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Chen M, Lu Z, Li X, Zong Y, Xie Q, Li S, Zhou P. Compound muscle action potential (CMAP) scan examination of paretic and contralateral muscles reveals motor unit alterations after stroke. SCIENCE CHINA. LIFE SCIENCES 2023; 66:2604-2613. [PMID: 37258801 PMCID: PMC11057326 DOI: 10.1007/s11427-022-2308-8] [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: 11/24/2022] [Accepted: 03/19/2023] [Indexed: 06/02/2023]
Abstract
This study presents a novel compound muscle action potential (CMAP) examination of motor unit changes in paretic muscle post stroke. CMAP scan of the first dorsal interosseous (FDI) muscle was performed bilaterally in 16 chronic stroke subjects. Various parameters were derived from the CMAP scan to examine paretic muscle changes, including CMAP amplitude, D50, step index (STEPIX) and amplitude index (AMPIX). A significant decrease in CMAP amplitude and STEPIX was observed in paretic muscles compared with contralateral muscles (CMAP amplitude: paretic (9.0±0.5) mV, contralateral (11.3±0.9) mV, P=0.024; STEPIX: paretic 101.2±7.6, contralateral 121.9±6.5, P=0.020). No significant difference in D50 and AMPIX was observed between the paretic and contralateral sides (P>0.05). The findings revealed complex paretic muscle changes including motor unit degeneration, muscle fiber denervation, reinnervation and atrophy, providing useful insights to help understand neuromuscular mechanisms associated with weakness and other functional deterioration post stroke. The CMAP scan experimental protocols and the applied processing methods are noninvasive, convenient, and automated, offering practical benefits for clinical application.
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Affiliation(s)
- Maoqi Chen
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, China
| | - Zhiyuan Lu
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, China.
| | - Xiaoyan Li
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, 53226, USA
- Fischell Department of Bioengineering, University of Maryland at College Park, College Park, MD, 20742, USA
| | - Ya Zong
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, 77030, USA
- TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, Houston, TX, 77030, USA
| | - Ping Zhou
- School of Rehabilitation Science and Engineering, University of Health and Rehabilitation Sciences, Qingdao, 266071, China
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Liu Y, Chen YT, Zhang C, Zhou P, Li S, Zhang Y. Motor Unit Number Estimation in Spastic Biceps Brachii Muscles of Chronic Stroke Survivors Before and After BoNT Injection. IEEE Trans Biomed Eng 2023; 70:1045-1052. [PMID: 36126033 PMCID: PMC10676740 DOI: 10.1109/tbme.2022.3208078] [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: 11/06/2022]
Abstract
OBJECTIVE The study aims to characterize the motor unit (MU) loss in spastic biceps brachii muscle (BBM) of chronic stroke survivors before and after botulinum neurotoxin (BoNT) injection. METHODS High-density weighted average (HDWA) motor unit number estimation (MUNE) was employed to estimate the number of functioning motor units of BBMs of eight chronic stroke survivors 1-week before (1st visit) and 3-week after (2nd visit) BoNT injection based on the surface electromyography (sEMG) signals recorded during voluntary contraction and supramaximal electrical stimulation. RESULT Significant lower MUNE was estimated from the spastic BBMs compared to the non-spastic MUNEs during two visits. A surprisingly higher MUNE was obtained from the spastic side during the 2nd visit after BoNT injection. CONCLUSIONS The HDWA MUNE technique can be employed to characterize the motor unit loss in spastic muscle caused by upper motor neuro lesions at contraction level up to 30% MVC, but may fail to detect the MU loss caused by the chemodenervation effect of BoNT due to the non-uniform denervation of small and large size MUs. SIGNIFICANCE This study presents the first effort to evaluate the applicability of HDWA MUNE technique to characterize the MU loss in the spastic muscle following stroke and the subsequent BoNT injection for the treatment of post-stroke spasticity. The finding of this study suggests that HDWA MUNE can be a sensitive approach to detect the MU loss in spastic muscles after stroke, but the large inter-subject MUNE variability after the BoNT injection should be interpreted with caution.
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Affiliation(s)
- Yang Liu
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204 USA
| | - Yen-Ting Chen
- (1) Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX 77030, United States; (2) TIRR Memorial Hermann Hospital, Houston, TX 77030, USA; (3) Department of Health and Kinesiology, Northeastern State University, Broken Arrow, OK 74014, USA
| | - Chuan Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204 USA
| | - Ping Zhou
- Faculty of Rehabilitation Engineering, University of Health and Rehabilitation Sciences, Qingdao 266024, China
| | - Sheng Li
- (1) Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX 77030, United States; (2) TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204 USA
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Oguz-Akarsu E, Sirin NG, Artug T, Erbas B, Orhan EK, Idrisoğlu HA, Ketenci A, Baslo MB, Oge AE. Automatic detection of F-waves and F-MUNE in Two Types of Motor Neuron Diseases. Muscle Nerve 2022; 65:422-432. [PMID: 35020950 DOI: 10.1002/mus.27494] [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] [Received: 04/02/2021] [Revised: 01/02/2022] [Accepted: 01/06/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIMS Motor unit number estimation by F-waves (F-MUNE) is an uncommonly used MUNE technique. The aim of this study was to analyze the sensitivity of F-MUNE values elicited with newly developed software in motor neuron diseases. METHODS F-waves were recorded by 300 submaximal stimuli from abductor digiti minimi (ADM) and abductor pollicis brevis (APB) muscles of 35 patients with amyotrophic lateral sclerosis, 18 with previous poliomyelitis, and 20 controls. The software extracted the surface motor unit action potentials (sMUAP) and calculated the F-MUNE values. CMAP Scans were also recorded to obtain step% and MScanFit. RESULTS sMUAP amplitudes were higher and F-MUNE values were lower in both muscles of the patients than in controls. F-MUNE values were able to distinguish the patients from controls. Significant correlations were found between F-MUNE and MScanFit in patient groups. DISCUSSION The new F-MUNE software gave promising results in revealing motor unit loss caused by motor neuron diseases.
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Affiliation(s)
- Emel Oguz-Akarsu
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Neurology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Nermin Gorkem Sirin
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugrul Artug
- Department of Electrical and Electronics Engineering, Faculty of Engineering, Izmir Democracy University, Izmir, Turkey
| | - Bahar Erbas
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.,Department of Pharmacology, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Halil Atilla Idrisoğlu
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aysegul Ketenci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ali Emre Oge
- Departments of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Model-Based Analysis of Muscle Strength and EMG-Force Relation with respect to Different Patterns of Motor Unit Loss. Neural Plast 2021; 2021:5513224. [PMID: 34257638 PMCID: PMC8245245 DOI: 10.1155/2021/5513224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/02/2021] [Accepted: 06/01/2021] [Indexed: 01/07/2023] Open
Abstract
This study presents a model-based sensitivity analysis of the strength of voluntary muscle contraction with respect to different patterns of motor unit loss. A motor unit pool model was implemented including simulation of a motor neuron pool, muscle force, and surface electromyogram (EMG) signals. Three different patterns of motor unit loss were simulated, including (1) motor unit loss restricted to the largest ones, (2) motor unit loss restricted to the smallest ones, and (3) motor unit loss without size restriction. The model outputs including muscle force amplitude, variability, and the resultant EMG-force relation were quantified under two different motor neuron firing strategies. It was found that motor unit loss restricted to the largest ones had the most dominant impact on muscle strength and significantly changed the EMG-force relation, while loss restricted to the smallest motor units had a pronounced effect on force variability. These findings provide valuable insight toward our understanding of the neurophysiological mechanisms underlying experimental observations of muscle strength, force control, and EMG-force relation in both normal and pathological conditions.
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Li X, Fisher M, Rymer WZ, Zhou P. Application of the F-Response for Estimating Motor Unit Number and Amplitude Distribution in Hand Muscles of Stroke Survivors. IEEE Trans Neural Syst Rehabil Eng 2015; 24:674-81. [PMID: 26168437 DOI: 10.1109/tnsre.2015.2453274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The F-response was used in this study to assess changes in the first dorsal interosseous (FDI) muscle after a hemispheric stroke. The number of motor units and their sizes were estimated bilaterally in 12 stroke survivors by recording both the compound muscle action potential (CMAP) and F wave responses. These F waves were induced by applying a large number of electrical stimuli to the ulnar nerve. The amplitude distribution of individual motor unit action potentials (MUAPs) was also compared between paretic and contralateral muscles. When averaged across all the subjects, a significantly lower motor unit number estimate was obtained for the paretic FDI muscle ( 88 ±13) compared with the contralateral side ( 139 ±11) ( ). Pooled surface MUAP amplitude analysis demonstrated a right-skewed distribution for both paretic (kurtosis 3.0) and contralateral (kurtosis 8.52) muscles. When normalized to each individual muscle's CMAP, the surface MUAP amplitude ranged from 0.22% to 4.94% (median 1.17%) of CMAP amplitude for the paretic muscle, and from 0.13% to 3.2% (median 0.62%) of CMAP amplitude for the contralateral muscle. A significant difference in MUAP outliers was also observed between the paretic and contralateral muscles. The findings of this study suggest significant motor unit loss and muscle structural reorganization after stroke.
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Naseri M, Petramfar P, Ashraf A. Effect of Motor Imagery on the F-Wave Parameters in Hemiparetic Stroke Survivors. Ann Rehabil Med 2015; 39:401-8. [PMID: 26161346 PMCID: PMC4496511 DOI: 10.5535/arm.2015.39.3.401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/09/2014] [Indexed: 12/03/2022] Open
Abstract
Objective To assess the effect of motor imagery, as a rehabilitation method in stroke, on F-wave parameters that undergo changes during upper motor neuron involvement. Methods Twenty-one fully conscious hemiparetic stroke survivors with a completely plegic hand (power 0/5) and a minimum interval of 72 hours since stroke were recruited into this study. The mean F-wave latency, amplitude, and persistence in the median and ulnar nerves were measured in both the affected and non-affected sides at rest and in the paretic hand during a mental task. Comparison was made between data from the affected hand and the non-affected hand as well as between data from the affected hand at baseline and during motor imagery. Results Patients had significantly different F-wave persistence between the affected and non-affected sides (paired t-test, p<0.001). Motor imagery could improve F-wave persistence in both the investigated nerves (paired t-test, p=0.01 for ulnar nerve and p<0.001 for median nerve) and F-response amplitude in the median nerve (paired t-test, p=0.01) of the affected limb. Conclusion The amplitude and persistence of F-wave were improved during motor imagery, representing F-wave facilitation. This result suggests that motor imagery can restore motor neuron excitability, which is depressed after stroke.
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Affiliation(s)
- Mahshid Naseri
- Department of Physical Medicine and Rehabilitation and Shiraz Burn Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Department of Neurology, Shiraz University of Medical, Shiraz, Iran
| | - Alireza Ashraf
- Department of Physical Medicine and Rehabilitation and Shiraz Burn Research Centre, Shiraz University of Medical Sciences, Shiraz, Iran
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Gooch CL, Doherty TJ, Chan KM, Bromberg MB, Lewis RA, Stashuk DW, Berger MJ, Andary MT, Daube JR. Motor unit number estimation: A technology and literature review. Muscle Nerve 2014; 50:884-93. [PMID: 25186553 DOI: 10.1002/mus.24442] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Clifton L. Gooch
- Department of Neurology; University of South Florida; Tampa Florida USA
| | - Timothy J. Doherty
- Department of Physical Medicine and Rehabilitation; University of Western Ontario; London Ontario Canada
- Department of Clinical Neurological Sciences; University of Western Ontario; London Ontario Canada
- Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - K. Ming Chan
- Division of Physical Medicine and Rehabilitation/Centre for Neuroscience; University of Alberta; Edmonton Alberta Canada
| | - Mark B. Bromberg
- Department of Neurology; University of Utah; Salt Lake City Utah USA
| | - Richard A. Lewis
- Department of Neurology; Cedars-Sinai; Los Angeles California USA
| | - Dan W. Stashuk
- Systems Design Engineering; University of Waterloo; Waterloo Ontario Canada
| | - Michael J. Berger
- School of Kinesiology; University of Western Ontario; London Ontario Canada
- Schulich School of Medicine and Dentistry; University of Western Ontario; London Ontario Canada
| | - Michael T. Andary
- College of Osteopathic Medicine; Michigan State University; East Lansing Michigan USA
| | - Jasper R. Daube
- Department of Neurology; Mayo Clinic; Rochester Minnesota USA
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Kouzi I, Trachani E, Anagnostou E, Rapidi CA, Ellul J, Sakellaropoulos GC, Chroni E. Motor unit number estimation and quantitative needle electromyography in stroke patients. J Electromyogr Kinesiol 2014; 24:910-6. [PMID: 25304197 DOI: 10.1016/j.jelekin.2014.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 09/06/2014] [Accepted: 09/08/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of upper motor neuron damage upon motor units' function by means of two separate and supplementary electrophysiological methods. METHODS The abductor digiti minimi muscle of the non-paretic and the paretic side was studied in forty-six stroke patients with (a) motor unit number estimation (MUNE) - adapted multiple point stimulation method and (b) computerized quantitative needle electromyography (EMG) assessing the configuration of voluntary recruited motor unit potentials. Main outcome comparisons were focused on differences between non-paretic and paretic side. RESULTS On the affected hands mean MUNE value was significantly lower and mean area of the surface recorded single motor unit potentials was significantly larger than the corresponding ones on the non-paretic hands. EMG findings did not reveal remarkable differences between the two sides. Neither severity nor chronicity of stroke was related to MUNE or EMG parameters. DISCUSSION MUNE results, which suggested reduced motor unit numbers in stroke patients, in conjunction with the normal EMG features in these same muscles has given rise to different interpretations. In a clinical setting, reinnervation type changes in the EMG similar to that occurring in neuronopathies or axonal neuropathies should not be expected in muscles with central neurogenic lesion.
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Affiliation(s)
- Ioanna Kouzi
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Eftichia Trachani
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Evangelos Anagnostou
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Christina-Anastasia Rapidi
- Departments of Spinal Cord Lesions Rehabilitation, School of Medicine, University of Patras, Patras, Greece
| | - John Ellul
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece
| | | | - Elisabeth Chroni
- Departments of Neurology, School of Medicine, University of Patras, Patras, Greece.
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Li X, Rymer WZ, Zhou P. A simulation-based analysis of motor unit number index (MUNIX) technique using motoneuron pool and surface electromyogram models. IEEE Trans Neural Syst Rehabil Eng 2012; 20:297-304. [PMID: 22514208 PMCID: PMC3556460 DOI: 10.1109/tnsre.2012.2194311] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Motor unit number index (MUNIX) measurement has recently achieved increasing attention as a tool to evaluate the progression of motoneuron diseases. In our current study, the sensitivity of the MUNIX technique to changes in motoneuron and muscle properties was explored by a simulation approach utilizing variations on published motoneuron pool and surface electromyogram (EMG) models. Our simulation results indicate that, when keeping motoneuron pool and muscle parameters unchanged and varying the input motor unit numbers to the model, then MUNIX estimates can appropriately characterize changes in motor unit numbers. Such MUNIX estimates are not sensitive to different motor unit recruitment and rate coding strategies used in the model. Furthermore, alterations in motor unit control properties do not have a significant effect on the MUNIX estimates. Neither adjustment of the motor unit recruitment range nor reduction of the motor unit firing rates jeopardizes the MUNIX estimates. The MUNIX estimates closely correlate with the maximum M-wave amplitude. However, if we reduce the amplitude of each motor unit action potential rather than simply reduce motor unit number, then MUNIX estimates substantially underestimate the motor unit numbers in the muscle. These findings suggest that the current MUNIX definition is most suitable for motoneuron diseases that demonstrate secondary evidence of muscle fiber reinnervation. In this regard, when MUNIX is applied, it is of much importance to examine a parallel measurement of motor unit size index (MUSIX), defined as the ratio of the maximum M-wave amplitude to the MUNIX. However, there are potential limitations in the application of the MUNIX methods in atrophied muscle, where it is unclear whether the atrophy is accompanied by loss of motor units or loss of muscle fiber size.
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Affiliation(s)
- Xiaoyan Li
- Sensory Motor Performance Program (SMPP) of the Rehabilitation Institute of Chicago, Chicago, 60611, USA
| | - William Zev Rymer
- SMPP of the Rehabilitation Institute of Chicago, and Departments of Physical Medicine and Rehabilitation, Physiology, and Biomedical Engineering of Northwestern University, Chicago, 60611, USA
| | - Ping Zhou
- SMPP of the Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation of Northwestern University, Chicago, 60611, USA, and the Institute of Biomedical Engineering of the University of Science and Technology of China, Hefei, China, phone: 01-312-238-1365
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Naghdi S, Ansari NN, Mansouri K, Hasson S. A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke. Brain Inj 2010; 24:1372-8. [PMID: 20715900 DOI: 10.3109/02699052.2010.506860] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PRIMARY OBJECTIVE To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS). RESEARCH DESIGN A concurrent criterion-related validity study. INTERVENTIONS Not applicable. METHODS AND PROCEDURES Thirty patients (15 men and 15 women; mean ± SD = 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, H(max)/M(max) ratio and Hslp. MAIN OUTCOMES AND RESULTS There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r = -0.81, p < 0.0001). CONCLUSIONS The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia.
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Affiliation(s)
- Soofia Naghdi
- Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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