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van Ravestyn C, Gerardin E, Térémetz M, Hamdoun S, Baron JC, Calvet D, Vandermeeren Y, Turc G, Maier MA, Rosso C, Mas JL, Dupin L, Lindberg PG. Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity. Neurorehabil Neural Repair 2024; 38:373-385. [PMID: 38572686 DOI: 10.1177/15459683241245416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.
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Affiliation(s)
- Coralie van Ravestyn
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Eloïse Gerardin
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Maxime Térémetz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
| | - Sonia Hamdoun
- Service de Médecine Physique et de Réadaptation, GHU Paris Psychiatrie & Neurosciences, Paris, France
| | - Jean-Claude Baron
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - David Calvet
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Yves Vandermeeren
- Department of Neurology, Stroke Unit, CHU UCL Namur, UCLouvain, Yvoir, Belgium
- NEUR Division, Institute of NeuroScience, UCLouvain, Brussels, Belgium
| | - Guillaume Turc
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Marc A Maier
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Charlotte Rosso
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Louis Mas
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
- GHU-Paris Psychiatrie & Neurosciences, FHU NeuroVasc, Hôpital Sainte Anne, F-75014 Paris, France
| | - Lucile Dupin
- Université Paris Cité, INCC UMR 8002, CNRS, Paris, France
| | - Påvel G Lindberg
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1226, F-75014 Paris, France
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Parma C, Doria F, Zulueta A, Lanzone J, Boscarino M, Giani L, Lunetta C, Vassallo M, Parati EA, Picozzi M, Sattin D. An Overview of the Bodily Awareness Representation and Interoception: Insights and Progress in the Field of Neurorehabilitation Research. Brain Sci 2024; 14:386. [PMID: 38672035 PMCID: PMC11048399 DOI: 10.3390/brainsci14040386] [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: 12/30/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
In the last two decades, the scientific literature on so-called body representations has been increasing, and the notion of body awareness (BA) is particularly interesting for neurorehabilitation. In this article, we present results derived from recent studies on this representation, considering the different definitions and explicative models proposed as well as the empirical settings used to test it, providing an extensive overview of these issues. This article discusses the challenge of understanding how we integrate the sensory experiences of proprioception (knowing where our body is in space) and interoception (sensing internal bodily sensations, like hunger of thirst) with our perception of self. This is a difficult problem to analyze because our awareness of our body is inherently linked to our perspective, since the body is the means through which we interact with the world. Presenting the different viewpoints offered by recent theories on this concern, we highlighted that the neurorehabilitation and psychiatric settings offer two important fields useful for the study of BA because in them it is possible to analyze bodily representations by inducing/observing a controlled discrepancy between dysfunctional content and sensory inputs.
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Affiliation(s)
- Chiara Parma
- Medicina Clinica e Sperimentale e Medical Humanities, PhD. Program, Insubria University, 21100 Varese, Italy;
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (F.D.); (D.S.)
| | - Federica Doria
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (F.D.); (D.S.)
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (M.B.); (L.G.); (E.A.P.)
| | - Marilisa Boscarino
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (M.B.); (L.G.); (E.A.P.)
| | - Luca Giani
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (M.B.); (L.G.); (E.A.P.)
| | - Christian Lunetta
- Amyotrophic Lateral Sclerosis Unit, Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy;
| | - Marta Vassallo
- Medicina Clinica e Sperimentale e Medical Humanities, PhD. Program, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Neurorehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (M.B.); (L.G.); (E.A.P.)
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (F.D.); (D.S.)
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Tulimieri DT, Semrau JA. Impaired proprioception and magnified scaling of proprioceptive error responses in chronic stroke. J Neuroeng Rehabil 2024; 21:51. [PMID: 38594762 PMCID: PMC11003069 DOI: 10.1186/s12984-024-01350-9] [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: 12/05/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Previous work has shown that ~ 50-60% of individuals have impaired proprioception after stroke. Typically, these studies have identified proprioceptive impairments using a narrow range of reference movements. While this has been important for identifying the prevalence of proprioceptive impairments, it is unknown whether these error responses are consistent for a broad range of reference movements. The objective of this study was to characterize proprioceptive accuracy as function of movement speed and distance in stroke. METHODS Stroke (N = 25) and controls (N = 21) completed a robotic proprioception test that varied movement speed and distance. Participants mirror-matched various reference movement speeds (0.1-0.4 m/s) and distances (7.5-17.5 cm). Spatial and temporal parameters known to quantify proprioception were used to determine group differences in proprioceptive accuracy, and whether patterns of proprioceptive error were consistent across testing conditions within and across groups. RESULTS Overall, we found that stroke participants had impaired proprioception compared to controls. Proprioceptive errors related to tested reference movement scaled similarly to controls, but some errors showed amplified scaling (e.g., significantly overshooting or undershooting reference speed). Further, interaction effects were present for speed and distance reference combinations at the extremes of the testing distribution. CONCLUSIONS We found that stroke participants have impaired proprioception and that some proprioceptive errors were dependent on characteristics of the movement (e.g., speed) and that reference movements at the extremes of the testing distribution resulted in significantly larger proprioceptive errors for the stroke group. Understanding how sensory information is utilized across a broad spectrum of movements after stroke may aid design of rehabilitation programs.
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Affiliation(s)
- Duncan Thibodeau Tulimieri
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
- Program in Biomechanics and Movement Science (BIOMS), University of Delaware, 100 Discovery Blvd, Tower at STAR, Rm 234, Newark, DE, 19713, USA
| | - Jennifer A Semrau
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA.
- Program in Biomechanics and Movement Science (BIOMS), University of Delaware, 100 Discovery Blvd, Tower at STAR, Rm 234, Newark, DE, 19713, USA.
- Department of Biomedical Engineering, University of Delaware, Newark, USA.
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Hoh JE, Borich MR, Kesar TM, Reisman DS, Semrau JA. Limitations in utilization and prioritization of standardized somatosensory assessments after stroke: A cross-sectional survey of neurorehabilitation clinicians. Top Stroke Rehabil 2024; 31:29-43. [PMID: 37061928 DOI: 10.1080/10749357.2023.2200304] [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: 12/16/2022] [Accepted: 04/02/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND AND PURPOSE Somatosensory impairments are common after stroke, but receive limited evaluation and intervention during neurorehabilitation, despite negatively impacting functional movement and recovery. OBJECTIVES Our objective was to understand the scope of somatosensory assessments used by clinicians in stroke rehabilitation, and barriers to increasing use in clinical practice. METHODS An electronic survey was distributed to clinicians (physical therapists, occupational therapists, physicians, and nurses) who assessed at least one individual with stroke in the past 6 months. The survey included questions on evaluation procedures, type, and use of somatosensory assessments, as well as barriers and facilitators in clinical practice. RESULTS Clinicians (N = 431) indicated greater familiarity with non-standardized assessments, and greater utilization compared to standardized assessments (p < 0.0001). Components of tactile sensation were the most commonly assessed modality of somatosensation (25%), while proprioception was rarely assessed (1%). Overall, assessments of motor function were prioritized over assessments of somatosensory function (p < 0.0001). DISCUSSION Respondents reported assessing somatosensation less frequently than motor function and demonstrated a reliance on rapid and coarse non-standardized assessments that ineffectively capture multi-modal somatosensory impairments, particularly for proprioceptive deficits common post-stroke. In general, clinicians were not familiar with standardized somatosensory assessments, and this knowledge gap likely contributes to lack of translation of these assessments into practice. CONCLUSIONS Clinicians utilize somatosensory assessments that inadequately capture the multi-modal nature of somatosensory impairments in stroke survivors. Addressing barriers to clinical translation has the potential to increase utilization of standardized assessments to improve the characterization of somatosensory deficits that inform clinical decision-making toward enhancing stroke rehabilitation outcomes.
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Affiliation(s)
- Joanna Eskander Hoh
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
| | - Michael R Borich
- Center for Physical Therapy and Movement Science, Emory University, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Trisha M Kesar
- Center for Physical Therapy and Movement Science, Emory University, Atlanta, GA, USA
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Darcy S Reisman
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Physical Therapy, University of Delaware, Newark, USA
| | - Jennifer A Semrau
- Biomechanics and Movement Science Program, University of Delaware, Newark, USA
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
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Kenzie JM, Rajashekar D, Goodyear BG, Dukelow SP. Resting state functional connectivity associated with impaired proprioception post-stroke. Hum Brain Mapp 2024; 45:e26541. [PMID: 38053448 PMCID: PMC10789217 DOI: 10.1002/hbm.26541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Deficits in proprioception, the knowledge of limb position and movement in the absence of vision, occur in ~50% of all strokes; however, our lack of knowledge of the neurological mechanisms of these deficits diminishes the effectiveness of rehabilitation and prolongs recovery. We performed resting-state functional magnetic resonance imaging (fMRI) on stroke patients to determine functional brain networks that exhibited changes in connectivity in association with proprioception deficits determined by a Kinarm robotic exoskeleton assessment. Thirty stroke participants were assessed for proprioceptive impairments using a Kinarm robot and underwent resting-state fMRI at 1 month post-stroke. Age-matched healthy control (n = 30) fMRI data were also examined and compared to stroke data in terms of the functional connectivity of brain regions associated with proprioception. Stroke patients exhibited reduced connectivity of the supplementary motor area and the supramarginal gyrus, relative to controls. Functional connectivity of these regions plus primary somatosensory cortex and parietal opercular area was significantly associated with proprioceptive function. The parietal lobe of the lesioned hemisphere is a significant node for proprioception after stroke. Assessment of functional connectivity of this region after stroke may assist with prognostication of recovery. This study also provides potential targets for therapeutic neurostimulation to aid in stroke recovery.
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Affiliation(s)
- Jeffrey M. Kenzie
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health ServicesCalgaryAlbertaCanada
| | - Deepthi Rajashekar
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Bradley G. Goodyear
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health ServicesCalgaryAlbertaCanada
- Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Sean P. Dukelow
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health ServicesCalgaryAlbertaCanada
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Chen G, Wu M, Chen J, Cai G, Liu Q, Zhao Y, Huang Z, Lan Y. Non-invasive brain stimulation effectively improves post-stroke sensory impairment: a systematic review and meta-analysis. J Neural Transm (Vienna) 2023; 130:1219-1230. [PMID: 37495840 DOI: 10.1007/s00702-023-02674-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
More than half of stroke patients experience sensory dysfunction that affects their quality of life. Previous training modalities are ineffective in improving sensory function. In contrast, non-invasive brain stimulation (NIBS) is a new promising intervention for stroke rehabilitation. The aim of this meta-analysis was to summarize the current effectiveness of NIBS in the treatment of post-stroke sensory dysfunction. Articles published in PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), Chinese scientific journals full-text database (VIP), and Wanfang database from the inception to March 8, 2023 were searched. There were no restrictions on language. A total of 14 RCTs were included (combined n = 804). Moderate-quality evidence suggested that NIBS significantly improved sensory function after stroke, and significant effects were observed up to 1 year after the intervention. In subgroup analysis, treatment with transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) was significantly more effective than controls for recovery of sensory function in stroke patients. Stimulation of the primary motor cortex (M1), primary somatosensory cortex (S1) or M1 + S1 stimulation sites significantly improved sensory function. NIBS for sensory dysfunction showed significant therapeutic potential in patients with different stages of stroke. No significant effects were observed in subjects with less than 10 NIBS stimulations. Significant therapeutic effects were observed with either high-frequency or low-frequency rTMS.
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Affiliation(s)
- Gengbin Chen
- Postgraduate Research Institute, Guangzhou Sport University, No. 1268, Guangzhou Avenue Middle, Tianhe District, Guangzhou, Guangdong, China
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1st Panfu Rd, Guangzhou, Guangdong, China
| | - Manfeng Wu
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1st Panfu Rd, Guangzhou, Guangdong, China
| | - Jialin Chen
- Postgraduate Research Institute, Guangzhou Sport University, No. 1268, Guangzhou Avenue Middle, Tianhe District, Guangzhou, Guangdong, China
| | - Guiyuan Cai
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1st Panfu Rd, Guangzhou, Guangdong, China
| | - Quan Liu
- Postgraduate Research Institute, Guangzhou Sport University, No. 1268, Guangzhou Avenue Middle, Tianhe District, Guangzhou, Guangdong, China
| | - Yinchun Zhao
- Postgraduate Research Institute, Guangzhou Sport University, No. 1268, Guangzhou Avenue Middle, Tianhe District, Guangzhou, Guangdong, China
| | - Zhiguan Huang
- Postgraduate Research Institute, Guangzhou Sport University, No. 1268, Guangzhou Avenue Middle, Tianhe District, Guangzhou, Guangdong, China.
- Engineering Technology Research Center for Sports Assistive Devices of Guangdong, School of Sport and Health, Guangzhou Sport University, Guangzhou, China.
| | - Yue Lan
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, 1st Panfu Rd, Guangzhou, Guangdong, China.
- Guangzhou Key Laboratory of Aging Frailty and Neurorehabilitation, Guangzhou, China.
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Huo Y, Wang X, Zhao W, Hu H, Li L. Effects of EMG-based robot for upper extremity rehabilitation on post-stroke patients: a systematic review and meta-analysis. Front Physiol 2023; 14:1172958. [PMID: 37256069 PMCID: PMC10226272 DOI: 10.3389/fphys.2023.1172958] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/20/2023] [Indexed: 06/01/2023] Open
Abstract
Objective: A growing body of research shows the promise and efficacy of EMG-based robot interventions in improving the motor function in stroke survivors. However, it is still controversial whether the effect of EMG-based robot is more effective than conventional therapies. This study focused on the effects of EMG-based robot on upper limb motor control, spasticity and activity limitation in stroke survivors compared with conventional rehabilitation techniques. Methods: We searched electronic databases for relevant randomized controlled trials. Outcomes included Fugl-Meyer assessment scale (FMA), Modified Ashworth Scale (MAS), and activity level. Result: Thirteen studies with 330 subjects were included. The results showed that the outcomes post intervention was significantly improved in the EMG-based robot group. Results from subgroup analyses further revealed that the efficacy of the treatment was better in patients in the subacute stage, those who received a total treatment time of less than 1000 min, and those who received EMG-based robotic therapy combined with electrical stimulation (ES). Conclusion: The effect of EMG-based robot is superior to conventional therapies in terms of improving upper extremity motor control, spasticity and activity limitation. Further research should explore optimal parameters of EMG-based robot therapy and its long-term effects on upper limb function in post-stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/; Identifier: 387070.
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Affiliation(s)
- Yunxia Huo
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
| | - Xiaohan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
| | - Weihua Zhao
- Northwestern Polytechnical University Hospital, Xi’an, China
| | - Huijing Hu
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
- Research & Development Institute of Northwestern Polytechnical University in Shenzhen, Shenzhen, China
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Shahid J, Kashif A, Shahid MK. A Comprehensive Review of Physical Therapy Interventions for Stroke Rehabilitation: Impairment-Based Approaches and Functional Goals. Brain Sci 2023; 13:brainsci13050717. [PMID: 37239189 DOI: 10.3390/brainsci13050717] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Stroke is the fourth leading cause of mortality and is estimated to be one of the major reasons for long-lasting disability worldwide. There are limited studies that describe the application of physical therapy interventions to prevent disabilities in stroke survivors and promote recovery after a stroke. In this review, we have described a wide range of interventions based on impairments, activity limitations, and goals in recovery during different stages of a stroke. This article mainly focuses on stroke rehabilitation tactics, including those for sensory function impairments, motor learning programs, hemianopia and unilateral neglect, flexibility and joint integrity, strength training, hypertonicity, postural control, and gait training. We conclude that, aside from medicine, stroke rehabilitation must address specific functional limitations to allow for group activities and superior use of a hemiparetic extremity. Medical doctors are often surprised by the variety of physiotherapeutic techniques available; they are unfamiliar with the approaches of researchers such as Bobath, Coulter, and Brunnstrom, among others, as well as the scientific reasoning behind these techniques.
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Affiliation(s)
- Jawaria Shahid
- Department of Physical Therapy, Ikram Hospital, Gujrat 50700, Pakistan
- Center of Physical Therapy, Rayan Medical Center, Gujrat 50700, Pakistan
| | - Ayesha Kashif
- Department of Senior Health Care, Eulji University, Uijeongbu 11759, Republic of Korea
| | - Muhammad Kashif Shahid
- Research Institute of Environment & Biosystem, Chungnam National University, Daejeon 34134, Republic of Korea
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de Miguel-Fernández J, Lobo-Prat J, Prinsen E, Font-Llagunes JM, Marchal-Crespo L. Control strategies used in lower limb exoskeletons for gait rehabilitation after brain injury: a systematic review and analysis of clinical effectiveness. J Neuroeng Rehabil 2023; 20:23. [PMID: 36805777 PMCID: PMC9938998 DOI: 10.1186/s12984-023-01144-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND In the past decade, there has been substantial progress in the development of robotic controllers that specify how lower-limb exoskeletons should interact with brain-injured patients. However, it is still an open question which exoskeleton control strategies can more effectively stimulate motor function recovery. In this review, we aim to complement previous literature surveys on the topic of exoskeleton control for gait rehabilitation by: (1) providing an updated structured framework of current control strategies, (2) analyzing the methodology of clinical validations used in the robotic interventions, and (3) reporting the potential relation between control strategies and clinical outcomes. METHODS Four databases were searched using database-specific search terms from January 2000 to September 2020. We identified 1648 articles, of which 159 were included and evaluated in full-text. We included studies that clinically evaluated the effectiveness of the exoskeleton on impaired participants, and which clearly explained or referenced the implemented control strategy. RESULTS (1) We found that assistive control (100% of exoskeletons) that followed rule-based algorithms (72%) based on ground reaction force thresholds (63%) in conjunction with trajectory-tracking control (97%) were the most implemented control strategies. Only 14% of the exoskeletons implemented adaptive control strategies. (2) Regarding the clinical validations used in the robotic interventions, we found high variability on the experimental protocols and outcome metrics selected. (3) With high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented a combination of trajectory-tracking and compliant control showed the highest clinical effectiveness for acute stroke. However, they also required the longest training time. With high grade of evidence and low number of participants (N = 8), assistive control strategies that followed a threshold-based algorithm with EMG as gait detection metric and control signal provided the highest improvements with the lowest training intensities for subacute stroke. Finally, with high grade of evidence and a moderate number of participants (N = 19), assistive control strategies that implemented adaptive oscillator algorithms together with trajectory-tracking control resulted in the highest improvements with reduced training intensities for individuals with chronic stroke. CONCLUSIONS Despite the efforts to develop novel and more effective controllers for exoskeleton-based gait neurorehabilitation, the current level of evidence on the effectiveness of the different control strategies on clinical outcomes is still low. There is a clear lack of standardization in the experimental protocols leading to high levels of heterogeneity. Standardized comparisons among control strategies analyzing the relation between control parameters and biomechanical metrics will fill this gap to better guide future technical developments. It is still an open question whether controllers that provide an on-line adaptation of the control parameters based on key biomechanical descriptors associated to the patients' specific pathology outperform current control strategies.
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Affiliation(s)
- Jesús de Miguel-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | | | - Erik Prinsen
- Roessingh Research and Development, Roessinghsbleekweg 33b, 7522AH Enschede, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Diagonal 647, 08028 Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain
| | - Laura Marchal-Crespo
- Cognitive Robotics Department, Delft University of Technology, Mekelweg 2, 2628 Delft, Netherlands
- Motor Learning and Neurorehabilitation Lab, ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010 Bern, Switzerland
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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Peng J, Su J, Song L, Lv Q, Gao Y, Chang J, Zhang H, Zou Y, Chen X. Altered Functional Activity and Functional Connectivity of Seed Regions Based on ALFF Following Acupuncture Treatment in Patients with Stroke Sequelae with Unilateral Limb Numbness. Neuropsychiatr Dis Treat 2023; 19:233-245. [PMID: 36744205 PMCID: PMC9890273 DOI: 10.2147/ndt.s391616] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Limb numbness is a frequent symptom of post-stroke somatosensory dysfunction, which may be alleviated by non-invasive therapy such as acupuncture. However, the precise mechanism via acupuncture remains unknown. The goal of this study was to investigate how the amplitude of low-frequency fluctuations (ALFF) and functional connectivity (FC) changed between stroke patients with limb numbness and healthy people, as well as how acupuncture might work. METHODS 24 stroke sequelae patients with unilateral limb numbness and 14 matched healthy controls were enrolled in the study. The patients with limb numbness received acupuncture therapy three days a week for four weeks. We mainly assessed the clinical outcomes via the visual analogue scale (VAS). In addition, fMRI data from patients with unilateral limb numbness at baseline and after treatment (4th week) were collected, as well as data from healthy controls at baseline. RESULTS Compared with the healthy subjects, the patient group demonstrated significantly decreased ALFF in several brain regions, mainly associated with the sensorimotor network (SMN) and default mode network (DMN), including left superior frontal gyrus (SFG), right temporal fusiform cortex (TFC), right middle frontal gyrus (MFG), bilateral middle temporal gyrus (MTG), right putamen (PUT), right precentral gyrus (preCG), right planum polare (PP), and left supplementary motor area (SMA). These regions were chosen as the seeds for investigating the FC alteration induced by acupuncture. Several sensorimotor-related brain regions were activated by acupuncture, and the FC of the left supramarginal gyrus (SMG) with right MTG, as well as brain-stem, cerebellum vermis 9 with right MFG showed enhancement following acupuncture in the patient group, which had a significant correlation with clinical outcomes. CONCLUSION Acupuncture treatment may be used to stimulate brain areas associated with somatosensory processing and to strengthen the FC of sensorimotor and cognitive brain networks in order to achieve therapeutic effect.
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Affiliation(s)
- Jing Peng
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Jiaming Su
- Department of Nephrology, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Lei Song
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Qiuyi Lv
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Ying Gao
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Jingling Chang
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Hua Zhang
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Yihuai Zou
- Department of Encephalopathy, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Xing Chen
- Department of Brain Function Examination, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, People's Republic of China
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Young BM, Yadav R, Rana S, Kim WS, Liu C, Batth R, Sakthi S, Farahmand E, Han S, Patel D, Luo J, Ramsey C, Feldman M, Cardoso-Ferreira I, Holl C, Nguyen T, Brinkman L, Su M, Chang TY, Cramer SC. Wrist Proprioception in Adults with and without Subacute Stroke. Brain Sci 2022; 13:brainsci13010031. [PMID: 36672014 PMCID: PMC9856542 DOI: 10.3390/brainsci13010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Proprioception is critical to motor control and functional status but has received limited study early after stroke. Patients admitted to an inpatient rehabilitation facility for stroke (n = 18, mean(±SD) 12.5 ± 6.6 days from stroke) and older healthy controls (n = 19) completed the Wrist Position Sense Test (WPST), a validated, quantitative measure of wrist proprioception, as well as motor and cognitive testing. Patients were serially tested when available (n = 12, mean 11 days between assessments). In controls, mean(±SD) WPST error was 9.7 ± 3.5° in the dominant wrist and 8.8 ± 3.8° in the nondominant wrist (p = 0.31). In patients with stroke, WPST error was 18.6 ± 9° in the more-affected wrist, with abnormal values present in 88.2%; and 11.5 ± 5.6° in the less-affected wrist, with abnormal values present in 72.2%. Error in the more-affected wrist was higher than in the less-affected wrist (p = 0.003) or in the dominant (p = 0.001) and nondominant (p < 0.001) wrist of controls. Age and BBT performance correlated with dominant hand WPST error in controls. WPST error in either wrist after stroke was not related to age, BBT, MoCA, or Fugl-Meyer scores. WPST error did not significantly change in retested patients. Wrist proprioception deficits are common, bilateral, and persistent in subacute stroke and not explained by cognitive or motor deficits.
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Affiliation(s)
- Brittany M. Young
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Rishika Yadav
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Shivam Rana
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Won-Seok Kim
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si 13620, Gyeonggi-do, Republic of Korea
| | - Camellia Liu
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Rajan Batth
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Shivani Sakthi
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Eden Farahmand
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Simon Han
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Darshan Patel
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Jason Luo
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Christina Ramsey
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Marc Feldman
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Isabel Cardoso-Ferreira
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Christina Holl
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Tiffany Nguyen
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Lorie Brinkman
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Michael Su
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Tracy Y. Chang
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
| | - Steven C. Cramer
- Department of Neurology, University of California, 710 Westwood Plaza, Los Angeles, CA 90095, USA
- California Rehabilitation Institute, 2070 Century Park East Rm 117, Los Angeles, CA 90067, USA
- Correspondence:
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12
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Du YH, Ma J, Hu JY, Zhu L, Wang LY, Yang RY, Liang LC, Jiang M, Cai M, Pu J. Effects of dual-task training on gait and motor ability in patients with Parkinson's disease: A systematic review and meta-analysis. Clin Rehabil 2022; 37:942-953. [PMID: 36537108 DOI: 10.1177/02692155221146085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Parkinson's disease is one of the most common neurodegenerative diseases in the world, which seriously damages motor and balance ability. Dual-task training is discussed as an appropriate intervention. The aim of this review was to synthesize the existing research findings on the efficacy of dual-task training for people with Parkinson's disease. DATA RESOURCES A systematic search on PubMed, CENTRAL, Embase, Web of Science, and PEDro, randomized-controlled trials (RCTs) of dual-task training for individuals with Parkinson's disease. METHODS Articles published until 1 November 2022 were included. Our search identified 7 RCTs with a total of 406 subjects. Review Manager 5.4 software was used for bias evaluation and to process the results of the outcome measures collected from the investigations. RESULTS Dual-task training was associated with significant improvement in most motor and balance outcomes including gait velocity (standard mean difference (SMD) = 0.62; 95% CI, 0.37-0.87; I2 = 31%; P = 0.21), cadence (SMD = 0.29; 95% CI, 0.05-0.53; I2 = 0%; P = 0.71), timed-up-and-go test (mean difference (MD) = -2.38; 95% CI, -3.93 to -0.84; I2 = 32%; P = 0.22) and mini-balance evaluation systems test (MD = 2.04; 95% CI, 1.05-3.03; I2 = 0%; P = 0.92). CONCLUSION Evidence from meta-analyses suggests that dual-task training may improve motor and balance abilities in Parkinson's disease patients. Future research should focus on finding the most appropriate dual-task treatment model for patients with different degrees, in order to further improve the rehabilitation treatment of Parkinson's disease.
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Affiliation(s)
- Yi-Hong Du
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Ma
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Yun Hu
- Central Lab, 596680Shanghai Pudong New Area People's Hospital, Shanghai, China
| | - Lei Zhu
- College of Sport Sciences, 56650Qufu Normal University, Qufu, Shandong Province, China
| | - Li-Yan Wang
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ruo-Yu Yang
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Lei-Chao Liang
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Men Jiang
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ming Cai
- College of Rehabilitation Science, 191610Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Jung HT, Kim Y, Lee J, Lee SI, Choe EK. Envisioning the use of in-situ arm movement data in stroke rehabilitation: Stroke survivors' and occupational therapists' perspectives. PLoS One 2022; 17:e0274142. [PMID: 36264782 PMCID: PMC9584451 DOI: 10.1371/journal.pone.0274142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The key for successful stroke upper-limb rehabilitation includes the personalization of therapeutic interventions based on patients' functional ability and performance level. However, therapists often encounter challenges in supporting personalized rehabilitation due to the lack of information about how stroke survivors use their stroke-affected arm outside the clinic. Wearable technologies have been considered as an effective, objective solution to monitor patients' arm use patterns in their naturalistic environments. However, these technologies have remained a proof of concept and have not been adopted as mainstream therapeutic products, and we lack understanding of how key stakeholders perceive the use of wearable technologies in their practice. OBJECTIVE We aim to understand how stroke survivors and therapists perceive and envision the use of wearable sensors and arm activity data in practical settings and how we could design a wearable-based performance monitoring system to better support the needs of the stakeholders. METHODS We conducted semi-structured interviews with four stroke survivors and 15 occupational therapists (OTs) based on real-world arm use data that we collected for contextualization. To situate our participants, we leveraged a pair of finger-worn accelerometers to collect stroke survivors' arm use data in real-world settings, which we used to create study probes for stroke survivors and OTs, respectively. The interview data was analyzed using the thematic approach. RESULTS Our study unveiled a detailed account of (1) the receptiveness of stroke survivors and OTs for using wearable sensors in clinical practice, (2) OTs' envisioned strategies to utilize patient-generated sensor data in the light of providing patients with personalized therapy programs, and (3) practical challenges and design considerations to address for the accelerated integration of wearable systems into their practice. CONCLUSIONS These findings offer promising directions for the design of a wearable solution that supports OTs to develop individually-tailored therapy programs for stroke survivors to improve their affected arm use.
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Affiliation(s)
- Hee-Tae Jung
- Department of BioHealth Informatics, School of Informatics and Computing, Indiana University at IUPUI, Indianapolis, IN, United States of America
| | - Yoojung Kim
- Graduate School of Convergence Science and Technology, Seoul National University, Seoul, S. Korea
| | - Juhyeon Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, United States of America,* E-mail: (EKC); (SIL)
| | - Eun Kyoung Choe
- College of Information Studies, University of Maryland at College Park, College Park, MD, United States of America,* E-mail: (EKC); (SIL)
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14
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O'Keeffe R, Shirazi SY, Bilaloglu S, Jahed S, Bighamian R, Raghavan P, Atashzar SF. Nonlinear functional muscle network based on information theory tracks sensorimotor integration post stroke. Sci Rep 2022; 12:13029. [PMID: 35906239 PMCID: PMC9338017 DOI: 10.1038/s41598-022-16483-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Sensory information is critical for motor coordination. However, understanding sensorimotor integration is complicated, especially in individuals with impairment due to injury to the central nervous system. This research presents a novel functional biomarker, based on a nonlinear network graph of muscle connectivity, called InfoMuNet, to quantify the role of sensory information on motor performance. Thirty-two individuals with post-stroke hemiparesis performed a grasp-and-lift task, while their muscle activity from 8 muscles in each arm was measured using surface electromyography. Subjects performed the task with their affected hand before and after sensory exposure to the task performed with the less-affected hand. For the first time, this work shows that InfoMuNet robustly quantifies changes in functional muscle connectivity in the affected hand after exposure to sensory information from the less-affected side. > 90% of the subjects conformed with the improvement resulting from this sensory exposure. InfoMuNet also shows high sensitivity to tactile, kinesthetic, and visual input alterations at the subject level, highlighting its potential use in precision rehabilitation interventions.
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Affiliation(s)
- Rory O'Keeffe
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA
| | - Seyed Yahya Shirazi
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA
| | - Seda Bilaloglu
- Department of Medicine, New York University Langone Health, New York, NY, USA
| | - Shayan Jahed
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA
| | - Ramin Bighamian
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Preeti Raghavan
- Departments of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - S Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, USA.
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, USA.
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15
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Provencher J, Beaulieu-Guay ÉM, Loranger SD, Schneider C. Repetitive Peripheral Magnetic Stimulation to Improve Ankle Function and Gait in Cerebral Palsy at Adulthood: An open-label Case Study. Brain Res 2022; 1792:147999. [PMID: 35780866 DOI: 10.1016/j.brainres.2022.147999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/26/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022]
Abstract
Repetitive peripheral magnetic stimulation (rPMS) is noninvasive and painless. It drives plasticity of the primary motor cortex (M1) in children with cerebral palsy (CP) and this improves the ankle function and gait. Our study explored whether rPMS of muscles could influence motricity in an adult CP case. A 30-year-old woman with mixed CP participated in four sessions (S1 to S4, one per week) where rPMS was applied bilaterally on leg and trunk muscles (tibialis anterior-TA, hamstrings, transverse abdominis, paraspinal multifidus). Clinical scores and M1 excitability (probed by transcranial magnetic stimulation) were tested at pre-rPMS at S1 (baseline) and S4, then 40 days later (follow-up). The active ankle dorsiflexion was significantly increased and the plantar flexors resistance to stretch reduced as compared to baseline. The improvement of the ankle function was carried-over to the quality of locomotor patterns. Changes persisted until follow-up and were paralleled by drastic changes of M1 excitability. These original findings of rPMS influence on M1 plasticity and motricity are promising for the functional improvement of adult people living with CP and should be replicated in larger-sampled studies.
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Affiliation(s)
- Janie Provencher
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
| | - Éva Marion Beaulieu-Guay
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
| | - Sophy Desbiens Loranger
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
| | - Cyril Schneider
- Laboratory of noninvasive neurostimulation, Centre de recherche du CHU de Québec - Université Laval, Neuroscience division, Department of rehabilitation - Faculty of medicine, Québec City, Canada.
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16
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Borstad A, Nichols-Larsen D, Uswatte G, Strahl N, Simeo M, Proffitt R, Gauthier L. Tactile Sensation Improves Following Motor Rehabilitation for Chronic Stroke: The VIGoROUS Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:525-534. [PMID: 35695197 DOI: 10.1177/15459683221107893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Up to 85% of people with chronic stroke experience somatosensory impairment, which contributes to poor sensorimotor control and non-use of the affected limb. Neurophysiological mechanisms suggest motor rehabilitation may improve tactile sense post-stroke, however, somatosensory recovery has rarely been reported in controlled trials. Objective. To compare the effect of four upper limb motor rehabilitation programs on the recovery of tactile sensation in adults with chronic stroke. Methods. Adults with chronic stroke and mild or moderate upper extremity hemiparesis (n = 167) were enrolled in a multi-site randomized controlled trial. Participants completed three weeks of gaming therapy, gaming therapy with additional telerehabilition, Constraint-Induced Movement therapy, or traditional rehabilitation. Here, we report the results of a secondary outcome, tactile sensation, measured with monofilaments, before and after treatment, and 6 months later. Results. A mixed-effects general linear model revealed similar positive change in tactile sensitivity regardless of the type of training. On average, participants were able to detect a stimulus that was 32% and 33% less after training and at 6-month follow-up, respectively. One-third of participants experienced recategorization of their level of somatosensory impairment (e.g., regained protective sensation) following training. Poorer tactile sensation at baseline was associated with greater change. Conclusions. About one-third of individuals with mild/moderate chronic hemiparesis experience sustained improvements in tactile sensation following motor rehabilitation, regardless of the extent of tactile input in the rehabilitation program. Potential for sensory improvement is an additional motivator for those post-stroke. Characteristics of those who improve and mechanisms of improvement are important future questions. Clinicaltrials.gov NCT02631850.
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Affiliation(s)
- Alexandra Borstad
- Department of Physical Therapy, 3031College of St. Scholastica, Duluth, MN, USA
| | | | - Gitendra Uswatte
- Department of Psychology, University of Alabama Birmingham, Birmingham, AL, USA
| | | | | | - Rachel Proffitt
- Department of Occupational Therapy, University of Missouri, Columbia, MO, USA
| | - Lynne Gauthier
- Department Physical Therapy and Kinesiology, 14710University of Massachusetts Lowell, Lowell, MA, USA
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17
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Ofek H, Alperin M, Knoll T, Livne D, Laufer Y. Explicit versus implicit lower extremity sensory retraining for post-stroke chronic sensory deficits: a randomized controlled trial. Disabil Rehabil 2022:1-7. [PMID: 35649684 DOI: 10.1080/09638288.2022.2080288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Sensory impairment post-stroke limits rehabilitation of balance and gait. This study aims to compare the effect of explicit sensory retraining (ESR) versus implicit repeated exposure (IRE) to stimuli of the lower extremity, assessing their effects on sensation, balance, and gait in individuals with chronic post-stroke sensory impairment. MATERIALS AND METHODS A two-arm parallel double-blind multicenter randomized controlled trial was conducted in physical therapy outpatient clinics. Volunteers with chronic sensory impairment post-stroke participated in 10 sessions of 45 min ESR or IRE, according to a detailed protocol. Outcome measures assessed sensation, balance, mobility, and participation. RESULTS A total of 64 participants were recruited (ESR, n = 34; IRE, n = 30). The intention-to-treat pre-post analysis demonstrated clinically meaningful changes for both interventions (10-31% improvement for the various measures), with no between-group difference or time × group interaction. The effect size for the time effect varied, with the largest being 0.63 for the miniBEST. CONCLUSIONS Sensory rehabilitation treatment by either ESR or IRE led to similar clinically significant changes in the performance of the lower extremity and participation in subjects with sensory loss post-stroke. Both treatment protocols are easy to implement in an outpatient clinic. . CLINICALTRIALS.GOV REGISTRATION NCT01988220. Implications for rehabilitationStandardized, structured, sensory-focused training can improve balance and gait in subjects with chronic post-stroke sensory impairment.Both explicit and implicit learning-based sensory protocols focused on the lower extremity effectively improved balance, mobility, and gait abilities, resulting in enhanced participation of individuals in the chronic post-stroke phase.A series of ten 45-minute treatment sessions in outpatient clinics lead to clinically significant improvements.
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Affiliation(s)
- Hadas Ofek
- Department of Physical Therapy, School of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Department of Physical Therapy, Zefat Academic College, Safed, Israel
| | | | - Tsipi Knoll
- Clalit Health Services, Haifa and Western Galilee, Haifa, Israel
| | - Daphna Livne
- Department of Physical Therapy, Zefat Academic College, Safed, Israel.,Clalit Health Services, Haifa and Western Galilee, Haifa, Israel
| | - Yocheved Laufer
- Department of Physical Therapy, School of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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18
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Zhang X, Xu F, Shi H, Liu R, Wan X. Effects of dual-task training on gait and balance in stroke patients: A meta-analysis. Clin Rehabil 2022; 36:1186-1198. [PMID: 35469457 DOI: 10.1177/02692155221097033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the effects of dual-task training on gait and balance in stroke patients.Data sources: A systematic review of PubMed, Web of Science, Embase and Cochrane Library from their inception through 20 August 2021. REVIEW METHODS The bibliography was screened to identify randomized controlled trials that applied dual-task training to rehabilitation function training in stroke patients. Two reviewers independently screened references, selected relevant studies, extracted data and assessed risk of bias using the Cochrane tool of bias. The primary outcome was the gait and balance parameters. RESULTS A total of 1992 studies were identified and 15 randomized controlled trials were finally included (512 individuals) were analyzed. A meta-analysis was performed and a beneficial effect on rehabilitation training was found. Compared to patients who received conventional rehabilitation therapy, those who received dual-task training showed greater improvement in step length (MD = 3.46, 95% CI [1.01, 5.92], P = 0.006), cadence (MD = 4.92, 95% CI [3.10, 6.74], P < 0.001) and berg balance scale score (MD = 3.10, 95% CI [0.11, 6.09], P = 0.040). There were no differences in the improvements in gait speed (MD = 2.89, 95% CI [ - 2.02, 7.80], P = 0.250) and timed up and go test (MD = -2.62, 95% CI [ - 7.94, 2.71], P = 0.340) between dual-task and control groups. CONCLUSION Dual-task training is an effective training for rehabilitation of stroke patients in step length and cadence, however, the superiority of dual-task training for improving balance function needs further discussion.
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Affiliation(s)
- Xueyi Zhang
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
| | - Feng Xu
- People's Hospital of Queshan, Henan, China
| | - Huijuan Shi
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
| | - Ruijiao Liu
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
| | - Xianglin Wan
- Biomechanics Laboratory, 47838Beijing Sport University, Beijing, China
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19
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Lee KW, Kang SH, Lim SC. Simple and Reliable Position Sense Assessment under Different External Torques: Toward Developing a Post-stroke Proprioception Evaluation Device. IEEE Trans Neural Syst Rehabil Eng 2022; 30:823-832. [PMID: 35324443 DOI: 10.1109/tnsre.2022.3161948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Evaluation of position sense post-stroke is essential for rehabilitation. Position sense may be an output of a process needing position information, external torque, and the sense of effort. Even for healthy individuals, it is unclear whether external torque affects position sense. Thus, evaluation of position sense under different external torques in clinical settings is strongly needed. However, simple devices for measuring position sense under different external torques in clinical settings are lacking. Technologically advanced devices that may evaluate the elbow position sense under different torques were reported to be infeasible clinically because of device complexity and the need for technical experts when analyzing data. To address the unmet need, in this study, a simple and light elbow position sense measurement device was developed that allows clinicians to measure elbow position sense under different external torques in the form of position matching error objectively without any technical difficulties. The feasibility of the device, including intra-session intra-rater reliability and test-retest reliability over two consecutive days, was verified to be clinically applicable using tests with 25 healthy subjects. Thanks to its ease of use, high reliability, and ease of data analysis, it is expected that the device can help to evaluate the position sense post-stroke comprehensively.
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20
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Carlsson H, Lindgren I, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. Experiences of SENSory Relearning of the UPPer Limb (SENSUPP) after Stroke and Perceived Effects: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063636. [PMID: 35329318 PMCID: PMC8955037 DOI: 10.3390/ijerph19063636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 02/04/2023]
Abstract
Recently, it was shown that sensory relearning of the upper limb (SENSUPP) is a promising intervention to improve sensorimotor function after stroke. There is limited knowledge, however, of how participants perceive the training. Here, we explored how persons with sensory impairments in the upper limb experienced the SENSUPP protocol (combined sensory- and motor training and home exercises for 5 weeks) and its effect. Fifteen persons (mean age 59 years; 10 men; >6 months post-stroke) were individually interviewed, and data were analyzed with qualitative content analysis. An overall theme ‘Sensory relearning was meaningful and led to improved ability to perform daily hand activities’ and two categories with six subcategories emerged. The outpatient training was perceived as meaningful, although the exercises were demanding and required concentration. Support from the therapist was helpful and training in small groups appreciated. The home training was challenging due to lack of support, time, and motivation. Small improvements in sensory function were perceived, whereas increased movement control and ability in performing daily hand activities were reported. In conclusion, the SENSUPP protocol is meaningful and beneficial in improving the functioning of the UL in chronic stroke. Improving compliance to the home training, regular follow-ups, and an exercise diary are recommended.
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Affiliation(s)
- Håkan Carlsson
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
- Correspondence:
| | - Ingrid Lindgren
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
| | - Birgitta Rosén
- Department of Translational Medicine—Hand Surgery, Lund University, 205 02 Malmö, Sweden;
- Department of Hand Surgery, Skåne University Hospital, 205 02 Malmö, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
- Department of Clinical Sciences, Lund University, 221 00 Lund, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, 221 00 Lund, Sweden; (I.L.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, 222 41 Lund, Sweden;
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21
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Serrada I, Hordacre B, Hillier S. Recovery of Body Awareness After Stroke: An Observational Study. Front Neurol 2021; 12:745964. [PMID: 34912283 PMCID: PMC8666978 DOI: 10.3389/fneur.2021.745964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Body awareness (BA) is a process that involves sensory awareness originating from the body's physiological states, processes and actions, and is shaped by one's attitudes, perceptions, beliefs and experience of social and cultural context. Impairments in body awareness after stroke are believed to be common and may be an important influence on recovery outcomes. However, recovery of body awareness is poorly understood and receives little consideration in rehabilitation. Aims: To investigate if body awareness changes over time following stroke; and identify if body awareness after stroke is associated with sensation, motor impairment, self-efficacy and quality of life. Methods: An exploratory longitudinal observational study was performed. Participants with a stroke diagnosis and associated motor impairment were recruited from an acute stroke unit. An assessment battery consisting of sensory and motor impairment and function, body awareness, self-efficacy and quality of life measures were used at baseline, 1, 3 and 6 months. Results: A total of 105 people with stroke were recruited. Most recovery in sensation and body awareness occurred within the first month after stroke (all p < 0.01). Sensation and body awareness were correlated with other clinical outcomes (motor impairment, self-efficacy and quality of life), demographics, and stroke specific clinical characteristics (all p < 0.01). Conclusions: This is the first study to track recovery of body awareness after stroke and investigate the relationship it may have in recovery of sensation, motor impairment and function, self-efficacy and quality of life. Further research is now warranted to continue investigation of body awareness and to develop effective stroke-specific assessment and intervention strategies.
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Affiliation(s)
- Ines Serrada
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
| | - Susan Hillier
- Allied Health and Human Performance, Innovation, Implementation and Clinical Translation in Health, University of South Australia, Adelaide, SA, Australia
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22
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Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial. J Hand Ther 2021; 34:515-520. [PMID: 32565102 DOI: 10.1016/j.jht.2020.03.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a single-blinded clinical trial study. Clinical Trial Number registry: IRCT201610223551N4. INTRODUCTION Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life. PURPOSE OF THE STUDY The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke. METHODS Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups. RESULTS The intervention group made improvement in motor function (P = .0001, Cohen's d = 2.14), activities of daily living of upper limb (P = .0001, Cohen's d = 1.32), and spasticity (P = .002, Cohen's d = -0.94). DISCUSSION Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest. CONCLUSION Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.
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23
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Carlsson H, Rosén B, Björkman A, Pessah-Rasmussen H, Brogårdh C. SENSory re-learning of the UPPer limb (SENSUPP) after stroke: development and description of a novel intervention using the TIDieR checklist. Trials 2021; 22:430. [PMID: 34225764 PMCID: PMC8259306 DOI: 10.1186/s13063-021-05375-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background Sensorimotor impairments of upper limb (UL) are common after stroke, leading to difficulty to use the UL in daily life. Even though many have sensory impairments in the UL, specific sensory training is often lacking in stroke rehabilitation. Thus, the aim of this paper is to provide a detailed description of the novel intervention “SENSory re-learning of the UPPer limb after stroke (SENSUPP)” that we have developed to improve functioning in the UL in persons with mild to moderate impairments after stroke. Methods The SENSUPP protocol was designed using information from literature reviews, clinical experience and through consultation of experts in the field. The protocol integrates learning principles based on current neurobiological knowledge and includes repetitive intensive practice, difficulty graded exercises, attentive exploration of a stimulus with focus on the sensory component, and task-specific training in meaningful activities that includes feedback. For reporting the SENSUPP protocol, the Template for Intervention Description and Replication (TIDieR) checklist was used. Results The essential features of the SENSUPP intervention comprise four components: applying learning principles based on current neurobiological knowledge, sensory re-learning (exercises for touch discrimination, proprioception and tactile object recognition), task-specific training in meaningful activities, and home-training. The training is performed twice a week, in 2.5-h sessions for 5 weeks. Conclusion Since there is close interaction between the sensory and motor systems, the SENSUPP intervention may be a promising method to improve UL functioning after stroke. The TIDieR checklist has been very useful for reporting the procedure and development of the training. Trial registration ClinicalTrials.govNCT03336749. Registered on 8 November 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05375-6.
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Affiliation(s)
- Håkan Carlsson
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden. .,Department of Health Sciences, Lund University, Lund, Sweden.
| | - Birgitta Rosén
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Anders Björkman
- Department of Translational Medicine - Hand Surgery, Skåne University Hospital, Malmö, Sweden.,Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christina Brogårdh
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Malmö, Sweden.,Department of Health Sciences, Lund University, Lund, Sweden
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24
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Hagenberg A, Lambert DG, Jussab S, Maltby J, Robinson TG. Inter-lateral Referral of Sensation in Health and Disease Using a Mirror Illusion-A Scoping Review. Arch Clin Neuropsychol 2021; 37:849-864. [PMID: 34152397 PMCID: PMC9113492 DOI: 10.1093/arclin/acab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Perception of touch is expected at the location where it is applied. However, there are indications that being touched may be perceived on the contralateral side when seen as a reflection in a mirror at midline. Such inter-lateral referral of sensation (RS) lacks evidence, as mirror therapy research usually focusses on movement-based techniques. This study aimed to map out existing research across disciplines regarding the effect of RS in health and disease, and to understand whether there is rehabilitation potential in RS. METHOD A scoping review was conducted to map out concepts and keywords across disciplines interested in this topic, using keywords in several languages, and a wide range of databases and additional sources. RESULTS The review revealed mostly cross-sectional experiments and included over 486 participants: healthy, or with stroke, complex regional pain syndrome, amputation, nerve graft surgery or radial fracture. Procedures varied regarding stimulation tool, time and location, with two stimulating replacements, one the face and one a variety of areas. Response rates ranged from 0 to 100%.In general, RS was regarded as a phenomenon or even as a predictor of maladaptive neuroplasticity. There was little research into using RS stimulation as a modulatory tool to improve sensory perception. CONCLUSIONS RS challenges the understanding of touch perception and elicits a range of questions regarding neuro-processing. A modulatory approach using RS has not been described, requires investigation and, if promising, development as an intervention.
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Affiliation(s)
- Annegret Hagenberg
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Health and Social Sciences, Hochschule Fresenius, University of Applied Sciences Idstein, Munich, Germany.,Department of Informatics, University of Leicester, Leicester, UK
| | - Dave G Lambert
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Shifa Jussab
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - John Maltby
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Thompson G Robinson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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25
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Kessner SS, Schlemm E, Gerloff C, Thomalla G, Cheng B. Grey and white matter network disruption is associated with sensory deficits after stroke. NEUROIMAGE-CLINICAL 2021; 31:102698. [PMID: 34023668 PMCID: PMC8163991 DOI: 10.1016/j.nicl.2021.102698] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 12/04/2022]
Abstract
Somatosensory deficits occur in about 60% of patients after ischaemic stroke. Clinical and imaging data of 101 ischaemic stroke patients were analysed. Stroke lesions may disrupt grey (GM) and/or white matter (WM) network. Lesion volume explains 23% of sensory deficit variance; GM / WM disruption adds 14% Subnetwork of postcentral, supramarginal, transverse temporal gyri involved.
Somatosensory deficits after ischaemic stroke are common and can occur in patients with lesions in the anterior parietal cortex and subcortical nuclei. It is less clear to what extent damage to white matter tracts within the somatosensory system may contribute to somatosensory deficits after stroke. We compared the roles of cortical damage and disruption of subcortical white matter tracts as correlates of somatosensory deficit after ischaemic stroke. Clinical and imaging data were assessed in incident stroke patients. Somatosensory deficits were measured using a standardized somatosensory test. Remote effects were quantified by projecting the MRI-based segmented stroke lesions onto a predefined atlas of white matter connectivity. Direct ischaemic damage to grey matter was computed by lesion overlap with grey matter areas. The association between lesion impact scores and sensory deficit was assessed statistically. In 101 patients, median sensory score was 188/193 (97.4%). Lesion volume was associated with somatosensory deficit, explaining 23.3% of variance. Beyond this, the stroke-induced grey and white matter disruption within a subnetwork of the postcentral, supramarginal, and transverse temporal gyri explained an additional 14% of the somatosensory outcome variability. On mutual comparison, white matter network disruption was a stronger predictor than grey matter damage. Ischaemic damage to both grey and white matter are structural correlates of acute somatosensory disturbance after ischaemic stroke. Our data suggest that white matter integrity of a somatosensory network of primary and secondary cortex is a prerequisite for normal processing of somatosensory inputs and might be considered as an additional parameter for stroke outcome prediction in the future.
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Affiliation(s)
- Simon S Kessner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Eckhard Schlemm
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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26
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Gurari N, Drogos JM, Dewald JPA. Investigation of how accurately individuals with hemiparetic stroke can mirror their forearm positions. PLoS One 2021; 16:e0250868. [PMID: 33930065 PMCID: PMC8087025 DOI: 10.1371/journal.pone.0250868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/15/2021] [Indexed: 11/19/2022] Open
Abstract
Current literature suggests that greater than 50% of survivors of a stroke cannot accurately perceive where their upper extremity is positioned. Our recent work demonstrates that the extent to which this perception is affected can depend on how the task is performed. For example, individuals with stroke who have a deficit in mirroring the position of their passively-placed paretic forearm during a between-arms task may accurately reproduce the position of their actively-controlled paretic forearm during a single-arm task. Moreover, the ability of individuals with various types of unilateral lesions to locate their thumb can depend on whether they reach for their paretic thumb or non-paretic thumb. Consequently, we investigated to what extent the accuracy of individuals post-hemiparetic stroke in mirroring forearm positions on a between-arms task is influenced by various conditions. Eighteen participants with hemiparetic stroke rotated their reference forearm to a target position, and then rotated their opposite forearm to concurrently mirror the position of their reference forearm. This task was performed when participants referenced each forearm (paretic, non-paretic) at two target positions (extension, flexion) for two modes of limb control (passive, active). We quantified for every testing scenario of each participant their position-mirroring error. The number of times for which participants were classified as having a deficit was least when mirroring forearm positions at the flexed position when referencing their non-paretic forearm. Additionally, the difference in the magnitude of errors when participants referenced each arm was greater during active than passive movements. Findings from this study provide further evidence that the accuracy with which individuals post stroke perceive the position of their limbs can depend on how a task is performed. Factors to consider include whether movements are active versus passive, which limb is referenced, and where the limb is positioned.
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Affiliation(s)
- Netta Gurari
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America
- Department of Mechanical Engineering, Northwestern University, Evanston, Illinois, United States of America
- * E-mail:
| | - Justin M. Drogos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America
| | - Julius P. A. Dewald
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
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27
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Ferrari F, Shell CE, Thumser ZC, Clemente F, Plow EB, Cipriani C, Marasco PD. Proprioceptive Augmentation With Illusory Kinaesthetic Sensation in Stroke Patients Improves Movement Quality in an Active Upper Limb Reach-and-Point Task. Front Neurorobot 2021; 15:610673. [PMID: 33732129 PMCID: PMC7956990 DOI: 10.3389/fnbot.2021.610673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke patients often have difficulty completing motor tasks even after substantive rehabilitation. Poor recovery of motor function can often be linked to stroke-induced damage to motor pathways. However, stroke damage in pathways that impact effective integration of sensory feedback with motor control may represent an unappreciated obstacle to smooth motor coordination. In this study we investigated the effects of augmenting movement proprioception during a reaching task in six stroke patients as a proof of concept. We used a wearable neurorobotic proprioceptive feedback system to induce illusory kinaesthetic sensation by vibrating participants' upper arm muscles over active limb movements. Participants were instructed to extend their elbow to reach-and-point to targets of differing sizes at various distances, while illusion-inducing vibration (90 Hz), sham vibration (25 Hz), or no vibration was applied to the distal tendons of either their biceps brachii or their triceps brachii. To assess the impact of augmented kinaesthetic feedback on motor function we compared the results of vibrating the biceps or triceps during arm extension in the affected arm of stroke patients and able-bodied participants. We quantified performance across conditions and participants by tracking limb/hand kinematics with motion capture, and through Fitts' law analysis of reaching target acquisition. Kinematic analyses revealed that injecting 90 Hz illusory kinaesthetic sensation into the actively contracting (agonist) triceps muscle during reaching increased movement smoothness, movement directness, and elbow extension. Conversely, injecting 90 Hz illusory kinaesthetic sensation into the antagonistic biceps during reaching negatively impacted those same parameters. The Fitts' law analyses reflected similar effects with a trend toward increased throughput with triceps vibration during reaching. Across all analyses, able-bodied participants were largely unresponsive to illusory vibrational augmentation. These findings provide evidence that vibration-induced movement illusions delivered to the primary agonist muscle involved in active movement may be integrated into rehabilitative approaches to help promote functional motor recovery in stroke patients.
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Affiliation(s)
- Francesca Ferrari
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Courtney E Shell
- Laboratory for Bionic Integration, Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Zachary C Thumser
- Laboratory for Bionic Integration, Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Francesco Clemente
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Christian Cipriani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paul D Marasco
- Laboratory for Bionic Integration, Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
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28
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Cahill LS, Carey LM, Mak-Yuen Y, McCluskey A, Neilson C, O'Connor DA, Lannin NA. Factors influencing allied health professionals' implementation of upper limb sensory rehabilitation for stroke survivors: a qualitative study to inform knowledge translation. BMJ Open 2021; 11:e042879. [PMID: 33608401 PMCID: PMC7896620 DOI: 10.1136/bmjopen-2020-042879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Somatosensory loss is common after stroke with one-in-two individuals affected. Although clinical practice guidelines recommend providing somatosensory rehabilitation, this impairment often remains unassessed and untreated. To address the gap between guideline recommendations and clinical practice, this study sought to understand the factors influencing delivery of evidence-based upper limb sensory rehabilitation after stroke. DESIGN Qualitative study involving focus groups and interviews. Data analysis used an inductive approach (thematic analysis) and deductive analysis using implementation theory (the Theoretical Domains Framework and Normalisation Process Theory). SETTING Eight healthcare organisations in metropolitan and regional areas of Victoria and New South Wales, Australia. PARTICIPANTS Eighty-seven rehabilitation therapists (79% occupational therapists and 21% physiotherapists) were purposively sampled and participated in a knowledge translation study with staggered recruitment from 2014 to 2018. RESULTS Three types of factors influenced therapists' delivery of upper limb somatosensory rehabilitation: individual ('The uncertain, unskilled therapist'), patient ('Patient understanding and priorities') and organisational ('System pressures and resources'). Deductive analysis using implementation theory identified key determinants of practice change, such as opportunities to consolidate new skills, the anticipated benefits of upskilling as a therapy team and the work anticipated by therapists to incorporate a new somatosensory rehabilitation approach. CONCLUSIONS Occupational therapists and physiotherapists hold valuable insights towards practice change in somatosensory rehabilitation from the 'frontline'. Therapists experience barriers to change including a lack of knowledge and skills, lack of resources and organisational pressures. Facilitators for change were identified, including social support and therapists' perceived legitimacy in using new somatosensory rehabilitation approaches. Results will inform the design of a tailored implementation strategy to increase the use of evidence-based somatosensory rehabilitation in Australia. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12615000933550).
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Affiliation(s)
- Liana S Cahill
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
- Occupational Therapy, School of Allied Health, Australian Catholic University, Melbourne, Victoria, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Yvonne Mak-Yuen
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The StrokeEd Collaboration, Sydney, New South Wales, Australia
| | - Cheryl Neilson
- Occupational Therapy, Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Clayton, Victoria, Australia
- Allied Health (Occupational Therapy), Alfred Health, Melbourne, Victoria, Australia
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29
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Handelzalts S, Ballardini G, Avraham C, Pagano M, Casadio M, Nisky I. Integrating Tactile Feedback Technologies Into Home-Based Telerehabilitation: Opportunities and Challenges in Light of COVID-19 Pandemic. Front Neurorobot 2021; 15:617636. [PMID: 33679364 PMCID: PMC7925397 DOI: 10.3389/fnbot.2021.617636] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/07/2021] [Indexed: 12/02/2022] Open
Abstract
The COVID-19 pandemic has highlighted the need for advancing the development and implementation of novel means for home-based telerehabilitation in order to enable remote assessment and training for individuals with disabling conditions in need of therapy. While somatosensory input is essential for motor function, to date, most telerehabilitation therapies and technologies focus on assessing and training motor impairments, while the somatosensorial aspect is largely neglected. The integration of tactile devices into home-based rehabilitation practice has the potential to enhance the recovery of sensorimotor impairments and to promote functional gains through practice in an enriched environment with augmented tactile feedback and haptic interactions. In the current review, we outline the clinical approaches for stimulating somatosensation in home-based telerehabilitation and review the existing technologies for conveying mechanical tactile feedback (i.e., vibration, stretch, pressure, and mid-air stimulations). We focus on tactile feedback technologies that can be integrated into home-based practice due to their relatively low cost, compact size, and lightweight. The advantages and opportunities, as well as the long-term challenges and gaps with regards to implementing these technologies into home-based telerehabilitation, are discussed.
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Affiliation(s)
- Shirley Handelzalts
- Department of Physical Therapy, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
| | - Giulia Ballardini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Chen Avraham
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Mattia Pagano
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Maura Casadio
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
- S.C.I.L Joint Lab, Department of Informatics, Bioengineering, Robotics and System Engineering (DIBRIS), Santa Corona Hospital, Pietra Ligure, Italy
| | - Ilana Nisky
- The Translational Neurorehabilitation Lab at Adi Negev Nahalat Eran, Ofakim, Israel
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Pundik S, Skelly M, McCabe J, Akbari H, Tatsuoka C, Plow EB. Does rTMS Targeting Contralesional S1 Enhance Upper Limb Somatosensory Function in Chronic Stroke? A Proof-of-Principle Study. Neurorehabil Neural Repair 2021; 35:233-246. [PMID: 33514270 DOI: 10.1177/1545968321989338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Somatosensory deficits are prevalent after stroke, but effective interventions are limited. Brain stimulation of the contralesional primary somatosensory cortex (S1) is a promising adjunct to peripherally administered rehabilitation therapies. OBJECTIVE To assess short-term effects of repetitive transcranial magnetic stimulation (rTMS) targeting contralesional (S1) of the upper extremity. METHODS Using a single-session randomized crossover design, stroke survivors with upper extremity somatosensory loss participated in 3 rTMS treatments targeting contralesional S1: Sham, 5 Hz, and 1 Hz. rTMS was delivered concurrently with peripheral of sensory electrical stimulation and vibration of the affected hand. Outcomes included 2-point discrimination (2PD), proprioception, vibration perception threshold, monofilament threshold (size), and somatosensory evoked potential (SEP). Measures were collected before, immediately after treatment, and 1 hour after treatment. Mixed models were fit to analyze the effects of the 3 interventions. RESULTS Subjects were 59.8 ± 8.1 years old and 45 ± 39 months poststroke. There was improvement in 2PD after 5-Hz rTMS for the stroke-affected (F(2, 76.163) = 3.5, P = .035) and unaffected arm (F(2, 192.786) = 10.6, P < .0001). Peak-to-peak SEP amplitudes were greater after 5-Hz rTMS for N33-P45 (F(2, 133.027) = 3.518, P = .032) and N45-P60 (F(2, 67.353) = 3.212, P = .047). Latencies shortened after 5-Hz rTMS for N20 (F(2, 69.64) = 3.37, P = .04), N60 (F(2, 47.343) = 4.375, P = .018), and P100 (F(2, 37.608) = 3.537, P = .039) peaks. There were no differences between changes immediately after the intervention and an hour later. CONCLUSIONS Short-term application of facilitatory high-frequency rTMS (5Hz) to contralesional S1 combined with peripheral somatosensory stimulation may promote somatosensory function. This intervention may serve as a useful adjunct in somatosensory rehabilitation after stroke.
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Affiliation(s)
- Svetlana Pundik
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Margaret Skelly
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Jessica McCabe
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Heba Akbari
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Ela B Plow
- Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA
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Darrow MJ, Mian TM, Torres M, Haider Z, Danaphongse T, Seyedahmadi A, Rennaker RL, Hays SA, Kilgard MP. The tactile experience paired with vagus nerve stimulation determines the degree of sensory recovery after chronic nerve damage. Behav Brain Res 2021; 396:112910. [PMID: 32971197 PMCID: PMC7572822 DOI: 10.1016/j.bbr.2020.112910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 12/22/2022]
Abstract
Loss of sensory function is a common consequence of neurological injury. Recent clinical and preclinical evidence indicates vagus nerve stimulation (VNS) paired with tactile rehabilitation, consisting of delivery of a variety of mechanical stimuli to the hyposensitive skin surface, yields substantial and long-lasting recovery of somatosensory function after median and ulnar nerve transection and repair. Here, we tested the hypothesis that a specific component of the tactile rehabilitation paired with VNS is necessary for recovery of somatosensory function. In a second experiment in a separate cohort, we investigated whether VNS paired with tactile rehabilitation could improve skilled forelimb motor function. Elements of the study design, including planned sample size, assessments, and statistical comparisons, were preregistered prior to beginning data collection (https://osf.io/3tm8u/). Animals received a peripheral nerve injury (PNI) causing chronic sensory loss. Eight weeks after injury, animals were given a VNS implant followed by six weeks of tactile rehabilitation sessions consisting of repeated application of one of two distinct mechanical stimuli, a filament or a paintbrush, to the previously denervated forepaw. VNS paired with either filament indentation or brushing of the paw significantly improved recovery of forelimb withdrawal thresholds after PNI compared to tactile rehabilitation without VNS. The effect size was twice as large when VNS was paired with brushing compared to VNS paired with point indentation. An independent replication in a second cohort confirmed that VNS paired with brush restored forelimb withdrawal thresholds to normal. These rats displayed significant improvements in performance on a skilled forelimb task compared to rats that did not receive VNS. These findings support the utility of pairing VNS with tactile rehabilitation to improve recovery of somatosensory and motor function after neurological injury. Additionally, this study demonstrates that the sensory characteristics of the rehabilitation paired with VNS determine the degree of recovery.
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Affiliation(s)
- Michael J Darrow
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Tabarak M Mian
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Miranda Torres
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Zainab Haider
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Tanya Danaphongse
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Armin Seyedahmadi
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Robert L Rennaker
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
| | - Seth A Hays
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States.
| | - Michael P Kilgard
- The University of Texas at Dallas, Texas Biomedical Device Center, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, Erik Jonsson School of Engineering and Computer Science, Department of Bioengineering, 800 West Campbell Road, Richardson, TX 75080-3021, United States; The University of Texas at Dallas, School of Behavioral and Brain Sciences, 800 West Campbell Road, Richardson, TX 75080-3021, United States
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Pinto JO, Dores AR, Peixoto B, Geraldo A, Barbosa F. Systematic Review of Sensory Stimulation Programs in the Rehabilitation of Acquired Brain Injury. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Acquired Brain Injury (ABI) can lead to sensory deficits and compromise functionality. However, most studies have been focused on motor stimulation in stroke and traumatic brain injury (TBI). Sensory stimulation in stroke and mild/moderate TBI has received reduced interest. The main objective of this review is to know the methodological characteristics and effects of sensory programs in ABI. Studies with the purpose of testing the efficacy of those programs were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty-three studies were included in this review. The results show that in most studies sensory stimulation started within 12 months after injury and there is no consensus regarding frequency, duration and number of sessions, duration of intervention, and instruments used to assess outcomes. Most programs involved unisensory stimulation, and vision was the predominant target. The most used methods were compensation and somatosensory discrimination training. Most studies used a pre- and post-intervention assessment, with few studies comprising follow-up assessment. Regarding the studies revised, the interventions with positive outcomes in ABI are: compensation, cognitive training, vestibular intervention, somatosensory discrimination training, proprioceptive stimulation with muscle vibration, and sustained attention training with olfactory stimulation. Available findings suggest that sensory stimulation has positive results with immediate and long-term improvements in sensory functioning. This review provides useful information to improve rehabilitation and to design future investigation.
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Affiliation(s)
- Joana O. Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | | | - Bruno Peixoto
- CESPU, University Institute of Health Sciences, Gandra, Portugal
- NeuroGen – Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Andreia Geraldo
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Portugal
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Pillette L, Lotte F, N'Kaoua B, Joseph PA, Jeunet C, Glize B. Why we should systematically assess, control and report somatosensory impairments in BCI-based motor rehabilitation after stroke studies. NEUROIMAGE-CLINICAL 2020; 28:102417. [PMID: 33039972 PMCID: PMC7551360 DOI: 10.1016/j.nicl.2020.102417] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/22/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
Brain-Computer Interfaces (BCI)-based therapy relies on timely sensory feedback. Somatosensory loss is usually not reported for these therapies. Yet, it influences motor imagery, neuroplasticity and motor rehabilitation. And stroke-induced somatosensory impairments are frequent and diverse. Thus, BCI-based motor therapy efficiency likely depends on somatosensory abilities.
The neuronal loss resulting from stroke forces 80% of the patients to undergo motor rehabilitation, for which Brain-Computer Interfaces (BCIs) and NeuroFeedback (NF) can be used. During the rehabilitation, when patients attempt or imagine performing a movement, BCIs/NF provide them with a synchronized sensory (e.g., tactile) feedback based on their sensorimotor-related brain activity that aims at fostering brain plasticity and motor recovery. The co-activation of ascending (i.e., somatosensory) and descending (i.e., motor) networks indeed enables significant functional motor improvement, together with significant sensorimotor-related neurophysiological changes. Somatosensory abilities are essential for patients to perceive the feedback provided by the BCI system. Thus, somatosensory impairments may significantly alter the efficiency of BCI-based motor rehabilitation. In order to precisely understand and assess the impact of somatosensory impairments, we first review the literature on post-stroke BCI-based motor rehabilitation (14 randomized clinical trials). We show that despite the central role that somatosensory abilities play on BCI-based motor rehabilitation post-stroke, the latter are rarely reported and used as inclusion/exclusion criteria in the literature on the matter. We then argue that somatosensory abilities have repeatedly been shown to influence the motor rehabilitation outcome, in general. This stresses the importance of also considering them and reporting them in the literature in BCI-based rehabilitation after stroke, especially since half of post-stroke patients suffer from somatosensory impairments. We argue that somatosensory abilities should systematically be assessed, controlled and reported if we want to precisely assess the influence they have on BCI efficiency. Not doing so could result in the misinterpretation of reported results, while doing so could improve (1) our understanding of the mechanisms underlying motor recovery (2) our ability to adapt the therapy to the patients’ impairments and (3) our comprehension of the between-subject and between-study variability of therapeutic outcomes mentioned in the literature.
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Affiliation(s)
- Léa Pillette
- Inria, 200 av.de la Vieille Tour, 33400 Talence, France; LaBRI (Univ.Bordeaux, CNRS, Bordeaux-INP), 351, cours de la Libération, 33405 Talence, France.
| | - Fabien Lotte
- Inria, 200 av.de la Vieille Tour, 33400 Talence, France; LaBRI (Univ.Bordeaux, CNRS, Bordeaux-INP), 351, cours de la Libération, 33405 Talence, France.
| | - Bernard N'Kaoua
- Handicap, Activity, Cognition, Health, Inserm/University of Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France.
| | - Pierre-Alain Joseph
- Handicap, Activity, Cognition, Health, Inserm/University of Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France; Service MPR Pôle de Neurosciences Cliniques CHU, University of Bordeaux, Place Amélie Raba-Léon, 33000 Bordeaux cedex, France.
| | - Camille Jeunet
- CLLE (CNRS, Univ.Toulouse Jean Jaurès), 5 Allées Antonio Machado, 31058 Toulouse cedex 9, France.
| | - Bertrand Glize
- Handicap, Activity, Cognition, Health, Inserm/University of Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux cedex, France; Service MPR Pôle de Neurosciences Cliniques CHU, University of Bordeaux, Place Amélie Raba-Léon, 33000 Bordeaux cedex, France.
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Mahmoudzadeh A, Nakhostin Ansari N, Naghdi S, Sadeghi-Demneh E, Motamedzadeh O, Shaw BS, Shariat A, Shaw I. Effect of Ankle Plantar Flexor Spasticity Level on Balance in Patients With Stroke: Protocol for a Cross-Sectional Study. JMIR Res Protoc 2020; 9:e16045. [PMID: 32663137 PMCID: PMC7474409 DOI: 10.2196/16045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/10/2019] [Accepted: 10/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The lower limb spasticity after stroke can affect the balance and gait of patients with stroke. OBJECTIVE The aim of this study is to assess the effects of ankle plantar flexor spasticity level on balance in patients with stroke. METHODS Patients with stroke were recruited from neurology and physiotherapy clinics in Tehran, Iran. Based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS), the eligible patients with stroke were divided into 2 groups: high spasticity (MMAS score≥2) and low spasticity (MMAS score<2). The primary outcome measures were the MMAS scores, Activities-Specific Balance Confidence questionnaire scores, eyes-open and eyes-closed posturography measures, and Timed Up and Go test results. The secondary outcome measures were the ankle passive range of motion and ankle joint proprioception. The t test, mixed model univariate analysis of variance, and Spearman rank correlation were used for statistical analysis. RESULTS Data collection and statistical analysis are complete. The interpretation of results is underway. We expect the results to be published in winter 2020. CONCLUSIONS We believe that patients with high ankle plantar flexor spasticity after stroke will demonstrate greater balance dysfunction, which will worsen with impaired proprioception, passive range of motion, and eyes closed. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/16045.
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Affiliation(s)
- Ashraf Mahmoudzadeh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Neuroscience Institute, Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Neuroscience Institute, Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Sadeghi-Demneh
- Prosthetics and Orthotics Department, Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Motamedzadeh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Brandon S Shaw
- Department of Human Movement Science, University of Zululand, Kwazulu-Natal, South Africa
| | - Ardalan Shariat
- Neuroscience Institute, Sports Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, Kwazulu-Natal, South Africa
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35
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Nataletti S, Leo F, Seminara L, Trompetto C, Valle M, Dosen S, Brayda L. Temporal Asynchrony but Not Total Energy Nor Duration Improves the Judgment of Numerosity in Electrotactile Stimulation. Front Bioeng Biotechnol 2020; 8:555. [PMID: 32656190 PMCID: PMC7325877 DOI: 10.3389/fbioe.2020.00555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/07/2020] [Indexed: 11/13/2022] Open
Abstract
Stroke patients suffer from impairments of both motor and somatosensory functions. The functional recovery of upper extremities is one of the primary goals of rehabilitation programs. Additional somatosensory deficits limit sensorimotor function and significantly affect its recovery after the neuromotor injury. Sensory substitution systems, providing tactile feedback, might facilitate manipulation capability, and improve patient's dexterity during grasping movements. As a first step toward this aim, we evaluated the ability of healthy subjects in exploiting electrotactile feedback on the shoulder to determine the number of perceived stimuli in numerosity judgment tasks. During the experiment, we compared four different stimulation patterns (two simultaneous: short and long, intermittent and sequential) differing in total duration, total energy, or temporal synchrony. The experiment confirmed that the subject ability to enumerate electrotactile stimuli decreased with increasing the number of active electrodes. Furthermore, we found that, in electrotactile stimulation, the temporal coding schemes, and not total energy or duration modulated the accuracy in numerosity judgment. More precisely, the sequential condition resulted in significantly better numerosity discrimination than intermittent and simultaneous stimulation. These findings, together with the fact that the shoulder appeared to be a feasible stimulation site to communicate tactile information via electrotactile feedback, can serve as a guide to deliver tactile feedback to proximal areas in stroke survivors who lack sensory integrity in distal areas of their affected arm, but retain motor skills.
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Affiliation(s)
- Sara Nataletti
- Robotics, Brain and Cognitive Science Department, Istituto Italiano di Tecnologia, Genoa, Italy.,Department of Informatics Bioengineering Robotics, and System Engineering, University of Genoa, Genoa, Italy
| | - Fabrizio Leo
- Robotics, Brain and Cognitive Science Department, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lucia Seminara
- Department of Electrical, Electronic, Telecommunications Engineering and Naval Architecture, University of Genoa, Genoa, Italy
| | - Carlo Trompetto
- Department of Neuroscience, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences, University of Genoa, Genoa, Italy
| | - Maurizio Valle
- Department of Electrical, Electronic, Telecommunications Engineering and Naval Architecture, University of Genoa, Genoa, Italy
| | - Strahinja Dosen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Luca Brayda
- Robotics, Brain and Cognitive Science Department, Istituto Italiano di Tecnologia, Genoa, Italy.,Acoesis Inc., Genoa, Italy
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Gray VL, Fujimoto M, Rogers MW. Lateral Perturbation-Induced and Voluntary Stepping in Fallers and Nonfallers After Stroke. Phys Ther 2020; 100:1557-1567. [PMID: 32529236 PMCID: PMC7608778 DOI: 10.1093/ptj/pzaa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 01/23/2020] [Accepted: 04/09/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke. METHODS This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated. RESULTS Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation. CONCLUSION A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed. IMPACT Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk.
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Affiliation(s)
| | - Masahiro Fujimoto
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, Kashiwa, Japan
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine
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Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. SENSORS 2020; 20:s20113247. [PMID: 32517315 PMCID: PMC7308812 DOI: 10.3390/s20113247] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.
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Hejazi-Shirmard M, Taghizadeh G, Azad A, Lajevardi L, Rassafiani M. Sensory retraining improves light touch threshold of the paretic hand in chronic stroke survivors: a single-subject A-B design. Somatosens Mot Res 2020; 37:74-83. [PMID: 32162568 DOI: 10.1080/08990220.2020.1736021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Light touch, one of the primary and basic sensations, is often neglected in sensory retraining programmes for stroke survivors.Objective: This study aimed to investigate the effects of sensory retraining on the light touch threshold of the hand, dexterity and upper limb motor function of chronic stroke survivors.Methods: Five chronic stroke survivors with sensory impairment participated in this single-subject A-B design study. In baseline (A) phase, they only received standard rehabilitation. In the treatment (B) phase, they received a 6-week sensory retraining intervention in addition to standard rehabilitation. In both phases, they were evaluated every 3 days. Light touch threshold, manual dexterity and upper limb motor function were assessed using Semmes-Weinstein Monofilaments, Box-Block Test and Fugl-Meyer Assessment, respectively. Visual analysis, nonparametric Mann-Whitney U test and, c-statistic were used for assessing the changes between phases.Results: All participants indicated changes in trend or slope of the total score of light touch or both between the two phases. The results of the c-statistic also showed the statistical difference in the total score of light touch between baseline and treatment in all participants (p < 0.001). Also, the results of the c-statistic and Mann-Whitney U test supported the difference of manual dexterity and motor function of the upper limb between baseline and treatment in all participants (p < 0.001).Conclusion: Current findings showed that sensory retraining may be an effective adjunctive intervention for improving the light touch threshold of the hand, dexterity and upper limb motor function in chronic stroke survivors.
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Affiliation(s)
- Mahnaz Hejazi-Shirmard
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Akram Azad
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Laleh Lajevardi
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Mehdi Rassafiani
- Occupational Therapy Department, Faculty of Allied Health Sciences, Kuwait University, Kuwait City, Kuwait.,Neurorehabilitation Research Center, The University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Zandvliet SB, van Wegen EEH, Campfens SF, van der Kooij H, Kwakkel G, Meskers CGM. Position-Cortical Coherence as a Marker of Afferent Pathway Integrity Early Poststroke: A Prospective Cohort Study. Neurorehabil Neural Repair 2020; 34:344-359. [PMID: 32129142 PMCID: PMC7168808 DOI: 10.1177/1545968319893289] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. Addressing the role of somatosensory impairment, that is, afferent pathway integrity, in poststroke motor recovery may require neurophysiological assessment. Objective. We investigated the longitudinal construct validity of position-cortical coherence (PCC), that is, the agreement between mechanically evoked wrist perturbations and electroencephalography (EEG), as a measure of afferent pathway integrity. Methods. PCC was measured serially in 48 patients after a first-ever ischemic stroke in addition to Fugl-Meyer motor assessment of the upper extremity (FM-UE) and Nottingham Sensory Assessment hand-finger subscores (EmNSA-HF, within 3 and at 5, 12, and 26 weeks poststroke. Changes in PCC over time, represented by percentage presence of PCC (%PCC), mean amplitude of PCC over the affected (Amp-A) and nonaffected hemisphere (Amp-N) and a lateralization index (L-index), were analyzed, as well as their association with FM-UE and EmNSA-HF. Patients were retrospectively categorized based on FM-UE score at baseline and 26 weeks poststroke into high- and low-baseline recoverers and non-recoverers. Results. %PCC increased from baseline to 12 weeks poststroke (β = 1.6%, CI = 0.32% to 2.86%, P = .01), which was no longer significant after adjusting for EmNSA-HF and FM-UE. A significant positive association was found between %PCC, Amp-A, and EmNSA-HF. Low-baseline recoverers (n = 8) showed longitudinally significantly higher %PCC than high-baseline recoverers (n = 23). Conclusions. We demonstrated the longitudinal construct validity of %PCC and Amp-A as a measure of afferent pathway integrity. A high %PCC in low-baseline recoverers suggests that this measure also contains information on cortical excitability. Use of PCC as an EEG-based measure to address the role of somatosensory integrity to motor recovery poststroke requires further attention.
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Affiliation(s)
- Sarah B Zandvliet
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, , Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, , Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - S Floor Campfens
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Herman van der Kooij
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, , Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centres, Reade, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, , Amsterdam Neuroscience and Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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40
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Beaulieu LD, Schneider C, Massé-Alarie H, Ribot-Ciscar E. A new method to elicit and measure movement illusions in stroke by means of muscle tendon vibration: the Standardized Kinesthetic Illusion Procedure (SKIP). Somatosens Mot Res 2020; 37:28-36. [PMID: 31973656 DOI: 10.1080/08990220.2020.1713739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Muscle tendon vibration (MTV) strongly activates muscle spindles and can evoke kinaesthetic illusions. Although potentially relevant for sensorimotor rehabilitation in stroke, MTV is scarcely used in clinical practice, likely because of the absence of standardised procedures to elicit and characterise movement illusions. This work developed and validated a Standardised Kinaesthetic Illusion Procedure (SKIP) to favour the use of MTV-induced illusions in clinical settings.Materials and methods: SKIP scores were obtained in 15 individuals with chronic stroke and 18 age- and gender-matched healthy counterparts. A further 13 healthy subjects were tested to provide more data with the general population. MTV was applied over the Achilles tendon and SKIP scoring system characterised the clearness and direction of the illusions of ankle dorsiflexion movements.Results: All healthy and stroke participants perceived movement illusions. SKIP scores on the paretic side were significantly lower compared to the non paretic and healthy. Illusions were less clear and sometimes in unexpected directions with the impaired ankle, but still possible to elicit in the presence of sensorimotor deficits.Conclusions: SKIP represents an ancillary and potentially useful clinical method to elicit and characterise illusions of movements induced by MTV. SKIP could be relevant to further assess the processing of proprioceptive afferents in stroke and their potential impact on motor control and recovery. It may be used to guide therapy and improve sensorimotor recovery. Future work is needed to investigate the metrological properties of our method (reliability, responsiveness, etc.), and also the neurophysiological underpinnings of MTV-induced illusions.
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Affiliation(s)
- Louis-David Beaulieu
- Biomechanical and Neurophysiological Research Lab in neuro-musculo-skelettal Rehabilitation (BioNR Lab, Université du Québec à Chicoutimi, Chicoutimi, Canada
| | - Cyril Schneider
- Noninvasive Stimulation Laboratory, Research Center - Neuroscience Division and Department Rehabilitation, CHU de Québec-Université Laval, Quebec City, Canada
| | - Hugo Massé-Alarie
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Université Laval, Quebec City, Canada
| | - Edith Ribot-Ciscar
- Laboratoire de Neurosciences Sensorielles et Cognitives, Aix Marseille Univ, CNRS, LNSC, Marseille, France
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41
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Kessner SS, Schlemm E, Cheng B, Bingel U, Fiehler J, Gerloff C, Thomalla G. Somatosensory Deficits After Ischemic Stroke. Stroke 2020; 50:1116-1123. [PMID: 30943883 DOI: 10.1161/strokeaha.118.023750] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background and Purpose- About 50% to 80% of stroke survivors present with somatosensory deficits. Somatosensory deficits because of an ischemic stroke are determined by the infarct location. However, a detailed understanding of the long-term effect of lesions on somatosensory performance is lacking. Methods- This prospective observational study enrolled 101 ischemic stroke patients. For voxel-based lesion-symptom mapping, magnetic resonance imaging fluid-attenuated inversion recovery imaging infarct lesions were segmented within 5 days after stroke. Standardized tests such as the National Institutes of Health Stroke Scale and the Rivermead Assessment of Somatosensory Performance were performed during acute stage, after 3 and 12 months. This included bilateral testing for multiple tactile and proprioceptive somatosensory modalities (pressure, light touch, sharp-dull discrimination, temperature discrimination, sensory extinction, 2-point discrimination, and joint position and movement sense). We further study the association of acute somatosensory deficit with functional outcome 12 months after stroke assessed by the modified Rankin Scale using univariate and multiple linear regression analysis also including acute motor deficit assessed by the arm research action test. Results- Sixty patients (59.4%) showed impairment in at least one somatosensory modality. Light touch was most frequently affected (38.7%), whereas temperature was least frequently affected (21.8%). After 3 months, significant recovery was observed in all somatosensory modalities, with only minor additional improvements after 12 months. Voxel-based lesion-symptom mapping revealed significant associations of lesions in the primary and secondary somatosensory and insular cortex with somatosensory deficits. Acute somatosensory deficit was associated with functional outcome at 12 months. However, including the acute motor deficit, somatosensory deficit was no longer an independent predictor of functional outcome. Conclusions- Our study confirms that somatosensory deficits are frequent in acute ischemic stroke but largely recover over time. Infarct lesions in the primary and secondary somatosensory cortex and insula show a robust association with somatosensory impairment. Long-term disability is influenced by somatosensory deficits but driven by motor symptoms.
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Affiliation(s)
- Simon S Kessner
- From the Department of Neurology (S.S.K., E.S., B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Eckhard Schlemm
- From the Department of Neurology (S.S.K., E.S., B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Bastian Cheng
- From the Department of Neurology (S.S.K., E.S., B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Germany (U.B.)
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Gerloff
- From the Department of Neurology (S.S.K., E.S., B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
| | - Götz Thomalla
- From the Department of Neurology (S.S.K., E.S., B.C., C.G., G.T.), University Medical Center Hamburg-Eppendorf, Germany
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Darrow MJ, Mian TM, Torres M, Haider Z, Danaphongse T, Rennaker RL, Kilgard MP, Hays SA. Restoration of Somatosensory Function by Pairing Vagus Nerve Stimulation with Tactile Rehabilitation. Ann Neurol 2020; 87:194-205. [PMID: 31875975 DOI: 10.1002/ana.25664] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Sensory dysfunction is a common consequence of many forms of neurological injury, including stroke and nerve damage. Rehabilitative paradigms that incorporate sensory retraining can provide modest benefits, but the majority of patients are left with lasting sensory loss. We have developed a novel strategy that uses closed-loop vagus nerve stimulation (VNS) paired with tactile rehabilitation to enhance synaptic plasticity and facilitate recovery of sensory function. METHODS A clinical case report provides initial evidence that a similar implementation of closed-loop VNS paired with a tactile rehabilitation regimen could improve recovery of somatosensory function. Here, we sought to build on these promising initial clinical data and rigorously evaluate the ability of VNS paired with tactile rehabilitation to improve recovery in an animal model of chronic sensory loss. The study design, including planned sample size, assessments, and statistical comparisons, was preregistered prior to beginning data collection (https://osf.io/xsnj5/). RESULTS VNS paired with tactile rehabilitation resulted in a significant and nearly complete recovery of mechanosensory withdrawal thresholds. Equivalent tactile rehabilitation without VNS failed to improve sensory function. This VNS-dependent restoration of sensory thresholds was maintained for several months after the cessation of stimulation, illustrating long-term benefits. Moreover, VNS paired with tactile rehabilitation resulted in significant generalized improvements in other measures of sensorimotor forepaw function. INTERPRETATION Given the safety and tolerability of VNS therapy, these findings suggest that incorporating VNS paired with sensory retraining into rehabilitative regimens may represent a fundamentally new method to increase recovery of sensory function after neurological injury. ANN NEUROL 2020;87:194-205.
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Affiliation(s)
- Michael J Darrow
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX
| | - Tabarak M Mian
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Miranda Torres
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Zainab Haider
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Tanya Danaphongse
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX
| | - Robert L Rennaker
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Michael P Kilgard
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
| | - Seth A Hays
- Texas Biomedical Device Center, University of Texas at Dallas, Richardson, TX.,Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, University of Texas at Dallas, Richardson, TX.,School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX
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43
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Abualait TS. Effects of transcranial direct current stimulation of primary motor cortex on cortical sensory deficits and hand dexterity in a patient with stroke: A case study. J Int Med Res 2019; 48:300060519894137. [PMID: 31885346 PMCID: PMC7783281 DOI: 10.1177/0300060519894137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Fine motor and manual dexterity deficits are the main causes of significant
physical and psychosocial impairments in stroke survivors. Transcranial direct
current stimulation (tDCS) is a noninvasive brain stimulation technique used to
modulate brain activity and improve clinical outcomes. This study was performed
to investigate the efficacy of dual-hemispheric tDCS of the primary motor cortex
(M1) in a patient with stroke exhibiting cortical sensation deficits. A
double-blind, sham-controlled, single-case study was conducted. The patient
underwent 30 sessions of sham tDCS followed by 30 real-stimulation sessions over
both M1 cortices. Each session involved 20 minutes of 2-mA stimulation (current
density, 0.08 mA/cm2; total charge density, 0.096 C/cm2).
Functional measures were assessed using the Action Research Arm Test, grooved
pegboard test, nine-hole peg test, and box and block test at several time
points. Structural and diffusion tensor imaging data were acquired before
(t0) and after (t1) stimulation. Slight improvements
following sham tDCS were observed. However, following real stimulation, all
results at all time points were clinically significant. Higher fractional
anisotropy of the corticospinal tract and regional gray matter density were
positively correlated with better recovery of fine motor skills. tDCS
intervention induced functional improvement and structural changes in this
patient with stroke.
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Affiliation(s)
- Turki S. Abualait
- Turki S. Abualait, Department of Physical
Therapy, College of Applied Medical Sciences, Eastern Campus, Imam Abdulrahman
Bin Faisal University, PO Box 2435, Dammam 31451, Saudi Arabia.
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44
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Rafiei MH, Kelly KM, Borstad AL, Adeli H, Gauthier LV. Predicting Improved Daily Use of the More Affected Arm Poststroke Following Constraint-Induced Movement Therapy. Phys Ther 2019; 99:1667-1678. [PMID: 31504952 PMCID: PMC7105113 DOI: 10.1093/ptj/pzz121] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/02/2019] [Accepted: 04/24/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Constraint-induced movement therapy (CI therapy) produces, on average, large and clinically meaningful improvements in the daily use of a more affected upper extremity in individuals with hemiparesis. However, individual responses vary widely. OBJECTIVE The study objective was to investigate the extent to which individual characteristics before treatment predict improved use of the more affected arm following CI therapy. DESIGN This study was a retrospective analysis of 47 people who had chronic (> 6 months) mild to moderate upper extremity hemiparesis and were consecutively enrolled in 2 CI therapy randomized controlled trials. METHODS An enhanced probabilistic neural network model predicted whether individuals showed a low, medium, or high response to CI therapy, as measured with the Motor Activity Log, on the basis of the following baseline assessments: Wolf Motor Function Test, Semmes-Weinstein Monofilament Test of touch threshold, Motor Activity Log, and Montreal Cognitive Assessment. Then, a neural dynamic classification algorithm was applied to improve prognostic accuracy using the most accurate combination obtained in the previous step. RESULTS Motor ability and tactile sense predicted improvement in arm use for daily activities following intensive upper extremity rehabilitation with an accuracy of nearly 100%. Complex patterns of interaction among these predictors were observed. LIMITATIONS The fact that this study was a retrospective analysis with a moderate sample size was a limitation. CONCLUSIONS Advanced machine learning/classification algorithms produce more accurate personalized predictions of rehabilitation outcomes than commonly used general linear models.
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Affiliation(s)
- Mohammad H Rafiei
- Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Kristina M Kelly
- Department of Neurology, The Ohio State University, Columbus, Ohio
| | - Alexandra L Borstad
- Department of Physical Therapy, The College of St Scholastica, Duluth, Minnesota
| | - Hojjat Adeli
- Department of Biomedical Informatics, Department of Neurology, Department of Neuroscience, The Ohio State University
| | - Lynne V Gauthier
- Department of Physical Therapy and Kinesiology, University of Massachusetts Lowell, 3 Solomon Way, Weed Hall 218D, Lowell, MA 01854 (USA)
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45
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Marini F, Zenzeri J, Pippo V, Morasso P, Campus C. Neural correlates of proprioceptive upper limb position matching. Hum Brain Mapp 2019; 40:4813-4826. [PMID: 31348604 PMCID: PMC6865654 DOI: 10.1002/hbm.24739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022] Open
Abstract
Proprioceptive information allows humans to perform smooth coordinated movements by constantly updating one's mind with knowledge of the position of one's limbs in space. How this information is combined with other sensory modalities and centrally processed to form conscious perceptions of limb position remains relatively unknown. What has proven even more elusive is pinpointing the contribution of proprioception in cortical activity related to motion. This study addresses these gaps by examining electrocortical dynamics while participants performed an upper limb position matching task in two conditions, namely with proprioceptive feedback or with both visual and proprioceptive feedback. Specifically, we evaluated the reduction of the electroencephalographic power (desynchronization) in the μ frequency band (8-12 Hz), which is known to characterize the neural activation associated with motor control and behavior. We observed a stronger desynchronization in the left motor and somatosensory areas, contralateral to the moving limb while, parietal and occipital regions, identifying association and visual areas, respectively, exhibited a similar activation level in the two hemispheres. Pertaining to the influence of the two experimental conditions it affected only movement's offset, and precisely we found that when matching movements are performed relying only on proprioceptive information, a lower cortical activity is entailed. This effect was strongest in the visual and association areas, while there was a minor effect in the hand motor and somatosensory areas.
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Affiliation(s)
- Francesca Marini
- Department of Robotics, Brain and Cognitive SciencesIstituto Italiano di TecnologiaGenoaItaly
| | - Jacopo Zenzeri
- Department of Robotics, Brain and Cognitive SciencesIstituto Italiano di TecnologiaGenoaItaly
| | - Valentina Pippo
- Department of Robotics, Brain and Cognitive SciencesIstituto Italiano di TecnologiaGenoaItaly
| | - Pietro Morasso
- Department of Robotics, Brain and Cognitive SciencesIstituto Italiano di TecnologiaGenoaItaly
| | - Claudio Campus
- U‐VIP Unit for Visually Impaired PeopleIstituto Italiano di TecnologiaGenoaItaly
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Herter TM, Scott SH, Dukelow SP. Vision does not always help stroke survivors compensate for impaired limb position sense. J Neuroeng Rehabil 2019; 16:129. [PMID: 31666135 PMCID: PMC6822422 DOI: 10.1186/s12984-019-0596-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Position sense is commonly impaired after stroke. Traditional rehabilitation methods instruct patients to visualize their limbs to compensate for impaired position sense. OBJECTIVE Our goal was to evaluate how the use of vision influences impaired position sense. METHODS We examined 177 stroke survivors, an average of 12.7 days (+/- 10 days (SD)) post-stroke, and 133 neurologically-intact controls with a robotic assessment of position sense. The robot positioned one limb (affected) and subjects attempted to mirror-match the position using the opposite limb (unaffected). Subjects completed the test without, then with vision of their limbs. We examined three measures of position sense: variability (Var), contraction/expansion (C/E) and systematic shift (Shift). We classified stroke survivors as having full compensation if they performed the robotic task abnormally without vision but corrected performance within the range of normal with vision. Stroke survivors were deemed to have partial compensation if they performed the task outside the range of normal without and with vision, but improved significantly with vision. Those with absent compensation performed the task abnormally in both conditions and did not improve with vision. RESULTS Many stroke survivors demonstrated impaired position sense with vision occluded [Var: 116 (66%), C/E: 91 (51%), Shift: 52 (29%)]. Of those stroke survivors with impaired position sense, some exhibited full compensation with vision [Var: 23 (20%), C/E: 42 (46%), Shift: 32 (62%)], others showed partial compensation [Var: 37 (32%), C/E: 8 (9%), Shift: 3 (6%)] and many displayed absent compensation (Var: 56 (48%), C/E: 41 (45%), Shift: 17 (33%)]. Stroke survivors with an affected left arm, visuospatial neglect and/or visual field defects were less likely to compensate for impaired position sense using vision. CONCLUSIONS Our results indicate that vision does not help many stroke survivors compensate for impaired position sense, at least within the current paradigm. This contrasts with historical reports that vision helps compensate for proprioceptive loss following neurologic injuries.
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Affiliation(s)
- Troy M Herter
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Department of Anatomy and Cell Biology, Queen's University, Kingston, Ontario, Canada
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Sean P Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
- Department of Clinical Neurosciences, University of Calgary, 1403 29th St NW, Foothills Medical Centre, South Tower-Room 905, Calgary, AB, T2N2T9, Canada.
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Zhang Y, Nolan KJ, Zanotto D. Immediate Effects of Force Feedback and Plantar Somatosensory Stimuli on Inter-limb Coordination During Perturbed Walking. IEEE Int Conf Rehabil Robot 2019; 2019:252-257. [PMID: 31374638 DOI: 10.1109/icorr.2019.8779565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Single-sided motor weakness, also known as hemiparesis, is the most prevalent gait impairment among stroke survivors, which often results in gait asymmetry. Studies on robot-assisted gait training (RAGT) have shown positive effects of force feedback on spatial symmetry; somatosensory stimulation is thought to facilitate recovery of temporal symmetry. Despite the known importance of sensorimotor integration for motor recovery, interventions that incorporate RAGT and somatosensory stimuli have been largely overlooked so far. In this paper, we explore how gait symmetry can be restored in healthy subjects following unilateral foot perturbations, using adaptive assistive forces and plantar vibrotactile stimuli provided by a bilateral powered ankle-foot orthosis. Results suggest that combined force feedback and vibrotactile stimuli may be more effective than force feedback alone in reducing spatial asymmetry. Further, force feedback did not produce significant improvements in temporal symmetry, unlike the combined modality. We discuss possible implications of these preliminary findings for future training paradigms for RAGT.
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48
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Marini F, Zenzeri J, Pippo V, Morasso P, Campus C. Movement related activity in the μ band of the human EEG during a robot-based proprioceptive task. IEEE Int Conf Rehabil Robot 2019; 2019:1019-1024. [PMID: 31374763 DOI: 10.1109/icorr.2019.8779552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Innovative research in the fields of prosthetic, neurorehabilitation, motor control and human physiology has been focusing on the study of proprioception, the sense through which we perceive the position and movement of our body, and great achievements have been obtained regarding its assessment and characterization. However, how proprioceptive signals are combined with other sensory modalities and processed by the central nervous system to form a conscious body image, is still unknown. Such a crucial question was addressed in this study, which involved 23 healthy subjects, by combining a robot-based proprioceptive test with a specific analysis of electroencephalographic activity (EEG) in the $\mu$ frequency band (8-12 Hz). We observed important activation in the motor area contralateral to the moving hand, and besides, a substantial bias in brain activation and proprioceptive acuity when visual feedback was provided in addition to the proprioceptive information during movement execution. In details, brain activation and proprioceptive acuity were both higher in case of movements performed with visual feedback. Remarkably, we also found a correlation between the level of activation in the brain motor area contralateral to the moving hand and the value of proprioceptive acuity.
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Ofek H, Alperin M, Laufer Y. Lower Extremity Position Test: A new clinical quantitative assessment tool of proprioception post stroke. NeuroRehabilitation 2019; 44:479-484. [PMID: 31256083 DOI: 10.3233/nre-182662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To develop a quantitative, inexpensive and easy to use tool, for assessing proprioception of the lower extremity of individuals post-stroke, and examine its test-retest reliability and known-groups validity. METHODS The Lower Extremity Position Test was developed. Testing procedure: seated subjects were asked to reproduce 12 cm or 22 cm distances on a plastic surface, by verbally stopping passive movement of the foot produced by the tester. The deviation from the target point was measured as the mismatch score. Fifty one subjects post-stroke (n = 51) participated in prospective test-retest assessment. The tests were performed one week apart by a single assessor, in physical therapy out-patient clinics. The t-test, ICC and Bland-Altman tests were used to determine known-groups validity by determining leg differences and test-retest reliability. RESULTS Post-stroke involved foot demonstrated significantly higher mismatch scores then the uninvolved foot did (p < 0.0001). Good test-retest reliability was demonstrated for the involved leg for both 12 cm and 22 cm distances (ICC = 0.79 and 0.85, respectively). The 95% repeatability ranges were leg related. CONCLUSIONS The Lower Extremity Position Test (LEPT) is a newly-developed testing tool with good clinical utility, reliable in post-stroke population and has known-group validity (involved versus uninvolved foot).
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50
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Chia FS, Kuys S, Low Choy N. Sensory retraining of the leg after stroke: systematic review and meta-analysis. Clin Rehabil 2019; 33:964-979. [PMID: 30897960 PMCID: PMC6557007 DOI: 10.1177/0269215519836461] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This systematic review aimed to investigate the effects of interventions intended for retraining leg somatosensory function on somatosensory impairment, and secondary outcomes of balance and gait, after stroke. Data sources: Databases searched from inception to 16 January 2019 included Cochrane Library, PubMed, MEDLINE, CINAHL, EMBASE, PEDro, PsycINFO, and Scopus. Reference lists of relevant publications were also manually searched. Review methods: All types of quantitative studies incorporating interventions that intended to improve somatosensory function in the leg post stroke were retrieved. The Quality Assessment Tool for Quantitative Studies was used for quality appraisal. Standardised mean differences were calculated and meta-analyses were performed using preconstructed Microsoft Excel spreadsheets. Results: The search yielded 16 studies, comprising 430 participants, using a diverse range of interventions. In total, 10 of the included studies were rated weak in quality, 6 were rated moderate, and none was rated strong. Study quality was predominantly affected by high risk of selection bias, lack of blinding, and the use of somatosensory measures that have not been psychometrically evaluated. A significant heterogeneous positive summary effect size (SES) was found for somatosensory outcomes (SES: 0.52; 95% confidence interval (CI): 0.04 to 1.01; I2 = 74.48%), which included joint position sense, light touch, and two-point discrimination. There was also a significant heterogeneous positive SES for Berg Balance Scale scores (SES: 0.62; 95% CI: 0.10 to 1.14; I2 = 59.05%). Gait SES, mainly of gait velocity, was not significant. Conclusion: This review suggests that interventions used for retraining leg somatosensory impairment after stroke significantly improved somatosensory function and balance but not gait.
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Affiliation(s)
- Fenny Sf Chia
- 1 School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.,2 Community Rehabilitation Unit, Tasmanian Health Service, Hobart, TAS, Australia
| | - Suzanne Kuys
- 1 School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia
| | - Nancy Low Choy
- 1 School of Physiotherapy, Faculty of Health Sciences, Australian Catholic University, Brisbane, QLD, Australia.,3 Queensland Health Service, Brisbane, QLD, Australia
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