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Chen S, Mao M, Zhu G, Chen Y, Qiu Y, Ye B, Xu D. Cortical activity in patients with high-functioning ischemic stroke during the Purdue Pegboard Test: insights into bimanual coordinated fine motor skills with functional near-infrared spectroscopy. Neural Regen Res 2024; 19:1098-1104. [PMID: 37862214 PMCID: PMC10749618 DOI: 10.4103/1673-5374.385312] [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: 03/08/2023] [Revised: 07/05/2023] [Accepted: 08/08/2023] [Indexed: 10/22/2023] Open
Abstract
After stroke, even high-functioning individuals may experience compromised bimanual coordination and fine motor dexterity, leading to reduced functional independence. Bilateral arm training has been proposed as a promising intervention to address these deficits. However, the neural basis of the impairment of functional fine motor skills and their relationship to bimanual coordination performance in stroke patients remains unclear, limiting the development of more targeted interventions. To address this gap, our study employed functional near-infrared spectroscopy to investigate cortical responses in patients after stroke as they perform functional tasks that engage fine motor control and coordination. Twenty-four high-functioning patients with ischemic stroke (7 women, 17 men; mean age 64.75 ± 10.84 years) participated in this cross-sectional observational study and completed four subtasks from the Purdue Pegboard Test, which measures unimanual and bimanual finger and hand dexterity. We found significant bilateral activation of the sensorimotor cortices during all Purdue Pegboard Test subtasks, with bimanual tasks inducing higher cortical activation than the assembly subtask. Importantly, patients with better bimanual coordination exhibited lower cortical activation during the other three Purdue Pegboard Test subtasks. Notably, the observed neural response patterns varied depending on the specific subtask. In the unaffected hand task, the differences were primarily observed in the ipsilesional hemisphere. In contrast, the bilateral sensorimotor cortices and the contralesional hemisphere played a more prominent role in the bimanual task and assembly task, respectively. While significant correlations were found between cortical activation and unimanual tasks, no significant correlations were observed with bimanual tasks. This study provides insights into the neural basis of bimanual coordination and fine motor skills in high-functioning patients after stroke, highlighting task-dependent neural responses. The findings also suggest that patients who exhibit better bimanual performance demonstrate more efficient cortical activation. Therefore, incorporating bilateral arm training in post-stroke rehabilitation is important for better outcomes. The combination of functional near-infrared spectroscopy with functional motor paradigms is valuable for assessing skills and developing targeted interventions in stroke rehabilitation.
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Affiliation(s)
- Siyun Chen
- The Second Rehabilitation Hospital of Shanghai, Shanghai, China
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Mengchai Mao
- The Second Rehabilitation Hospital of Shanghai, Shanghai, China
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
| | - Guangyue Zhu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yufeng Chen
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuqi Qiu
- School of Statistics, East China Normal University, Shanghai, China
| | - Bin Ye
- The Third Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Dongsheng Xu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Tongji University, Shanghai, China
- Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Beyaz O, Eyraud V, Demirhan G, Akpinar S, Przybyla A. Effects of Short-Term Novice Archery Training on Reaching Movement Performance and Interlimb Asymmetries. J Mot Behav 2023; 56:78-90. [PMID: 37586703 DOI: 10.1080/00222895.2023.2245352] [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: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Previous studies showed numerous evidence for the interlimb asymmetries in motor performance during arm reaching movements. Furthermore, these interlimb asymmetries have been shown to associate with spatial patterns of hand selection behavior. Importantly, these interlimb asymmetries can be modified systematically by occlusion of visual feedback, or a long-term sports training. In this study, we asked about the effects of a short-term training on interlimb asymmetries. Eighteen healthy young participants underwent a 12-week novice traditional archery training (TAT). Their unimanual dominant and nondominant arm reaching movement performance was assessed before and after TAT. We found that movement accuracy, movement precision, and movement efficiency in the experimental group have all improved significantly as a result of TAT. These improvements were comparable across both arms, thus the interlimb differences in movement performance were not affected by the short-term TAT and remained similar. These results suggest that while short-term training may contribute positively to reaching performance, it is unlikely to have a significant impact on the differences observed between the dominant and nondominant arms. This unique characteristics of dominant and nondominant arm should be taken into consideration when developing targeted sports and rehabilitation programs for athletes or individuals with acute or chronic motor deficits.
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Affiliation(s)
- Ozkan Beyaz
- Department of Physical Education and Sports, Faculty of Sport Science, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Virginie Eyraud
- Department of Physical Therapy, University of North Georgia, Dahlonega, Georgia, USA
| | - Gıyasettin Demirhan
- Department of Physical Education and Sports, Faculty of Sport Science, Hacettepe University, Ankara, Turkey
| | - Selcuk Akpinar
- Department of Physical Education and Sports, Faculty of Sport Science, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Andrzej Przybyla
- Department of Physical Therapy, University of North Georgia, Dahlonega, Georgia, USA
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Rogojin A, Gorbet DJ, Sergio LE. Sex differences in the neural underpinnings of unimanual and bimanual control in adults. Exp Brain Res 2023; 241:793-806. [PMID: 36738359 DOI: 10.1007/s00221-023-06561-5] [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: 08/23/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
While many of the movements we make throughout our day involve just one upper limb, most daily movements require a certain degree of coordination between both upper limbs. Historically, sex differences in eye-hand coordination have been observed. As well, there are demonstrated sex-specific differences in hemisphere symmetry, interhemispheric connectivity, and motor cortex organization. While it has been suggested that these anatomical differences may underlie sex-related differences in performance, sex differences in the functional neural correlate underlying bimanual performance have not been explicitly investigated. In the current study we tested the hypothesis that the functional connectivity underlying bimanual movement control differed depending on the sex of an individual. Participants underwent MRI scanning to acquire anatomical and functional brain images. During the functional runs, participants performed unimanual and bimanual coordination tasks using two button boxes. The tasks included pressing the buttons in time to an auditory cue with either their left or their right hand individually (unimanual), or with both hands simultaneously (bimanual). The bimanual task was further divided into either an in-phase (mirror/symmetrical) or anti-phase (parallel/asymmetrical) condition. Participants were provided with extensive training to ensure task comprehension, and performance error rates were found to be equivalent between men and women. A generalized psychophysiological interaction (gPPI) analysis was implemented to examine how functional connectivity in each condition was modulated by sex. In support of our hypothesis, women and men demonstrated differences in the neural correlates underlying unimanual and bimanual movements. In line with previous literature, functional connectivity patterns showed sex-related differences for right- vs left-hand movements. Sex-specific functional connectivity during bimanual movements was not a sum of the functional connectivity underlying right- and left-hand unimanual movements. Further, women generally showed greater interhemispheric functional connectivity across all conditions compared to men and had greater connectivity between task-related cortical areas, while men had greater connectivity involving the cerebellum. Sex differences in brain connectivity were associated with both unimanual and bimanual movement control. Not only do these findings provide novel insight into the fundamentals of how the brain controls bimanual movements in both women and men, they also present potential clinical implications on how bimanual movement training used in rehabilitation can best be tailored to the needs of individuals.
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Affiliation(s)
- Alica Rogojin
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
- Vision: Science to Applications (VISTA) Program, York University, Toronto, ON, Canada
| | - Diana J Gorbet
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
- Centre for Vision Research, York University, Toronto, ON, Canada
- Vision: Science to Applications (VISTA) Program, York University, Toronto, ON, Canada
| | - Lauren E Sergio
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
- Centre for Vision Research, York University, Toronto, ON, Canada.
- Vision: Science to Applications (VISTA) Program, York University, Toronto, ON, Canada.
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Straudi S, Baluardo L, Arienti C, Bozzolan M, Lazzarini SG, Agostini M, Aprile I, Paci M, Casanova E, Marino D, La Rosa G, Bressi F, Sterzi S, Giansanti D, Perrero L, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G. Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews. NeuroRehabilitation 2022; 51:559-576. [PMID: 36530097 DOI: 10.3233/nre-220027] [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: 12/15/2022]
Abstract
BACKGROUND Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.
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Affiliation(s)
- Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
| | - Ludovica Baluardo
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
| | | | - Michela Bozzolan
- Interdepartmental Educational Service, Azienda Ospedaliero Universitaria S. Anna Ferrara, Ferrara, Italy
| | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center "Bonino Pulejo", Messina, Italy
| | | | - Federica Bressi
- Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Silvia Sterzi
- Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital,, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company), Euganea Padova - Distretto 4 "Alta Padovana", Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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De Laet C, Herman B, Riga A, Bihin B, Regnier M, Leeuwerck M, Raymackers JM, Vandermeeren Y. Bimanual motor skill learning after stroke: Combining robotics and anodal tDCS over the undamaged hemisphere: An exploratory study. Front Neurol 2022; 13:882225. [PMID: 36061986 PMCID: PMC9433746 DOI: 10.3389/fneur.2022.882225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSince a stroke can impair bimanual activities, enhancing bimanual cooperation through motor skill learning may improve neurorehabilitation. Therefore, robotics and neuromodulation with transcranial direct current stimulation (tDCS) are promising approaches. To date, tDCS has failed to enhance bimanual motor control after stroke possibly because it was not integrating the hypothesis that the undamaged hemisphere becomes the major poststroke hub for bimanual control.ObjectiveWe tested the following hypotheses: (I) In patients with chronic hemiparetic stroke training on a robotic device, anodal tDCS applied over the primary motor cortex of the undamaged hemisphere enhances bimanual motor skill learning compared to sham tDCS. (II) The severity of impairment correlates with the effect of tDCS on bimanual motor skill learning. (III) Bimanual motor skill learning is less efficient in patients than in healthy individuals (HI).MethodsA total of 17 patients with chronic hemiparetic stroke and 7 healthy individuals learned a complex bimanual cooperation skill on the REAplan® neurorehabilitation robot. The bimanual speed/accuracy trade-off (biSAT), bimanual coordination (biCo), and bimanual force (biFOP) scores were computed for each performance. In patients, real/sham tDCS was applied in a crossover, randomized, double-blind approach.ResultsCompared to sham, real tDCS did not enhance bimanual motor skill learning, retention, or generalization in patients, and no correlation with impairment was noted. The healthy individuals performed better than patients on bimanual motor skill learning, but generalization was similar in both groups.ConclusionA short motor skill learning session with a robotic device resulted in the retention and generalization of a complex skill involving bimanual cooperation. The tDCS strategy that would best enhance bimanual motor skill learning after stroke remains unknown.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT02308852, identifier: NCT02308852.
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Affiliation(s)
- Chloë De Laet
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Materials and Civil Engineering (iMMC), Institute of Mechanics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Audrey Riga
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Clinical Division (NEUR), Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Jean-Marc Raymackers
- Department of Neurology and Neurosurgery, Clinique Saint-Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | - Yves Vandermeeren
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Clinical Division (NEUR), Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
- *Correspondence: Yves Vandermeeren
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Chen S, Qiu Y, Bassile CC, Lee A, Chen R, Xu D. Effectiveness and Success Factors of Bilateral Arm Training After Stroke: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2022; 14:875794. [PMID: 35547621 PMCID: PMC9082277 DOI: 10.3389/fnagi.2022.875794] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 12/05/2022] Open
Abstract
Bilateral arm training (BAT) presents as a promising approach in upper extremity (UE) rehabilitation after a stroke as it may facilitate neuroplasticity. However, the effectiveness of BAT is inconclusive, and no systematic reviews and meta-analyses have investigated the impact of different factors on the outcomes of BAT. This systematic review and meta-analysis aimed to (1) compare the effects of bilateral arm training (BAT) with unilateral arm training (UAT) and conventional therapy (CT) on the upper limb (UL) motor impairments and functional performance post-stroke, and (2) investigate the different contributing factors that may influence the success of BAT. A comprehensive literature search was performed in five databases. Randomized control trials (RCTs) that met inclusion criteria were selected and assessed for methodological qualities. Data relating to outcome measures, characteristics of participants (stroke chronicity and severity), and features of intervention (type of BAT and dose) were extracted for meta-analysis. With 25 RCTs meeting the inclusion criteria, BAT demonstrated significantly greater improvements in motor impairments as measured by Fugl-Meyer Assessment of Upper Extremity (FMA-UE) than CT (MD = 3.94, p = < 0.001), but not in functional performance as measured by the pooled outcomes of Action Research Arm Test (ARAT), Box and Block Test (BBT), and the time component of Motor Function Test (WMFT-time) (SMD = 0.28, p = 0.313). The superior motor impairment effects of BAT were associated with recruiting mildly impaired individuals in the chronic phase of stroke (MD = 6.71, p < 0.001), and applying a higher dose of intervention (MD = 6.52, p < 0.001). Subgroup analysis showed that bilateral functional task training (BFTT) improves both motor impairments (MD = 7.84, p < 0.001) and functional performance (SMD = 1.02, p = 0.049). No significant differences were detected between BAT and UAT for motor impairment (MD = -0.90, p = 0.681) or functional performance (SMD = -0.09, p = 0.457). Thus, our meta-analysis indicates that BAT may be more beneficial than CT in addressing post-stroke UL motor impairment, particularly in the chronic phase with mild UL paresis. The success of BAT may be dose-dependent, and higher doses of intervention may be required. BFTT appears to be a valuable form of BAT that could be integrated into stroke rehabilitation programs. BAT and UAT are generally equivalent in improving UL motor impairments and functional performance.
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Affiliation(s)
- Siyun Chen
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Yuqi Qiu
- School of Statistics, East China Normal University, Shanghai, China
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Clare C. Bassile
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Anita Lee
- Department of Rehabilitation and Regenerative Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
| | - Ruifeng Chen
- Division of Biostatistics and Bioinformatics, University of California, San Diego, La Jolla, CA, United States
| | - Dongsheng Xu
- College of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, China
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Kumari R, Janković M, Costa A, Savić A, Konstantinović L, Djordjević O, Vucković A. Short term priming effect of brain-actuated muscle stimulation using bimanual movements in stroke. Clin Neurophysiol 2022; 138:108-121. [DOI: 10.1016/j.clinph.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 11/03/2022]
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Zhuang JY, Ding L, Shu BB, Chen D, Jia J. Associated Mirror Therapy Enhances Motor Recovery of the Upper Extremity and Daily Function after Stroke: A Randomized Control Study. Neural Plast 2021; 2021:7266263. [PMID: 34630560 PMCID: PMC8494575 DOI: 10.1155/2021/7266263] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022] Open
Abstract
Bimanual cooperation plays a vital role in functions of the upper extremity and daily activities. Based on the principle of bilateral movement, mirror therapy could provide bimanual cooperation training. However, conventional mirror therapy could not achieve the isolation of the mirror. A novel paradigm mirror therapy called associated mirror therapy (AMT) was proposed to achieve bimanual cooperation task-based mirror visual feedback isolating from the mirror. The study was aimed at exploring the feasibility and effectiveness of AMT on stroke patients. We conducted a single-blind, randomized controlled trial. Thirty-six eligible patients were equally assigned into the experimental group (EG) receiving AMT and the control group (CG) receiving bimanual training without mirroring for five days/week, lasting four weeks. The Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) for upper extremity motor impairment was used as the primary outcome. The secondary outcomes were the Box and Block Test (BBT) and Functional Independence Measure (FIM) for motor and daily function. All patients participated in trials throughout without adverse events or side effects. The scores of FMA-UL and FIM improved significantly in both groups following the intervention. Compared to CG, the scores of FMA-UL and FIM were improved more significantly in EG after the intervention. The BBT scores were improved significantly for EG following the intervention, but no differences were found in the BBT scores of CG after the intervention. However, no differences in BBT scores were observed between the two groups. In summary, our study suggested that AMT was a feasible and practical approach to enhance the motor recovery of paretic arms and daily function in stroke patients. Furthermore, AMT may improve manual dexterity for poststroke rehabilitation.
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Affiliation(s)
- Jin-Yang Zhuang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Bei-Bei Shu
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Dan Chen
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Department of Rehabilitation Medicine, Shanghai Jing'an District Central Hospital, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, China
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9
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Cardoso LRL, Pedro LM, Forner-Cordero A. Handlebar Robotic System for Bimanual Motor Control and Learning Research. SENSORS (BASEL, SWITZERLAND) 2021; 21:5991. [PMID: 34577199 PMCID: PMC8472032 DOI: 10.3390/s21185991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Robotic devices can be used for motor control and learning research. In this work, we present the construction, modeling and experimental validation of a bimanual robotic device. We tested some hypotheses that may help to better understand the motor learning processes involved in the interlimb coordination function. The system emulates a bicycle handlebar with rotational motion, thus requiring bilateral upper limb control and a coordinated sequence of joint sub-movements. The robotic handlebar is compact and portable and can register in a fast rate both position and forces independently from arms, including prehension forces. An impedance control system was implemented in order to promote a safer environment for human interaction and the system is able to generate force fields, suitable for implementing motor learning paradigms. The novelty of the system is the decoupling of prehension and manipulation forces of each hand, thus paving the way for the investigation of hand dominance function in a bimanual task. Experiments were conducted with ten healthy subjects, kinematic and dynamic variables were measured during a rotational set of movements. Statistical analyses showed that movement velocity decreased with practice along with an increase in reaction time. This suggests an increase of the task planning time. Prehension force decreased with practice. However, an unexpected result was that the dominant hand did not lead the bimanual task, but helped to correct the movement, suggesting different roles for each hand during a cooperative bimanual task.
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Affiliation(s)
- Lucas R. L. Cardoso
- Programa de Pós-Graduação Interunidades em Bioengenharia (EESC/FMRP/IQSC), University of São Paulo, São Carlos 13566-590, Brazil
| | - Leonardo M. Pedro
- Department of Mechanical Engineering, Federal University of São Carlos, São Carlos 13565-905, Brazil;
| | - Arturo Forner-Cordero
- Biomechatronics Laboratory—Escola Politecnica, University of São Paulo, São Paulo 05508-010, Brazil;
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10
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Dutcher AM, Truong KV, Miller DD, Allred RP, Nudi E, Jones TA. Training in a cooperative bimanual skilled reaching task, the popcorn retrieval task, improves unimanual function after motor cortical infarcts in rats. Behav Brain Res 2020; 396:112900. [PMID: 32941880 DOI: 10.1016/j.bbr.2020.112900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Disuse of the paretic hand after stroke is encouraged by compensatory reliance on the nonparetic hand, to exacerbate impairment and potentially constrain motor rehabilitation efficacy. Rodent stroke model findings support that learning new unimanual skills with the nonparetic forelimb diminishes functional improvements that can be driven by rehabilitative training of the paretic forelimb. The influence of learning new ways of skillfully using the two hands together on paretic side function is much less clear. To begin to explore this, we developed a new cooperative bimanual skilled reaching task for rats, the Popcorn Retrieval Task. After motor cortical infarcts impaired an established unimanual reaching skill in the paretic forelimb, rats underwent a 7 week period of de novo bimanual training (BiT) or no-training control procedures (Cont). Probes of paretic forelimb unimanual performance revealed significant improvements during and after the training period in BiT vs. Cont. We additionally observed a striking change in the bimanual task strategy over training days: a switch from the paretic to the nonparetic forelimb for initiating reach-to-grasp sequences. This motivated another study to test whether rats that established the bimanual skill prior to the infarcts would similarly switch handedness, which they did not, though paretic paw use for manipulative movements diminished. These results indicate that unimanual function of the paretic side can be improved by novel bimanual skill practice, even when it involves compensatory reliance on the nonparetic hand. They further support the suitability of the Popcorn Retrieval Task for studying bimanual skill learning effects in rats.
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Affiliation(s)
| | | | | | | | - Evan Nudi
- Psychology Department, United States
| | - Theresa A Jones
- Institute for Neuroscience, United States; Psychology Department, United States.
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11
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Lee JH, Hong I, Park JH, Shin JH. Validation of Yonsei-Bilateral Activity Test (Y-BAT)-Bilateral Upper Extremity Inventory Using Rasch Analysis. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2020; 40:277-286. [PMID: 32458733 DOI: 10.1177/1539449220920732] [Citation(s) in RCA: 2] [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
There is little assessment to provide specific information about quality of bilateral upper extremity movement specifically. This study examined the psychometric properties of the Yonsei-Bilateral Activity Test (Y-BAT). An observational cross-sectional design was used with 100 stroke survivors. Unidimensionality was examined using factor analyses, and Rasch analysis was used to test rating scale structure, fit statistics, and precision of the Y-BAT. The Y-BAT demonstrated a unidimensional measurement construct, and 19 of the 27 items fit the Rasch model. The instrument demonstrated good precision, including person reliability and person strata. The Y-BAT estimated person measures within a wide range of theta values with a reliability of .9 with good precision. Our results indicate that a revised, 19-item version of the Y-BAT demonstrates sound internal validity and may be a useful instrument for clinicians to measure upper extremity function with good precision following stroke.
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Affiliation(s)
| | - Ickpyo Hong
- The University of Texas Medical Branch at Galveston, USA
| | | | - Joon-Ho Shin
- National Rehabilitation Center, Seoul, Republic of Korea
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12
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The Effect of Occupation-Based Bilateral Upper Extremity Training in a Medical Setting for Stroke Patients: A Single-Blinded, Pilot Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:104335. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
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Arya KN, Pandian S, Sharma A, Kumar V, Kashyap VK. Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial. Top Stroke Rehabil 2019; 27:272-289. [PMID: 31707972 DOI: 10.1080/10749357.2019.1682368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 - 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 - 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Abhishek Sharma
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
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Valdés BA, Menon C. Effects of Noisy Galvanic Vestibular Stimulation During a Bimanual Tracking Robotic Task. Front Neurosci 2019; 13:1132. [PMID: 31749673 PMCID: PMC6843009 DOI: 10.3389/fnins.2019.01132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/07/2019] [Indexed: 12/21/2022] Open
Abstract
Background Noisy galvanic vestibular stimulation (nGVS) has been shown to improve motor performance in people with and without disabilities. Previous investigations on the use of nGVS to improve upper-limb motor performance have focused on unimanual fine motor movements, nevertheless, bimanual gross movements are also essential for conducting activities of daily living and can be affected as a result of cerebral dysfunction. Consequently, in this study we investigated the effects of nGVS on bimanual gross motor performance. Methods Twelve healthy participants completed a visuomotor task in which they performed bimanual upper-limb movements using two robots. During the task, participants tracked a target that oscillated following a sinusoidal amplitude-modulated trajectory. In half of the trials, participants received subthreshold nGVS, in the other half, they received sham stimulation. Primary outcome measure: percent improvement in root mean square error (RMSE) between the target’s and cursors’ trajectories. Secondary outcome measures: percent improvement in lag between the cursors and target; and percent improvement in RMSE between the cursors’ trajectories. A post-test questionnaire was administered to evaluate the experience of participants. Results Tracking error was not affected by nGVS: left −2.6(5.5)%, p = 0.128; right −0.9(6.2)%, p = 0.639; nor was bimanual coordination −1.5(9.6)%, p = 0.590. When comparing if one hand was affected more than the other, we did not find a statistically significant difference (−1.7(3.3)%, p = 0.098). Similar results were found for the lag. Questionnaire results indicated that the robotic devices did not limit participants’ movements, did not make participants feel unsafe, nor were they difficult to control. Furthermore, participants did not feel unsafe with the nGVS device, nor did they report any discomfort due to nGVS. Conclusion Results suggest that nGVS applied to people without disabilities do not affect bimanual gross motor performance. However, as this was the first study to investigate such effects, stimulation parameters were based on previous unimanual fine motor studies. Future studies should investigate optimal stimulation parameters for improving upper-limb gross motor performance. Overall, participants felt safe using the robotic devices and receiving the noisy electrical stimulation. As such, a similar setup could potentially be employed for subsequent studies investigating the relation between upper-limb performance and nGVS.
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Affiliation(s)
- Bulmaro A Valdés
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
| | - Carlo Menon
- Menrva Research Group, Schools of Mechatronic Systems and Engineering Science, Simon Fraser University, Metro Vancouver, BC, Canada
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15
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Doost MY, Orban de Xivry JJ, Herman B, Vanthournhout L, Riga A, Bihin B, Jamart J, Laloux P, Raymackers JM, Vandermeeren Y. Learning a Bimanual Cooperative Skill in Chronic Stroke Under Noninvasive Brain Stimulation: A Randomized Controlled Trial. Neurorehabil Neural Repair 2019; 33:486-498. [PMID: 31088342 DOI: 10.1177/1545968319847963] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Transcranial direct current stimulation (tDCS) has been suggested to improve poststroke recovery. However, its effects on bimanual motor learning after stroke have not previously been explored. Objective. We investigated whether dual-tDCS of the primary motor cortex (M1), with cathodal and anodal tDCS applied over undamaged and damaged hemispheres, respectively, improves learning and retention of a new bimanual cooperative motor skill in stroke patients. Method. Twenty-one chronic hemiparetic patients were recruited for a randomized, double-blinded, cross-over, sham-controlled trial. While receiving real or sham dual-tDCS, they trained on a bimanual cooperative task called CIRCUIT. Changes in performance were quantified via bimanual speed/accuracy trade-off (Bi-SAT) and bimanual coordination factor (Bi-Co) before, during, and 0, 30, and 60 minutes after dual-tDCS, as well as one week later to measure retention. A generalization test then followed, where patients were asked to complete a new CIRCUIT layout. Results. The patients were able to learn and retain the bimanual cooperative skill. However, a general linear mixed model did not detect a significant difference in retention between the real and sham dual-tDCS conditions for either Bi-SAT or Bi-Co. Similarly, no difference in generalization was detected for Bi-SAT or Bi-Co. Conclusion. The chronic hemiparetic stroke patients learned and retained the complex bimanual cooperative task and generalized the newly acquired skills to other tasks, indicating that bimanual CIRCUIT training is promising as a neurorehabilitation approach. However, bimanual motor skill learning was not enhanced by dual-tDCS in these patients.
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Affiliation(s)
- Maral Yeganeh Doost
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Jean-Jacques Orban de Xivry
- 4 Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Belgium.,5 Leuven Brain Institute, KU Leuven, Belgium
| | - Benoît Herman
- 3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium.,6 Université catholique de Louvain (UCLouvain), Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Léna Vanthournhout
- 3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium.,6 Université catholique de Louvain (UCLouvain), Institute of Mechanics, Materials and Civil Engineering (iMMC), Louvain-la-Neuve, Belgium
| | - Audrey Riga
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Benoît Bihin
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium
| | - Jacques Jamart
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium
| | - Patrice Laloux
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium
| | | | - Yves Vandermeeren
- 1 Université catholique de Louvain (UCLouvain), CHU UCL Namur (Mont-Godinne), Yvoir, Belgium.,2 Université catholique de Louvain (UCLouvain), Institute of NeuroScience (IoNS), NEUR division, Brussels, Belgium.,3 Université catholique de Louvain (UCLouvain), Louvain Bionics, Louvain-la-Neuve, Belgium
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16
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Schaffert N, Janzen TB, Mattes K, Thaut MH. A Review on the Relationship Between Sound and Movement in Sports and Rehabilitation. Front Psychol 2019; 10:244. [PMID: 30809175 PMCID: PMC6379478 DOI: 10.3389/fpsyg.2019.00244] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/24/2019] [Indexed: 12/19/2022] Open
Abstract
The role of auditory information on perceptual-motor processes has gained increased interest in sports and psychology research in recent years. Numerous neurobiological and behavioral studies have demonstrated the close interaction between auditory and motor areas of the brain, and the importance of auditory information for movement execution, control, and learning. In applied research, artificially produced acoustic information and real-time auditory information have been implemented in sports and rehabilitation to improve motor performance in athletes, healthy individuals, and patients affected by neurological or movement disorders. However, this research is scattered both across time and scientific disciplines. The aim of this paper is to provide an overview about the interaction between movement and sound and review the current literature regarding the effect of natural movement sounds, movement sonification, and rhythmic auditory information in sports and motor rehabilitation. The focus here is threefold: firstly, we provide an overview of empirical studies using natural movement sounds and movement sonification in sports. Secondly, we review recent clinical and applied studies using rhythmic auditory information and sonification in rehabilitation, addressing in particular studies on Parkinson's disease and stroke. Thirdly, we summarize current evidence regarding the cognitive mechanisms and neural correlates underlying the processing of auditory information during movement execution and its mental representation. The current state of knowledge here reviewed provides evidence of the feasibility and effectiveness of the application of auditory information to improve movement execution, control, and (re)learning in sports and motor rehabilitation. Findings also corroborate the critical role of auditory information in auditory-motor coupling during motor (re)learning and performance, suggesting that this area of clinical and applied research has a large potential that is yet to be fully explored.
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Affiliation(s)
- Nina Schaffert
- Department of Movement and Training Science, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Thenille Braun Janzen
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
| | - Klaus Mattes
- Department of Movement and Training Science, Institute for Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Michael H. Thaut
- Music and Health Science Research Collaboratory, Faculty of Music, University of Toronto, Toronto, ON, Canada
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The effects of unimanual and bimanual massed practice on upper limb function in adults with cervical spinal cord injury: a systematic review. Physiotherapy 2019; 105:200-213. [PMID: 30717883 DOI: 10.1016/j.physio.2018.10.003] [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: 10/03/2017] [Accepted: 10/12/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Individuals with cervical spinal cord injury (cSCI) have identified improving upper limb function as their most important rehabilitation goal. Unimanual massed practice (UMP) and bimanual massed practice (BMP) may help achieve this. OBJECTIVES To evaluate and compare the effects of UMP and BMP on upper limb function in adults with cSCI. DATA SOURCES Cochrane Central Register of Controlled Trials, PubMed, CINAHL, Web of Science and PEDro until April 2016. STUDY SELECTION Studies investigating the effects of UMP and/or BMP on upper limb function in adults with cSCI. DATA EXTRACTION AND SYNTHESIS Data was extracted using a standardised form. Studies were appraised using a modified version of the Cochrane risk of bias tool. The findings were qualitatively synthesised. RESULTS Five randomised controlled trials and 2 case studies were included. Six studies included UMP, three included BMP, and two compared these approaches. Overall the studies reported that UMP and BMP improved upper limb function, particularly when combined with electrical stimulation, with no clear differences between UMP and BMP. These findings should be interpreted with caution however, as 6 studies presented a high or unclear risk of bias for all functional upper limb outcome measures included, and the remaining study was a small pilot study with no control group. CONCLUSION Although the findings of the included studies support the use of UMP and BMP in adults with cSCI, only 7 studies, all with significant limitations, were included; hence robust conclusions cannot be drawn and further research is warranted. PROSPERO registration number: CRD42016037365.
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Ghai S. Effects of Real-Time (Sonification) and Rhythmic Auditory Stimuli on Recovering Arm Function Post Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2018; 9:488. [PMID: 30057563 PMCID: PMC6053522 DOI: 10.3389/fneur.2018.00488] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/05/2018] [Indexed: 01/15/2023] Open
Abstract
Background: External auditory stimuli have been widely used for recovering arm function post-stroke. Rhythmic and real-time auditory stimuli have been reported to enhance motor recovery by facilitating perceptuomotor representation, cross-modal processing, and neural plasticity. However, a consensus as to their influence for recovering arm function post-stroke is still warranted because of high variability noted in research methods. Objective: A systematic review and meta-analysis was carried out to analyze the effects of rhythmic and real-time auditory stimuli on arm recovery post stroke. Method: Systematic identification of published literature was performed according to PRISMA guidelines, from inception until December 2017, on online databases: Web of science, PEDro, EBSCO, MEDLINE, Cochrane, EMBASE, and PROQUEST. Studies were critically appraised using PEDro scale. Results: Of 1,889 records, 23 studies which involved 585 (226 females/359 males) patients met our inclusion criteria. The meta-analysis revealed beneficial effects of training with both types of auditory inputs for Fugl-Meyer assessment (Hedge's g: 0.79), Stroke impact scale (0.95), elbow range of motion (0.37), and reduction in wolf motor function time test (-0.55). Upon further comparison, a beneficial effect of real-time auditory feedback was found over rhythmic auditory cueing for Fugl-meyer assessment (1.3 as compared to 0.6). Moreover, the findings suggest a training dosage of 30 min to 1 h for at least 3-5 sessions per week with either of the auditory stimuli. Conclusion: This review suggests the application of external auditory stimuli for recovering arm functioning post-stroke.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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19
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Kantak S, Jax S, Wittenberg G. Bimanual coordination: A missing piece of arm rehabilitation after stroke. Restor Neurol Neurosci 2018; 35:347-364. [PMID: 28697575 DOI: 10.3233/rnn-170737] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inability to use the arm in daily actions significantly lowers quality of life after stroke. Most contemporary post-stroke arm rehabilitation strategies that aspire to re-engage the weaker arm in functional activities have been greatly limited in their effectiveness. Most actions of daily life engage the two arms in a highly coordinated manner. In contrast, most rehabilitation approaches predominantly focus on restitution of the impairments and unilateral practice of the weaker hand alone. We present a perspective that this misalignment between real world requirements and intervention strategies may limit the transfer of unimanual capability to spontaneous arm use and functional recovery. We propose that if improving spontaneous engagement and use of the weaker arm in real life is the goal, arm rehabilitation research and treatment need to address the coordinated interaction between arms in targeted theory-guided interventions. Current narrow focus on unimanual deficits alone, difficulty in quantifying bimanual coordination in real-world actions and limited theory-guided focus on control and remediation of different coordination modes are some of the biggest obstacles to successful implementation of effective interventions to improve bimanual coordination in the real world. We present a theory-guided taxonomy of bimanual actions that will facilitate quantification of coordination for different real-world tasks and provide treatment targets for addressing coordination deficits. We then present evidence in the literature that points to bimanual coordination deficits in stroke survivors and demonstrate how current rehabilitation approaches are limited in their impact on bimanual coordination. Importantly, we suggest theory-based areas of future investigation that may assist quantification, identification of neural mechanisms and scientifically-based training/remediation approaches for bimanual coordination deficits post-stroke. Advancing the science and practice of arm rehabilitation to incorporate bimanual coordination will lead to a more complete functional recovery of the weaker arm, thus improving the effectiveness of rehabilitation interventions and augmenting quality of life after stroke.
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Affiliation(s)
- Shailesh Kantak
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA.,Department of Physical Therapy, Arcadia University, Elkins Park, PA, USA
| | - Steven Jax
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - George Wittenberg
- Department of Neurology, Baltimore VAMC, University of Maryland, Glenside, PA, USA
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Lee JH, Park JH. Development of an item list to assess bilateral upper extremity function of stroke patients with hemiplegia. NeuroRehabilitation 2018; 42:37-42. [DOI: 10.3233/nre-172152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joo-Hyun Lee
- Department of Occupational Therapy, Yonsei University, Wonju, Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy, Yonsei University, Wonju, Korea
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Lin SH, Dionne TP. Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. J Particip Med 2018; 10:e3. [PMID: 33052128 PMCID: PMC7434068 DOI: 10.2196/jopm.8929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors.
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Affiliation(s)
- Susan Hamady Lin
- Institute of Health Professions, Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Timothy P Dionne
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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Lee Y, Kim MY, Park JH, Park HY. Comparison of the effects of bilateral and unilateral training after stroke: A meta-analysis. NeuroRehabilitation 2017; 40:301-313. [PMID: 28211818 DOI: 10.3233/nre-161418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The differential effects of bilateral and unilateral training on upper extremity (UE) function remain unclear. OBJECTIVE To compare the effectiveness of bilateral and unilateral training on UE function and activities of daily living (ADL) after stroke. METHODS Randomized controlled trials (RCTs) were selected for inclusion by two reviewers after searching the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Methodological qualities were assessed using the PEDro scale. Effect size was estimated by calculating the standardized mean difference (SMD). RESULTS Eleven RCTs of sufficient quality were included in our meta-analysis. The effect size on UE capacity was statistically significant in favor of the Constraint-Induced Movement Therapy (CIMT) groups (SMD [fixed], g: - 0.34; 95% CI: - 0.59-0.08; p = 0.01; I2 = 0%). No other SMDs were significant. CONCLUSION The CIMT tasks were more effective than bilateral training with regard to increased UE capacity; however, this result should be cautiously interpreted since the evaluation tools were designed for assessment of unilateral UE function, not bilateral UE function. Further, the effect of the CIMT tasks on UE capacity was not translated into ADL. Considering the disadvantages of CIMT such as fatigue, bilateral training may be more appropriate for improving ADL.
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Raghavan P, Aluru V, Milani S, Thai P, Geller D, Bilaloglu S, Lu Y, Weisz DJ. Coupled Bimanual Training Using a Non-Powered Device for Individuals with Severe Hemiparesis: A Pilot Study. ACTA ACUST UNITED AC 2017; 5. [PMID: 29034265 PMCID: PMC5636010 DOI: 10.4172/2329-9096.1000404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few options exist for training arm movements in participants with severe post-stroke hemiparesis who have little active range of motion. The purpose of this study was to test the safety and feasibility of training with a non-powered device, the Bimanual Arm Trainer (BAT), to facilitate motor recovery in individuals with severe hemiparesis. The BAT enabled coupled bimanual training of shoulder external rotation, which is reduced in individuals with severe post-stroke hemiplegia. The rationale for bimanual training was to harness contralesional cortical activity to drive voluntary movement in the affected arm in patients who could barely perform unimanual movements. METHODS Nine participants with post-stroke hemiparesis, preserved passive range of motion and Modified Ashworth score of <3 in the shoulder and elbow joints, trained with the device for 45 minutes, twice a week for six weeks, and were assessed pre- and post-training. RESULTS All participants tolerated the training and no adverse events were reported. Participants showed significant improvement in the upper extremity Fugl-Meyer score post-training with an effect size of 0.89. Changes in the flexor synergy pattern accounted for 64.7% of the improvement. Improvement in active range of motion in the paretic limb occurred for both trained and untrained movements. Some participants showed improvement in the time taken to perform selected tasks on the Wolf Motor Function Test post-training. CONCLUSION The results demonstrate the safety and feasibility of using the Bimanual Arm Trainer to facilitate motor recovery in individuals with severe hemiparesis.
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Affiliation(s)
- Preeti Raghavan
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Viswanath Aluru
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Sina Milani
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Peter Thai
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Daniel Geller
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Seda Bilaloglu
- Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY, USA
| | - Ying Lu
- Promotion of Research Involving Innovative Statistical Methodology (PRIISM), Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Donald J Weisz
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA
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Ramírez-Fernández C, Morán AL, García-Canseco E, Gómez-Montalvo JR. Evaluation Results of an Ontology-based Design Model of Virtual Environments for Upper Limb Motor Rehabilitation of Stroke Patients. Methods Inf Med 2017; 56:145-155. [PMID: 28220927 DOI: 10.3414/me16-02-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/30/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES 1) To enhance the content of an ontology for designing virtual environments (VEs) for upper limb motor rehabilitation of stroke patients according to the suggestions and comments of rehabilitation specialists and software developers, 2) to characterize the perceived importance level of the ontology, 3) to determine the perceived usefulness of the ontology, and 4) to identify the safety characteristics of the ontology for VEs design according to the rehabilitation specialists. METHODS Using two semi-structured Web questionnaires, we asked six rehabilitation specialists and six software developers to provide us with their perception regarding the level of importance and the usability of the ontology. From their responses we have identified themes related to perceived and required safety characteristics of the ontology. RESULTS Significant differences in the importance level were obtained for the Stroke Disability, VE Configuration, Outcome Measures, and Safety Calibration classes, which were perceived as highly important by rehabilitation specialists. Regarding usability, the ontology was perceived by both groups with high usefulness, ease of use, learnability and intention of use. Concerning the thematic analysis of recommendations, eight topics for safety characteristics of the ontology were identified: adjustment of therapy strategies; selection and delimitation of movements; selection and proper calibration of the interaction device; proper selection of measuring instruments; gradual modification of the difficulty of the exercise; adaptability and variability of therapy exercises; feedback according to the capabilities of the patient; and real-time support for exercise training. CONCLUSIONS The rehabilitation specialists and software developers confirmed the importance of the information contained in the ontology regarding motor rehabilitation of the upper limb. Their recommendations highlight the safety features and the advantages of the ontology as a guide for the effective design of VEs.
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Affiliation(s)
- Cristina Ramírez-Fernández
- Cristina Ramírez-Fernández, Facultad de Ciencias, Universidad Autónoma de Baja California, Carretera Tijuana-Ensenada, 22860, Mexico, E-mail:
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Kinematic Manifestation of Arm-Trunk Performance during Symmetric Bilateral Reaching After Stroke. Am J Phys Med Rehabil 2017; 96:146-151. [DOI: 10.1097/phm.0000000000000554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Valdés BA, Glegg SMN, Van der Loos HFM. Trunk Compensation During Bimanual Reaching at Different Heights by Healthy and Hemiparetic Adults. J Mot Behav 2016; 49:580-592. [PMID: 27935472 DOI: 10.1080/00222895.2016.1241748] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The authors explored how trunk compensation and hand symmetry in stroke survivors and healthy controls were affected by the distance and height of virtual targets during a bimanual reaching task. Participants were asked to reach to 4 different virtual targets set at: 90% of their arm length at shoulder, xiphoid process, and knee height, and 50% of their arm length at xiphoid process height. For the stroke group, for all targets, the hands' movements were more asymmetrical than those of the healthy group, with more asymmetry observed in the direction of gravity, and trunk forward displacement values were larger and more variable. The knee targets had the largest trunk displacement values; index of curvature and trunk displacement were strongly correlated with participants' impairment scores. A strong correlation was found between the hands' asymmetry in the anterior or posterior direction for the shoulder targets, and the impairment scores. The results suggest that target height influences the degree of trunk compensation and hand symmetry during bimanual reaching by hemiparetic participants.
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Affiliation(s)
- Bulmaro A Valdés
- a RREACH: Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare Laboratory, Department of Mechanical Engineering , The University of British Columbia , Vancouver , Canada
| | - Stephanie M N Glegg
- b Therapy Department , Sunny Hill Health Centre for Children , Vancouver , Canada
| | - H F Machiel Van der Loos
- a RREACH: Robotics for Rehabilitation Exercise and Assessment in Collaborative Healthcare Laboratory, Department of Mechanical Engineering , The University of British Columbia , Vancouver , Canada
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Bang DH, Shin WS, Choi HS. Effects of modified constraint-induced movement therapy combined with trunk restraint in chronic stroke: A double-blinded randomized controlled pilot trial. NeuroRehabilitation 2015; 37:131-7. [PMID: 26409698 DOI: 10.3233/nre-151245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reducing the compensatory mechanism by restraining the unnecessary movement may be helpful in relearning the upper-limb movement. OBJECTIVE To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint (TR) in chronic stroke patients with moderate impairment. METHODS Eighteen participants with hemiparesis were randomly assigned to mCIMT + TR or mCIMT. Each group underwent 20 (1 h/d) intervention session (5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer assessment upper extremity (FMA-UE), the modified Barthel index (MBI), and the motor activity log (MAL-AOU and MAL-QOM). RESULTS The mCIMT combined with trunk restraint group exhibited greater changes in the ARAT, FMA, MBI, and MAL (MAL-AOU and MAL-QOM) compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (Z = -2.17, P = 0.03), FMA-UE (Z = -2.49, P = 0.01), MBI (Z = -2.44, P = 0.02), MAL-AOU (Z = -2.17, P = 0.03), and MAL-QOM (Z = -2.17, P = 0.03) between groups. CONCLUSION These finding suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in patient with chronic stroke.
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Affiliation(s)
- Dae-Hyouk Bang
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
| | - Won-Seob Shin
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea.,Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
| | - Ho-Suk Choi
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
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Abbruzzese G, Trompetto C, Mori L, Pelosin E. Proprioceptive rehabilitation of upper limb dysfunction in movement disorders: a clinical perspective. Front Hum Neurosci 2014; 8:961. [PMID: 25505402 PMCID: PMC4243688 DOI: 10.3389/fnhum.2014.00961] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 11/12/2014] [Indexed: 11/15/2022] Open
Abstract
Movement disorders (MDs) are frequently associated with sensory abnormalities. In particular, proprioceptive deficits have been largely documented in both hypokinetic (Parkinson’s disease) and hyperkinetic conditions (dystonia), suggesting a possible role in their pathophysiology. Proprioceptive feedback is a fundamental component of sensorimotor integration allowing effective planning and execution of voluntary movements. Rehabilitation has become an essential element in the management of patients with MDs, and there is a strong rationale to include proprioceptive training in rehabilitation protocols focused on mobility problems of the upper limbs. Proprioceptive training is aimed at improving the integration of proprioceptive signals using “task-intrinsic” or “augmented feedback.” This perspective article reviews the available evidence on the effects of proprioceptive stimulation in improving upper limb mobility in patients with MDs and highlights the emerging innovative approaches targeted to maximizing the benefits of exercise by means of enhanced proprioception.
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Affiliation(s)
- Giovanni Abbruzzese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
| | - Laura Mori
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
| | - Elisa Pelosin
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa , Genoa , Italy
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Bang DH, Shin WS, Choi SJ. The effects of modified constraint-induced movement therapy combined with trunk restraint in subacute stroke: a double-blinded randomized controlled trial. Clin Rehabil 2014; 29:561-9. [PMID: 25246609 DOI: 10.1177/0269215514552034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/27/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint in subacute stroke patients. DESIGN Double-blind, randomized controlled trial. SETTING Rehabilitation clinic. PARTICIPANTS Eighteen subacute stroke patients with moderate motor impairment. INTERVENTIONS The patients were treated with either mCIMT combined with trunk restraint or mCIMT for 5 days per week for 4 weeks. The mCIMT combined with trunk restraint group participated in structured intervention sessions for use of the more affected upper-extremity in task-oriented activities with trunk restraint for 1 hour per day, and with the less affected upper-extremity restrained for 5 hours per day weeks. The mCIMT group followed the same protocol without trunk restraint. MAIN OUTCOME MEASURES The outcome measures included the action research arm test (ARAT), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), the motor activity log (MAL) and the maximal elbow extension angle during reaching (MEEAR) were completed at baseline and post intervention. RESULTS The mCIMT combined with trunk restraint group exhibited more improved in the ARAT, FMA, MBI, MAL and MEEAR compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (P = 0.046), FMA (P = 0.008), MBI (P = 0.001), MAL-AOU (P = 0.024), MAL-QOM (P = 0.010) and MEEAR (P = 0.001) between groups. CONCLUSIONS These results suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in subacute stroke patients with moderate motor impairment.
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Affiliation(s)
- Dae-Hyouk Bang
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
| | - Won-Seob Shin
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea Department of Physical Therapy, Natural Science College, Daejeon University, Daejeon, Republic of Korea
| | - Sung-Jin Choi
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
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