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Pham TT, Le LH, Andersen J, Lou EH. Optimal configurations of an electromagnetic tracking system for 3D ultrasound imaging of pediatric hips - A phantom study. Med Eng Phys 2024; 131:104221. [PMID: 39284650 DOI: 10.1016/j.medengphy.2024.104221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 07/17/2024] [Accepted: 08/01/2024] [Indexed: 09/19/2024]
Abstract
Tracking the position and orientation of a two-dimensional (2D) ultrasound scanner to reconstruct a 3D volume is common, and its accuracy is important. In this study, a specific miniaturized electromagnetic (EM) tracking system was selected and integrated with a 2D ultrasound scanner, which was aimed to capture hip displacement in children with cerebral palsy. The objective of this study was to determine the optimum configuration, including the distance between the EM source and sensor, to provide maximum accuracy. The scanning volume was aimed to be 320 mm × 320 mm × 76 mm. The accuracy of the EM tracking was evaluated by comparing its tracking with those from a motion capture camera system. A static experiment showed that a warm-up time of 20 min was needed. The EM system provided the highest precision of 0.07 mm and 0.01° when the distance between the EM source and sensor was 0.65 m. Within the testing volume, the maximum position and rotational errors were 2.31 mm and 1.48°, respectively. The maximum error of measuring hip displacement on the 3D hip phantom study was 4 %. Based on the test results, the tested EM system was suitable for 3D ultrasound imaging of pediatric hips to assess hip displacement when optimal configuration was used.
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Affiliation(s)
- Thanh-Tu Pham
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, T6G 2V2, Canada
| | - Lawrence H Le
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, T6G 2V2, Canada
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Edmond H Lou
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, Alberta, T6G 2V2, Canada; Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Alberta, T6G 1H9, Canada.
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Bissolotti L, Brojka A, Vezzoli M, Calza S, Nicoli F, Romero-Morales C, Villafañe JH. Effects of Limbs' Spasticity on Spinopelvic Alignment in Post-Stroke Patients: A Cross-Sectional Study. J Clin Med 2024; 13:3840. [PMID: 38999407 PMCID: PMC11242033 DOI: 10.3390/jcm13133840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Objectives: This study aimed to determine the impacts of upper and lower limb (UL and LL) spasticity and impairment on spinal alignment in chronic post-stroke patients. Methods: A total of 45 consecutive chronic post-stroke patients, 18 women and 27 men, from 18 to 70 years old who presented post-stroke hemiparesis were recruited in this cross-sectional study. The clinical assessment included the Modified Ashworth Scale (UL-MAS and LL-MAS spasticity), Upper Limb Motricity Index (UL-MI), FAST-UL, and Five Times Sit-to-Stand Test (5T-STS); the Associated Reaction Rating Scale was used to measure associated reactions in the hemiparetic UL, the plumb line distance from the spinous process of C7 on the sagittal (PL-C7s) and frontal plane (Pl-C7f), the kyphosis apex (PL-AK), and the spinous process of L3 (PL-L3). Angular measures of spinal alignment were measured by a Bunnell scoliometer™ (angle of trunk rotation-ATR) and a gravity-dependent inclinometer (inclination at C7-T1 and T12-L1). Results: In chronic post-stroke patients, there was found to be an association between the 5T-STS and PL-C7f (β = 0.41, p = 0.05) and the angle of inclination at T12-L1 (β = 0.44, p = 0.01). The FAST-UL correlated with PL-C7f (β = -0.41, p = 0.05), while the UL-MI correlated with this last parameter (β = -0.36, p = 0.04) and the ATR (β = -0.31, p = 0.05). The UL-MAS showed correlation with the ATR (β = 0.38, p = 0.01). Conclusions: The results lead to the possibility that, in chronic post-stroke patients, spinal misalignment on the frontal and sagittal plane is associated both with strength impairment and UL spasticity. The improvement or restoration of spinopelvic parameters can take advantage of therapeutic interventions targeted at motor improvement and spasticity reduction of the hemiparetic side.
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Affiliation(s)
- Luciano Bissolotti
- Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy; (L.B.); (F.N.)
| | - Alice Brojka
- Physical Medicine & Rehabiltation School of Specialty, University of Pavia, 27100 Pavia, Italy;
| | - Marika Vezzoli
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.V.); (S.C.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy; (M.V.); (S.C.)
| | - Federico Nicoli
- Fondazione Teresa Camplani Casa di Cura Domus Salutis, 25123 Brescia, Italy; (L.B.); (F.N.)
| | - Carlos Romero-Morales
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
| | - Jorge Hugo Villafañe
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain;
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
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Hwang IS, Ryu JW, Jin S, Kim SA, Kim MS. Long-Term Enhancement of Botulinum Toxin Injections for Post-Stroke Spasticity by Use of Stretching Exercises-A Randomized Controlled Trial. Toxins (Basel) 2024; 16:267. [PMID: 38922161 PMCID: PMC11209169 DOI: 10.3390/toxins16060267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/27/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
Botulinum toxin A (BONT/A) injections play a central role in the treatment of upper limb spasticity in stroke patients. We proposed structured stretching exercises to enhance the effect of post-stroke spasticity relief of the upper limbs following BONT/A injections. A total of 43 patients who had a stroke with grade 2 spasticity or higher on the Modified Ashworth Scale (MAS) in their upper-limb muscles were randomly assigned to the intervention (n = 21) or control group (n = 22). The former received structured stretching exercises after their BONT/A injections for 20 min, 5 days per week, for 6 months at a hospital, while the others conducted self-stretching exercises at home. The outcome measures were assessed before the intervention (T0) and after three (T1) and six months (T2). Significantly greater improvements in the MAS scores of the elbows, wrists, and fingers were found in the intervention group's patients at T1 and T2. The behavioral outcome measures, including shoulder pain, activities of daily living, and quality of life, and our electrophysiological studies also showed a significantly higher enhancement in this patient group. In conclusion, the structured stretching exercises plus BONT/A injections for six months showed a superior effect in relieving post-stroke upper-limb spasticity compared to self-stretching exercises.
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Affiliation(s)
- In-Su Hwang
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.-W.R.); (S.J.); (S.-A.K.)
| | - Jin-Whan Ryu
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.-W.R.); (S.J.); (S.-A.K.)
| | - Sol Jin
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.-W.R.); (S.J.); (S.-A.K.)
| | - Soo-A Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.-W.R.); (S.J.); (S.-A.K.)
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.-W.R.); (S.J.); (S.-A.K.)
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea
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Sakamoto D, Hamaguchi T, Kanemura N, Yasojima T, Kubota K, Suwabe R, Nakayama Y, Abo M. Feature analysis of joint motion in paralyzed and non-paralyzed upper limbs while reaching the occiput: A cross-sectional study in patients with mild hemiplegia. PLoS One 2024; 19:e0295101. [PMID: 38781257 PMCID: PMC11115294 DOI: 10.1371/journal.pone.0295101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/03/2024] [Indexed: 05/25/2024] Open
Abstract
The reaching motion to the back of the head with the hand is an important movement for daily living. The scores of upper limb function tests used in clinical practice alone are difficult to use as a reference when planning exercises for movement improvements. This cross-sectional study aimed to clarify in patients with mild hemiplegia the kinematic characteristics of paralyzed and non-paralyzed upper limbs reaching the occiput. Ten patients with post-stroke hemiplegia who attended the Department of Rehabilitation Medicine of the Jikei University Hospital and met the eligibility criteria were included. Reaching motion to the back of the head by the participants' paralyzed and non-paralyzed upper limbs was measured using three-dimensional motion analysis, and the motor time, joint angles, and angular velocities were calculated. Repeated measures multivariate analysis of covariance was performed on these data. After confirming the fit to the binomial logistic regression model, the cutoff values were calculated using receiver operating characteristic curves. Pattern identification using random forest clustering was performed to analyze the pattern of motor time and joint angles. The cutoff values for the movement until the hand reached the back of the head were 1.6 s for the motor time, 55° for the maximum shoulder joint flexion angle, and 145° for the maximum elbow joint flexion angle. The cutoff values for the movement from the back of the head to the hand being returned to its original position were 1.6 s for the motor time, 145° for the maximum elbow joint flexion angle, 53°/s for the maximum angular velocity of shoulder joint abduction, and 62°/s for the maximum angular velocity of elbow joint flexion. The numbers of clusters were three, four, and four for the outward non-paralyzed side, outward and return paralyzed side, and return non-paralyzed side, respectively. The findings obtained by this study can be used for practice planning in patients with mild hemiplegia who aim to improve the reaching motion to the occiput.
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Affiliation(s)
- Daigo Sakamoto
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Toyohiro Hamaguchi
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Naohiko Kanemura
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Takashi Yasojima
- Department of Rehabilitation, Graduate School of Health Science, Saitama Prefectural University, Saitama, Japan
| | - Keisuke Kubota
- Research Development Center, Saitama Prefectural University, Saitama, Japan
| | - Ryota Suwabe
- Department of Rehabilitation Medicine, The Jikei University School of Medicine Hospital, Tokyo, Japan
| | - Yasuhide Nakayama
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Masahiro Abo
- Department of Rehabilitation Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Liu Z, Li Z, Duan C. Effects of Maitland mobilization technique on upper extremity function in stroke survivors with spasticity: An experimental study. Medicine (Baltimore) 2024; 103:e38184. [PMID: 38758885 PMCID: PMC11098168 DOI: 10.1097/md.0000000000038184] [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] [Received: 12/14/2023] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The recovery of upper limb function is of great significance for stroke patients to regain their self-care ability, yet it is still a difficult point in clinical practice of neurological rehabilitation. This study aimed to investigate the effect of Maitland joint mobilization technique on the recovery of upper extremity function in patients with spasticity after stroke. METHODS From August to December 2023, 71 patients with upper extremity flexor spasm after stroke were recruited and randomly divided into experimental group (n = 35) and control group (n = 36). The control group was given conventional rehabilitation treatment, while the experimental group was treated with Maitland mobilization technique treatment of upper extremity joints on the basis of the control group. The experiment lasted for 8 weeks. Participants of the 2 groups were observed for Fugl-Meyer motor assessment-upper extremity (FMA-UE), box and block test (BBT) and Brunnstrom stage, modified Ashworth scale (MAS), and functional independence measure (FIM) at pre- and post-8 weeks study. RESULTS There was no significant difference in gender distribution, hemiplegic side, diagnosis, past history, age, duration, body mass index, and mini-mental state examination between the 2 groups (P > .05). After 8 weeks of intervention, both groups showed significant improvement in FMA-UE, Brunnstrom stage, BBT, FIM, and MAS of the shoulder (P < .05); however, there was no significant change in MAS of the elbow, wrist, and finger joints (P > .05). The posttreatment values showed a significant improvement in FMA-UE, BBT, and FIM in the experimental group compared to the control group. Comparing the changes in pretreatment and posttreatment, FMA-UE, BBT, and FIM in the experimental group were significantly improved compared with those in the control group (P < .05). CONCLUSION Maitland joint mobilization can improve the motor function of upper extremity and the spasticity of shoulder joint complex in patients with stroke.
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Affiliation(s)
- Ziqing Liu
- Department of Rehabilitation, Shanghai Yangpu Hospital of TCM, Shanghai, China
| | - Zhangjie Li
- Department of Rehabilitation, Yangpu Hospital, Tongji University, Shanghai, China
| | - Chaoyang Duan
- Department of Rehabilitation, Shanghai Yangpu Hospital of TCM, Shanghai, China
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Huang X, Liao O, Jiang S, Li J, Ma X. Kinematic analysis in post-stroke patients with moderate to severe upper limb paresis and non-disabled controls. Clin Biomech (Bristol, Avon) 2024; 113:106206. [PMID: 38401320 DOI: 10.1016/j.clinbiomech.2024.106206] [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] [Received: 10/04/2023] [Revised: 12/23/2023] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Kinematic analysis has been recommended to quantify the upper limb motor function after stroke. However, previous studies have rarely reported the kinematic data of the post-stroke patients with moderate to severe upper limb paresis due to the poor accomplishment of the complex tasks. METHODS 27 post-stroke individuals and 20 non-disabled people participated in the study. The trunk and upper limb movements during the Hand-to-mouth task were captured by the motion capture system and upper extremity kinematic analysis software automatically. The subgroup analysis within stroke group were conducted layering by the Fugl-Meyer Assessment for Upper Extremity scores (severe: 16-31; moderate: 32-50). FINDINGS The paretic upper limbs in the stroke group tended to use more trunk and shoulder compensatory strategies to offset the impact of spasticity and weakness compared with non-disabled controls. The less-affected limbs in the stroke group also showed abnormal kinematic data. There were significant differences between the kinematic metrics of severe and moderate subgroups. INTERPRETATION The Hand-to-mouth task is a good and feasible option for kinematic analysis of these patients. It is essential to layer the severity of the paresis and put more emphasis on trunk movements in the future kinematic studies.
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Affiliation(s)
- Xinyun Huang
- Acupuncture Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China
| | - Ouping Liao
- Yueyang Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China; Traditional Chinese Medicine department, DeYang People's Hospital, Sichuan 618099, China
| | - Shuyun Jiang
- Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jing Li
- Acupuncture Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xiaopeng Ma
- Acupuncture Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China.
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Huang L, Yi L, Huang H, Zhan S, Chen R, Yue Z. Corticospinal tract: a new hope for the treatment of post-stroke spasticity. Acta Neurol Belg 2024; 124:25-36. [PMID: 37704780 PMCID: PMC10874326 DOI: 10.1007/s13760-023-02377-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023]
Abstract
Stroke is the third leading cause of death and disability worldwide. Post-stroke spasticity (PSS) is the most common complication of stroke but represents only one of the many manifestations of upper motor neuron syndrome. As an upper motor neuron, the corticospinal tract (CST) is the only direct descending motor pathway that innervates the spinal motor neurons and is closely related to the recovery of limb function in patients with PSS. Therefore, promoting axonal remodeling in the CST may help identify new therapeutic strategies for PSS. In this review, we outline the pathological mechanisms of PSS, specifically their relationship with CST, and therapeutic strategies for axonal regeneration of the CST after stroke. We found it to be closely associated with astroglial scarring produced by astrocyte activation and its secretion of neurotrophic factors, mainly after the onset of cerebral ischemia. We hope that this review offers insight into the relationship between CST and PSS and provides a basis for further studies.
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Affiliation(s)
- Linxing Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Lizhen Yi
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Huiyuan Huang
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Sheng Zhan
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Ruixue Chen
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Zenghui Yue
- College of Acupuncture, Massage and Rehabilitation, Hunan University of Chinese Medicine, Changsha, 410208, China.
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Levin MF, Berman S, Weiss N, Parmet Y, Baniña MC, Frenkel-Toledo S, Soroker N, Solomon JM, Liebermann DG. ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range. Sci Rep 2023; 13:22934. [PMID: 38129527 PMCID: PMC10739929 DOI: 10.1038/s41598-023-49974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
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Affiliation(s)
- Mindy F Levin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada.
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Weiss
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melanie C Baniña
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel.
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Xia X, Dong X, Huo H, Zhang Y, Song J, Wang D. Clinical study of low-frequency acupoint electrical stimulation to improve thumb-to-finger movements after stroke: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e35755. [PMID: 38013325 PMCID: PMC10681496 DOI: 10.1097/md.0000000000035755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/02/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To examine the effect of low-frequency acupoint electrical stimulation (LFES) on the surface electromyographic (sEMG) signals of the thumb-to-finger movement muscles in stroke patients, and to evaluate the clinical efficacy of LFES on hand function recovery after stroke. METHODS Sixty patients who met the inclusion criteria were randomly assigned to a LFES group or an electroacupuncture (EA) group, with 30 patients in each group. Both groups received conventional treatment, and the EA group was treated with acupoints from the book of Acupuncture and Moxibustion, while the LFES group was treated with acupoints from a previous study. The sEMG characteristic values (maximum value and RMS), Chinese Stroke Clinical Neurological Deficit Scale (CSS), Brunnstrom Motor Function Evaluation, Modified Ashworth Scale (MAS), Lindmark Hand Function Score and Lovett Muscle Strength Classification were measured before and after treatment. RESULTS After treatment, both groups showed improvement in sEMG characteristic values, Brunnstrom motor function score, Lindmark hand function score, and Lovett muscle strength classification compared with before treatment, and the improvement in the LFES group was significantly better than that in the EA group (P < .05). The CSS score and MAS classification of both groups decreased compared with before treatment, and the decrease in the LFES group was significantly better than that in the EA group (P < .05). The total effective rate of the LFES group was 92.86%, and that of the EA group was 79.31%. The difference between the 2 groups was statistically significant (P < .05). CONCLUSION Both LFES and EA were effective in restoring thumb-to-finger movement function after stroke, as evidenced by the increased maximum value and root mean square values of the first dorsal interosseous muscle and the extensor pollicis brevis muscle, the decreased CSS score, the increased Brunnstrom motor function score, the decreased MAS classification, the increased Lindmark hand function score, and the increased Lovett muscle strength classification. However, LFES showed more obvious improvement and better efficacy than EA, which is worthy of clinical promotion.
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Affiliation(s)
- Xue Xia
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xu Dong
- Second Affiliated Hospital of Heilongjiang University of Chinese medicine, Harbin, China
| | - Hong Huo
- Second Affiliated Hospital of Heilongjiang University of Chinese medicine, Harbin, China
| | - Ying Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
- Second Affiliated Hospital of Heilongjiang University of Chinese medicine, Harbin, China
| | - Jing Song
- Second Affiliated Hospital of Heilongjiang University of Chinese medicine, Harbin, China
| | - Dongyan Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
- Second Affiliated Hospital of Heilongjiang University of Chinese medicine, Harbin, China
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Ramirez-Nava AG, Mercado-Gutierrez JA, Quinzaños-Fresnedo J, Toledo-Peral C, Vega-Martinez G, Gutierrez MI, Pacheco-Gallegos MDR, Hernández-Arenas C, Gutiérrez-Martínez J. Functional electrical stimulation therapy controlled by a P300-based brain-computer interface, as a therapeutic alternative for upper limb motor function recovery in chronic post-stroke patients. A non-randomized pilot study. Front Neurol 2023; 14:1221160. [PMID: 37669261 PMCID: PMC10470638 DOI: 10.3389/fneur.2023.1221160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/03/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Up to 80% of post-stroke patients present upper-limb motor impairment (ULMI), causing functional limitations in daily activities and loss of independence. UMLI is seldom fully recovered after stroke when using conventional therapeutic approaches. Functional Electrical Stimulation Therapy (FEST) controlled by Brain-Computer Interface (BCI) is an alternative that may induce neuroplastic changes, even in chronic post-stroke patients. The purpose of this work was to evaluate the effects of a P300-based BCI-controlled FEST intervention, for ULMI recovery of chronic post-stroke patients. Methods A non-randomized pilot study was conducted, including 14 patients divided into 2 groups: BCI-FEST, and Conventional Therapy. Assessments of Upper limb functionality with Action Research Arm Test (ARAT), performance impairment with Fugl-Meyer assessment (FMA), Functional Independence Measure (FIM) and spasticity through Modified Ashworth Scale (MAS) were performed at baseline and after carrying out 20 therapy sessions, and the obtained scores compared using Chi square and Mann-Whitney U statistical tests (𝛼 = 0.05). Results After training, we found statistically significant differences between groups for FMA (p = 0.012), ARAT (p < 0.001), and FIM (p = 0.025) scales. Discussion It has been shown that FEST controlled by a P300-based BCI, may be more effective than conventional therapy to improve ULMI after stroke, regardless of chronicity. Conclusion The results of the proposed BCI-FEST intervention are promising, even for the most chronic post-stroke patients often relegated from novel interventions, whose expected recovery with conventional therapy is very low. It is necessary to carry out a randomized controlled trial in the future with a larger sample of patients.
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Affiliation(s)
- Ana G. Ramirez-Nava
- Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Jorge A. Mercado-Gutierrez
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Jimena Quinzaños-Fresnedo
- Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Cinthya Toledo-Peral
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Gabriel Vega-Martinez
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Mario Ibrahin Gutierrez
- Consejo Nacional de Humanidades, Ciencias y Tecnologías - Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | | | - Claudia Hernández-Arenas
- Neurological Rehabilitation Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
| | - Josefina Gutiérrez-Martínez
- Medical Engineering Research Division, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra”, Tlalpan, Mexico
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Qin Y, Liu X, Zhang Y, Wu J, Wang X. Effects of transcranial combined with peripheral repetitive magnetic stimulation on limb spasticity and resting-state brain activity in stroke patients. Front Hum Neurosci 2023; 17:992424. [PMID: 37082150 PMCID: PMC10110929 DOI: 10.3389/fnhum.2023.992424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
Background and objectiveTranscranial magnetic stimulation and peripheral repetitive magnetic stimulation (rPMS), as non-invasive neuromodulation techniques, can promote functional recovery in patients with post-stroke spasticity (PSS), but the effects of transcranial magnetic stimulation combined with peripheral magnetic stimulation on PSS remain largely unknown. Therefore, we examined the effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) combined with rPMS on PSS patients and its potential neural correlates to behavioral improvements.MethodsForty-nine PSS patients were divided randomly into three groups: a combined group (n = 20), a LF-rTMS group (n = 15), and a control group (n = 14). The combined group received LF-rTMS and rPMS treatment, the rTMS group received LF-rTMS treatment, and the control group received only routine rehabilitation. All patients underwent Ashworth Spasm Scale (MAS), upper extremity Fugl-Meyer (FMA-UE), and modified Barthel Index (MBI) assessments before and after intervention. In addition, resting-state functional magnetic resonance imaging data were collected pre- and post-treatment to observe changes in the amplitude of low-frequency fluctuation (ALFF).ResultsThe MAS score was decreased, FMA-UE score and MBI scores were increased in the three groups after therapy than before therapy (all P < 0.05). In particular, the combined group showed significant effect on improved motor function and relieved spasticity in PSS (P < 0.01). Moreover, the combined treatment increased ALFF values mainly in the right supplementary motor area, right middle frontal gyrus, and right cerebellum, while reduced ALFF values mainly in the right post-central gyrus compared with pre-treatment. Compared with the LF-rTMS and control groups, the combined treatment increased ALFF values in the right cerebellum and reduced ALFF values mainly in the frontoparietal cortex. Improvements in the MAS score were positively correlated with the change in ALFF values in the right cerebellum (r = 0.698, P = 0.001) and the right supplementary motor area (r = 0.700, P = 0.001) after combined treatment.ConclusionTranscranial combined with peripheral repetitive magnetic stimulation could improve spastic state and motor function in PSS patients, and this effect may be associated with altered cerebellar and frontoparietal cortical activity.Clinical trial registrationhttp://www.chictr.org.cn/index.aspx, identifier ChiCTR1800019452.
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Affiliation(s)
- Yin Qin
- Department of Rehabilitation Medicine, The 900th Hospital of People’s Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, Fujian, China
- *Correspondence: Yin Qin,
| | - Xiaoying Liu
- Department of Rehabilitation Medicine, The 900th Hospital of People’s Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, Fujian, China
| | - Yinxin Zhang
- Department of Rehabilitation Medicine, The 900th Hospital of People’s Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, Fujian, China
| | - Jiwei Wu
- Department of Rehabilitation Medicine, The 900th Hospital of People’s Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, Fujian, China
| | - Xiaoyang Wang
- Department of Radiology, The 900th Hospital of People’s Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, Fujian, China
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Asimakidou E, Sidiropoulos C. A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity. Toxins (Basel) 2023; 15:toxins15040256. [PMID: 37104194 PMCID: PMC10145352 DOI: 10.3390/toxins15040256] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023] Open
Abstract
Accurate targeting of overactive muscles is fundamental for successful botulinum neurotoxin (BoNT) injections in the treatment of spasticity. The necessity of instrumented guidance and the superiority of one or more guidance techniques are ambiguous. Here, we sought to investigate if guided BoNT injections lead to a better clinical outcome in adults with limb spasticity compared to non-guided injections. We also aimed to elucidate the hierarchy of common guidance techniques including electromyography, electrostimulation, manual needle placement and ultrasound. To this end, we conducted a Bayesian network meta-analysis and systematic review with 245 patients using the MetaInsight software, R and the Cochrane Review Manager. Our study provided, for the first time, quantitative evidence supporting the superiority of guided BoNT injections over the non-guided ones. The hierarchy comprised ultrasound on the first level, electrostimulation on the second, electromyography on the third and manual needle placement on the last level. The difference between ultrasound and electrostimulation was minor and, thus, appropriate contextualization is essential for decision making. Taken together, guided BoNT injections based on ultrasound and electrostimulation performed by experienced practitioners lead to a better clinical outcome within the first month post-injection in adults with limb spasticity. In the present study, ultrasound performed slightly better, but large-scale trials should shed more light on which modality is superior.
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Wallace ML, McTeague L, Graves JL, Kissel N, Tortora C, Wheeler B, Iyengar S. Quantifying Distances Between Non-Elliptical Clusters to Enhance the Identification of Meaningful Emotional Reactivity Subtypes. DATA SCIENCE IN SCIENCE 2023; 1:34-59. [PMID: 37162763 PMCID: PMC10166186 DOI: 10.1080/26941899.2022.2157349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 05/11/2023]
Abstract
Coordinated emotional responses across psychophysiological and subjective indices is a cornerstone of adaptive emotional functioning. Using clustering to identify cross-diagnostic subgroups with similar emotion response profiles may suggest novel underlying mechanisms and treatments.However, many psychophysiological measures are non-normal even in homogenous samples, and over-reliance on traditional elliptical clustering approaches may inhibit the identification of meaningful subgroups. Finite mixture models that allow for non-elliptical cluster distributions is an emerging methodological field that may overcome this hurdle. Furthermore, succinctly quantifying pairwise cluster separation could enhance the clinical utility of the clustering solutions. However, a comprehensive examination of distance measures in the context of elliptical and non-elliptical model-based clustering is needed to provide practical guidance on the computation, benefits, and disadvantages of existing measures. We summarize several measures that can quantify the multivariate distance between two clusters and suggest practical computational tools. Through a simulation study, we evaluate the measures across three scenarios that allow for clusters to differ in location, scale, skewness, and rotation. We then demonstrate our approaches using psychophysiological and subjective responses to emotional imagery captured through the Transdiagnostic Anxiety Study. Finally, we synthesize findings to provide guidance on how to use distance measures in clustering applications.
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Affiliation(s)
| | - L. McTeague
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | | | - N. Kissel
- Department of Statistics, Carnegie Mellon University
| | - C. Tortora
- Department of Mathematics and Statistics, San Jose State University
| | - B. Wheeler
- School of Computing and Information, University of Pittsburgh
| | - S. Iyengar
- Department of Statistics, University of Pittsburgh
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Shared and distinct voxel-based lesion-symptom mappings for spasticity and impaired movement in the hemiparetic upper limb. Sci Rep 2022; 12:10169. [PMID: 35715476 PMCID: PMC9206020 DOI: 10.1038/s41598-022-14359-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/06/2022] [Indexed: 12/17/2022] Open
Abstract
Hemiparesis and spasticity are common co-occurring manifestations of hemispheric stroke. The relationship between impaired precision and force in voluntary movement (hemiparesis) and the increment in muscle tone that stems from dysregulated activity of the stretch reflex (spasticity) is far from clear. Here we aimed to elucidate whether variation in lesion topography affects hemiparesis and spasticity in a similar or dis-similar manner. Voxel-based lesion-symptom mapping (VLSM) was used to assess the impact of lesion topography on (a) upper limb paresis, as reflected by the Fugl-Meyer Assessment scale for the upper limb and (b) elbow flexor spasticity, as reflected by the Tonic Stretch Reflex Threshold, in 41 patients with first-ever stroke. Hemiparesis and spasticity were affected by damage to peri-Sylvian cortical and subcortical regions and the putamen. Hemiparesis (but not spasticity) was affected by damage to the corticospinal tract at corona-radiata and capsular levels, and by damage to white-matter association tracts and additional regions in the temporal cortex and pallidum. VLSM conjunction analysis showed only a minor overlap of brain voxels where the existence of damage affected both hemiparesis and spasticity, suggesting that control of voluntary movement and regulation of muscle tone at rest involve largely separate parts of the motor network.
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