1
|
Rizor E, Fridriksson J, Peters DM, Rorden C, Bonilha L, Yourganov G, Fritz SL, Stewart JC. Brain-Hand Function Relationships Based on Level of Grasp Function in Chronic Left-Hemisphere Stroke. Neurorehabil Neural Repair 2024; 38:752-763. [PMID: 39162287 DOI: 10.1177/15459683241270080] [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] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND OBJECTIVE The biomarkers of hand function may differ based on level of motor impairment after stroke. The objective of this study was to determine the relationship between resting state functional connectivity (RsFC) and unimanual contralesional hand function after stroke and whether brain-behavior relationships differ based on level of grasp function. METHODS Sixty-two individuals with chronic, left-hemisphere stroke were separated into three functional levels based on Box and Blocks Test performance with the contralesional hand: Low (moved 0 blocks), Moderate (moved >0% but <90% of blocks relative to the ipsilesional hand), and High (moved ≥90% of blocks relative to the ipsilesional hand). RESULTS RsFC in the ipsilesional and interhemispheric motor networks was reduced in the Low group compared to the Moderate and High groups. While interhemispheric RsFC correlated with hand function (grip strength and Stroke Impact Scale Hand) across the sample, contralesional RsFC correlated with hand function in the Low group and no measures of connectivity correlated with hand function in the Moderate and High groups. Linear regression modeling found that contralesional RsFC significantly predicted hand function in the Low group, while no measure correlated with hand function in the High group. Corticospinal tract integrity was the only predictor of hand function for the Moderate group and in an analysis across the entire sample. CONCLUSIONS Differences in brain-hand function relationships based on level of motor impairment may have implications for predictive models of treatment response and the development of intervention protocols aimed at improving hand function after stroke.
Collapse
Affiliation(s)
- Elizabeth Rizor
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department Communication Sciences & Disorders, University of South Carolina, Columbia, SC, USA
| | - Denise M Peters
- Department of Rehabilitation & Movement Science, University of Vermont, Burlington, VT, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Grigori Yourganov
- Department of Rehabilitation & Movement Science, University of Vermont, Burlington, VT, USA
| | - Stacy L Fritz
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | | |
Collapse
|
2
|
Lee SI, Liu Y, Vergara-Díaz G, Pugliese BL, Black-Schaffer R, Stoykov ME, Bonato P. Wearable-Based Kinematic Analysis of Upper-Limb Movements During Daily Activities Could Provide Insights into Stroke Survivors' Motor Ability. Neurorehabil Neural Repair 2024; 38:659-669. [PMID: 39109662 PMCID: PMC11405131 DOI: 10.1177/15459683241270066] [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] [Indexed: 09/15/2024]
Abstract
BACKGROUND Frequent and objective monitoring of motor recovery progression holds significant importance in stroke rehabilitation. Despite extensive studies on wearable solutions in this context, the focus has been predominantly on evaluating limb activity. This study aims to address this limitation by delving into a novel measure of wrist kinematics more intricately related to patients' motor capacity. OBJECTIVE To explore a new wearable-based approach for objectively and reliably assessing upper-limb motor ability in stroke survivors using a single inertial sensor placed on the stroke-affected wrist. METHODS Seventeen stroke survivors performed a series of daily activities within a simulated home setting while wearing a six-axis inertial measurement unit on the wrist affected by stroke. Inertial data during point-to-point upper-limb movements were decomposed into movement segments, from which various kinematic variables were derived. A data-driven approach was then employed to identify a kinematic variable demonstrating robust internal reliability, construct validity, and convergent validity. RESULTS We have identified a key kinematic variable, namely the 90th percentile of movement segment distance during point-to-point movements. This variable exhibited robust reliability (intra-class correlation coefficient of .93) and strong correlations with established clinical measures of motor capacity (Pearson's correlation coefficients of .81 with the Fugl-Meyer Assessment for Upper-Extremity; .77 with the Functional Ability component of the Wolf Motor Function Test; and -.68 with the Performance Time component of the Wolf Motor Function Test). CONCLUSIONS The findings underscore the potential for continuous, objective, and convenient monitoring of stroke survivors' motor progression throughout rehabilitation.
Collapse
Affiliation(s)
- Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Yunda Liu
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Gloria Vergara-Díaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Benito Lorenzo Pugliese
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Randie Black-Schaffer
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Mary Ellen Stoykov
- Arm & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
| |
Collapse
|
3
|
Abedi M, Behzadipour S. A novel biomechanical index for quality assessment of the upper-extremity movements in post-stroke patients. Comput Biol Med 2024; 179:108875. [PMID: 39018881 DOI: 10.1016/j.compbiomed.2024.108875] [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: 01/02/2024] [Revised: 06/22/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND While motor recovery is preferred to compensatory movements for stroke patients with mild to moderate motion impairment, current movement quality assessments rarely reflect the differences between a patient's pre- and post-stroke movement patterns. Such comparison can help therapists to identify the rate of the restoration of premorbid motion patterns and prescribe the most effective treatment. METHODS This paper attempted to present a new biomechanical metric for the quality of upper-limb movements which uses the subject's optimal movements as a reference to evaluate his/her UL movement quality. To this end, an inverse optimal control algorithm was applied to find an estimation of the patient's premorbid motion patterns. The new biomechanical index was then calculated as a measure of similarity between the optimal and actual movement trajectories. In the next part, various simulation and clinimetric investigations were performed to evaluate the responses of the new index to variations of the movement quality as well as its test-retest reliability and concurrent validity. RESULTS Simulation-based analyses demonstrated that the proposed index, in contrast to the previous popular biomechanical indices, can successfully detect a wide range of abnormalities in motion signals. In addition, it showed good test-retest reliability (ICC = 0.89) and moderate correlation with clinical indices, Fugl-Meyer Assessment (r = 0.66), Action Research Arm Test (r = 0.47), and ABILHAND (r = 0.27). CONCLUSIONS Although the proposed index has the same degree of clinimetric properties as the previous metrics, the ability to identify the level of movement restoration and also various types and severities of motor disabilities may lead to better design and management of motor rehabilitation.
Collapse
Affiliation(s)
- Majid Abedi
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; Djawad Movafaghian Research Center in Rehab Technologies, Sharif University of Technology, Tehran, Iran.
| |
Collapse
|
4
|
Lin GH, Lee SC, Huang CY, Wang I, Lee YC, Hsueh IP, Hsieh CL. Developing an Accumulative Assessment System of Upper Extremity Motor Function in Patients With Stroke Using Deep Learning. Phys Ther 2024; 104:pzae050. [PMID: 38531775 DOI: 10.1093/ptj/pzae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/03/2023] [Accepted: 02/13/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE The Fugl-Meyer assessment for upper extremity (FMA-UE) is a measure for assessing upper extremity motor function in patients with stroke. However, the considerable administration time of the assessment decreases its feasibility. This study aimed to develop an accumulative assessment system of upper extremity motor function (AAS-UE) based on the FMA-UE to improve administrative efficiency while retaining sufficient psychometric properties. METHODS The study used secondary data from 3 previous studies having FMA-UE datasets, including 2 follow-up studies for subacute stroke individuals and 1 test-retest study for individuals with chronic stroke. The AAS-UE adopted deep learning algorithms to use patients' prior information (ie, the FMA-UE scores in previous assessments, time interval of adjacent assessments, and chronicity of stroke) to select a short and personalized item set for the following assessment items and reproduce their FMA-UE scores. RESULTS Our data included a total of 682 patients after stroke. The AAS-UE administered 10 different items for each patient. The AAS-UE demonstrated good concurrent validity (r = 0.97-0.99 with the FMA-UE), high test-retest reliability (intra-class correlation coefficient = 0.96), low random measurement error (percentage of minimal detectable change = 15.6%), good group-level responsiveness (standardized response mean = 0.65-1.07), and good individual-level responsiveness (30.5%-53.2% of patients showed significant improvement). These psychometric properties were comparable to those of the FMA-UE. CONCLUSION The AAS-UE uses an innovative assessment method, which makes good use of patients' prior information to achieve administrative efficiency with good psychometric properties. IMPACT This study demonstrates a new assessment method to improve administrative efficiency while retaining psychometric properties, especially individual-level responsiveness and random measurement error, by making good use of patients' basic information and medical records.
Collapse
Affiliation(s)
- Gong-Hong Lin
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Inga Wang
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| |
Collapse
|
5
|
Feingold-Polak R, Barzel O, Levy-Tzedek S. Socially Assistive Robot for Stroke Rehabilitation: A Long-Term in-the-Wild Pilot Randomized Controlled Trial. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1616-1626. [PMID: 38598401 DOI: 10.1109/tnsre.2024.3387320] [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: 04/12/2024]
Abstract
Socially assistive robots (SARs) have been suggested as a platform for post-stroke training. It is not yet known whether long-term interaction with a SAR can lead to an improvement in the functional ability of individuals post-stroke. The aim of this pilot study was to compare the changes in motor ability and quality of life following a long-term intervention for upper-limb rehabilitation of post-stroke individuals using three approaches: 1) training with a SAR in addition to usual care; 2) training with a computer in addition to usual care; and 3) usual care with no additional intervention. Thirty-three post-stroke patients with moderate-severe to mild impairment were randomly allocated into three groups: two intervention groups - one with a SAR (ROBOT group) and one with a computer (COMPUTER group) - and one control group with no intervention (CONTROL group). The intervention sessions took place three times/week, for a total of 15 sessions/participant; The study was conducted over a period of two years, during which 306 sessions were held. Twenty-six participants completed the study. Participants in the ROBOT group significantly improved in their kinematic and clinical measures which included smoothness of movement, action research arm test (ARAT), and Fugl-Meyer upper-extremity assessment (FMA-UE). No significant improvement in these measures was found in the COMPUTER or the control groups. 100% of the participants in the SAR group gained improvement which reached - or exceeded - the minimal clinically important difference in the ARAT, the gold standard for upper-extremity activity performance post-stroke. This study demonstrates both the feasibility and the clinical benefit of using a SAR for long-term interaction with post-stroke individuals as part of their rehabilitation program. Trial Registration: ClinicalTrials.gov NCT03651063.
Collapse
|
6
|
da Silva Matuti G, Firmo Dos Santos J, da Silva ML, Menezes de Oliveira E, Lunardi AC, Biney F, Uswatte G, Taub E, Regina Alouche S. Grade-4/5 motor activity log-Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study. Disabil Rehabil 2024:1-9. [PMID: 38265026 DOI: 10.1080/09638288.2024.2305298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE This study examined the clinimetrics of the Brazilian-Portuguese translation of the Grade-4/5 Motor Activity Log (MAL 4/5), which assesses everyday use of the more affected upper-limb (UL) in stroke survivors with moderate/severe or severe motor impairment. MATERIALS AND METHODS The translated MAL 4/5 was administered to 47 stroke survivors with moderate/severe or severe UL motor impairment. Accelerometers were worn on participants' wrists for five days on average prior to the first assessment. Test-retest and inter-rater reliabilities were assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach's α, and construct validity was tested with correlations with the accelerometry. The measurement error (SEM) and the minimal detectable change (MDC) were calculated. RESULTS MAL4/5-Brazil's test-retest reliability (AOU: ICC = 0.84; QOU: ICC = 0.90), inter-rater reliability (AOU: ICC = 0.83; QOU: ICC = 0.91), internal consistency (Cronbach's α = 0.91 and 0.95 for AOU and QOU scales, respectively), the SEM and MDC were 0.3 and 0.8 points for the AOU subscale and 0.2 and 0.5 points for the QOU subscale, respectively. The construct validity (AOU scale: r = 0.67; QOU scale: r = 0.76) was high. CONCLUSION Grade-4/5 Motor Activity Log-Brazil is a reliable and valid instrument for assessing the more-affected UL use of stroke patients with moderate/severe or severe UL motor impairments.
Collapse
Affiliation(s)
| | | | - Maria Liliane da Silva
- Physiotherapy Department of Associação de Assistência à Criança Deficiente, São Paulo, Brazil
| | | | - Adriana Cláudia Lunardi
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Fedora Biney
- Department of Physical Medicine and Rehabilitation, University of AL at Birmingham, Birmingham, AL, USA
| | - Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra Regina Alouche
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
7
|
Coremans M, Carmeli E, De Bauw I, Essers B, Lemmens R, Verheyden G. Error Enhancement for Upper Limb Rehabilitation in the Chronic Phase after Stroke: A 5-Day Pre-Post Intervention Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:471. [PMID: 38257564 PMCID: PMC10820998 DOI: 10.3390/s24020471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
A large proportion of chronic stroke survivors still struggle with upper limb (UL) problems in daily activities, typically reaching tasks. During three-dimensional reaching movements, the deXtreme robot offers error enhancement forces. Error enhancement aims to improve the quality of movement. We investigated clinical and patient-reported outcomes and assessed the quality of movement before and after a 5 h error enhancement training with the deXtreme robot. This pilot study had a pre-post intervention design, recruiting 22 patients (mean age: 57 years, mean days post-stroke: 1571, male/female: 12/10) in the chronic phase post-stroke with UL motor impairments. Patients received 1 h robot treatment for five days and were assessed at baseline and after training, collecting (1) clinical, (2) patient-reported, and (3) kinematic (KINARM, BKIN Technologies Ltd., Kingston, ON, Canada) outcome measures. Our analysis revealed significant improvements (median improvement (Q1-Q3)) in (1) UL Fugl-Meyer assessment (1.0 (0.8-3.0), p < 0.001) and action research arm test (2.0 (0.8-2.0), p < 0.001); (2) motor activity log, amount of use (0.1 (0.0-0.3), p < 0.001) and quality of use (0.1 (0.1-0.5), p < 0.001) subscale; (3) KINARM-evaluated position sense (-0.45 (-0.81-0.09), p = 0.030) after training. These findings provide insight into clinical self-reported and kinematic improvements in UL functioning after five hours of error enhancement UL training.
Collapse
Affiliation(s)
- Marjan Coremans
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Eli Carmeli
- Department of Physical Therapy, University of Haifa, Haifa 3498838, Israel;
| | - Ineke De Bauw
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology, KU Leuven, 3000 Leuven, Belgium;
- Department of Neurology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, 3001 Leuven, Belgium; (I.D.B.); (B.E.)
| |
Collapse
|
8
|
Hsu HY, Koh CL, Yang KC, Lin YC, Hsu CH, Su FC, Kuo LC. Effects of an assist-as-needed equipped Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) on upper limb function in patients with chronic stroke. J Neuroeng Rehabil 2024; 21:5. [PMID: 38173006 PMCID: PMC10765635 DOI: 10.1186/s12984-023-01298-2] [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: 06/02/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The original version of the Tenodesis-Induced-Grip Exoskeleton Robot (TIGER) significantly improved the motor and functional performance of the affected upper extremity of chronic stroke patients. The assist-as-needed (AAN) technique in robot-involved therapy is widely favored for promoting patient active involvement, thereby fostering motor recovery. However, the TIGER lacked an AAN control strategy, which limited its use in different clinical applications. The present study aimed to develop and analyze the training effects of an AAN control mode to be integrated into the TIGER, to analyze the impact of baseline patient characteristics and training paradigms on outcomes for individuals with chronic stroke and to compare training effects on the upper limb function between using the AAN-equipped TIGER and using the original prototype. METHODS This was a single-arm prospective interventional study which was conducted at a university hospital. In addition to 20 min of regular task-specific motor training, each participant completed a 20-min robotic training program consisting of 10 min in the AAN control mode and 10 min in the functional mode. The training sessions took place twice a week for 9 weeks. The primary outcome was the change score of the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), and the secondary outcomes were the change score of the Box and Blocks Test (BBT), the amount of use (AOU) and quality of movement (QOM) scales of the Motor Activity Log (MAL), the Semmes-Weinstein Monofilament (SWM) test, and the Modified Ashworth Scale (MAS) for fingers and wrist joints. The Generalized Estimating Equations (GEE) and stepwise regression model were used as the statistical analysis methods. RESULTS Sixteen chronic stroke patients completed all steps of the study. The time from stroke onset to entry into the trial was 21.7 ± 18.9 months. After completing the training with the AAN-equipped TIGER, they exhibited significant improvements in movement reflected in their total score (pre/post values were 34.6 ± 11.5/38.5 ± 13.4) and all their sub-scores (pre/post values were 21.5 ± 6.0/23.3 ± 6.5, 9.5 ± 6.2/11.3 ± 7.2, and 3.6 ± 1.0/3.9 ± 1.0 for the shoulder, elbow, and forearm sub-category, the wrist and hand sub-category, and the coordination sub-category, respectively) on the FMA-UE (GEE, p < 0.05), as well as their scores on the BBT (pre/post values were 5.9 ± 6.5/9.5 ± 10.1; GEE, p = 0.004) and the AOU (pre/post values were 0.35 ± 0.50/0.48 ± 0.65; GEE, p = 0.02). However, the original TIGER exhibited greater improvements in their performance on the FMA-UE than the participants training with the AAN-equipped TIGER (GEE, p = 0.008). The baseline score for the wrist and hand sub-category of the FMA-UE was clearly the best predictor of TIGER-mediated improvements in hand function during the post-treatment assessment (adjusted R2 = 0.282, p = 0.001). CONCLUSIONS This study developed an AAN-equipped TIGER system and demonstrated its potential effects on improving both the function and activity level of the affected upper extremity of patients with stroke. Nevertheless, its training effects were not found to be advantageous to the original prototype. The baseline score for the FMA-UE sub-category of wrist and hand was the best predictor of improvements in hand function after TIGER rehabilitation. Clinical trial registration ClinicalTrials.gov, identifier NCT03713476; date of registration: October19, 2018. https://clinicaltrials.gov/ct2/show/NCT03713476.
Collapse
Affiliation(s)
- Hsiu-Yun Hsu
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Chia-Lin Koh
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
| | - Kang-Chin Yang
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Ching Lin
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh-Hsiang Hsu
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fong-Chin Su
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Li-Chieh Kuo
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan, 701, Taiwan.
- Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
9
|
Ota H, Mukaino M, Inoue Y, Matsuura S, Yagi S, Kanada Y, Saitoh E, Otaka Y. Movement Component Analysis of Reaching Strategies in Individuals With Stroke: Preliminary Study. JMIR Rehabil Assist Technol 2023; 10:e50571. [PMID: 38051570 PMCID: PMC10731574 DOI: 10.2196/50571] [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: 07/05/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. OBJECTIVE This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. METHODS A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. RESULTS A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5%, SD 24.5% vs mean 85.2%, SD 4.5%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0%, SD 28.5% vs mean 3.0%, SD 2.8%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8%, SD 23.7% vs mean 90.7%, SD 11.8%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5%, SD 5.7% vs mean 6.5%, SD 3.0%; P=.02 and mean 16.5%, SD 18.7% vs mean 3.0%, SD 10.4%; P=.02, respectively). CONCLUSIONS Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation.
Collapse
Affiliation(s)
- Hirofumi Ota
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yukari Inoue
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Shoh Matsuura
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Senju Yagi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| |
Collapse
|
10
|
Boccuni L, Abellaneda-Pérez K, Martín-Fernández J, Leno-Colorado D, Roca-Ventura A, Prats Bisbe A, Buloz-Osorio EA, Bartrés-Faz D, Bargalló N, Cabello-Toscano M, Pariente JC, Muñoz-Moreno E, Trompetto C, Marinelli L, Villalba-Martinez G, Duffau H, Pascual-Leone Á, Tormos Muñoz JM. Neuromodulation-induced prehabilitation to leverage neuroplasticity before brain tumor surgery: a single-cohort feasibility trial protocol. Front Neurol 2023; 14:1243857. [PMID: 37849833 PMCID: PMC10577187 DOI: 10.3389/fneur.2023.1243857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/04/2023] [Indexed: 10/19/2023] Open
Abstract
Introduction Neurosurgery for brain tumors needs to find a complex balance between the effective removal of targeted tissue and the preservation of surrounding brain areas. Neuromodulation-induced cortical prehabilitation (NICP) is a promising strategy that combines temporary inhibition of critical areas (virtual lesion) with intensive behavioral training to foster the activation of alternative brain resources. By progressively reducing the functional relevance of targeted areas, the goal is to facilitate resection with reduced risks of neurological sequelae. However, it is still unclear which modality (invasive vs. non-invasive neuromodulation) and volume of therapy (behavioral training) may be optimal in terms of feasibility and efficacy. Methods and analysis Patients undertake between 10 and 20 daily sessions consisting of neuromodulation coupled with intensive task training, individualized based on the target site and neurological functions at risk of being compromised. The primary outcome of the proposed pilot, single-cohort trial is to investigate the feasibility and potential effectiveness of a non-invasive NICP protocol on neuroplasticity and post-surgical outcomes. Secondary outcomes investigating longitudinal changes (neuroimaging, neurophysiology, and clinical) are measured pre-NICP, post-NICP, and post-surgery. Ethics and dissemination Ethics approval was obtained from the Research Ethical Committee of Fundació Unió Catalana d'Hospitals (approval number: CEI 21/65, version 1, 13/07/2021). The results of the study will be submitted to a peer-reviewed journal and presented at scientific congresses. Clinical trial registration ClinicalTrials.gov, identifier NCT05844605.
Collapse
Affiliation(s)
- Leonardo Boccuni
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Kilian Abellaneda-Pérez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jesús Martín-Fernández
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
- Department of Neurosurgery, Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
- Department of Basic Medical Sciences, Universidad de La Laguna, Tenerife, Spain
| | - David Leno-Colorado
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alba Roca-Ventura
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Alba Prats Bisbe
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Edgar Antonio Buloz-Osorio
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
- Department of Morphological Sciences (Human Anatomy and Embriology Unit), Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Nuria Bargalló
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic de Barcelona, Barcelona, Spain
| | - María Cabello-Toscano
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Emma Muñoz-Moreno
- Experimental 7T MRI Unit, Magnetic Resonance Imaging Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Carlo Trompetto
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Neuroscience, Division of Neurorehabilitation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucio Marinelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- Department of Neuroscience, Division of Clinical Neurophysiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Álvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew Senior Life, Boston, MA, United States
- Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Josep María Tormos Muñoz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Centro de Investigación Traslacional San Alberto Magno, Facultad de Medicina y Ciencias de la Salud, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| |
Collapse
|
11
|
Rozevink SG, Hijmans JM, Horstink KA, van der Sluis CK. Effectiveness of task-specific training using assistive devices and task-specific usual care on upper limb performance after stroke: a systematic review and meta-analysis. Disabil Rehabil Assist Technol 2023; 18:1245-1258. [PMID: 34788166 DOI: 10.1080/17483107.2021.2001061] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Task-specific rehabilitation is a key indicator for successful rehabilitation to improve the upper limb performance after stroke. Assistive robotic and non-robotic devices are emerging to provide rehabilitation therapy; however, the effectiveness of task-specific training programs using assistive training devices compared with task-specific usual care training has not been summarized yet. Therefore, the effectiveness of task-specific training using assistive arm devices (TST-AAD) compared with task-specific usual care (TSUC) on the upper limb performance of patients with a stroke was investigated. To assess task specificity, a set of criteria was proposed: participation, program, relevant, repeated, randomized, reconstruction and reinforced. MATERIALS AND METHODS Out of 855 articles, 17 fulfilled the selection criteria. A meta-analysis was performed on the Fugl-Meyer Assessment scores in the subacute and chronic stages after stroke and during follow-up. RESULTS AND CONCLUSION Both TST-AAD and TSUC improved the upper limb performance after stroke. In the sub-acute phase after stroke, TST-AAD was more effective than TSUC in reducing the upper limb impairment, although findings were based on only three studies. In the chronic phase, TST-AAD and TSUC showed similar effectiveness. No differences between the two types of training were found at the follow-up measurements. Future studies should describe training, device usage and criteria of task specificity in a standardized way to ease comparison.Implications for rehabilitationArm or hand function is often undertreated in stroke patients, assistive training devices may be able to improve the upper limb performance.Task-specific training using assistive devices is effective in improving the upper limb performance after stroke.Task-specific training using assistive devices seems to be more effective in reducing impairment compared with task specific usual care in the subacute phase after stroke, but they are equally effective in the chronic phase of stroke.
Collapse
Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Koen A Horstink
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| |
Collapse
|
12
|
Laclergue Z, Ghédira M, Gault-Colas C, Billy L, Gracies JM, Baude M. Reliability of the Modified Frenchay Scale for the Assessment of Upper Limb Function in Adults With Hemiparesis. Arch Phys Med Rehabil 2023; 104:1596-1605. [PMID: 37121532 DOI: 10.1016/j.apmr.2023.04.003] [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: 06/21/2022] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVES To investigate the reliability of the Modified Frenchay Scale (MFS) in adults with hemiparesis. DESIGN Prospective analysis of videos. SETTING Study conducted in a Neurorehabilitation Unit of a University Hospital. PARTICIPANTS Fifty-one patients (17 women [33%], age 46±15, time since injury 5.2±6.7 years) with hemiparesis secondary to stroke (N=47), tumor (N=3), or spinal cord injury (N=1) were enrolled. INTERVENTION The MFS measures active upper limb function in spastic hemiparesis based on a video recording of 10 daily living tasks, each rated from 0 to 10. Six tasks are bimanual and 4 are unimanual with the paretic hand. MFS videos performed in routine care of patients with hemiparesis between 2015 and 2021 were collected. After a 3-hour group training session, each MFS video was assessed twice, 1 week apart by 4 rehabilitation professionals with various levels of experience in using the scale. MAIN OUTCOME MEASURES Internal consistency was determined using Cronbach's alpha. Intra- and inter-rater reliability was measured using intraclass correlation coefficients (ICC, mean [95% CI]), mean differences between ratings and minimal detectable change (MDC). Bland-Altman plots were also performed for inter-rater assessments. RESULTS The mean overall MFS score was 4.95±1.20 with no floor or ceiling effect. Cronbach's α was 0.97. For the overall MFS score, intra- and inter-rater ICCs were 0.99[0.99;1.00] and 0.97[0.95;0.98], respectively; mean intra- and inter-rater differences were 0.10±0.04 and 0.24±0.12, respectively; and MDC were 0.17 and 0.37, respectively. CONCLUSIONS The MFS is an internally consistent and reliable scale to assess upper limb function in adults with hemiparesis.
Collapse
Affiliation(s)
- Zoé Laclergue
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
| | - Mouna Ghédira
- UR 7377 BIOTN, Université Paris Est Créteil (UPEC), Créteil, France
| | - Caroline Gault-Colas
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Laurène Billy
- Pôle de Médecine Physique et Réadaptation, Fondation Mallet, Richebourg, France
| | - Jean-Michel Gracies
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; UR 7377 BIOTN, Université Paris Est Créteil (UPEC), Créteil, France
| | - Marjolaine Baude
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France; UR 7377 BIOTN, Université Paris Est Créteil (UPEC), Créteil, France
| |
Collapse
|
13
|
Woodbury M, Grattan ES, Li CY. Development of a Short Form Assessment Combining the Fugl-Meyer Assessment-Upper Extremity and the Wolf Motor Function Test for Evaluating Stroke Recovery. Arch Phys Med Rehabil 2023; 104:1661-1668. [PMID: 37245692 PMCID: PMC10543466 DOI: 10.1016/j.apmr.2023.04.029] [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: 10/17/2022] [Revised: 02/14/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To use Rasch methodologies to combine the items of the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, motor skill) and the Wolf Motor Function Test (WMFT, motor function) onto a single measurement metric and create an FMA-UE+WMFT short form. DESIGN Secondary analysis of preintervention data from 2 upper extremity stroke rehabilitation trials. Confirmatory factor analysis and Rasch rating scale analysis were first applied to examine the properties of the pooled item bank and then item response theory methodologies were used to develop the short form. Confirmatory factor analysis and Rasch analysis were then applied to the short form to examine the dimensionality and measurement properties. SETTING Outpatient academic medical research center. PARTICIPANTS Data from 167 participants who completed the FMA-UE and WMFT (rating scale score) were pooled (N=167). Participants were eligible if they had a stroke ≥3 months prior and had upper extremity (UE) hemiparesis and excluded if they had severe UE hemiparesis, severe UE spasticity, or UE pain. INTERVENTION Not applicable. MAIN OUTCOME MEASURES The dimensionality and measurement properties of the pooled 30-item FMA-UE and the 15-item WMFT and short form were examined. RESULTS Five items from the pool of 45 items were misfit and were removed. The 40-item pool demonstrated adequate measurement properties. A 15-item short form was then developed and met rating diagnostic scale criteria. All items on the 15-item short form met the Rasch fit criteria, and the assessment met criteria for reliability (Cronbach alpha=.94), separation (person separation = 3.7), and strata (number of strata = 5). CONCLUSIONS Items from the FMA-UE and WMFT can be pooled to create a psychometrically sound 15-item short form.
Collapse
Affiliation(s)
- Michelle Woodbury
- Department of Health Sciences & Research & Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC.
| | - Emily S Grattan
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; Pittsburgh VA Medical Center, Human Engineering Research Laboratories, Pittsburgh, PA
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX
| |
Collapse
|
14
|
Vales Y, Catalan JM, Bertomeu-Motos A, Garcia-Perez JV, Lledo LD, Blanco-Ivorra A, Marzo CA, Mas G, Garcia-Aracil N. Influence of Robotic Therapy on Severe Stroke Patients. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941295 DOI: 10.1109/icorr58425.2023.10304780] [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: 11/10/2023]
Abstract
Robotic rehabilitation has emerged as a promising approach to enhance motor recovery after stroke, but there is limited knowledge about its efficacy in individuals who have experienced severe stroke. The study presented in this paper aims to analyze the effect of robotic therapy on the recovery of patients with severe stroke when combined with conventional rehabilitation therapies, and we want to observe whether there is a relationship between the clinical assessment provided by the therapist and the data recorded by the robotic device. Participants were divided into an experimental group and a control group, both receiving 15 sessions of conventional therapy in three consecutive weeks, but the experimental group underwent three out of five sessions per week with a robotic device. Both groups were evaluated using clinical scales, and in addition the experimental group was evaluated using an assessment game incorporated in the robotic device that provides session data such as the level of assistance needed by each user to complete the activity, or the score obtained in the game. These preliminary results showed that patients who received robot-assisted therapy had better motor function recovery compared to those who only received conventional therapy. In addition, it is also observed that the robot assistance needed by patients in the experimental group decreased as the sessions progressed, suggesting that robot-assisted therapy could be an effective tool for severe stroke patients.
Collapse
|
15
|
Llamas-Ramos R, Llamas-Ramos I, Pérez-Robledo F, Sánchez-González JL, Bermejo-Gil BM, Frutos-Bernal E, Martín-Nogueras AM. Validity of the telematic Fugl Meyer assessment scale - upper extremity (TFMA-UE) Spanish version. Front Neurol 2023; 14:1226192. [PMID: 37638200 PMCID: PMC10449578 DOI: 10.3389/fneur.2023.1226192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Background Telematic assistance has become indispensable in recent years. The increased prevalence of Acquired brain injury and the sequels it causes, requires long-lasting multidisciplinary treatments. Validated tools to assess the evolution of the disabilities and limitations of this pathology are essential to individualize and prescribe adapted treatments. The aim has been to create the telematic version of the Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) Spanish scale and its adaptation to the remote assessment of neurologic patients. Methods An adapted scale was designed based on the Fugl Meyer Assessment scale-telematic version (FMA-TV): TFMA-UE. This scale is composed by 21 items which evaluate the upper extremity motor function. Physiotherapists trained in this tool, evaluate the results obtained from applying the two versions (on-site and telematic) to compare the results. Results TFMA-UE was administered to 30 patients with acquired brain injury. It was applied on site and through the web platform selected by the patients in two different days. Patients completed all the scale in an easily way without help. The exploratory and confirmatory factor analysis confirmed a factorial structure with a factor (76.08% of the variance). The Cronbach's internal consistency index obtained was 0.98 and the weight kappa index used to measure agreement between the two versions was 0.78 which represents substantial agreement. Conclusion The Telematic Fugl Meyer Assessment-Upper Extremity Motor Function (TFMA-UE) scale is a viable, useful and easy to apply tool that allows the upper extremity motor function assessment of Acquired Brain Injury patients.
Collapse
Affiliation(s)
- Rocío Llamas-Ramos
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Inés Llamas-Ramos
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | - Fátima Pérez-Robledo
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Juan Luis Sánchez-González
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Beatriz María Bermejo-Gil
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| | - Elisa Frutos-Bernal
- Department of Statistics, Facultad de Medicina, Universidad de Salamanca, Campus Miguel de Unamuno, Salamanca, Spain
| | - Ana María Martín-Nogueras
- Department of Nursery and Physiotherapy, Faculty of Nursery and Physiotherapy, Universidad de Salamanca, Salamanca, Spain
| |
Collapse
|
16
|
Parnandi A, Kaku A, Venkatesan A, Pandit N, Fokas E, Yu B, Kim G, Nilsen D, Fernandez-Granda C, Schambra H. Data-Driven Quantitation of Movement Abnormality after Stroke. Bioengineering (Basel) 2023; 10:648. [PMID: 37370579 PMCID: PMC10294965 DOI: 10.3390/bioengineering10060648] [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: 04/27/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Stroke commonly affects the ability of the upper extremities (UEs) to move normally. In clinical settings, identifying and measuring movement abnormality is challenging due to the imprecision and impracticality of available assessments. These challenges interfere with therapeutic tracking, communication, and treatment. We thus sought to develop an approach that blends precision and pragmatism, combining high-dimensional motion capture with out-of-distribution (OOD) detection. We used an array of wearable inertial measurement units to capture upper body motion in healthy and chronic stroke subjects performing a semi-structured, unconstrained 3D tabletop task. After data were labeled by human coders, we trained two deep learning models exclusively on healthy subject data to classify elemental movements (functional primitives). We tested these healthy subject-trained models on previously unseen healthy and stroke motion data. We found that model confidence, indexed by prediction probabilities, was generally high for healthy test data but significantly dropped when encountering OOD stroke data. Prediction probabilities worsened with more severe motor impairment categories and were directly correlated with individual impairment scores. Data inputs from the paretic UE, rather than trunk, most strongly influenced model confidence. We demonstrate for the first time that using OOD detection with high-dimensional motion data can reveal clinically meaningful movement abnormality in subjects with chronic stroke.
Collapse
Affiliation(s)
- Avinash Parnandi
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Aakash Kaku
- NYU Center for Data Science, New York, NY 10011, USA; (A.K.)
| | - Anita Venkatesan
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Natasha Pandit
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Emily Fokas
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Boyang Yu
- NYU Center for Data Science, New York, NY 10011, USA; (A.K.)
| | - Grace Kim
- Department of Occupational Therapy, NYU Steinhardt, New York, NY 10011, USA
| | - Dawn Nilsen
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032, USA
| | - Carlos Fernandez-Granda
- NYU Center for Data Science, New York, NY 10011, USA; (A.K.)
- Courant Institute of Mathematical Sciences, New York, NY 10011, USA
| | - Heidi Schambra
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10017, USA
| |
Collapse
|
17
|
Rodríguez-Hernández M, Polonio-López B, Corregidor-Sánchez AI, Martín-Conty JL, Mohedano-Moriano A, Criado-Álvarez JJ. Can specific virtual reality combined with conventional rehabilitation improve poststroke hand motor function? A randomized clinical trial. J Neuroeng Rehabil 2023; 20:38. [PMID: 37016408 PMCID: PMC10071242 DOI: 10.1186/s12984-023-01170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/30/2023] [Indexed: 04/06/2023] Open
Abstract
TRIAL OBJECTIVE To verify whether conventional rehabilitation combined with specific virtual reality is more effective than conventional therapy alone in restoring hand motor function and muscle tone after stroke. TRIAL DESIGN This prospective single-blind randomized controlled trial compared conventional rehabilitation based on physiotherapy and occupational therapy (control group) with the combination of conventional rehabilitation and specific virtual reality technology (experimental group). Participants were allocated to these groups in a ratio of 1:1. The conventional rehabilitation therapists were blinded to the study, but neither the participants nor the therapist who applied the virtual reality-based therapy could be blinded to the intervention. PARTICIPANTS Forty-six patients (43 of whom completed the intervention period and follow-up evaluation) were recruited from the Neurology and Rehabilitation units of the Hospital General Universitario of Talavera de la Reina, Spain. INTERVENTION Each participant completed 15 treatment sessions lasting 150 min/session; the sessions took place five consecutive days/week over the course of three weeks. The experimental group received conventional upper-limb strength and motor training (100 min/session) combined with specific virtual reality technology devices (50 min/session); the control group received only conventional training (150 min/session). RESULTS As measured by the Ashworth Scale, a decrease in wrist muscle tone was observed in both groups (control and experimental), with a notably larger decrease in the experimental group (baseline mean/postintervention mean: 1.22/0.39; difference between baseline and follow-up: 0.78; 95% confidence interval: 0.38-1.18; effect size = 0.206). Fugl-Meyer Assessment scores were observed to increase in both groups, with a notably larger increase in the experimental group (total motor function: effect size = 0.300; mean: - 35.5; 95% confidence interval: - 38.9 to - 32.0; wrist: effect size = 0.290; mean: - 5.6; 95% confidence interval: - 6.4 to - 4.8; hand: effect size = 0.299; mean: - -8.9; 95% confidence interval: - 10.1 to - 7.6). On the Action Research Arm Test, the experimental group quadrupled its score after the combined intervention (effect size = 0.321; mean: - 32.8; 95% confidence interval: - 40.1 to - 25.5). CONCLUSION The outcomes of the study suggest that conventional rehabilitation combined with a specific virtual reality technology system can be more effective than conventional programs alone in improving hand motor function and voluntary movement and in normalizing muscle tone in subacute stroke patients. With combined treatment, hand and wrist functionality and motion increase; resistance to movement (spasticity) decreases and remains at a reduced level. TRIALS REGISTRY International Clinical Trials Registry Platform: ISRCTN27760662 (15/06/2020; retrospectively registered).
Collapse
Affiliation(s)
- Marta Rodríguez-Hernández
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain.
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain.
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Alicia Mohedano-Moriano
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Juan-José Criado-Álvarez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600, Talavera de la Reina, Spain
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Institute of Health Sciences, Talavera de la Reina, Spain
| |
Collapse
|
18
|
Hsu SP, Lu CF, Lin BF, Tang CW, Kuo IJ, Tsai YA, Guo CY, Lee PL, Shyu KK, Niddam DM, Lee IH. Effects of bihemispheric transcranial direct current stimulation on motor recovery in subacute stroke patients: a double-blind, randomized sham-controlled trial. J Neuroeng Rehabil 2023; 20:27. [PMID: 36849990 PMCID: PMC9969953 DOI: 10.1186/s12984-023-01153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/17/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Bihemispheric transcranial direct current stimulation (tDCS) of the primary motor cortex (M1) can simultaneously modulate bilateral corticospinal excitability and interhemispheric interaction. However, how tDCS affects subacute stroke recovery remains unclear. We investigated the effects of bihemispheric tDCS on motor recovery in subacute stroke patients. METHODS We enrolled subacute inpatients who had first-ever ischemic stroke at subcortical regions and moderate-to-severe baseline Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score 2-56. Participants between 14 and 28 days after stroke were double-blind, randomly assigned (1:1) to receive real (n = 13) or sham (n = 14) bihemispheric tDCS (with ipsilesional M1 anode and contralesional M1 cathode, 20 min, 2 mA) during task practice twice daily for 20 sessions in two weeks. Residual integrity of the ipsilesional corticospinal tract was stratified between groups. The primary efficacy outcome was the change in FMA-UE score from baseline (responder as an increase ≥ 10). The secondary measures included changes in the Action Research Arm Test (ARAT), FMA-Lower Extremity (FMA-LE) and explorative resting-state MRI functional connectivity (FC) of target regions after intervention and three months post-stroke. RESULTS Twenty-seven participants completed the study without significant adverse effects. Nineteen patients (70%) had no recordable baseline motor-evoked potentials (MEP-negative) from the paretic forearm. Compared with the sham group, the real tDCS group showed enhanced improvement of FMA-UE after intervention (p < 0.01, effect size η2 = 0.211; responder rate: 77% vs. 36%, p = 0.031), which sustained three months post-stroke (p < 0.01), but not ARAT. Interestingly, in the MEP-negative subgroup analysis, the FMA-UE improvement remained but delayed. Additionally, the FMA-LE improvement after real tDCS was not significantly greater until three months post-stroke (p < 0.01). We found that the individual FMA-UE improvements after real tDCS were associated with bilateral intrahemispheric, rather than interhemispheric, FC strengths in the targeted cortices, while the improvements after sham tDCS were associated with predominantly ipsilesional FC changes after adjustment for age and sex (p < 0.01). CONCLUSIONS Bihemispheric tDCS during task-oriented training may facilitate motor recovery in subacute stroke patients, even with compromised corticospinal tract integrity. Further studies are warranted for tDCS efficacy and network-specific neuromodulation. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov: (ID: NCT02731508).
Collapse
Affiliation(s)
- Shih-Pin Hsu
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan
| | - Chia-Feng Lu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Bing-Fong Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Chih-Wei Tang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Ju Kuo
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yun-An Tsai
- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Po-Lei Lee
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - Kuo-Kai Shyu
- Department of Electrical Engineering, National Central University, Taoyuan, Taiwan
| | - David M Niddam
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - I-Hui Lee
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei City, Taiwan. .,Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 11217, Taiwan. .,Brain Research Center, National Yang Ming Chiao Tung University, Taipei City, Taiwan.
| |
Collapse
|
19
|
Upper Limb Function Recovery by Combined Repetitive Transcranial Magnetic Stimulation and Occupational Therapy in Patients with Chronic Stroke According to Paralysis Severity. Brain Sci 2023; 13:brainsci13020284. [PMID: 36831827 PMCID: PMC9953939 DOI: 10.3390/brainsci13020284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, the degree of improvement according to paralysis severity remains unverified. Target activities of daily living using upper limb functions can be established by predicting the amount of change after treatment for each paralysis severity level to further aid practice planning. We estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full), stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Motor paralysis severity was the fixed factor for the analysis of covariance; the delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores according to paralysis severity before treatment. We implemented a longitudinal, prospective, interventional, uncontrolled, and multicenter cohort design and analyzed a dataset of 907 patients with stroke hemiplegia. The largest treatment-related changes were observed in the Limited recovery group for upper limb motor paralysis and the Full recovery group for quality-of-life activities using the paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.
Collapse
|
20
|
Lin GH, Wang I, Lee SC, Huang CY, Wang YC, Hsieh CL. Development of a 13-item Short Form for Fugl-Meyer Assessment of Upper Extremity Scale Using a Machine Learning Approach. Arch Phys Med Rehabil 2023:S0003-9993(23)00049-7. [PMID: 36736809 DOI: 10.1016/j.apmr.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/28/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To develop and validate a short form of the Fugl-Meyer Assessment of Upper Extremity Scale (FMA-UE) using a machine learning approach (FMA-UE-ML). In addition, scores of items not included in the FMA-UE-ML were predicted. DESIGN Secondary data from a previous study, which assessed individuals post-stroke using the FMA-UE at 4 time points: 5-30 days post-stroke screen, 2-month post-stroke baseline assessment, 6-month post-stroke assessment, and 12-month post-stroke assessment. SETTING Rehabilitation units in hospitals. PARTICIPANTS A total of 408 individuals post-stroke (N=408). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The 30-item FMA-UE. RESULTS We established 29 candidate versions of the FMA-UE-ML with different numbers of items, from 1 to 29, and examined their concurrent validity and responsiveness. We found that the responsiveness of the candidate versions obviously declined when the number of items was less than 13. Thus, the 13-item version was selected as the FMA-UE-ML. The concurrent validity was good (intra-class correlation coefficients ≥0.99). The standardized response means of the FMA-UE-ML and FMA-UE were 0.54-0.88 and 0.52-0.91, respectively. The Pearson's rs between the change scores of the FMA-UE-ML and those of the FMA-UE were 0.96-0.98. The predicted item scores had acceptable to good accuracy (Kappa=0.50-0.92). CONCLUSIONS The FMA-UE-ML seems a promising short form to improve administrative efficiency while retaining good concurrent validity and responsiveness. In addition, the FAM-UE-ML can provide all item scores of the FMA-UE for users.
Collapse
Affiliation(s)
- Gong-Hong Lin
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Inga Wang
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Shih-Chieh Lee
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan
| | - Chien-Yu Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Ching Wang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| |
Collapse
|
21
|
Ekstrand E, Alt Murphy M, Sunnerhagen KS. Clinical interpretation and cutoff scores for manual ability measured by the ABILHAND questionnaire in people with stroke. Top Stroke Rehabil 2023; 30:21-31. [PMID: 34590536 DOI: 10.1080/10749357.2021.1978631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The ABILHAND questionnaire is recommended to assess perceived manual ability after stroke; however, more knowledge on interpretability is needed to improve the clinical applicability. OBJECTIVES To determine clinically meaningful cutoff scores for different levels of perceived manual ability, assessed by ABILHAND, corresponding to established observed and perceived upper extremity assessments post stroke. METHODS This cross-sectional study, part of the Stroke Arm Longitudinal Study (SALGOT) at the University of Gothenburg, included 80 participants with upper extremity impairments after stroke. The self-reported upper extremity functioning was assessed with ABILHAND and Stroke Impact Scale Hand (SIS Hand), and the observed functioning was assessed by Fugl-Meyer Assessment for Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) at 3 months after stroke. Receiver operating characteristic curve, sensitivity, and specificity analyses were used to determine the cutoffs. RESULTS The overall discriminating accuracy was excellent (AUC > 0.90) for most of the cutoffs and sensitivity and specificity values ranged from 0.73 to 1.0. The ABILHAND cutoff score 1.78 discriminated well between low and good functioning resulting in a 95% match with SIS Hand and 87.5% match with ARAT and FMA-UE. CONCLUSIONS The determined cutoff scores of the ABILHAND, validated through established upper extremity assessments, will provide a useful tool to clinicians when interpreting the logit scores and when selecting individualized treatment options. ABILHAND matched well with self-reported SIS Hand, but discrepancies found with observed scales implies that self-perceived assessments should be complemented with observed assessments.
Collapse
Affiliation(s)
- Elisabeth Ekstrand
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.,Department of Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
22
|
Jimenez-Marin A, De Bruyn N, Gooijers J, Llera A, Meyer S, Alaerts K, Verheyden G, Swinnen SP, Cortes JM. Multimodal and multidomain lesion network mapping enhances prediction of sensorimotor behavior in stroke patients. Sci Rep 2022; 12:22400. [PMID: 36575263 PMCID: PMC9794717 DOI: 10.1038/s41598-022-26945-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
Beyond the characteristics of a brain lesion, such as its etiology, size or location, lesion network mapping (LNM) has shown that similar symptoms after a lesion reflects similar dis-connectivity patterns, thereby linking symptoms to brain networks. Here, we extend LNM by using a multimodal strategy, combining functional and structural networks from 1000 healthy participants in the Human Connectome Project. We apply multimodal LNM to a cohort of 54 stroke patients with the aim of predicting sensorimotor behavior, as assessed through a combination of motor and sensory tests. Results are two-fold. First, multimodal LNM reveals that the functional modality contributes more than the structural one in the prediction of sensorimotor behavior. Second, when looking at each modality individually, the performance of the structural networks strongly depended on whether sensorimotor performance was corrected for lesion size, thereby eliminating the effect that larger lesions generally produce more severe sensorimotor impairment. In contrast, functional networks provided similar performance regardless of whether or not the effect of lesion size was removed. Overall, these results support the extension of LNM to its multimodal form, highlighting the synergistic and additive nature of different types of network modalities, and their corresponding influence on behavioral performance after brain injury.
Collapse
Affiliation(s)
- Antonio Jimenez-Marin
- Computational Neuroimaging Group, Biocruces-Bizkaia Health Research Institute, Biocruces Bizkaia, Plaza de Cruces S/N, 48903, Barakaldo, Spain
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Nele De Bruyn
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jolien Gooijers
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
- LBI-KU Leuven Brain Institute, Leuven, Belgium
| | - Alberto Llera
- Donders Institute for Brain, Cognition and Behaviour, Centre for Cognitive Neuroimaging, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
- LIS Data Solutions, Machine Learning Group, Santander, Spain
| | - Sarah Meyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Alaerts
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Stephan P Swinnen
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
- LBI-KU Leuven Brain Institute, Leuven, Belgium
| | - Jesus M Cortes
- Computational Neuroimaging Group, Biocruces-Bizkaia Health Research Institute, Biocruces Bizkaia, Plaza de Cruces S/N, 48903, Barakaldo, Spain.
- Cell Biology and Histology Department, University of the Basque Country (UPV/EHU), Leioa, Spain.
- IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain.
| |
Collapse
|
23
|
Study Protocol for a Multicenter, Randomized Controlled Trial to Improve Upper Extremity Hemiparesis in Chronic Stroke Patients by One-to-One Training (NEURO ®) with Repetitive Transcranial Magnetic Stimulation. J Clin Med 2022; 11:jcm11226835. [PMID: 36431312 PMCID: PMC9695575 DOI: 10.3390/jcm11226835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/11/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
During recovery from upper limb motor paralysis after stroke, it is important to (1) set the exercise difficulty level according to the motor paralysis severity, (2) provide adequate exercises, and (3) motivate the patient to achieve the goal. However, these factors have not been well-formulated. This multicenter, randomized controlled trial study aims to examine the therapeutic effects of these three factors on patients undergoing a novel intervention using repetitive transcranial magnetic stimulation and intensive one-to-one training (NEURO®) and to formulate a corresponding research protocol. The control group will receive conventional NEURO® occupational therapy. In the intervention group, four practice plans will be selected according to the Fugl-Meyer assessment (FMA-UE) scores of the upper extremity. The goal is to predict the post-treatment outcomes based on the pre-treatment FMA-UE scores. Based on the degree of difficulty and amount of practice required, we can formulate a practice plan to promote upper limb motor recovery. This occupational therapy plan will be less influenced by the therapist's skill, facilitating effective rehabilitation. The study findings may be utilized to promote upper limb motor paralysis recovery and provide a basis for proposing activities of daily living adapted to upper limb function.
Collapse
|
24
|
Schwartz E, Guidry K, Lee A, Dinh D, Levin MF, Demers M. Clinical Motor Coordination Tests in Adult Neurology: A Scoping Review. Physiother Can 2022; 74:387-395. [PMID: 37324609 PMCID: PMC10262719 DOI: 10.3138/ptc-2021-0025] [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: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/22/2021] [Indexed: 08/26/2023]
Abstract
Purpose: This scoping review aimed to identify which clinical tests are used to assess upper limb, lower limb, and trunk motor coordination, and their metric and measurement properties for adult neurological populations. Method: MEDLINE (1946-) and EMBASE (1996-) databases were searched using keywords such as movement quality, motor performance, motor coordination, assessment, and psychometrics. Data regarding the body part assessed, neurological condition, psychometric properties, and scored metrics of spatial and/or temporal coordination were independently extracted by two reviewers. Alternate versions of some tests such as the Finger-to-Nose Test were included. Results: Fifty-one included articles yielded 2 tests measuring spatial coordination, 7 tests measuring temporal coordination, and 10 tests measuring both. Scoring metrics and measurement properties differed between tests, with a majority of tests having good-to-excellent measurement properties. Conclusions: The metrics of motor coordination scored by current tests vary. Since tests do not assess functional task performance, the onus falls on clinicians to infer the connection between coordination impairments and functional deficits. Clinical practice would benefit from the development of a battery of tests that assesses the metrics of coordination related to functional performance.
Collapse
Affiliation(s)
- Elka Schwartz
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Kathryn Guidry
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Amanda Lee
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Danny Dinh
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Mindy F. Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| | - Marika Demers
- Centre Intégré de Santé et Services Sociaux de Laval–Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Quebec, Canada
| |
Collapse
|
25
|
Huang YJ, Wang SM, Chen C, Chen CA, Wu CW, Chen JJ, Peng CW, Lin CW, Huang SW, Chen SC. High-Definition Transcranial Direct Current with Electrical Theta Burst on Post-Stroke Motor Rehabilitation: A Pilot Randomized Controlled Trial. Neurorehabil Neural Repair 2022; 36:645-654. [PMID: 36047662 DOI: 10.1177/15459683221121751] [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
BACKGROUND High-definition transcranial electrical theta burst superimposing direct current stimulation (HD-tDCS-eTBS) not only incorporates the therapeutic advantages of tDCS and TBS but enhances stimulation focality and practicality. However, the applicability of this innovative neuromodulatory device in post-stroke rehabilitation remains uncertain. OBJECTIVE This study aimed to assess the efficacy and safety of the HD-tDCS-eTBS on upper extremity (UE) motor function in patients with chronic stroke. METHODS A patient-blinded, randomized controlled study was conducted. Twenty-four participants were randomly assigned into either the active HD-tDCS-eTBS group or sham HD-tDCS-eTBS group. Both groups received 20 minutes of active/sham HD-tDCS-eTBS combined with 30 minutes of conventional UE rehabilitation each time, 3 times a week for 4 weeks. Outcome measures including the Fugl-Meyer Assessment of Upper Extremity, Wolf Motor Function Test, Jebsen-Taylor Hand Function Test, Finger-Nose Test, and Modified Ashworth Scale were assessed before and immediately after the intervention period. RESULTS Spasticity of shoulder adductor (P = .05), elbow extensor (P = .04), and thumb flexor (P < .01) were significantly reduced in the active HD-tDCS-eTBS group versus the sham group. Nonsignificant trends in the improvements of most other outcome measures were in favor of the active HD-tDCS-eTBS group with moderate to large effect sizes (P = .06-.26, ηp2 = 0.06-0.16). No severe adverse events except for slight skin redness under the stimulus electrode was detected after the HD-tDCS-eTBS. CONCLUSIONS Our findings support that HD-tDCS-eTBS is safe and has therapeutic potential for post-stroke UE motor rehabilitation. TRIAL REGISTRATION ClinicalTrials.gov (ID: NCT04278105).
Collapse
Affiliation(s)
- Yi-Jing Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei
| | - Shun-Min Wang
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan
| | - Chieh Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei
| | - Chien-An Chen
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan
| | - Chun-Wei Wu
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei
| | - Jia-Jin Chen
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan
| | - Chih-Wei Peng
- School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei.,International PhD Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei.,School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei
| | - Che-Wei Lin
- Department of Biomedical Engineering, College of Engineering, National Cheng Kung University, Tainan.,Medical Device Innovation Center, National Cheng Kung University, Tainan.,Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan.,Institute of Medical Informatics, College of Electrical Engineering and Computer Science, National Cheng Kung University, Tainan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Shih-Ching Chen
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| |
Collapse
|
26
|
Gomez-Arrunategui JP, Eng JJ, Hodgson AJ. Monitoring Arm Movements Post-Stroke for Applications in Rehabilitation and Home Settings. IEEE Trans Neural Syst Rehabil Eng 2022; 30:2312-2321. [PMID: 35947559 DOI: 10.1109/tnsre.2022.3197993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Optimal recovery of arm function following stroke requires patients to perform a large number of functional arm movements in clinical therapy sessions, as well as at home. Technology to monitor adherence to this activity would be helpful to patients and clinicians. Current approaches to monitoring arm movements are limited because of challenges in distinguishing between functional and non-functional movements. Here, we present an Arm Rehabilitation Monitor (ARM), a device intended to make such measurements in an unobtrusive manner. The ARM device is based on a single Inertial Measurement Unit (IMU) worn on the wrist and uses machine learning techniques to interpret the resulting signals. We characterized the ability of the ARM to detect reaching actions in a functional assessment dataset (functional assessment tasks) and an Activities-of-Daily-Living (ADL) dataset (pizza-making and walking task) from 12 participants with stroke. The Convolutional Neural Network (CNN) and Random Forests (RF) classifiers had a Matthews Correlation Coefficient score of 0.59 and 0.58 when trained and tested on the functional dataset, 0.50 and 0.49 when trained and tested on the ADL dataset, and 0.37 and 0.36 when trained on the functional dataset and tested on the ADL dataset, respectively. The latter is the most relevant scenario for the intended application of training during a clinical visit for monitoring movements in the in-home setting. The classifiers showed good performance in estimating the time spent reaching and number of reaching gestures and showed low sensitivity to irrelevant arm movements produced during walking. We conclude that the ARM has sufficient accuracy and robustness to merit being used in preliminary studies to monitor arm activity in rehabilitation or home applications.
Collapse
|
27
|
Scott SH, Lowrey CR, Brown IE, Dukelow SP. Assessment of Neurological Impairment and Recovery Using Statistical Models of Neurologically Healthy Behavior. Neurorehabil Neural Repair 2022:15459683221115413. [PMID: 35932111 DOI: 10.1177/15459683221115413] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While many areas of medicine have benefited from the development of objective assessment tools and biomarkers, there have been comparatively few improvements in techniques used to assess brain function and dysfunction. Brain functions such as perception, cognition, and motor control are commonly measured using criteria-based, ordinal scales which can be coarse, have floor/ceiling effects, and often lack the precision to detect change. There is growing recognition that kinematic and kinetic-based measures are needed to quantify impairments following neurological injury such as stroke, in particular for clinical research and clinical trials. This paper will first consider the challenges with using criteria-based ordinal scales to quantify impairment and recovery. We then describe how kinematic-based measures can overcome many of these challenges and highlight a statistical approach to quantify kinematic measures of behavior based on performance of neurologically healthy individuals. We illustrate this approach with a visually-guided reaching task to highlight measures of impairment for individuals following stroke. Finally, there has been considerable controversy about the calculation of motor recovery following stroke. Here, we highlight how our statistical-based approach can provide an effective estimate of impairment and recovery.
Collapse
Affiliation(s)
- Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Catherine R Lowrey
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Ian E Brown
- Kinarm, BKIN Technologies Ltd. Kingston, ON, Canada
| | - Sean P Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
28
|
Duff SV, Miller A, Quinn L, Youdan G, Bishop L, Ruthrauff H, Wade E. Quantifying intra- and interlimb use during unimanual and bimanual tasks in persons with hemiparesis post-stroke. J Neuroeng Rehabil 2022; 19:44. [PMID: 35525970 PMCID: PMC9077965 DOI: 10.1186/s12984-022-01020-8] [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] [Received: 08/23/2021] [Accepted: 04/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited. Objective To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance. Methods Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0–1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM). Results A significant group × task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality. Conclusions Our algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.
Collapse
Affiliation(s)
- Susan V Duff
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, 9401 Jeronimo Rd, Irvine, CA, 92618, USA.
| | - Aaron Miller
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Gregory Youdan
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Lauri Bishop
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Heather Ruthrauff
- Department of Occupational Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Eric Wade
- Department of Mechanical, Aerospace, and Biomedical Engineering, University of Tennessee, Knoxville, TN, USA
| |
Collapse
|
29
|
Tauchi Y, Kyougoku M, Okita Y, Takebayashi T. Structural validity and internal consistency of a hypothesized factor structure of the Fugl-Meyer Assessment of the upper extremity. Top Stroke Rehabil 2022; 30:501-511. [PMID: 35491995 DOI: 10.1080/10749357.2022.2070361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Many studies have confirmed the psychometric properties of Fugl-Meyer Assessment of the upper extremity (FMA-UE). Although several modified versions of the FMA-UE form exist, their structural validity has not been fully established. OBJECTIVES To assess the structural validity and internal consistency of the original, short, and hypothesized FMA-UE forms. METHODS In this cross-sectional, multicenter, observational study, the factor structure was assessed using confirmatory factor analysis (CFA) to evaluate the adequate model of each hypothetical FMA-UE form (original, 30-item, 27-item, and 6-item forms). The internal consistency of each FMA-UE form and subscale was assessed using Cronbach's alpha after factor structure evaluation. RESULTS We recruited 363 patients with first-episode stroke (median age = 70.0, median days = 75.0). The results of the original form models were not estimated by CFA. Of all FMA-UE forms, the 30-item form lacked three reflex items (4-factor, 30-item model) and the 27-item form lacked three reflex and three coordination items (3-factor, 27-item, second-order model); these forms demonstrated an adequate model fitness (root mean square error of approximation = 0.056/0.059, comparative fit index = 0.995/0.996, Tucker-Lewis index = 0.995/0.995). The 6-item form demonstrated a poor model fit. All FMA-UE forms and subscales showed a high internal consistency (Cronbach's alpha>0.91). CONCLUSIONS Both 30- and 27-item FMA-UE forms showed a good factor structure; therefore, these forms are eligible for use in clinical practice. However, future studies should define the factor structure of the 6-item form.
Collapse
Affiliation(s)
- Yuta Tauchi
- Graduate School of Comprehensive Rehabilitation, Osaka Metropolitan University, Osaka, Japan
| | - Makoto Kyougoku
- Department of Occupational Therapy, School of Health Sciences, Kibi International University, Okayama, Japan
| | - Yuho Okita
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Takashi Takebayashi
- Graduate School of Comprehensive Rehabilitation, Osaka Metropolitan University, Osaka, Japan
| |
Collapse
|
30
|
Seo NJ, Ramakrishnan V, Woodbury ML, Bonilha L, Finetto C, Schranz C, Scronce G, Coupland K, Blaschke J, Baker A, Howard K, Meinzer C, Velozo CA, Adams RJ. Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke. Trials 2022; 23:262. [PMID: 35382902 PMCID: PMC8981199 DOI: 10.1186/s13063-022-06241-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. Methods A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. Discussion This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. Trial registration NCT04569123. Registered on September 29, 2020
Collapse
Affiliation(s)
- Na Jin Seo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA. .,Ralph H. Johnson VA Medical Center, Charleston, SC, USA. .,Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA.
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Michelle L Woodbury
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
| | - Christian Finetto
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Christian Schranz
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Gabrielle Scronce
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Kristen Coupland
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Jenna Blaschke
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Adam Baker
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Keith Howard
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Caitlyn Meinzer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Craig A Velozo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
| |
Collapse
|
31
|
Zonjee VJ, Selles RW, Roorda LD, Nijland RH, van der Oest MJW, Bosomworth HJ, van Wijck F, Meskers CGM, van Schaik SM, Van den Berg-Vos RM, Kwakkel G. Reducing the number of test items of the Action Research Arm Test post stroke: A decision tree analysis. Arch Phys Med Rehabil 2022; 103:1582-1591. [PMID: 34998711 DOI: 10.1016/j.apmr.2021.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/07/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
Objective - The present study aimed to create a shorter version of the Action Research Arm Test (ARAT) without compromising its measurement properties. Design - Secondary analysis of stroke recovery cohorts that used the ARAT to measure upper-limb impairment. Setting - Rehabilitation centers. Participants - Patients with stroke from five different stroke recovery cohorts. Interventions - Not applicable. Main Outcome Measures - A decision tree version of the ARAT (ARAT-DT) was developed using Chi-squared Automated Interaction Detection (CHAID). In an independent validation subset, criterion validity, agreement of ARAT-DT with original ARAT scores and score categories, and construct validity with the Fugl-Meyer upper extremity (FM-UE) score were determined. Results - In total, 3738 ARAT measurements were available involving 1,425 subjects. CHAID analysis in the development subset (n=2803) revealed an optimized decision tree with a maximum of four consecutive items. In the validation dataset (n=935), the ARAT-DT differed by a mean of 0.19 points (0.3% of the total scale) from the original ARAT scores (limits of agreement: -5.67 to 6.05). The ARAT-DT demonstrated excellent criterion validity with the original ARAT scores (ICC=0.99 and ρ=0.99) and scoring categories (κw=0.97). The ARAT-DT showed very good construct validity with the FM-UE motor scale (ρ=0.92). Conclusion - A decision tree version of the ARAT was developed, reducing the maximum number of items necessary for ARAT administration from 19 to 4. The scores produced by the decision tree had excellent criterion validity with original ARAT scores.
Collapse
Affiliation(s)
- V J Zonjee
- Department of Neurology, OLVG, Amsterdam, the Netherlands.
| | - R W Selles
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - L D Roorda
- Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - R H Nijland
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre Reade, Amsterdam, the Netherlands
| | - M J W van der Oest
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic and Reconstructive Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - H J Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - F van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - C G M Meskers
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - S M van Schaik
- Department of Neurology, OLVG, Amsterdam, the Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, OLVG, Amsterdam, the Netherlands; Department of Neurology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - G Kwakkel
- Department of Neurorehabilitation, Amsterdam Rehabilitation Research Centre Reade, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| |
Collapse
|
32
|
Egger M, Steinböck M, Müller F, Bergmann J. The German version of the Stroke Upper Limb Capacity Scale: Translation, cross-cultural adaption and evaluation of its psychometric properties. Clin Rehabil 2021; 36:272-282. [PMID: 34789042 DOI: 10.1177/02692155211043502] [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: 11/17/2022]
Abstract
OBJECTIVE To investigate the psychometric properties of a newly developed German version of the Stroke Upper Limb Capacity Scale (SULCS). DESIGN Prospective cohort study. SETTING Neurorehabilitation clinic. SUBJECTS Patients after stroke (n = 50) with moderate to severe upper limb hemiparesis undergoing inpatient rehabilitation. INTERVENTION Not applicable. MAIN MEASURES The SULCS was administered twice by two different raters on the first day of assessments and another time the day after. Additionally the Fugl-Meyer-Assessment, Action Research Arm Test and the Box and Block Test were conducted. Three and six weeks later, the SULCS, Fugl-Meyer-Assessment and Box and Block Test were repeated. Floor and ceiling effects were analyzed. RESULTS Reliability was demonstrated to be excellent as displayed by weighted kappa of 0.960 (95%-confidence interval: CIκw = 0.808-1.112) for the intra-rater reliability and 0.936 (CIκw = 0.749-1.123) for the inter-rater reliability. High correlations of the SULCS with the Fugl-Meyer-Assessment (ρ = 0.889), Action Research Arm Test (ρ = 0.872), and Box and Block Test (ρ = 0.845; all P < 0.001) confirmed a high convergent validity. The longitudinal validity was determined by a moderate to high correlation of the SULCS and Box and Block Test changes (ρ ⩾ 0.695, P ⩽ 0.001). Although floor effects were observed for the SULCS (16%), they were more substantial for the Action Research Arm Test and the Box and Block Test (>38%). CONCLUSION Due to the good to excellent psychometric properties and the low level of floor effects of the German version of the SULCS, the usage for clinical and scientific purposes can be recommended.
Collapse
Affiliation(s)
| | | | | | - Jeannine Bergmann
- Schoen Clinic Bad Aibling, Bad Aibling, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-University of Munich, Munich, Germany
| |
Collapse
|
33
|
Muller CO, Muthalib M, Mottet D, Perrey S, Dray G, Delorme M, Duflos C, Froger J, Xu B, Faity G, Pla S, Jean P, Laffont I, Bakhti KKA. Recovering arm function in chronic stroke patients using combined anodal HD-tDCS and virtual reality therapy (ReArm): a study protocol for a randomized controlled trial. Trials 2021; 22:747. [PMID: 34702317 PMCID: PMC8549202 DOI: 10.1186/s13063-021-05689-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-week UL VRT and conventional therapy program on paretic UL function in chronic stroke. METHODS The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-week in-patient rehabilitation program, which includes 13 days of VRT (Armeo Spring, 1 × 30 min session/day) and conventional therapy (3 × 30 min sessions/day). Twenty-nine patients will receive real stimulation (4x1 anodal HD-tDCS montage, 2 mA, 20 min) to the ipsilesional primary motor cortex during the VRT session and the other 29 patients will receive active sham stimulation (2 mA, 30 s). All outcome measures will be assessed at baseline, at the end of rehabilitation and again 3 months later. The primary outcome measure will be the wolf motor function test. Secondary outcomes will include measures of UL function (Box and Block Test), impairment (Fugl Meyer Upper Extremity), compensation (Proximal Arm Non-Use), ADL (Actimetry, Barthel Index). Other/exploratory outcomes will include pain, fatigue, effort and performance, kinematics, and motor cortical region activation during functional motor tasks. DISCUSSION This will be the first trial to determine the impact of adding HD-tDCS during UL VRT and conventional therapy in chronic stroke patients. We hypothesize that improvements in UL function will be greater and longer-lasting with real stimulation than in those receiving sham. TRIAL REGISTRATION The ReArm project was approved by The French Research Ethics Committee, (Comité de Protection des Personnes-CPP SUD-EST II, N°ID-RCB: 2019-A00506-51, http://www.cppsudest2.fr/ ). The ReArm project was registered on ClinicalTrials.gov ( NCT04291573 , 2nd March 2020.
Collapse
Affiliation(s)
- Camille O Muller
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Makii Muthalib
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
- Silverline Research, Brisbane, Australia
| | - Denis Mottet
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Stéphane Perrey
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Gérard Dray
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Marion Delorme
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, CHU Nîmes, Le Grau du Roi, France
| | - Claire Duflos
- Clinical Research and Epidemiology unit, CHU Montpellier, Université Montpellier, Montpellier, France
| | - Jérôme Froger
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
- Physical and Rehabilitation Medicine, CHU Nîmes, Le Grau du Roi, France
| | - Binbin Xu
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Germain Faity
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Simon Pla
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Pierre Jean
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Isabelle Laffont
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France
| | - Karima K A Bakhti
- Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) - Montpellier, Lapeyronie, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier, Cédex 15, France.
- EuroMov Digital Health in Motion, Université Montpellier, IMT Mines Alès, Montpellier, France.
- Health Directorate, CHU Montpellier, Montpellier, France.
- Clinical Investigation Centre, CHU Montpellier, Montpellier, France - Inserm, CIC 1411, Montpellier, France.
| |
Collapse
|
34
|
Rozevink SG, van der Sluis CK, Hijmans JM. HoMEcare aRm rehabiLItatioN (MERLIN): preliminary evidence of long term effects of telerehabilitation using an unactuated training device on upper limb function after stroke. J Neuroeng Rehabil 2021; 18:141. [PMID: 34538246 PMCID: PMC8449998 DOI: 10.1186/s12984-021-00934-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/01/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND While short term effects on upper limb function of stroke patients after training with robotic devices have been studied extensively, long term effects are often not addressed. HoMEcare aRm rehabiLItatioN (MERLIN) is a combination of an unactuated training device using serious games and a telerehabilitation platform in the patient's home situation. Short term effects showed that upper limb function improved after training with MERLIN. The aim was to determine long term effects on upper limb function and quality of life. METHODS Six months after cessation of the 6 week MERLIN training program, the upper limb function and quality of life of 11 chronic stroke patients were assessed. Upper limb function was measured using the Wolf Motor Function Test (WMFT), Action Research Arm Test (ARAT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE). EuroQoL-5D (EQ-5D) was used to measure quality of life. RESULTS The WMFT, ARAT and EQ-5D did not show significant differences 6 months after the training period compared to directly after training. At 6 months follow-up, FMA-UE results were significantly better than at baseline. Time plots showed a decreasing trend in all tests. CONCLUSION Training effects were still present at 6 months follow-up, since arm function seemed similar to directly after training and FMA-UE results were better than at baseline. However, because of the decreasing trend shown in all tests, it is questionable if improvements will be maintained longer than 6 months. Due to the sample size and study design, results should be interpreted with caution. Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18-02-2019, https://www.trialregister.nl/trial/7535.
Collapse
Affiliation(s)
- Samantha G Rozevink
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Corry K van der Sluis
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30001, 9700 RB, Groningen, The Netherlands
| | - Juha M Hijmans
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, PO Box 30001, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
35
|
Lee SH, Hwang YJ, Lee HJ, Kim YH, Ogrinc M, Burdet E, Kim JH. Proof-of-Concept of a Sensor-Based Evaluation Method for Better Sensitivity of Upper-Extremity Motor Function Assessment. SENSORS (BASEL, SWITZERLAND) 2021; 21:5926. [PMID: 34502816 PMCID: PMC8434647 DOI: 10.3390/s21175926] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022]
Abstract
In rehabilitation, the Fugl-Meyer assessment (FMA) is a typical clinical instrument to assess upper-extremity motor function of stroke patients, but it cannot measure fine changes of motor function (both in recovery and deterioration) due to its limited sensitivity. This paper introduces a sensor-based automated FMA system that addresses this limitation with a continuous rating algorithm. The system consists of a depth sensor (Kinect V2) and an algorithm to rate the continuous FM scale based on fuzzy inference. Using a binary logic based classification method developed from a linguistic scoring guideline of FMA, we designed fuzzy input/output variables, fuzzy rules, membership functions, and a defuzzification method for several representative FMA tests. A pilot trial with nine stroke patients was performed to test the feasibility of the proposed approach. The continuous FM scale from the proposed algorithm exhibited a high correlation with the clinician rated scores and the results showed the possibility of more sensitive upper-extremity motor function assessment.
Collapse
Affiliation(s)
| | - Ye-Ji Hwang
- School of Mechanical Engineering, Sungkyunkwan University, Suwon 16419, Korea;
| | - Hwang-Jae Lee
- Center for Prevention & Rehabilitation, Heart Vascular and Stroke, Samsung Medical Center, Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.L.); (Y.-H.K.)
| | - Yun-Hee Kim
- Center for Prevention & Rehabilitation, Heart Vascular and Stroke, Samsung Medical Center, Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (H.-J.L.); (Y.-H.K.)
| | - Matjaž Ogrinc
- Department of Bioengineering, Imperial College London, London SW72AZ, UK; (M.O.); (E.B.)
- GripAble Limited, Thornton House, 39 Thornton Road, London, SW19 4NQ, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College London, London SW72AZ, UK; (M.O.); (E.B.)
| | - Jong-Hyun Kim
- School of Mechanical Engineering, Sungkyunkwan University, Suwon 16419, Korea;
| |
Collapse
|
36
|
McCrea MA, Cramer SC, Okonkwo DO, Mattke S, Paadre S, Bates D, Nejadnik B, Giacino JT. Determining minimally clinically important differences for outcome measures in patients with chronic motor deficits secondary to traumatic brain injury. Expert Rev Neurother 2021; 21:1051-1058. [PMID: 34402352 DOI: 10.1080/14737175.2021.1968299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine minimally clinically important differences (MCIDs) for Disability Rating Scale (DRS), Fugl-Meyer Upper Extremity Subscale (FM-UE), Fugl-Meyer Lower Extremity Subscale (FM-LE), and Fugl-Meyer Motor Scale (FMMS) in patients with chronic motor deficits secondary to traumatic brain injury (TBI). METHODS Retrospective analysis from the 1-year, double-blind, randomized, surgical sham-controlled, Phase 2 STEMTRA trial (NCT02416492), in which patients with chronic motor deficits secondary to TBI (N = 61) underwent intracerebral stereotactic implantation of modified bone marrow-derived mesenchymal stromal (SB623) cells. MCIDs for DRS, FM-UE, FM-LE, and FMMS were triangulated with distribution-based, anchor-based, and Delphi panel estimates. RESULTS Triangulated MCIDs were: 1) -1.5 points for the Disability Rating Scale; 2) 6.2 points for the Fugl-Meyer Upper Extremity Subscale; 3) 3.2 points for the Fugl-Meyer Lower Extremity Subscale; and 4) 8.4 points for the Fugl-Meyer Motor Scale. CONCLUSIONS For the first time in the setting of patients with chronic motor deficits secondary to TBI, this study reports triangulated MCIDs for: 1) DRS, a measure of global outcome; and 2) Fugl-Meyer Scales, measures of motor impairment. These findings guide the use of DRS and Fugl-Meyer Scales in the assessment of global disability outcome and motor impairment in future TBI clinical trials.
Collapse
Affiliation(s)
- Michael A McCrea
- Co-Director, Center For Neurotrauma Research; And Professor, Department Of Neurosurgery, Medical College Of Wisconsin, Milwaukee, USA
| | - Steven C Cramer
- Professor, Department Of Neurology, University Of California, Los Angeles; Los Angeles, Ca; And Medical Director Of Research, California Rehabilitation Institute; Los Angeles, CA, USA
| | - David O Okonkwo
- Director, Neurotrauma Clinical Trials Center; And Professor, Department Of Neurological Surgery, University Of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Soeren Mattke
- Director, Center For Improving Chronic Illness Care, USC Dornsife, Los Angeles, Ca, USA
| | - Susan Paadre
- Associate Director, Biostatistics, Biostatistical Consulting Inc., Lexington, MA, USA
| | - Damien Bates
- Consultant, SanBio, Inc., Mountain View, CA, USA
| | - Bijan Nejadnik
- Chief Medical Officer, Global Head Of Regulatory, Medical Affairs, Research and Clinical Development, SanBio Inc., CA, USA
| | - Joseph T Giacino
- Director Of Rehabilitation Neuropsychology; Director, SRN Disorders Of Consciousness Program; Project Director, Spaulding-Harvard TBI Model System, Spaulding Rehabilitation Hospital, Charlestown, MA; And Consulting Neuropsychologist, Department Of Psychiatry, Massachusetts General Hospital, Boston, MA; And Professor, Department Of Physical Medicine And Rehabilitation, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
37
|
Tauchi Y, Kyougoku M, Takahashi K, Okita Y, Takebayashi T. Dimensionality and item-difficulty hierarchy of the Fugl-Meyer assessment of the upper extremity among Japanese patients who have experienced stroke. Top Stroke Rehabil 2021; 29:579-587. [PMID: 34414858 DOI: 10.1080/10749357.2021.1965797] [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: 10/20/2022]
Abstract
Background: The Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) has been used in many clinical studies and in stroke rehabilitation. In studies evaluating psychometric properties, confirmatory factor analysis (CFA) indicated that the FMA-UE is a multidimensional tool. Item Response Theory One-Parameter Logistic (IRT1PL) supports that item-difficulty hierarchy can be used as a treatment index of upper extremity function for stroke recovery. However, studies on the psychometric properties of the FMA-UE in Asian populations are lacking.Objectives: To investigate the dimensionality and item-difficulty hierarchy of the FMA-UE for stroke rehabilitation in Japanese patients. Methods: This was a cross-sectional study. The participants comprised 268 individuals admitted for de novo stroke (median age, 70.0 years; median days since stroke onset, 78.5) in 22 hospitals in Japan. The dimensionality of the FMA-UE was evaluated using CFA of selected items. The item-difficulty hierarchy of the FMA-UE using the appropriately selected model was demonstrated using IRT1PL analysis after confirming dimensionality.Results:Two reflex items were removed by utilizing the floor and ceiling effects. The 31- and 30-item FMA-UE exhibited a good model fit of the unidimensionality in the CFA. The 30-item FMA-UE was found to be a good model by model comparison (the 31-item vs. the 30-item). The item-difficulty hierarchy of the 30-item FMA-UE was found not to be consistent with the expected item order.Conclusions:This study provides evidence that the FMA-UE has multidimensionality and the 30-item FMA-UE is a valid instrument for measuring upper-extremity impairment after stroke.
Collapse
Affiliation(s)
- Yuta Tauchi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
| | - Makoto Kyougoku
- Department of Occupational Therapy, School of Health Sciences, Kibi International University, Okayama, Japan
| | - Kayoko Takahashi
- Department of Occupational Therapy, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia
| | - Takashi Takebayashi
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan.,College of Health and Human Sciences, School of Comprehensive Rehabilitation, Osaka Prefecture University, Osaka, Japan
| |
Collapse
|
38
|
Llorens R, Fuentes MA, Borrego A, Latorre J, Alcañiz M, Colomer C, Noé E. Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:108. [PMID: 34210347 PMCID: PMC8252292 DOI: 10.1186/s12984-021-00896-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. METHODS Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. RESULTS A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. CONCLUSION The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.
Collapse
Affiliation(s)
- Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain.
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain.
| | - María Antonia Fuentes
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
| | - Carolina Colomer
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Enrique Noé
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| |
Collapse
|
39
|
De Bruyn N, Saenen L, Thijs L, Van Gils A, Ceulemans E, Essers B, Alaerts K, Verheyden G. Brain connectivity alterations after additional sensorimotor or motor therapy for the upper limb in the early-phase post stroke: a randomized controlled trial. Brain Commun 2021; 3:fcab074. [PMID: 33937771 PMCID: PMC8072522 DOI: 10.1093/braincomms/fcab074] [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: 09/24/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/28/2022] Open
Abstract
Somatosensory function plays an important role for upper limb motor learning. However, knowledge about underlying mechanisms of sensorimotor therapy is lacking. We aim to investigate differences in therapy-induced resting-state functional connectivity changes between additional sensorimotor compared with motor therapy in the early-phase post stroke. Thirty first-stroke patients with a sensorimotor impairment were included for an assessor-blinded multi-centre randomized controlled trial within 8 weeks post stroke [13 (43%) females; mean age: 67 ± 13 years; mean time post stroke: 43 ± 13 days]. Patients were randomly assigned to additional sensorimotor (n = 18) or motor (n = 12) therapy, receiving 16 h of additional therapy within 4 weeks. Sensorimotor evaluations and resting-state functional magnetic resonance imaging were performed at baseline (T1), post-intervention (T2) and after 4 weeks follow-up (T3). Resting-state functional magnetic resonance imaging was also performed in an age-matched healthy control group (n = 19) to identify patterns of aberrant connectivity in stroke patients between hemispheres, or within ipsilesional and contralesional hemispheres. Mixed model analysis investigated session and treatment effects between stroke therapy groups. Non-parametric partial correlations were used to investigate brain−behaviour associations with age and frame-wise displacement as nuisance regressors. Connections within the contralesional hemisphere that showed hypo-connectivity in subacute stroke patients (compared with healthy controls) showed a trend towards a more pronounced pre-to-post normalization (less hypo-connectivity) in the motor therapy group, compared with the sensorimotor therapy group (mean estimated difference = −0.155 ± 0.061; P = 0.02). Further, the motor therapy group also tended to show a further pre-to-post increase in functional connectivity strength among connections that already showed hyper-connectivity in the stroke patients at baseline versus healthy controls (mean estimated difference = −0.144 ± 0.072; P = 0.06). Notably, these observed increases in hyper-connectivity of the contralesional hemisphere were positively associated with improvements in functional activity (r = 0.48), providing indications that these patterns of hyper-connectivity are compensatory in nature. The sensorimotor and motor therapy group showed no significant differences in terms of pre-to-post changes in inter-hemispheric connectivity or ipsilesional intrahemispheric connectivity. While effects are only tentative within this preliminary sample, results suggest a possible stronger normalization of hypo-connectivity and a stronger pre-to-post increase in compensatory hyper-connectivity of the contralesional hemisphere after motor therapy compared with sensorimotor therapy. Future studies with larger patient samples are however recommended to confirm these trend-based preliminary findings.
Collapse
Affiliation(s)
- Nele De Bruyn
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Leen Saenen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Liselot Thijs
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Annick Van Gils
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Eva Ceulemans
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Kaat Alaerts
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium
| |
Collapse
|
40
|
Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 259] [Impact Index Per Article: 86.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
Collapse
Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
41
|
Amano S, Umeji A, Takebayashi T, Takahashi K, Uchiyama Y, Domen K. Psychometric properties of the TEMPA for the assessment of arm motor activity capacity in hemiparetic Japanese patients after stroke. Disabil Rehabil 2021; 44:4421-4428. [PMID: 33847186 DOI: 10.1080/09638288.2021.1910352] [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: 10/21/2022]
Abstract
PURPOSE To investigate the psychometric properties of the Test d'Evaluation des Membres Suprieurs de Personnes Agres (TEMPA) for the affected upper extremity in a population of Japanese patients with stroke. MATERIALS AND METHODS A prospective, cross-sectional, single-center study involving 30 patients with stroke was conducted. The inter-rater reliability, the validity, and the internal consistency were assessed. The Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Motor Activity Log, and the Box-and-Block Test were employed for assessing the validity. RESULTS The English TEMPA instructions were successfully translated in accordance with the accepted principles of translation. The weighted Kappa coefficients for the functional rating scores were 0.87, 0.93, and 0.91 for combined total score, unilateral total score, and bilateral total scores. No statistically significant systematic disagreement was seen in the combined scores. The Spearman's rho values were higher than 0.70 regarding the gold standard tools (the FMA-UE motor domain and the ARAT). The Cronbach's alpha was 0.940 in the functional rating scale and 0.998 in the task analysis scale. CONCLUSIONS The most aspects of the Japanese TEMPA showed acceptable levels of inter-rater reliability and validity in patients with affected upper extremities after stroke.IMPLICATIONS FOR REHABILITATIONThe TEMPA is reliable and valid in measuring activity capacity of upper extremity in patients with stroke.The functional rating score of the TEMPA is recommended to assess activities related to daily living, especially when users need to focus on bimanual activities.The TEMPA may help guide intervention that improve bimanual activity as well as the affected arm activity.
Collapse
Affiliation(s)
- Satoru Amano
- Department of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan.,Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Atsushi Umeji
- Hyogo College of Medicine College Hospital, Nishinomiya, Japan
| | | | - Kayoko Takahashi
- Department of Occupational Therapy, Kitasato University, Kanagawa, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| |
Collapse
|
42
|
Lin GH, Huang CY, Lee SC, Chen KL, Lien JJJ, Chen MH, Huang YH, Hsieh CL. A 10-item Fugl-Meyer Motor Scale Based on Machine Learning. Phys Ther 2021; 101:6123581. [PMID: 33513236 DOI: 10.1093/ptj/pzab036] [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: 02/10/2020] [Revised: 08/22/2020] [Accepted: 12/21/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Fugl-Meyer motor scale (FM) is a well-validated measure for assessing upper extremity and lower extremity motor functions in people with stroke. The FM contains numerous items (50), which reduces its clinical usability. The purpose of this study was to develop a short form of the FM for people with stroke using a machine-learning methodology (FM-ML) and compare the efficiency (ie, number of items) and psychometric properties of the FM-ML with those of other FM versions, including the original FM, the 37-item FM, and the 12-item FM. METHODS This observational study with follow-up used secondary data analysis. For developing the FM-ML, the random lasso method of ML was used to select the 10 most informative items (in terms of index of importance). Next, the scores of the FM-ML were calculated using an artificial neural network. Finally, the concurrent validity, predictive validity, responsiveness, and test-retest reliability of all FM versions were examined. RESULTS The FM-ML used fewer items (80% fewer than the FM, 73% fewer than the 37-item FM, and 17% fewer than the 12-item FM) to achieve psychometric properties comparable with those of the other FM versions (concurrent validity: Pearson r = 0.95-0.99 vs 0.91-0.97; responsiveness: Pearson r = 0.78-0.91 vs 0.33-0.72; and test-retest reliability: intraclass correlation coefficient = 0.88-0.92 vs 0.93-0.98). CONCLUSION The findings preliminarily support the efficiency and psychometric properties of the 10-item FM-ML. IMPACT The FM-ML has potential to substantially improve the efficiency of motor function assessments in patients with stroke.
Collapse
Affiliation(s)
- Gong-Hong Lin
- Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Huang
- Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Lin Chen
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Jenn-Jier James Lien
- Department of Computer Science and Information Engineering, National Cheng Kung University
| | - Mei-Hsiang Chen
- Department of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan.,Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hui Huang
- School of Medicine, Chung Shan Medical University; and Department of Physical Medicine & Rehabilitation, Chung Shan Medical University Hospital
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, School of Occupational Therapy, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.,Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| |
Collapse
|
43
|
Maenza C, Wagstaff DA, Varghese R, Winstein C, Good DC, Sainburg RL. Remedial Training of the Less-Impaired Arm in Chronic Stroke Survivors With Moderate to Severe Upper-Extremity Paresis Improves Functional Independence: A Pilot Study. Front Hum Neurosci 2021; 15:645714. [PMID: 33776672 PMCID: PMC7994265 DOI: 10.3389/fnhum.2021.645714] [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: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.
Collapse
Affiliation(s)
- Candice Maenza
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
| | - David A Wagstaff
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, United States
| | - Rini Varghese
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - David C Good
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Robert L Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
| |
Collapse
|
44
|
Meyer S, Verheyden G, Kempeneers K, Michielsen M. Arm-Hand Boost Therapy During Inpatient Stroke Rehabilitation: A Pilot Randomized Controlled Trial. Front Neurol 2021; 12:652042. [PMID: 33716948 PMCID: PMC7952763 DOI: 10.3389/fneur.2021.652042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: It was the aim to assess feasibility, safety, and potential efficacy of a new intensive, focused arm-hand BOOST program and to investigate whether there is a difference between early vs. late delivery of the program in the sub-acute phase post stroke. Methods: In this pilot RCT, patients with stroke were randomized to the immediate group (IG): 4 weeks (4 w) BOOST +4 w CONTROL or the delayed group (DG): 4 w CONTROL +4 w BOOST, on top of their usual inpatient care program. The focused arm-hand BOOST program (1 h/day, 5x/week, 4 weeks) consisted of group exercises with focus on scapula-setting, core-stability, manipulation and complex ADL tasks. Additionally, 1 h per week the Armeo®Power (Hocoma AG, Switzerland) was used. The CONTROL intervention comprised a dose-matched program (24 one-hour sessions in 4 w) of lower limb strengthening exercises and general reconditioning. At baseline, after 4 and 8 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT), and stroke upper limb capacity scale (SULCS) were administered. Results: Eighteen participants (IG: n = 10, DG: n = 8) were included, with a median (IQR) time post stroke of 8.6 weeks (5-12). No adverse events were experienced. After 4 weeks of training, significant between-group differences were found for FMA-UE (p = 0.003) and SULCS (p = 0.033) and a trend for ARAT (p = 0.075) with median (IQR) change scores for the IG of 9 (7-16), 2 (1-3), and 12.5 (1-18), respectively, and for the DG of 0.5 (-3 to 3), 1 (0-1), and 1.5 (-1 to 9), respectively. In the IG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE after 4 weeks, compared to none of the DG patients. Between 4 and 8 weeks of training, patients in the DG tend to show larger improvements when compared to the IG, however, between-group comparisons did not reach significance. Conclusions: Results of this pilot RCT showed that an intensive, specific arm-hand BOOST program, on top of usual care, is feasible and safe in the sub-acute phase post stroke and suggests positive, clinical meaningful effects on upper limb function, especially when delivered in the early sub-acute phase post stroke. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04584177.
Collapse
Affiliation(s)
- Sarah Meyer
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Kristof Kempeneers
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| | - Marc Michielsen
- Jessa Hospital, Rehabilitation Centre, Campus Sint-Ursula, Herk-de-Stad, Belgium
| |
Collapse
|
45
|
Geed S, Lane CJ, Nelsen MA, Wolf SL, Winstein CJ, Dromerick AW. Inaccurate Use of the Upper Extremity Fugl-Meyer Negatively Affects Upper Extremity Rehabilitation Trial Design: Findings From the ICARE Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:270-279. [PMID: 32991872 PMCID: PMC7854957 DOI: 10.1016/j.apmr.2020.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the extent to which estimates of sample and effect size in stroke rehabilitation trials can be affected by simple summation of ordinal Upper Extremity Fugl-Meyer (UEFM) items compared with a Rasch-rescaled UEFM. DESIGN Rasch analysis of Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) phase III trial data, comparing 3 upper extremity (UE) motor treatments in stroke survivors enrolled 45.8±22.4 days poststroke. Participants underwent a structured UE motor training known as the Accelerated Skill Acquisition Program, usual and customary care, or dose-equivalent care. UEFM data from baseline, postintervention, and 6 and 12 months later were included for analysis. SETTING Outpatient stroke rehabilitation. PARTICIPANTS ICARE participants (N=361). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Item difficulties, person abilities, and sample size. RESULTS Because of their ordinality, summed raw UEFM scores measured motor impairment inconsistently across different ranges of stroke severity relative to the rescaled UEFM. In the full ICARE sample, raw UEFM understated scores relative to the rescaled UEFM by 7.4 points for the most severely impaired, but overstated scores by up to 8.4 points toward the ceiling. As a result, 50.9% of all UEFM observations showed a residual error greater than 10% of the total UEFM score. Relative to the raw scores, the rescaled UEFM improved the effect size of change in motor impairment between baseline and 1 year (d=0.35). For a hypothetical 3-arm trial resembling ICARE, UEFM rescaling reduced the required sample size by 32% (n=108) compared with raw UEFM (n=159). CONCLUSIONS In UE rehabilitation trials, a rescaled UEFM potentially decreases sample size by one-third, decreasing costs, duration, and the number of subjects exposed to experimental risks. This benefit is obtained through increased measurement efficiency. Reductions in ceiling effects are also possible. These findings apply to ICARE-like trials. Confirmatory validation in another phase III trial is needed.
Collapse
Affiliation(s)
- Shashwati Geed
- Department of Rehabilitation Medicine, Center for Brain Plasticity and Recovery, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC.
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Monica A Nelsen
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory School of Medicine, Atlanta, GA; Department of Medicine, Emory School of Medicine, Atlanta, GA; Department of Cell Biology, Emory School of Medicine, Atlanta, GA; Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Services, Decatur, GA
| | - Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alexander W Dromerick
- Department of Rehabilitation Medicine, Center for Brain Plasticity and Recovery, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC; Department of Neurology, Center for Brain Plasticity and Recovery, Georgetown University and MedStar National Rehabilitation Hospital, Washington, DC
| |
Collapse
|
46
|
De Bruyn N, Saenen L, Thijs L, Van Gils A, Ceulemans E, Essers B, Lafosse C, Michielsen M, Beyens H, Schillebeeckx F, Alaerts K, Verheyden G. Sensorimotor vs. Motor Upper Limb Therapy for Patients With Motor and Somatosensory Deficits: A Randomized Controlled Trial in the Early Rehabilitation Phase After Stroke. Front Neurol 2020; 11:597666. [PMID: 33343498 PMCID: PMC7746814 DOI: 10.3389/fneur.2020.597666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Somatosensory function plays an important role in motor learning. More than half of the stroke patients have somatosensory impairments in the upper limb, which could hamper recovery. Question: Is sensorimotor upper limb (UL) therapy of more benefit for motor and somatosensory outcome than motor therapy? Design: Randomized assessor- blinded multicenter controlled trial with block randomization stratified for neglect, severity of motor impairment, and type of stroke. Participants: 40 first-ever stroke patients with UL sensorimotor impairments admitted to the rehabilitation center. Intervention: Both groups received 16 h of additional therapy over 4 weeks consisting of sensorimotor (N = 22) or motor (N = 18) UL therapy. Outcome measures: Action Research Arm test (ARAT) as primary outcome, and other motor and somatosensory measures were assessed at baseline, post-intervention and after 4 weeks follow-up. Results: No significant between-group differences were found for change scores in ARAT or any somatosensory measure between the three time points. For UL impairment (Fugl-Meyer assessment), a significant greater improvement was found for the motor group compared to the sensorimotor group from baseline to post-intervention [mean (SD) improvement 14.65 (2.19) vs. 5.99 (2.06); p = 0.01] and from baseline to follow-up [17.38 (2.37) vs. 6.75 (2.29); p = 0.003]. Conclusion: UL motor therapy may improve motor impairment more than UL sensorimotor therapy in patients with sensorimotor impairments in the early rehabilitation phase post stroke. For these patients, integrated sensorimotor therapy may not improve somatosensory function and may be less effective for motor recovery. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03236376.
Collapse
Affiliation(s)
- Nele De Bruyn
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Leen Saenen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Liselot Thijs
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Annick Van Gils
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Eva Ceulemans
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Bea Essers
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | | | | | - Hilde Beyens
- Department Acquired Brain Injury, University Hospitals Leuven, Pellenberg, Belgium
| | | | - Kaat Alaerts
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| |
Collapse
|
47
|
Reoli R, Cherry-Allen K, Therrien A, Keller J, Leech K, Whitt AL, Bastian A. Can the ARAT Be Used to Measure Arm Function in People With Cerebellar Ataxia? Phys Ther 2020; 101:6039314. [PMID: 33336704 PMCID: PMC7899061 DOI: 10.1093/ptj/pzaa203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 05/13/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE For people with ataxia, there are validated outcome measures to address body function and structure (BFS) impairments and participation; however, no outcome measure exists for upper extremity (UE) activity level in this population. The purpose of this study was to determine whether the action research arm test (ARAT), a measure of UE activity validated for other neurological conditions, might be a useful outcome measure for capturing UE activity limitations in ataxia. METHODS A total of 22 participants with ataxia were evaluated to assess construct validity of the ARAT; 19 of the participants were included in the interrater reliability assessment. Participants received a neurologic examination and completed a battery of outcome measures, including the ARAT. ARAT performance was video recorded and scored by 4 additional raters. RESULTS For construct validity, Spearman rho showed a significant moderate relationship between the ARAT and BSF outcome measures. A small, nonsignificant relationship was noted for the ARAT and the participation measure. For interrater reliability, Spearman rho showed a large, significant relationship among all raters for the ARAT (range = .87-.94). High reliability was demonstrated using the intraclass correlation coefficient ([2,1] = .97). CONCLUSION The ARAT is moderately correlated with ataxia BFS outcome measures, but not with participation scores. The ARAT is a measure of UE activity, which is different from BFS and participation outcome measures. The ARAT was identified to have strong interrater reliability among raters with varying amounts of experience administering the ARAT. Thus, for the ataxic population, the ARAT may be useful for assessing UE activity limitations. IMPACT Ataxia can negatively affect reaching tasks; therefore, it is important to assess UE activity level in people with ataxia. Until this study, no outcome measure had been identified for this purpose. LAY SUMMARY People with ataxia may have difficulty with daily tasks that require reaching. The ARAT is an outcome measure that clinicians can use to assess UE activity limitations to help design a treatment program.
Collapse
Affiliation(s)
| | - Kendra Cherry-Allen
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Amanda Therrien
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Jennifer Keller
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Kristan Leech
- Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania, USA
| | | | - Amy Bastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland, USA,Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland, USA,Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, Maryland, USA,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
48
|
Hijikata N, Kawakami M, Ishii R, Tsuzuki K, Nakamura T, Okuyama K, Liu M. Item Difficulty of Fugl-Meyer Assessment for Upper Extremity in Persons With Chronic Stroke With Moderate-to-Severe Upper Limb Impairment. Front Neurol 2020; 11:577855. [PMID: 33304304 PMCID: PMC7701100 DOI: 10.3389/fneur.2020.577855] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: Limited research has been conducted with the aim of understanding which upper extremity movements are difficult for persons with severe chronic stroke. The purpose of this study was to test the structure of the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) using Rasch analysis in persons with chronic stroke with moderate to severe deficits and to determine the item difficulty hierarchy. Methods: This was a secondary analysis of data from previous randomized, controlled trials, or clinical trials. The participants were 101 persons with chronic stroke with moderate to severe hemiparesis (time after onset of stroke, 1375.3 ± 1157.9 days; the 33-item FMA-UE, 31.1 ± 12.8). Principal component analysis and infit statistics were used to evaluate dimensionality. Rasch analysis using a rating scale model was performed, and item difficulty was determined. Results: Six misfit items were removed. The results showed that the 27-item FMA-UE was unidimensional. Rasch analysis showed that the movements performed within synergies were among the easiest items. Shoulder and elbow movements were among the easiest items, whereas forearm and wrist movements were among the moderately to most difficult items. Hand items spanned various difficulty levels. Discussion and Conclusions: The FMA-UE is a valid assessment tool of upper extremity motor function in persons with chronic stroke with moderate to severe deficits. The results showed that item difficulty was consistent with the stepwise recovery course proposed by Fugl-Meyer. The movements that are difficult for patients with moderate to severe chronic paresis were determined, which would enable comparison of each movement using a measure of motion difficulty in future studies.
Collapse
Affiliation(s)
- Nanako Hijikata
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Keita Tsuzuki
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takuya Nakamura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
49
|
Kang MG, Yun SJ, Lee SY, Oh BM, Lee HH, Lee SU, Seo HG. Effects of Upper-Extremity Rehabilitation Using Smart Glove in Patients With Subacute Stroke: Results of a Prematurely Terminated Multicenter Randomized Controlled Trial. Front Neurol 2020; 11:580393. [PMID: 33240205 PMCID: PMC7680863 DOI: 10.3389/fneur.2020.580393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Although there have been many trials and interventions for reducing upper-extremity impairment in stroke survivors, it remains a challenge. A novel intervention is needed to provide high-repetition task-specific training early after stroke. Objective: This study aimed to investigate the effect of smart glove training (SGT) for upper-extremity rehabilitation in patients with subacute stroke. Methods: A prospective, multicenter, randomized, controlled study was conducted in patients with upper-extremity hemiparesis with Brunnstrom stage for arm 2–5 in the subacute phase after stroke. Eligible participants were randomly allocated to the SGT group or the control group. The SGT group underwent 30 min of standard occupational therapy plus 30 min of upper-extremity training with smart glove. The control group underwent standard occupational therapy for 30 min plus upper-extremity self-training (homework tasks at bedside) for 30 min. All participants underwent each intervention 5 days/week for 2 consecutive weeks. They were evaluated before, immediately after, and 4 weeks after the intervention. The primary outcome measure was the change in the score of the Fugl-Meyer assessment of the upper extremity (FMA-UE). Results: Twenty-three patients were enrolled. Repeated-measures analysis of covariance after controlling for age and disease duration showed significant time × group interaction effects in the FMA-UE, FMA-distal, and FMA-coordination/speed (p = 0.018, p = 0.002, p = 0.006). Repeated-measures analysis of variance showed significant time × group interaction effects in the FMA-UE, FMA-distal, and Box and Block Test (p = 0.034, p = 0.010, p = 0.046). Mann-Whitney U-test showed a statistically higher increase in the FMA-UE and FMA-distal in the SGT group than in the control group (p = 0.023, p = 0.032). Conclusion: Upper-extremity rehabilitation with a smart glove may reduce upper-extremity impairment in patients with subacute stroke. Clinical Trial Registration: ClinicalTrials.gov (NCT02592759).
Collapse
Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
50
|
A Comparative Study on the Effect of Task Specific Training on Right Versus Left Chronic Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217950. [PMID: 33138171 PMCID: PMC7663603 DOI: 10.3390/ijerph17217950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023]
Abstract
Functional impairment of the upper limb (UL) after stroke is a great problem. Finding methods that can improve UL function after stroke is a major concern to all medical service providers. This study was intended to compare the effect of upper limb task specific training (TST) on brain excitability of the affected hemisphere and motor function improvements in patients with left and right stroke. Forty male patients with mild impairment of UL functions were divided into two equal groups; G1 consisted of patients with left hemisphere affection (right side stroke) while G2 consisted of patients with right hemisphere affection (left side stroke). All patients received TST for the affected UL for one hour, three sessions per week for six consecutive weeks. Evaluation was performed twice, pre-, and post-treatment. Outcome measures used were Wolf Motor Function Test (WMFT) and Box and Block Test (BBT) as measures of UL motor function and Quantitative Electroencephalogram (QEEG) of motor and sensory areas of the affected hemisphere as a measure of brain reorganization post-stroke. Both groups showed improvement in motor function of the affected UL measured by WMFT and BBT with reported significant difference between them. G1 showed greater improvement in motor function of the affected UL post-treatment compared to G2. Additionally, there was a significant increase in peak frequency of motor and sensory areas with higher and significant excitability in G1 only. These findings imply that brain reorganization in the left hemisphere responded more to TST compared to the right hemisphere. Based on findings of the current study, we can recommend adding TST to the physical therapy program in stroke patients with left hemisphere lesions.
Collapse
|