Electromyographic analysis of constraint-induced movement therapy effects in patients after stroke in chronic course

The clinical effect of Kinesio taping and modified constraint-induced movement therapy on upper extremity function and spasticity in patients with stroke: a randomized controlled pilot study

BACKGROUND

Spasticity and impaired hand function are common complication in patients with stroke, and it pose negative impact on quality of life.

AIM

We aimed to assess the effect of the combined administration of kinesio taping (KT) and modified constraint-induced movement therapy (mCIMT) on upper extremity function and spasticity in hemiplegic patients with stroke.

DESIGN

A randomized controlled pilot study.

SETTING

A hospital center.

POPULATION

Patient of stroke with hemiplegia for 3-12 months.

METHODS

Thirty-five patients were enrolled and allocated into three groups, including the sham KT and mCIMT group, KT group, or KT and mCIMT group. The KT, sham KT, and mCIMT serve as additional therapies (5 days/week for 3 weeks) besides regular rehabilitation (5 days/week for 6 weeks). KT was applied over the dorsal side of the affected hand, while mCIMT was applied to restrain the unaffected upper extremity. The outcomes included the modified Tardieu scale (mTS), Brunnstrom stage, Box and Block Test (BBT), Fugl-Meyer assessment for the upper extremity (FMA-UE), and Stroke Impact Scale version 3.0. Measurements were taken at baseline, immediately after intervention (third week), and 3 weeks later (sixth week).

RESULTS

Between baseline and the third week, within-group comparisons yielded significant improvement in the wrist and hand parts of the FMA and BBT of the Sham KT and mCIMT group (P=0.007-0.035); in the hand part of the FMA, BBT, and mTS degree (P=0.005-0.024) of the KT group; and in the Brunnstrom stage of the wrist, FMA-UE, BBT, and mTS degrees (P=0.005-0.032) of the KT and mCIMT group. Between baseline and the sixth week, there was significant difference in the proximal part of the FMA and mTS degree in groups with KT, but an additional improvement on the Brunnstrom stage of the wrist was noted in the KT and mCIMT group.

CONCLUSIONS

KT benefits patients with stroke in spasticity reduction and upper extremity function. The combination of KT and mCIMT provides extra benefit in motor performance with a more long-lasting effect.

CLINICAL REHABILITATION IMPACT

Kinesio taping could act as potential adjuvant therapy in patient of stroke with hemiplegia.

Impact of the EMG normalization method on muscle activation and the antagonist-agonist co-contraction index during active elbow extension: Practical implications for post-stroke subjects

Electromyographic (EMG) raw signals are sensitive to intrinsic and extrinsic factors. Consequently, EMG normalization is required to draw proper interpretations of standardized data. Specific recommendations are needed regarding a relevant EMG normalization method for participants who show atypical EMG patterns, such as post-stroke subjects. This study compared three EMG normalization methods ("isometric MVC", "isokinetic MVC", "isokinetic MVC kinematic-related") on muscle activations and the antagonist-agonist co-contraction index. Fifteen post-stroke subjects and fifteen healthy controls performed active elbow extensions, followed by isometric and isokinetic maximum voluntary contractions (MVC). Muscle activations were obtained by normalizing EMG envelopes during active movement using a reference value determined for each EMG normalization method. The results showed no significant difference between the three EMG normalization methods in post-stroke subjects on muscle activation and the antagonist-agonist co-contraction index. We highlighted that the antagonist-agonist co-contraction index could underestimate the antagonist co-contraction in the presence of atypical EMG patterns. Based on its practicality and feasibility, we recommend the use of isometric MVC as a relevant procedure for EMG normalization in post-stroke subjects. We suggest combined analysis of the antagonist-agonist co-contraction index and agonist and antagonist activations to properly investigate antagonist co-contraction in the presence of atypical EMG patterns during movement.

Motor imagery training induces changes in brain neural networks in stroke patients

Motor imagery is the mental representation of an action without overt movement or muscle activation. However, the effects of motor imagery on stroke-induced hand dysfunction and brain neural networks are still unknown. We conducted a randomized controlled trial in the China Rehabilitation Research Center. Twenty stroke patients, including 13 males and 7 females, 32–51 years old, were recruited and randomly assigned to the traditional rehabilitation treatment group (PP group, n = 10) or the motor imagery training combined with traditional rehabilitation treatment group (MP group, n = 10). All patients received rehabilitation training once a day, 45 minutes per session, five times per week, for 4 consecutive weeks. In the MP group, motor imagery training was performed for 45 minutes after traditional rehabilitation training, daily. Action Research Arm Test and the Fugl-Meyer Assessment of the upper extremity were used to evaluate hand functions before and after treatment. Transcranial magnetic stimulation was used to analyze motor evoked potentials in the affected extremity. Diffusion tensor imaging was used to assess changes in brain neural networks. Compared with the PP group, the MP group showed better recovery of hand function, higher amplitude of the motor evoked potential in the abductor pollicis brevis, greater fractional anisotropy of the right dorsal pathway, and an increase in the fractional anisotropy of the bilateral dorsal pathway. Our findings indicate that 4 weeks of motor imagery training combined with traditional rehabilitation treatment improves hand function in stroke patients by enhancing the dorsal pathway. This trial has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-OCH-12002238).