct to treadmill training for enhancing lower limb muscle tone, motor function and walking velocity in patients with chronic stroke.
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Affiliation(s)
- Patrick Broderick
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - Frances Horgan
- b Department of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Catherine Blake
- c Department of Health Science , University College Dublin , Dublin , Ireland
| | - Paula Hickey
- d Department of Geriatrics , Sligo University Hospital , Sligo , Ireland
| | - Joanne O'Reilly
- e Department of Physiotherapy , Sligo University Hospital , Sligo , Ireland
| | | | - Daniel Simpson
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - David Roberts
- f Department of Design , Institute of Technology Sligo , Sligo , Ireland
| | - Kenneth Monaghan
- g Department of Health Science , Institute of Technology Sligo , Sligo , Ireland
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Bondoc S, Booth J, Budde G, Caruso K, DeSousa M, Earl B, Hammerton K, Humphreys J. Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity. Am J Occup Ther 2018; 72:7202205080p1-7202205080p8. [PMID: 29426386 DOI: 10.5014/ajot.2018.025064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke. METHOD This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home. RESULTS All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment. CONCLUSION Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis.
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Affiliation(s)
- Salvador Bondoc
- Salvador Bondoc, OTD, OTR/L, FAOTA, is Professor and Chair of Occupational Therapy, School of Health Sciences, Quinnipiac University, Hamden, CT;
| | - Julie Booth
- Julie Booth, DPT, PCS, is Clinical Associate Professor of Physical Therapy, School of Health Sciences, Quinnipiac University, Hamden, CT
| | - Grace Budde
- Grace Budde, MOT, OTR/L, is Occupational Therapist, Professional Hand Therapy, Merrick, NY
| | - Katelyn Caruso
- Katelyn Caruso, MOT, OTR/L, is Occupational Therapist, Excel Orthopaedic Specialists, Woburn, MA
| | - Michelle DeSousa
- Michelle DeSousa, DPT, is Physical Therapist, Lawrence + Memorial Hospital, New London, CT
| | - Brittany Earl
- Brittany Earl, MOT, OTR/L, is Occupational Therapist, CareOne at Wall, Wall Township, NJ
| | - Kaitlynn Hammerton
- Kaitlynn Hammerton, DPT, is Physical Therapist, Burke Rehabilitation Hospital, White Plains, NY
| | - Jill Humphreys
- Jill Humphreys, DPT, is Physical Therapist, The Center at Lowry, Denver, CO
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Naro A, Calabrò RS, Leo A, Russo M, Milardi D, Cannavò A, Manuli A, Buda A, Casella C, Bramanti P, Cacciola A, Bramanti A. Bridging the Gap Towards Awareness Detection in Disorders of Consciousness: An Experimental Study on the Mirror Neuron System. Brain Topogr 2018; 31:623-639. [DOI: 10.1007/s10548-018-0628-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/01/2018] [Indexed: 12/31/2022]
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Farina E, Baglio F, Pomati S, D'Amico A, Campini IC, Di Tella S, Belloni G, Pozzo T. The Mirror Neurons Network in Aging, Mild Cognitive Impairment, and Alzheimer Disease: A functional MRI Study. Front Aging Neurosci 2017; 9:371. [PMID: 29249956 PMCID: PMC5715339 DOI: 10.3389/fnagi.2017.00371] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022] Open
Abstract
The aim of the current study is to investigate the integrity of the Mirror Neurons (MN) network in normal aging, Mild Cognitive Impairment (MCI), and Alzheimer disease (AD). Although AD and MCI are considered “cognitive” diseases, there has been increasing recognition of a link between motor function and AD. More recently the embodied cognition hypothesis has also been developed: it postulates that a part of cognition results from the coupling between action and perception representations. MN represent a neuronal population which links perception, action, and cognition, therefore we decided to characterize MN functioning in neurodegenerative cognitive decline. Three matched groups of 16 subjects (normal elderly-NE, amnesic MCI with hippocampal atrophy and AD) were evaluated with a focused neuropsychological battery and an fMRI task specifically created to test MN: that comprised of an observation run, where subjects were shown movies of a right hand grasping different objects, and of a motor run, where subjects observed visual pictures of objects oriented to be grasped with the right hand. In NE subjects, the conjunction analysis (comparing fMRI activation during observation and execution), showed the activation of a bilateral fronto-parietal network in “classical” MN areas, and of the superior temporal gyrus (STG). The MCI group showed the activation of areas belonging to the same network, however, parietal areas were activated to a lesser extent and the STG was not activated, while the opposite was true for the right Broca's area. We did not observe any activation of the fronto-parietal network in AD participants. They did not perform as well as the NE subjects in all the neuropsychological tests (including tests of functions attributed to MN) whereas the MCI subjects were significantly different from the NE subjects only in episodic memory and semantic fluency. Here we show that the MN network is largely preserved in aging, while it appears involved following an anterior-posterior gradient in neurodegenerative decline. In AD, task performance decays and the MN network appears clearly deficient. The preservation of the anterior part of the MN network in MCI could possibly supplement the initial decay of the posterior part, preserving cognitive performance.
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Affiliation(s)
- Elisabetta Farina
- Neurorehabilitation Unit, IRCCS S. Maria Nascente, Don Gnocchi Foundation, Milan, Italy.,INSERM-U1093, Cognition-Action-Plasticité sensorimotrice, Campus Universitaire, Dijon, France
| | - Francesca Baglio
- Neurorehabilitation Unit, IRCCS S. Maria Nascente, Don Gnocchi Foundation, Milan, Italy.,Neuroimaging Unit, IRCCS S. Maria Nascente, Don Gnocchi Foundation, Milan, Italy
| | - Simone Pomati
- Neurology Unit, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alessandra D'Amico
- Neurorehabilitation Unit, IRCCS S. Maria Nascente, Don Gnocchi Foundation, Milan, Italy
| | - Isabella C Campini
- Neurology Unit, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Sonia Di Tella
- Neuroimaging Unit, IRCCS S. Maria Nascente, Don Gnocchi Foundation, Milan, Italy
| | - Giulia Belloni
- Neurorehabilitation Unit, IRCCS S. Maria Nascente, Don Gnocchi Foundation, Milan, Italy
| | - Thierry Pozzo
- INSERM-U1093, Cognition-Action-Plasticité sensorimotrice, Campus Universitaire, Dijon, France.,Centro di Neurofisiologia traslazionale, Istituto Italiano di Tecnologia, Ferrara, Italy
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Arya KN, Pandian S, Kumar V. Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial. Neuropsychol Rehabil 2017; 29:1193-1210. [DOI: 10.1080/09602011.2017.1377087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
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Lim H, Ku J. Flickering exercise video produces mirror neuron system (MNS) activation and steady state visually evoked potentials (SSVEPs). Biomed Eng Lett 2017; 7:281-286. [PMID: 30603177 DOI: 10.1007/s13534-017-0035-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/18/2017] [Accepted: 05/06/2017] [Indexed: 11/28/2022] Open
Abstract
The action of observing can be used as an effective rehabilitation paradigm, because it activates the mirror neuron system. However, it is difficult to fully use this paradigm because it is difficult to get patients to engage in watching video clips of exercise. In this study, we proposed a steady state visually evoked potential (SSVEP) based paradigm that could be used in a Brain Computer Interface, and examined its feasibility by investigating whether flickering video could activate the mirror neuron system and evoke SSVEPs at the same time. Twenty subjects were recruited and asked to watch the flickering videos at a rate of 20 Hz of upper limb motion and visual white noise, while an EEG signal was recorded. The mu rhythm (8-13 Hz) suppression and the SSVEP (19-21 Hz) evocation were analyzed from recorded EEG. The results showed that SSVEPs, evoked by the flickering stimulus, was observed in both conditions on O1 and O2, but the mu rhythm suppression on C3 and C4 was observed only in the exercise video condition. These results could signify that the flickering video is applicable for the BCI rehabilitation game, activating the mirror neuron system at the same time.
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Affiliation(s)
- Hyunmi Lim
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea
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Sallés L, Gironès X, Martín-Casas P, Lafuente JV. A neurocognitive approach to recovery of movement following stroke. PHYSICAL THERAPY REVIEWS 2016. [DOI: 10.1080/10833196.2015.1111579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kuk EJ, Kim JM, Oh DW, Hwang HJ. Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis. Top Stroke Rehabil 2016; 23:318-25. [DOI: 10.1080/10749357.2016.1157972] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Correa Mesa JF, Álvarez Peña PA. Neurología de la anticipación y sus implicaciones en el deporte. REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.50473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>El movimiento es una acción que involucra interconexiones complejas, por lo cual se requiere profundizar en los procesos de adaptación, predicción y anticipación que permiten entender la importancia de estos aspectos desde sus bases filogenéticas y ontogenéticas hasta su implicación en movimientos complejos. Parte de la optimización de los procesos descritos se haya en la calidad de información aferente, la cual permite la relación con el entorno —especialmente la entrada visual— que reconoce un flujo de imágenes y una proyección al contexto en el que se está inmerso. Las estructuras e interconexiones implicadas en la anticipación y predicción de movimientos son descritas de modo que se evidencia la congruencia y continuidad del flujo de información que caracteriza esta especialidad neuromecánica de movimiento. Por otro lado, se aborda la integración de centros puntuales del sistema nervioso central y redes neuronales que permiten el entramado de procesos de aprendizaje por observación, además de proveer equilibrio y eficiencia al sistema en la recepción de estímulos y su relación con la generación de eferencias motoras que cumplan con objetivos específicos. En el ámbito deportivo estos procesos favorecen la eficiencia del gesto optimizando el movimiento.</p>
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Motor Cortex Plasticity during Unilateral Finger Movement with Mirror Visual Feedback. Neural Plast 2015; 2016:6087896. [PMID: 26881121 PMCID: PMC4736016 DOI: 10.1155/2016/6087896] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/21/2015] [Accepted: 08/20/2015] [Indexed: 12/03/2022] Open
Abstract
Plasticity is one of the most important physiological mechanisms underlying motor recovery from brain lesions. Rehabilitation methods, such as mirror visual feedback therapy, which are based on multisensory integration of motor, cognitive, and perceptual processes, are considered effective methods to induce cortical reorganization. The present study investigated 3 different types of visual feedback (direct, mirrored, and blocked visual feedback: DVF, MVF, and BVF, resp.) on M1 cortex excitability and intracortical inhibition/facilitation at rest and during phasic unimanual motor task in 11 healthy individuals. The excitability of the ipsilateral M1 cortex and the intracortical facilitation increased during motor task performance in the DVF and MVF but not in the BVF condition. In addition, MVF induced cortical disinhibition of the ipsilateral hemisphere to the index finger performing the motor task, which was greater when compared to the BVF and restricted to the homologue first dorsal interosseous muscle. The visual feedback is relevant to M1 cortex excitability modulation but the MVF plays a crucial role in promoting changes in intracortical inhibition in comparison to BVF. Altogether, it can be concluded that a combination of motor training with MVF therapy may induce more robust neuroplastic changes through multisensory integration that is relevant to motor rehabilitation.
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Arya KN, Pandian S, Kumar D, Puri V. Task-Based Mirror Therapy Augmenting Motor Recovery in Poststroke Hemiparesis: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2015; 24:1738-48. [PMID: 26096318 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/06/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To establish the effect of the task-based mirror therapy (TBMT) on the upper limb recovery in stroke. METHODS A pilot, randomized, controlled, assessor-blinded trial was conducted in a rehabilitation institute. A convenience sample of 33 poststroke (mean duration, 12.5 months) hemiparetic subjects was randomized into 2 groups (experimental, 17; control, 16). The subjects were allocated to receive either TBMT or standard motor rehabilitation-40 sessions (5/week) for a period of 8 weeks. The TBMT group received movements using various goal-directed tasks and a mirror box. The movements were performed by the less-affected side superimposed on the affected side. The main outcome measures were Brunnstrom recovery stage (BRS) and Fugl-Meyer assessment (FMA)-FMA of upper extremity (FMA-UE), including upper arm (FMA-UA) and wrist-hand (FMA-WH). RESULTS The TBMT group exhibited highly significant improvement on mean scores of FMA-WH (P < .001) and FMA-UE (P < .001) at postassessment in comparison to the control group. Furthermore, there was a 12% increase in the number of subjects at BRS stage 5 (out of synergy movement) in the experimental group as compared to a 0% rise at the same stage in the control group. CONCLUSIONS This pilot trial confirmed the role of TBMT in improving the wrist-hand motor recovery in poststroke hemiparesis. MT using tasks may be used as an adjunct in stroke rehabilitation.
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya Institute for the Physically Handicapped, New Delhi, India.
| | - Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya Institute for the Physically Handicapped, New Delhi, India
| | - Dharmendra Kumar
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya Institute for the Physically Handicapped, New Delhi, India
| | - Vinod Puri
- Department of Neurology, GB Pant Post Graduate Institute of Medical Education and Research, New Delhi, India
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Schott N, Korbus H. Preventing functional loss during immobilization after osteoporotic wrist fractures in elderly patients: a randomized clinical trial. BMC Musculoskelet Disord 2014; 15:287. [PMID: 25175985 PMCID: PMC4158045 DOI: 10.1186/1471-2474-15-287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 08/26/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Distal radius fractures are among the most common fractures and account for approximately one-sixth of all fractures diagnosed. Therapy results after distal radius fracture, especially of elderly patients, are often suboptimal. The inevitable immobilization for several weeks leads to reduction in range of motion, deterioration of muscle strength, malfunction of fine motor skills as well as changes of motor and sensory representations in the brain. Currently, there are no strategies to counteract these immobilization problems. The overall aim of the study is to investigate the therapeutic potential of motor-cognitive approaches (mental practice or mirror therapy) on hand function after wrist fracture. METHODS/DESIGN This study is a controlled, randomized, longitudinal intervention study with three intervention groups. One experimental group imagines movements of the fractured upper extremity without executing them (mental practice). The second experimental group receives a mirror therapy program consisting of the performance of functional movement synergies using the unaffected forearm, wrist, and hand. The control group completes a relaxation training regime. Additionally, all patients receive usual care by the general practitioner. We include women aged 60 years and older having a distal radius fracture and sufficient cognitive function. All groups are visited at home for therapy sessions 5 times per week for the first 3 weeks and 3 times per week for weeks 4 to 6. Measurements are taken at therapy onset, and after 3, 6 and 12 weeks. The primary outcome measure will assess upper extremity functioning (Patient-Rated Wrist Evaluation [PRWE]), while secondary outcome measures cover subjective wrist function (Disabilities of the Arm and Shoulder; [DASH], objective impairment (range of motion, grip force) and quality of life (EuroQol-5D, [EQ5D]). DISCUSSION Results from this trial will contribute to the evidence on motor-cognitive approaches in the early therapy of distal radius fractures. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov with registration number NCT01394809 and was granted permission by the Medical Ethical Review Committee of the University of Tübingen in June 2011.
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Affiliation(s)
- Nadja Schott
- Department of Sports and Exercise Science, University of Stuttgart, Allmandring 28, 70569 Stuttgart, Germany
| | - Heide Korbus
- Department of Sports and Exercise Science, University of Stuttgart, Allmandring 28, 70569 Stuttgart, Germany
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