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Tang Z, Huang J, Zhou Y, Ren J, Duan X, Fu X, Pan R, Wang R, Zhang P, Ding M, Sun J, Zhang X, Chi Q, Zhang Y, Zhang X, Yu W, Xu L, Zhang H, Liu H. Efficacy and Safety of High-Dose TBS on Poststroke Upper Extremity Motor Impairment: A Randomized Controlled Trial. Stroke 2024; 55:2212-2220. [PMID: 39016009 PMCID: PMC11346718 DOI: 10.1161/strokeaha.124.046597] [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: 01/22/2024] [Revised: 06/19/2024] [Accepted: 07/01/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Upper extremity (UE) motor function impairment is a major poststroke complication whose recovery remains one of the most challenging tasks in neurological rehabilitation. This study examined the efficacy and safety of the personalized neuroimaging-guided high-dose theta-burst stimulation (TBS) for poststroke UE motor function recovery. METHODS Patients after stroke with UE motor impairment from a China rehabilitation center were randomly assigned to receive high-dose intermittent TBS (iTBS) to ipsilesional UE sensorimotor network, continuous TBS (cTBS) to contralesional UE sensorimotor network, or sham stimulation, along with conventional therapy for 3 weeks. The primary outcome was the score changes on the Fugl-Meyer assessment-UE from baseline to 1 and 3 weeks. The secondary outcomes included the response rate on Fugl-Meyer assessment-UE scores posttreatment (≥9-point improvement) and score changes in multidimensional scales measuring UE, lower extremity, and activities and participation. RESULTS From June 2021 to June 2022, 45 participants were randomized and 43 were analyzed. The iTBS and continuous TBS groups showed significantly greater improvement in Fugl-Meyer assessment-UE (mean improvement, iTBS: 10.73 points; continuous TBS: 10.79 points) than the sham group (2.43 points) and exhibited significantly greater response rates on Fugl-Meyer assessment-UE (iTBS, 60.0%; continuous TBS, 64.3%) than the sham group (0.0%). The active groups consistently exhibited superior improvement on the other 2 UE assessments at week 3. However, only the iTBS group showed greater efficacy on 1 lower extremity assessment than the sham group at week 3. Both active groups showed significant improvements in activities and participation assessments. CONCLUSIONS The study provides evidence for the efficacy and safety of high-dose TBS in facilitating poststroke UE rehabilitation. REGISTRATION URL: www.chictr.org.cn; Unique identifier: ChiCTR2100047340.
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Affiliation(s)
- Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Jianting Huang
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
- Academy for Advanced Interdisciplinary Studies (J.H.), Peking University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China (J.H.)
| | - Ying Zhou
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
| | - Jianxun Ren
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
| | - Xinyu Duan
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
| | - Xiaoxuan Fu
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
| | - Ruiqi Pan
- Neural Galaxy, Inc, Beijing, China (R.P., M.D., J.S.)
| | - Rongrong Wang
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Ping Zhang
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
| | - Mengying Ding
- Neural Galaxy, Inc, Beijing, China (R.P., M.D., J.S.)
| | - Jian Sun
- Neural Galaxy, Inc, Beijing, China (R.P., M.D., J.S.)
| | - Xiaonian Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Qianqian Chi
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Yue Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Xin Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Weiyong Yu
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Radiology (W.Y.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
| | - Liu Xu
- West China Medical School, Sichuan University, Chengdu (L.X.)
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, W.Y., H.Z.)
- Department of Neurorehabilitation (Z.T., R.W., Xiaonian Zhang, Q.C., Y. Zhang, Xin Zhang, H.Z.), Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing
- University of Health and Rehabilitation Sciences, Qingdao, China (H.Z.)
- Cheeloo College of Medicine, Shandong University, Jinan, China (H.Z.)
| | - Hesheng Liu
- Changping Laboratory, Beijing, China (J.H., Y. Zhou, J.R., X.D., X.F., P.Z., H.L.)
- Biomedical Pioneering Innovation Center (H.L.), Peking University, Beijing, China
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Li LL, Wu JJ, Li KP, Jin J, Xiang YT, Hua XY, Zheng MX, Xu JG. Comparative efficacy of different noninvasive brain stimulation protocols on upper-extremity motor function and activities of daily living after stroke: a systematic review and network meta-analysis. Neurol Sci 2024; 45:3641-3681. [PMID: 38520639 DOI: 10.1007/s10072-024-07437-4] [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: 10/18/2023] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
The objectives of the study were to systematically evaluate the rehabilitation effect of noninvasive brain stimulation (NIBS) on upper extremity motor function and activities of daily living in stroke patients and to prioritize various stimulation protocols for reliable evidence-based medical recommendations in patients with upper extremity motor dysfunction after stroke. Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM were searched to collect all randomized controlled trials (RCTs) of NIBS to improve upper extremity motor function in stroke patients. The retrieval time was from the establishment of all databases to May 2023. According to the Cochrane system evaluation manual, the quality of the included studies was evaluated, and the data were extracted. Statistical analysis was carried out by using RevMan 5.3, R 4.3.0, and Stata 17.0 software. Finally, 94 RCTs were included, with a total of 5546 patients. Meta-analysis showed that NIBS improved the Fugl-Meyer assessment (FMA) score (mean difference (MD) = 6.51, 95% CI 6.20 ~ 6.82, P < 0.05), MBI score (MD = 7.69, 95% CI 6.57 ~ 8.81, P < 0.05), ARAT score (MD = 5.06, 95% CI 3.85 ~ 6.27, P < 0.05), and motor evoked potential (MEP) amplitude. The modified Ashworth scale score (MD = - 0.37, 95% CI - 0.60 to - 0.14, P < 0.05), National Institutes of Health Stroke Scale score (MD = - 2.17, 95% CI - 3.32 to - 1.11, P < 0.05), incubation period of MEP (MD = - 0.72, 95% CI - 1.06 to - 0.38, P < 0.05), and central motor conduction time (MD = - 0.90, 95% CI - 1.29 to - 0.50, P < 0.05) were decreased in stroke patients. Network meta-analysis showed that the order of interventions in improving FMA scores from high to low was anodal-transcranial direct current stimulation (tDCS) (surface under the cumulative ranking curve (SUCRA) = 83.7%) > cathodal-tDCS (SUCRA = 80.2%) > high-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (SUCRA = 68.5%) > low-frequency (LF)-rTMS (SUCRA = 66.5%) > continuous theta burst stimulation (cTBS) (SUCRA = 54.2%) > bilateral-tDCS (SUCRA = 45.2%) > intermittent theta burst stimulation (iTBS) (SUCRA = 34.1%) > sham-NIBS (SUCRA = 16.0%) > CR (SUCRA = 1.6%). In terms of improving MBI scores, the order from high to low was anodal-tDCS (SUCRA = 88.7%) > cathodal-tDCS (SUCRA = 85.4%) > HF-rTMS (SUCRA = 63.4%) > bilateral-tDCS (SUCRA = 56.0%) > LF-rTMS (SUCRA = 54.2%) > iTBS (SUCRA = 32.4%) > sham-NIBS (SUCRA = 13.8%) > CR (SUCRA = 6.1%). NIBS can effectively improve upper extremity motor function and activities of daily living after stroke. Among the various NIBS protocols, anodal-tDCS demonstrated the most significant intervention effect, followed by cathodal-tDCS and HF-rTMS.
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Affiliation(s)
- Ling-Ling Li
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jia-Jia Wu
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Kun-Peng Li
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jing Jin
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yun-Ting Xiang
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xu-Yun Hua
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Mou-Xiong Zheng
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Jian-Guang Xu
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Seitz S, Schuster-Amft C, Wandel J, Bonati LH, Parmar K, Gerth HU, Behrendt F. Effect of concurrent action observation, peripheral nerve stimulation and motor imagery on dexterity in patients after stroke: a pilot study. Sci Rep 2024; 14:14858. [PMID: 38937566 PMCID: PMC11211322 DOI: 10.1038/s41598-024-65911-7] [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: 02/05/2024] [Accepted: 06/25/2024] [Indexed: 06/29/2024] Open
Abstract
Research to improve and expand treatment options for motor impairment after stroke remains an important issue in rehabilitation as the reduced ability to move affected limbs is still a limiting factor in the selection of training content for stroke patients. The combination of action observation and peripheral nerve stimulation is a promising method for inducing increased excitability and plasticity in the primary motor cortex of healthy subjects. In addition, as reported in the literature, the use of action observation and motor imagery in conjunction has an advantage over the use of one or the other alone in terms of the activation of motor-related brain regions. The aim of the pilot study was thus to combine these findings into a multimodal approach and to evaluate the potential impact of the concurrent application of the three methods on dexterity in stroke patients. The paradigm developed accordingly was tested with 10 subacute patients, in whom hand dexterity, thumb-index pinch force and thumb tapping speed were measured for a baseline assessment and directly before and after the single intervention. During the 10-min session, patients were instructed to watch a repetitive thumb-index finger tapping movement displayed on a monitor and to imagine the sensations that would arise from physically performing the same motion. They were also repeatedly electrically stimulated at the wrist on the motorically more affected body side and asked to place their hand behind the monitor for the duration of the session to support integration of the displayed hand into their own body schema. The data provide a first indication of a possible immediate effect of a single application of this procedure on the dexterity in patients after stroke.
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Affiliation(s)
- Sarina Seitz
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Corina Schuster-Amft
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- School of Engineering and Computer Science, Bern University of Applied Sciences, Biel, Switzerland
| | - Jasmin Wandel
- Institute for Optimization and Data Analysis, Bern University of Applied Sciences, Biel, Switzerland
| | - Leo H Bonati
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Katrin Parmar
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Hans Ulrich Gerth
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland
- Department of Medicine, University Hospital Münster, Münster, Germany
| | - Frank Behrendt
- Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
- School of Engineering and Computer Science, Bern University of Applied Sciences, Biel, Switzerland.
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De Pasquale P, Bonanno M, Mojdehdehbaher S, Quartarone A, Calabrò RS. The Use of Head-Mounted Display Systems for Upper Limb Kinematic Analysis in Post-Stroke Patients: A Perspective Review on Benefits, Challenges and Other Solutions. Bioengineering (Basel) 2024; 11:538. [PMID: 38927774 PMCID: PMC11200415 DOI: 10.3390/bioengineering11060538] [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: 04/11/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
In recent years, there has been a notable increase in the clinical adoption of instrumental upper limb kinematic assessment. This trend aligns with the rising prevalence of cerebrovascular impairments, one of the most prevalent neurological disorders. Indeed, there is a growing need for more objective outcomes to facilitate tailored rehabilitation interventions following stroke. Emerging technologies, like head-mounted virtual reality (HMD-VR) platforms, have responded to this demand by integrating diverse tracking methodologies. Specifically, HMD-VR technology enables the comprehensive tracking of body posture, encompassing hand position and gesture, facilitated either through specific tracker placements or via integrated cameras coupled with sophisticated computer graphics algorithms embedded within the helmet. This review aims to present the state-of-the-art applications of HMD-VR platforms for kinematic analysis of the upper limb in post-stroke patients, comparing them with conventional tracking systems. Additionally, we address the potential benefits and challenges associated with these platforms. These systems might represent a promising avenue for safe, cost-effective, and portable objective motor assessment within the field of neurorehabilitation, although other systems, including robots, should be taken into consideration.
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Affiliation(s)
- Paolo De Pasquale
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Sepehr Mojdehdehbaher
- Department of Mathematics, Computer Science, Physics and Earth Sciences (MIFT), University of Messina, Viale Ferdinando Stagno d’Alcontres, 31, 98166 Messina, Italy;
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi Bonino-Pulejo, Cda Casazza, SS 113, 98124 Messina, Italy; (P.D.P.); (A.Q.); (R.S.C.)
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Baroni A, Antonioni A, Fregna G, Lamberti N, Manfredini F, Koch G, D’Ausilio A, Straudi S. The Effectiveness of Paired Associative Stimulation on Motor Recovery after Stroke: A Scoping Review. Neurol Int 2024; 16:567-589. [PMID: 38804482 PMCID: PMC11130975 DOI: 10.3390/neurolint16030043] [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: 03/13/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
Paired associative stimulation (PAS) is a non-invasive brain stimulation technique combining transcranial magnetic stimulation and peripheral nerve stimulation. PAS allows connections between cortical areas and peripheral nerves (C/P PAS) or between cortical regions (C/C PAS) to be strengthened or weakened by spike-timing-dependent neural plasticity mechanisms. Since PAS modulates both neurophysiological features and motor performance, there is growing interest in its application in neurorehabilitation. We aimed to synthesize evidence on the motor rehabilitation role of PAS in stroke patients. We performed a literature search following the PRISMA Extension for Scoping Reviews Framework. Eight studies were included: one investigated C/C PAS between the cerebellum and the affected primary motor area (M1), seven applied C/P PAS over the lesional, contralesional, or both M1. Seven studies evaluated the outcome on upper limb and one on lower limb motor recovery. Although several studies omit crucial methodological details, PAS highlighted effects mainly on corticospinal excitability, and, more rarely, an improvement in motor performance. However, most studies failed to prove a correlation between neurophysiological changes and motor improvement. Although current studies seem to suggest a role of PAS in post-stroke rehabilitation, their heterogeneity and limited number do not yet allow definitive conclusions to be drawn.
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Affiliation(s)
- Andrea Baroni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Annibale Antonioni
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Giulia Fregna
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Nicola Lamberti
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), 44121 Ferrara, Italy
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
| | - Alessandro D’Ausilio
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), 44121 Ferrara, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44121 Ferrara, Italy; (A.B.); (G.F.); (N.L.); (F.M.); (G.K.); (A.D.); (S.S.)
- Department of Neuroscience, Ferrara University Hospital, 44124 Ferrara, Italy
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Usman JS, Salisu R, Abdullahi A, Salihu AT, Muhammad AH, Sulaiman SK, Yakasai AM. Assistive Technology utilization among stroke survivors in Kano, Northwest Nigeria: A cross-sectional study. Assist Technol 2024; 36:209-216. [PMID: 37699108 DOI: 10.1080/10400435.2023.2244560] [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] [Accepted: 07/30/2023] [Indexed: 09/14/2023] Open
Abstract
Mobility impairments and participation restrictions are common occurrences post-stroke, which may necessitate the need to utilize Assistive Technology (AT). This study investigated the prevalence, pattern, and satisfaction with AT utilization in stroke survivors (SS). The study was conducted in two hospitals in Kano, Nigeria. The QUBEC user evaluation of satisfaction with AT (QUEST) questionnaire and the Rivermead Mobility Index were used to assess satisfaction with AT utilization and mobility, respectively. Pearson correlation and independent t-test were used to determine the relationship and gender difference among the outcomes, respectively. A total of 280 SS participated; however, only 115 (41.07%) were AT users. The commonly used AT was wheelchair 84 (73%), while the least used was walking frame 3 (2.6%). About two-thirds of the participants were quite or very satisfied with their ATs. The duration of AT utilization is positively related to stroke duration (r = 0.940) but negatively related to mobility level (r = -0.246). There is no significant gender difference in duration and satisfaction with AT utilization. AT like wheelchairs seems uncommonly utilized among SS in Kano, Nigeria, likely due to patients' lack of knowledge of use, economic factors, and culture among others.
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Affiliation(s)
- Jibrin Sammani Usman
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Rabbilu Salisu
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Auwal Abdullahi
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
| | - Ashiru Hamza Muhammad
- Department of Public Health, Godiya Disability Inclusion and Development Initiative, Dutse, Jigawa, Nigeria
| | - Surajo Kamilu Sulaiman
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
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Liu S, Huang X, Liu Y, Yue J, Li Y, Chen L. A scoping review of the use of creative activities in stroke rehabilitation. Clin Rehabil 2024; 38:497-509. [PMID: 38232974 DOI: 10.1177/02692155241227049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVE Clarifying the distinctions between art-based creative activities in the domains of occupational therapy and art therapy in the context of stroke rehabilitation, while also describing the effects of art-based creative activities on stroke rehabilitation. DESIGN Scoping review. DATA SOURCE A systematic search was performed in nine databases (Web of Science, PubMed, EMBASE, Cochrane Library, CINAHL and four Chinese database) from their inception to December 2023. REVIEW METHODS The study included randomized and non-randomized controlled trials involving art-based creative activities, as well as qualitative research providing detailed intervention measures. The study focused on stroke patients, with primary outcomes related to patients' physiological recovery, psychological well-being, ADL, etc. Data extraction included information on intervention strategies and study results. RESULTS Seventeen studies were included, extracting six similarities and differences in creative activity between two domains. Creative activities were observed to have positive impacts on daily living activities, limb motor function, fine motor ability, and emotional well-being in stroke patients. CONCLUSION Creative activities, whether in occupational therapy or art therapy, involve providing participants with tangible crafting materials for the creation of artistic works. Future stroke rehabilitation practices should tailor activities and intervention focus based on patients' rehabilitation needs, preferences, and cultural background. The current comprehensive analysis provides initial support for the potential positive role of creative activities in stroke rehabilitation, but further in-depth research is needed to confirm their effectiveness.
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Affiliation(s)
- Shuang Liu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - XianYi Huang
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Yan Liu
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Jie Yue
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
| | - Yu Li
- The Oncology Department, Southwest Medical University Affiliated Hospital, Luzhou, Sichuan, China
| | - Li Chen
- School of Nursing, Southwest Medical University, Luzhou, Sichuan, China
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Meng H, Houston M, Zhang Y, Li S. Exploring the Prospects of Transcranial Electrical Stimulation (tES) as a Therapeutic Intervention for Post-Stroke Motor Recovery: A Narrative Review. Brain Sci 2024; 14:322. [PMID: 38671974 PMCID: PMC11047964 DOI: 10.3390/brainsci14040322] [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: 02/08/2024] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Stroke survivors often have motor impairments and related functional deficits. Transcranial Electrical Stimulation (tES) is a rapidly evolving field that offers a wide range of capabilities for modulating brain function, and it is safe and inexpensive. It has the potential for widespread use for post-stroke motor recovery. Transcranial Direct Current Stimulation (tDCS), Transcranial Alternating Current Stimulation (tACS), and Transcranial Random Noise Stimulation (tRNS) are three recognized tES techniques that have gained substantial attention in recent years but have different mechanisms of action. tDCS has been widely used in stroke motor rehabilitation, while applications of tACS and tRNS are very limited. The tDCS protocols could vary significantly, and outcomes are heterogeneous. PURPOSE the current review attempted to explore the mechanisms underlying commonly employed tES techniques and evaluate their prospective advantages and challenges for their applications in motor recovery after stroke. CONCLUSION tDCS could depolarize and hyperpolarize the potentials of cortical motor neurons, while tACS and tRNS could target specific brain rhythms and entrain neural networks. Despite the extensive use of tDCS, the complexity of neural networks calls for more sophisticated modifications like tACS and tRNS.
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Affiliation(s)
- Hao Meng
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michael Houston
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204, USA;
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Miami, Coral Gables, FL 33146, USA;
| | - Sheng Li
- Department of Physical Medicine & Rehabilitation, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
- TIRR Memorial Hermann Hospital, Houston, TX 77030, USA
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Li Z, Guo J, Ge R, Liu C. Rehabilitation effect of core muscle training combined with functional electrical stimulation on lower limb motor and balance functions in stroke patients. J Back Musculoskelet Rehabil 2024; 37:347-354. [PMID: 37781791 DOI: 10.3233/bmr-230074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Studies have shown that core muscle training can accelerate the recovery of motor function in stroke patients. However, there are no relevant reports to show the effect of core muscle training combined with functional electrical stimulation (FES) on the rehabilitation of stroke patients. OBJECTIVE This study aimed to observe the efficacy of core muscle training combined with FES on motor and balance functions of lower limbs in stroke patients. METHODS This study selected and divided 120 stroke patients with hemiplegia admitted to our hospital into the control and observation groups. Patients in the control group just received core muscle training; while patients in the observation group were treated by core muscle training combined with FES. Both groups were treated for 8 weeks. Subsequently, the clinical data and information of all patients were collected and counted. Muscle strength changes were observed by detecting paralytic dorsiflexor (pDF), plantar flexor (pPF), knee extensor (pKE), and knee flexor (pKF) before and after treatment. Motor and balance abilities of both groups were scored through the 10-meter walking test (10 MWT), Berg balance scale (BBS), functional ambulation category (FAC) scale, timed up and go (TUG) test, and lower extremity motricity index (MI-Lower). RESULTS No significant difference was found in clinical data between the two groups. The intensity of pDF, pPF, pKE, and pKF significantly increased in both groups after treatment, and the intensity of these parameters was higher in the observation group relative to the control group. Additionally, 10 MWT and TUG test scores of patients in the observation group were notably decreased while the BBS and MI-Lower scores were significantly increased after treatment compared with those in the control group. CONCLUSION Core muscle training combined with FES can significantly improve the rehabilitation effect of lower limb motor and balance functions in stroke patients.
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Affiliation(s)
- Zhuo Li
- Department of Traditional Chinese Medicine and Rehabilitation, Beijing Health Vocational College, Beijing, China
| | - Jingwei Guo
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ruidong Ge
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Chang Liu
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
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Isbel S, Holloway H, Greber C, Nguyen K, Frost J, Pearce C, D’Cunha NM. Virtual reality after stroke: Identifying important characteristics when designing experiences to improve engagement in upper limb rehabilitation. Digit Health 2024; 10:20552076241251634. [PMID: 38817838 PMCID: PMC11138195 DOI: 10.1177/20552076241251634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 04/12/2024] [Indexed: 06/01/2024] Open
Abstract
Objective Virtual reality (VR) has been used to improve upper limb function after stroke but there is little to guide product developers in building experiences that engage users in the sustained, repetitive training required. This research sought to understand the characteristics of VR scenarios best suited to engaging someone with a stroke during recovery to achieve therapeutic outcomes. Methods Five creative immersive VR scenarios were designed by an experienced VR content creator containing unique combinations of VR characteristics. The usefulness of the scenarios was reviewed by expert clinicians experienced in stroke rehabilitation. Following this review, seven stroke survivors participated in each experience and reported on their engagement and motivation. Outcome measures were the User Satisfaction Evaluation Questionnaire and the modified Intrinsic Motivation Inventory. Semi-structured interviews were conducted with five participants following their immersive VR experience and analysed thematically. Results Expert clinicians reported potential therapeutic value in the immersive VR scenarios by providing opportunities for repeated and graded practice of upper limb movements. Stroke survivors reported varied levels of enjoyment and engagement for each scenario. They recommended changes to the experiences, primarily relating to the tailoring of the scenarios to match varied upper limb capacities. Conclusion This study highlights the characteristics of immersive VR scenarios that are important in sustaining motivation and providing high-repetition task-specific movement experiences. Differences in the experience and preferences of stroke participants regarding the characteristics of immersive VR experiences indicate that a variety of experiences are necessary to engage and sustain participation in an immersive VR-related therapy programme.
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Affiliation(s)
- Stephen Isbel
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
- Faculty of Health, Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, Australia
| | - Helen Holloway
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
- Faculty of Health, Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, Australia
| | - Craig Greber
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Kelly Nguyen
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Jane Frost
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Claire Pearce
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
| | - Nathan M D’Cunha
- Faculty of Health, School of Exercise and Rehabilitation Sciences, University of Canberra, Canberra, ACT, Australia
- Faculty of Health, Centre for Ageing Research and Translation, University of Canberra, Bruce, ACT, Australia
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Abbate G, Giusti A, Randazzo L, Paolillo A. A mirror therapy system using virtual reality and an actuated exoskeleton for the recovery of hand motor impairments: a study of acceptability, usability, and embodiment. Sci Rep 2023; 13:22881. [PMID: 38129489 PMCID: PMC10739894 DOI: 10.1038/s41598-023-49571-7] [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: 10/13/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
Hand motor impairments are one of the main causes of disabilities worldwide. Rehabilitation procedures like mirror therapy are given crucial importance. In the traditional setup, the patient moves the healthy hand in front of a mirror; the view of the mirrored motion tricks the brain into thinking that the impaired hand is moving as well, stimulating the recovery of the lost hand functionalities. We propose an innovative mirror therapy system that leverages and couples cutting-edge technologies. Virtual reality recreates an immersive and effective mirroring effect; a soft hand exoskeleton accompanies the virtual visual perception by physically inducing the mirrored motion to the real hand. Three working modes of our system have been tested with 21 healthy users. The system is ranked as acceptable by the system usability scale; it does not provoke adverse events or sickness in the users, according to the simulator sickness questionnaire; the three execution modes are also compared w.r.t. the sense of embodiment, evaluated through another customized questionnaire. The achieved results show the potential of our system as a clinical tool and reveal its social and economic impact.
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Affiliation(s)
- Gabriele Abbate
- Dalle Molle Institute for Artificial Intelligence (IDSIA), USI-SUPSI, Lugano, Switzerland.
| | - Alessandro Giusti
- Dalle Molle Institute for Artificial Intelligence (IDSIA), USI-SUPSI, Lugano, Switzerland
| | - Luca Randazzo
- Emovo Care, EPFL Innovation Park, Lausanne, Switzerland
| | - Antonio Paolillo
- Dalle Molle Institute for Artificial Intelligence (IDSIA), USI-SUPSI, Lugano, Switzerland
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Shariat A, Najafabadi MG, Nakhostin Ansari N, Anastasio AT, Bagheri K, Hassanzadeh G, Farghadan M. Outcome Measures Utilized to Assess the Efficacy of Telerehabilitation for Post-Stroke Rehabilitation: A Scoping Review. Brain Sci 2023; 13:1725. [PMID: 38137173 PMCID: PMC10741539 DOI: 10.3390/brainsci13121725] [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: 11/07/2023] [Revised: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Outcome measures using telerehabilitation (TR) in the context of post-stroke rehabilitation are an area of emerging research. The current review assesses the literature related to TR for patients requiring post-stroke rehabilitation. The purpose of this study is to survey the outcome measures used in TR studies and to define which parts of the International Organization of Functioning are measured in trials. METHODS TR studies were searched in Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, Google Scholar, and Web of Science, The Cochrane Central Register of Controlled Trials (Cochrane Library), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Physiotherapy Evidence Database (PEDro) from 2016 to June 2023. Two reviewers individually assessed the full text. Discrepancies regarding inclusion or exclusion were resolved by an additional reviewer. RESULTS A total of 24 studies were included in the current review. The findings were synthesized and presented taking into account their implications within clinical practice, areas of investigation, and strategic implementation. CONCLUSIONS The scoping review has recognized a broad range of outcome measures utilized in TR studies, shedding light on gaps in the current literature. Furthermore, this review serves as a valuable resource for researchers and end users (such as clinicians and policymakers), providing insights into the most appropriate outcome measures for TR. There is a lack of studies examining the required follow-up after TR, emphasizing the need for future research in this area.
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Affiliation(s)
- Ardalan Shariat
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (A.S.); (G.H.)
| | - Mahboubeh Ghayour Najafabadi
- Department of Motor Behavior, Faculty of Sport Sciences and Health, University of Tehran, Tehran 1439957131, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran 141556559, Iran;
- Research Center for War-Affected People, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | | | - Kian Bagheri
- School of Osteopathic Medicine, Campbell University, Lillington, NC 27546, USA;
| | - Gholamreza Hassanzadeh
- Department of Digital Health, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran; (A.S.); (G.H.)
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran 1417613151, Iran
| | - Mahsa Farghadan
- Department of Artificial Intelligence, Faculty of Computer Engineering, Islamic Azad University of South Tehran Branch, Tehran 4147654919, Iran;
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Abit Kocaman A, Önal B, Sertel M, Karaca G. The effect of local vibration applied to the forearm extensor muscles on hand function and muscle activation in stroke patients: a randomized controlled study. Acta Neurol Belg 2023; 123:1957-1964. [PMID: 37481756 DOI: 10.1007/s13760-023-02335-6] [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: 11/13/2022] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE This study aims to reveal the effect of low-frequency local vibration applied to the forearm extensor muscles on stroke patients' muscle activation and hand functions. METHODS Twenty-four stroke patients were randomized to the vibration group (n = 12) or control group (n = 12). The vibration was applied at a 30 Hz frequency to the forearm extensor muscles with a local vibration device three days a week after the routine, conventional physical therapy sessions for four weeks. Six vibration sets were applied, including one vibration for one minute and a rest for 2 min. Routine, traditional physical therapy was used for the control group in 60-min sessions for 4 weeks. Patients were assessed for muscle activation with surface electromyography (MVC) and The Wolf Motor Function Test (WMFT), Functional Independent Test (FIM) was applied to all patients before and after treatment. RESULTS As a result of our study, MVC measurement, WMFT and FIM scores of the vibration group showed more improvement than the control group. Measurement results of vibration group; While MVC measurement increased from 10.21 to 13.79, WMFT-Functional Ability score increased from 42 to 50, WMFT-Performance Time duration increased from 68.78 to 61.83, and FIM score increased from 74.5 to 83. and the measurement results of the control group; MVC measurement increased from 12.28 to 12.22, WMFT-Functional Ability score increased from 48.5 to 51, WMFT-Performance Time duration increased from 70.39 to 70.61, and FIM score increased from 72.5 to 80.5. CONCLUSION It was concluded that low-frequency local vibration applied to the forearm extensor muscles improve forearm extensor muscle activation and hand motor function. CLINICAL TRIAL REGISTRATION NCT04562220.
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Affiliation(s)
- Ayşe Abit Kocaman
- Department of Physiotherapy and Rehabilitation, Kırıkkale University Faculty of Health Sciences, Kırıkkale, Turkey.
| | - Birol Önal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Meral Sertel
- Department of Physiotherapy and Rehabilitation, Kırıkkale University Faculty of Health Sciences, Kırıkkale, Turkey
| | - Gülten Karaca
- Department of Physical Therapy and Rehabilitation, Ankara Memorial Hospital, Ankara, Turkey
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Chan NH, Ng SSM. Psychometric properties of the Chinese version of the Arm Activity Measure in people with chronic stroke. Front Neurol 2023; 14:1248589. [PMID: 37808490 PMCID: PMC10556664 DOI: 10.3389/fneur.2023.1248589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction The Arm Activity Measure was developed to assess active and passive functions of the upper limb in people with unilateral paresis, but a Chinese version is not available and its psychometric properties have not been specifically tested in people with stroke. This study aimed to translate and culturally adapt the Chinese version of the Arm Activity Measure (ArmA-C) and establish its psychometric properties in people with chronic stroke. Methods The psychometric properties of ArmA-C were determined in 100 people with chronic stroke. Results The ArmA-C had good test-retest reliability (intraclass correlation coefficients [ICC] = 0.87-0.93; quadratic weighted Kappa coefficients = 0.53-1.00). A floor effect was identified in section A of the ArmA-C. The content validity and internal consistency (Cronbach's alpha coefficients = 0.75-0.95) were good. The construct validity of the ArmA-C was supported by acceptable fit to the two-factor structure model and significant correlations with the Fugl-Meyer Assessment for Upper Extremity score, grip strength, the Wolf Motor Function Test score, the Trail Walking Test completion time, and the Oxford Participation and Activities Questionnaire scores. Conclusions The ArmA-C is reliable and valid for assessing active and passive functions in people with chronic stroke.
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Affiliation(s)
- Nga Huen Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Shamay S. M. Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Research Centre for Chinese Medicine Innovation, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Kim H, Lee G, Lee J, Kim YH. Alterations in learning-related cortical activation and functional connectivity by high-definition transcranial direct current stimulation after stroke: an fNIRS study. Front Neurosci 2023; 17:1189420. [PMID: 37332855 PMCID: PMC10275383 DOI: 10.3389/fnins.2023.1189420] [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: 03/19/2023] [Accepted: 05/04/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Motor learning is a key component of stroke neurorehabilitation. High-definition transcranial direct current stimulation (HD-tDCS) was recently developed as a tDCS technique that increases the accuracy of current delivery to the brain using arrays of small electrodes. The purpose of this study was to investigate whether HD-tDCS alters learning-related cortical activation and functional connectivity in stroke patients using functional near-infrared spectroscopy (fNIRS). Methods Using a sham-controlled crossover study design, 16 chronic stroke patients were randomly assigned to one of two intervention conditions. Both groups performed the sequential finger tapping task (SFTT) on five consecutive days, either with (a) real HD-tDCS or (b) with sham HD-tDCS. HD-tDCS (1 mA for 20 min, 4 × 1) was administered to C3 or C4 (according to lesion side). fNIRS signals were measured during the SFTT with the affected hand before (baseline) and after each intervention using fNIRS measurement system. Cortical activation and functional connectivity of NIRS signals were analyzed using a statistical parametric mapping open-source software package (NIRS-SPM), OptoNet II®. Results In the real HD-tDCS condition, oxyHb concentration increased significantly in the ipsilesional primary motor cortex (M1). Connectivity between the ipsilesional M1 and the premotor cortex (PM) was noticeably strengthened after real HD-tDCS compared with baseline. Motor performance also significantly improved, as shown in response time during the SFTT. In the sham HD-tDCS condition, functional connectivity between contralesional M1 and sensory cortex was enhanced compared with baseline. There was tendency toward improvement in SFTT response time, but without significance. Discussion The results of this study indicated that HD-tDCS could modulate learning-related cortical activity and functional connectivity within motor networks to enhance motor learning performance. HD-tDCS can be used as an additional tool for enhancing motor learning during hand rehabilitation for chronic stroke patients.
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Affiliation(s)
- Heegoo Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Gihyoun Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Jungsoo Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
- Department of Physical and Rehabilitation Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
- Haeundae Sharing and Happiness Hospital, Pusan, Republic of Korea
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Mohamed FJ, Vijayakumar V, Manavalan N, Maheshkumar K. Screening and validation of the iris manifestation among patients with hemiplegia - an observational study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2023; 20:497-503. [PMID: 36594449 DOI: 10.1515/jcim-2022-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/21/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Understanding and validating the science behind traditional diagnostic methods is a niche area to be explored. Iris diagnosis is one such valuable diagnostic tool used in Naturopathy. In the current study, we have assessed and documented the iris changes observed among patients with hemiplegia with respect to the iridology chart. METHODS We recruited 35 patients with hemiplegia which includes both genders. Iris image was captured by Angel Kiss New 5.0MP Iridology Camera with Pro Iris Analysis Software. Lesion characters, such as open lesion, closed lesion, spot, furrow, radii solaris, intestinal crypts etc., in the iris were noted along with its various characteristics in an excel sheet in numerical order for analysis. RESULTS Majority of the included patients were male (n=30) and the mean age of the patients was 46 years. The most common iris lesions noted were radii solaris and intestinal crypt in the cerebrum and cerebellum regions. Other notable lesions include open lesion, closed lesion, brown spot, hole and nerve ring. ROC analysis for selected iris lesions showed that intestinal crypt (AUC=0.82, p=0.01) and radii solaris (AUC=0.62, p=0.04) to be potential markers for hemiplegia. CONCLUSIONS Two common lesions observed in patients with hemiplegia are radii solaris and intestinal crypt, corresponding to the cerebrum and cerebellum regions of the iris. Future studies with larger sample size would help warrant our current findings, and also the possible application of iris diagnosis as an early diagnostic marker for hemiplegia.
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Affiliation(s)
- Fathima Jebin Mohamed
- Department of Obstetrics and Gynaecology, Govt. Yoga & Naturopathy Medical College and Hospital, The Tamilnadu Dr. MGR Medical University, Chennai, India
| | - Venugopal Vijayakumar
- Department of Yoga, Govt. Yoga & Naturopathy Medical College and Hospital, The Tamilnadu Dr. MGR Medical University, Chennai, India
| | - Narayanaswamy Manavalan
- Department of Naturopathy, Govt. Yoga & Naturopathy Medical College and Hospital, The Tamilnadu Dr. MGR Medical University, Chennai, India
| | - Kuppusamy Maheshkumar
- Department of Physiology, Govt. Yoga & Naturopathy Medical College and Hospital, The Tamilnadu Dr. MGR Medical University, Chennai 600106, India
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Melnikova EA, Starkova EY, Razumov AN. [Modern view on upper limb physical rehabilitation after stroke. Literature review]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:42-53. [PMID: 36971671 DOI: 10.17116/kurort202310001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Stroke is the world's second leading cause of death and the first cause of disability among all diseases. The most common complication of a stroke is a violation of the motor function of the limbs, which significantly worsens the quality of life and the level of self-care and independence of patients. Restoring the function of the upper limb is one of the priority tasks of rehabilitation after a stroke. A large number of factors, such as the location and size of the primary brain lesion, the presence of complications in the form of spasticity, impaired skin and proprioceptive sensitivity, and comorbidities, determine the patient's rehabilitation potential and the prognosis of ongoing rehabilitation measures. Of particular note are the timing of the start of rehabilitation measures, the duration and regularity of the treatment methods. A number of authors propose scales for assessing the rehabilitation prognosis, as well as algorithms for compiling rehabilitation programs for restoring the function of the upper limb. A fairly large number of rehabilitation methods and their combinations have been proposed, including special methods of kinesitherapy, robotic mechanotherapy with biofeedback, the use of physiotherapeutic factors, manual and reflex effects, as well as ready-made programs that include sequential and combined use of various methods. Dozens of studies have been devoted to comparative analysis and evaluation of the effectiveness of these methods. The purpose of this work is to review current research on a given topic and draw up our own conclusion on the appropriateness of using and combining these methods at various stages of rehabilitation in stroke patients.
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Affiliation(s)
- E A Melnikova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - E Yu Starkova
- Moscow Regional Scientific Research Clinical Institute named after M.F. Vladimirsky, Moscow, Russia
| | - A N Razumov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Jang SH, Seo HR, Byun DH. Prognosis of the Ipsilesional Corticospinal Tracts with Preserved Integrities at the Early Stage of Cerebral Infarction: Follow Up Diffusion Tensor Tractography Study. Healthcare (Basel) 2022; 10:1096. [PMID: 35742146 PMCID: PMC9222213 DOI: 10.3390/healthcare10061096] [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: 04/19/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
This study examined the prognosis of the ipsilesional corticospinal tracts (CSTs) with preserved integrities at the early stage of cerebral infarction using follow-up diffusion tensor tractography (DTT). Thirty-one patients with a supratentorial infarction were recruited. DTT, Motricity Index (MI), modified Brunnstrom classification (MBC), and functional ambulation category (FAC) were performed twice at the early and chronic stages. The patients were classified into two groups based on the integrity of the ipsilesional CST on the second DTT: Group A (24 patients; 77.4%)—preserved integrity and Group B (7 patients; 22.6%)—disrupted integrity. No significant differences in MI, MBC, and FAC were observed between groups A and B at the first and second evaluations, except for FAC at the first evaluation (p > 0.05). MI, MBC, and FAC at the second evaluation were significantly higher than at the first evaluation in both groups A and B (p < 0.05). On the second DTT, one patient (4.2%) in group A showed a false-positive result, whereas five patients (71.4%) in group B had false-negative results. Approximately 20% of patients showed disruption of the ipsilesional CST at the chronic stage. However, the clinical outcomes in hand and gait functions were generally good. Careful interpretation considering the somatotopy of the ipsilesional CST is needed because of the high false-negative results on DTT at the chronic stage.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu 42415, Korea;
| | - Hye Rin Seo
- Sinchon Severance Hospital, Younsei University College of Medicine, Seoul 03722, Korea;
| | - Dong Hyun Byun
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu 42415, Korea;
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Anwer S, Waris A, Gilani SO, Iqbal J, Shaikh N, Pujari AN, Niazi IK. Reply to Morone, G.; Giansanti, D. Comment on "Anwer et al. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare 2022, 10, 190". Healthcare (Basel) 2022; 10:847. [PMID: 35627985 PMCID: PMC9142039 DOI: 10.3390/healthcare10050847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Thank you so much for your kind remarks [...].
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Affiliation(s)
- Saba Anwer
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Asim Waris
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Syed Omer Gilani
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Javaid Iqbal
- School of Mechanical & Manufacturing Engineering, National University of Sciences and Technology (NUST), Islamabad 45200, Pakistan; (S.A.); (A.W.); (S.O.G.); (J.I.)
| | - Nusratnaaz Shaikh
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
| | - Amit N. Pujari
- School of Physics, Engineering and Computer Science, University of Hertfordshire, Hatfield AL10 9AB, UK;
- School of Engineering, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Imran Khan Niazi
- Faculty of Health & Environmental Sciences, Health & Rehabilitation Research Institute, AUT University, Auckland 0627, New Zealand;
- Center of Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Center for Sensory-Motor Interaction, Department of Health Science & Technology, Aalborg University, 9000 Alborg, Denmark
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Morone G, Giansanti D. Comment on Anwer et al. Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies. Healthcare 2022, 10, 190. Healthcare (Basel) 2022; 10:846. [PMID: 35627983 PMCID: PMC9141591 DOI: 10.3390/healthcare10050846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
We are writing to you as the corresponding author of the interesting review study entitled "Rehabilitation of Upper Limb Motor Impairment in Stroke: A Narrative Review on the Prevalence, Risk Factors, and Economic Statistics of Stroke and State of the Art Therapies" [...].
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Affiliation(s)
- Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Daniele Giansanti
- Centre Tisp, The Italian National Institute of Health, 00161 Rome, Italy
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