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Rajashekar D, Boyer A, Larkin-Kaiser KA, Dukelow SP. Technological Advances in Stroke Rehabilitation: Robotics and Virtual Reality. Phys Med Rehabil Clin N Am 2024; 35:383-398. [PMID: 38514225 DOI: 10.1016/j.pmr.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Robotic technology and virtual reality (VR) have been widely studied technologies in stroke rehabilitation over the last few decades. Both technologies have typically been considered as ways to enhance recovery through promoting intensive, repetitive, and engaging therapies. In this review, we present the current evidence from interventional clinical trials that employ either robotics, VR, or a combination of both modalities to facilitate post-stroke recovery. Broadly speaking, both technologies have demonstrated some success in improving post-stroke outcomes and complementing conventional therapy. However, more high-quality, randomized, multicenter trials are required to confirm our current understanding of their role in precision stroke recovery.
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Affiliation(s)
- Deepthi Rajashekar
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexa Boyer
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Schulich School of Engineering: Department of Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Kelly A Larkin-Kaiser
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Ablerta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Luszawski CA, Plourde V, Sick SR, Galarneau JM, Eliason PH, Brooks BL, Mrazik M, Debert CT, Lebrun C, Babul S, Hagel BE, Dukelow SP, Schneider KJ, Emery CA, Yeates KO. Psychosocial Factors Associated With Time to Recovery After Concussion in Adolescent Ice Hockey Players. Clin J Sport Med 2024; 34:256-265. [PMID: 37707392 DOI: 10.1097/jsm.0000000000001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion. DESIGN Prospective cohort study, Safe to Play (2013-2018). SETTING Youth hockey leagues in Alberta and British Columbia, Canada. PARTICIPANTS Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions. INDEPENDENT VARIABLES Psychosocial variables. MAIN OUTCOME MEASURES Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit. RESULTS Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery. CONCLUSIONS Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.
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Affiliation(s)
- Caroline A Luszawski
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Vickie Plourde
- School of Psychology, Université de Moncton, Moncton, New Brunswick, Canada
- Centre de Formation médicale du Nouveau-Brunswick, Université de Sherbrooke, Sherbrooke, New Brunswick, Canada
- Faculté Saint-Jean, University of Alberta, Edmonton, Alberta, Canada
| | - Stacy R Sick
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Michel Galarneau
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Paul H Eliason
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Brian L Brooks
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Alberta Children's Hospital, Neurosciences Program, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Martin Mrazik
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Constance Lebrun
- Glen Sather Sports Medicine Clinic, Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shelina Babul
- Department of Pediatrics, Faculty of Medicine, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brent E Hagel
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; and
| | - Kathryn J Schneider
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carolyn A Emery
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Ignacio KHD, Muir RT, Diestro JDB, Singh N, Yu MHLL, Omari OE, Abdalrahman R, Barker-Collo SL, Hackett ML, Dukelow SP, Almekhlafi MA. Prevalence of depression and anxiety symptoms after stroke in young adults: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107732. [PMID: 38657829 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Young adults with stroke have distinct professional and social roles making them vulnerable to symptoms of post-stroke depression (PSD) and post-stroke anxiety (PSA). Prior reviews have examined the prevalence of anxiety and depression in stroke populations. However, there are a lack of studies that have focused on these conditions in young adults. OBJECTIVE We performed a systematic review and meta-analysis of observational studies that reported on symptoms of PSD, PSA and comorbid PSD/PSA in young adults aged 18 to 55 years of age. METHODS MEDLINE, EMBASE, SCOPUS and PsycINFO were searched for studies reporting the prevalence of symptoms of PSD and/or PSA in young adults with stroke from inception until June 23, 2023. We included studies that evaluated depression and/or anxiety symptoms with screening tools or interviews following ischemic or hemorrhagic stroke. Validated methods were employed to evaluate risk of bias. RESULTS 4748 patients from twenty eligible studies were included. Among them, 2420 were also evaluated for symptoms of PSA while 847 participants were evaluated for both PSD and PSA symptoms. Sixteen studies were included in the random effects meta-analysis for PSD symptoms, with a pooled prevalence of 31 % (95 % CI 24-38 %). Pooled PSA symptom prevalence was 39 % (95 % CI 30-48 %) and comorbid PSD with PSA symptom prevalence was 25 % (95 % CI 12-39 %). Varying definitions of 'young adult', combinations of stroke subtypes, and methods to assess PSD and PSA contributed to high heterogeneity amongst studies. CONCLUSIONS We identified high heterogeneity in studies investigating the prevalence of symptoms of PSD and PSA in young adults, emphasizing the importance of standardized approaches in future research to gain insight into the outcomes and prognosis of PSD and PSA symptoms following stroke in young adults. Larger longitudinal epidemiological studies as well as studies on tailored interventions are required to address the mental health needs of this important population. FUNDING None.
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Affiliation(s)
- Katrina Hannah D Ignacio
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada.
| | - Ryan T Muir
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Jose Danilo B Diestro
- Department of Medical Imaging, Division of Diagnostic and Therapeutic Neuroradiology, St Michael's Hospital, University of Toronto, Ontario, Canada
| | - Nishita Singh
- Neurology division, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | | | | | | | - Maree L Hackett
- University of New South Wales, Sydney, Australia; The School of Nursing and Midwifery, The University of Central Lancashire, Preston, United Kingdom
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Calgary Stroke Program, Cumming School of Medicine, University of Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Satkunam L, Dukelow SP, Yu J, McNeil S, Luu H, Martins KJB, Vu K, Nguyen PU, Richer L, Williamson T, Klarenbach SW. Poststroke Care Pathways and Spasticity Treatment: A Retrospective Study in Alberta. Can J Neurol Sci 2024:1-10. [PMID: 38515405 DOI: 10.1017/cjn.2024.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
BACKGROUND Limited evidence exists regarding care pathways for stroke survivors who do and do not receive poststroke spasticity (PSS) treatment. METHODS Administrative data was used to identify adults who experienced a stroke and sought acute care between 2012 and 2017 in Alberta, Canada. Pathways of stroke care within the health care system were determined among those who initiated PSS treatment (PSS treatment group: outpatient pharmacy dispensation of an anti-spastic medication, focal chemo-denervation injection, or a spasticity tertiary clinic visit) and those who did not (non-PSS treatment group). Time from the stroke event until spasticity treatment initiation, and setting where treatment was initiated were reported. Descriptive statistics were performed. RESULTS Health care settings within the pathways of stroke care that the PSS (n = 1,079) and non-PSS (n = 22,922) treatment groups encountered were the emergency department (86 and 84%), acute inpatient care (80 and 69%), inpatient rehabilitation (40 and 12%), and long-term care (19 and 13%), respectively. PSS treatment was initiated a median of 291 (interquartile range 625) days after the stroke event, and most often in the community when patients were residing at home (45%), followed by "other" settings (22%), inpatient rehabilitation (18%), long-term care (11%), and acute inpatient care (4%). CONCLUSIONS To our knowledge, this is the first population based cohort study describing pathways of care among adults with stroke who subsequently did or did not initiate spasticity treatment. Areas for improvement in care may include strategies for earlier identification and treatment of PSS.
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Affiliation(s)
- Lalith Satkunam
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of Adult Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jaime Yu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Division of Adult Rehabilitation, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Stephen McNeil
- Department of Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Huong Luu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karen J B Martins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Khanh Vu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Phuong Uyen Nguyen
- Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
| | - Lawrence Richer
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Tyler Williamson
- Centre for Health Informatics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, Alberta Children's Hospital Research Institute, Libin Cardiovascular Institute, O'Brie Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Scott W Klarenbach
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Bykowski EA, Petersson JN, Dukelow SP, Ho C, Debert CT, Montina T, Metz GAS. Blood-Derived Metabolic Signatures as Biomarkers of Injury Severity in Traumatic Brain Injury: A Pilot Study. Metabolites 2024; 14:105. [PMID: 38392997 PMCID: PMC10890255 DOI: 10.3390/metabo14020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/24/2024] [Accepted: 01/27/2024] [Indexed: 02/25/2024] Open
Abstract
Metabolomic biomarkers hold promise in aiding the diagnosis and prognostication of traumatic brain injury. In Canada, over 165,000 individuals annually suffer from a traumatic brain injury (TBI), making it one of the most prevalent neurological conditions. In this pilot investigation, we examined blood-derived biomarkers as proxy measures that can provide an objective approach to TBI diagnosis and monitoring. Using a 1H nuclear magnetic resonance (NMR)-based quantitative metabolic profiling approach, this study determined whether (1) blood-derived metabolites change during recovery in male participants with mild to severe TBI; (2) biological pathway analysis reflects mechanisms that mediate neural damage/repair throughout TBI recovery; and (3) changes in metabolites correlate to initial injury severity. Eight male participants with mild to severe TBI (with intracranial lesions) provided morning blood samples within 1-4 days and again 6 months post-TBI. Following NMR analysis, the samples were subjected to multivariate statistical and machine learning-based analyses. Statistical modelling displayed metabolic changes during recovery through group separation, and eight significant metabolic pathways were affected by TBI. Metabolic changes were correlated to injury severity. L-alanine (R= -0.63, p < 0.01) displayed a negative relationship with the Glasgow Coma Scale. This study provides pilot data to support the feasibility of using blood-derived metabolites to better understand changes in biochemistry following TBI.
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Affiliation(s)
- Elani A Bykowski
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Jamie N Petersson
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2R7, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Tony Montina
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Department of Chemistry and Biochemistry, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
| | - Gerlinde A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
- Southern Alberta Genome Sciences Centre, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada
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Hayward KS, Dalton EJ, Barth J, Brady M, Cherney LR, Churilov L, Clarkson AN, Dawson J, Dukelow SP, Feys P, Hackett M, Zeiler SR, Lang CE. Control intervention design for preclinical and clinical trials: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:169-179. [PMID: 37824750 PMCID: PMC10811967 DOI: 10.1177/17474930231199336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/16/2023] [Indexed: 10/14/2023]
Abstract
Control comparator selection is a critical trial design issue. Preclinical and clinical investigators who are doing trials of stroke recovery and rehabilitation interventions must carefully consider the appropriateness and relevance of their chosen control comparator as the benefit of an experimental intervention is established relative to a comparator. Establishing a strong rationale for a selected comparator improves the integrity of the trial and validity of its findings. This Stroke Recovery and Rehabilitation Roundtable (SRRR) taskforce used a graph theory voting system to rank the importance and ease of addressing challenges during control comparator design. "Identifying appropriate type of control" was ranked easy to address and very important, "variability in usual care" was ranked hard to address and of low importance, and "understanding the content of the control and how it differs from the experimental intervention" was ranked very important but not easy to address. The CONtrol DeSIGN (CONSIGN) decision support tool was developed to address the identified challenges and enhance comparator selection, description, and reporting. CONSIGN is a web-based tool inclusive of seven steps that guide the user through control comparator design. The tool was refined through multiple rounds of pilot testing that included more than 130 people working in neurorehabilitation research. Four hypothetical exemplar trials, which span preclinical, mood, aphasia, and motor recovery, demonstrate how the tool can be applied in practice. Six consensus recommendations are defined that span research domains, professional disciplines, and international borders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Peter Feys
- Reval University of Hasselt, Hasselt, Belgium
| | - Maree Hackett
- University of New South Wales, Sydney, NSW, Australia
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7
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Hayward KS, Dalton EJ, Barth J, Brady M, Cherney LR, Churilov L, Clarkson AN, Dawson J, Dukelow SP, Feys P, Hackett M, Zeiler SR, Lang CE. Control intervention design for preclinical and clinical trials: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:30-40. [PMID: 37837348 PMCID: PMC10798031 DOI: 10.1177/15459683231209162] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Control comparator selection is a critical trial design issue. Preclinical and clinical investigators who are doing trials of stroke recovery and rehabilitation interventions must carefully consider the appropriateness and relevance of their chosen control comparator as the benefit of an experimental intervention is established relative to a comparator. Establishing a strong rationale for a selected comparator improves the integrity of the trial and validity of its findings. This Stroke Recovery and Rehabilitation Roundtable (SRRR) taskforce used a graph theory voting system to rank the importance and ease of addressing challenges during control comparator design. "Identifying appropriate type of control" was ranked easy to address and very important, "variability in usual care" was ranked hard to address and of low importance, and "understanding the content of the control and how it differs from the experimental intervention" was ranked very important but not easy to address. The CONtrol DeSIGN (CONSIGN) decision support tool was developed to address the identified challenges and enhance comparator selection, description, and reporting. CONSIGN is a web-based tool inclusive of seven steps that guide the user through control comparator design. The tool was refined through multiple rounds of pilot testing that included more than 130 people working in neurorehabilitation research. Four hypothetical exemplar trials, which span preclinical, mood, aphasia, and motor recovery, demonstrate how the tool can be applied in practice. Six consensus recommendations are defined that span research domains, professional disciplines, and international borders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Peter Feys
- Reval University of Hasselt, Hasselt, Belgium
| | - Maree Hackett
- University of New South Wales, Sydney, NSW, Australia
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8
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Kenzie JM, Rajashekar D, Goodyear BG, Dukelow SP. Resting state functional connectivity associated with impaired proprioception post-stroke. Hum Brain Mapp 2024; 45:e26541. [PMID: 38053448 PMCID: PMC10789217 DOI: 10.1002/hbm.26541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Deficits in proprioception, the knowledge of limb position and movement in the absence of vision, occur in ~50% of all strokes; however, our lack of knowledge of the neurological mechanisms of these deficits diminishes the effectiveness of rehabilitation and prolongs recovery. We performed resting-state functional magnetic resonance imaging (fMRI) on stroke patients to determine functional brain networks that exhibited changes in connectivity in association with proprioception deficits determined by a Kinarm robotic exoskeleton assessment. Thirty stroke participants were assessed for proprioceptive impairments using a Kinarm robot and underwent resting-state fMRI at 1 month post-stroke. Age-matched healthy control (n = 30) fMRI data were also examined and compared to stroke data in terms of the functional connectivity of brain regions associated with proprioception. Stroke patients exhibited reduced connectivity of the supplementary motor area and the supramarginal gyrus, relative to controls. Functional connectivity of these regions plus primary somatosensory cortex and parietal opercular area was significantly associated with proprioceptive function. The parietal lobe of the lesioned hemisphere is a significant node for proprioception after stroke. Assessment of functional connectivity of this region after stroke may assist with prognostication of recovery. This study also provides potential targets for therapeutic neurostimulation to aid in stroke recovery.
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Affiliation(s)
- Jeffrey M. Kenzie
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health ServicesCalgaryAlbertaCanada
| | - Deepthi Rajashekar
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Bradley G. Goodyear
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health ServicesCalgaryAlbertaCanada
- Department of RadiologyUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
| | - Sean P. Dukelow
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Seaman Family MR Research Centre, Foothills Medical Centre, Alberta Health ServicesCalgaryAlbertaCanada
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9
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Mills PB, Phadke CP, Boulias C, Dukelow SP, Ismail F, McNeil SM, Miller TA, O'Connell CM, Reebye RN, Satkunam LE, Wein TH, Winston PJ. Spasticity Management Teams, Evaluations, and Tools: A Canadian Cross-Sectional Survey. Can J Neurol Sci 2023; 50:876-884. [PMID: 36408628 DOI: 10.1017/cjn.2022.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The objective of this study is to determine the physical evaluations and assessment tools used by a group of Canadian healthcare professionals treating adults with spasticity. METHODS A cross-sectional web-based 19-question survey was developed to determine the types of physical evaluations, tone-related impairment measurements, and assessment tools used in the management of adults with spasticity. The survey was distributed to healthcare professionals from the Canadian Advances in Neuro-Orthopedics for Spasticity Congress database. RESULTS Eighty study participants (61 physiatrists and 19 other healthcare professionals) completed the survey and were included. Nearly half (46.3%, 37/80) of the participants reported having an inter- or trans-disciplinary team managing individuals with spasticity. Visual observation of movement, available range of motion determination, tone during velocity-dependent passive range of motion looking for a spastic catch, spasticity, and clonus, and evaluation of gait were the most frequently used physical evaluations. The most frequently used spasticity tools were the Modified Ashworth Scale, goniometer, and Goal Attainment Scale. Results were similar in brain- and spinal cord-predominant etiologies. To evaluate goals, qualitative description was used most (37.5%). CONCLUSION Our findings provide a better understanding of the spasticity management landscape in Canada with respect to staffing, physical evaluations, and outcome measurements used in clinical practice. For all etiologies of spasticity, visual observation of patient movement, Modified Ashworth Scale, and qualitative goal outcomes descriptions were most commonly used to guide treatment and optimize outcomes. Understanding the current practice of spasticity assessment will help provide guidance for clinical evaluation and management of spasticity.
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Affiliation(s)
- Patricia B Mills
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehab Centre, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Chetan P Phadke
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Chris Boulias
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Canada
| | - Farooq Ismail
- Spasticity Research Program, West Park Healthcare Centre, Toronto, Ontario, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Stephen M McNeil
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Foothills Medical Centre, Calgary, Canada
- Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, Ontario, Canada
| | - Thomas A Miller
- St. Joseph's Health Care London, Western University, London, Ontario, Canada
| | - Colleen M O'Connell
- Stan Cassidy Centre, Fredericton, New Brunswick, Canada
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Rajiv N Reebye
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehab Centre, Vancouver, British Columbia, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Ontario, Canada
| | - Lalith E Satkunam
- Glenrose Rehabilitation Hospital and Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta, Canada
| | - Theodore H Wein
- Stroke Prevention Clinic, Montreal General Hospital and McGill University Health Center, Montreal, Quebec, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Paul J Winston
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Ontario, Canada
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10
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Park K, Ritsma BR, Dukelow SP, Scott SH. A robot-based interception task to quantify upper limb impairments in proprioceptive and visual feedback after stroke. J Neuroeng Rehabil 2023; 20:137. [PMID: 37821970 PMCID: PMC10568927 DOI: 10.1186/s12984-023-01262-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND A key motor skill is the ability to rapidly interact with our dynamic environment. Humans can generate goal-directed motor actions in response to sensory stimulus within ~ 60-200ms. This ability can be impaired after stroke, but most clinical tools lack any measures of rapid feedback processing. Reaching tasks have been used as a framework to quantify impairments in generating motor corrections for individuals with stroke. However, reaching may be inadequate as an assessment tool as repeated reaching can be fatiguing for individuals with stroke. Further, reaching requires many trials to be completed including trials with and without disturbances, and thus, exacerbate fatigue. Here, we describe a novel robotic task to quantify rapid feedback processing in healthy controls and compare this performance with individuals with stroke to (more) efficiently identify impairments in rapid feedback processing. METHODS We assessed a cohort of healthy controls (n = 135) and individuals with stroke (n = 40; Mean 41 days from stroke) in the Fast Feedback Interception Task (FFIT) using the Kinarm Exoskeleton robot. Participants were instructed to intercept a circular white target moving towards them with their hand represented as a virtual paddle. On some trials, the arm could be physically perturbed, the target or paddle could abruptly change location, or the target could change colour requiring the individual to now avoid the target. RESULTS Most participants with stroke were impaired in reaction time (85%) and end-point accuracy (83%) in at least one of the task conditions, most commonly with target or paddle shifts. Of note, this impairment was also evident in most individuals with stroke when performing the task using their unaffected arm (75%). Comparison with upper limb clinical measures identified moderate correlations with the FFIT. CONCLUSION The FFIT was able to identify a high proportion of individuals with stroke as impaired in rapid feedback processing using either the affected or unaffected arms. The task allows many different types of feedback responses to be efficiently assessed in a short amount of time.
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Affiliation(s)
- Kayne Park
- Centre for Neuroscience Studies, Queen's University, Botterell Hall, 18 Stuart St, Kingston, ON, K7L 3N6, Canada.
| | - Benjamin R Ritsma
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, ON, Canada
- Providence Care Hospital, Queen's University, Kingston, ON, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Botterell Hall, 18 Stuart St, Kingston, ON, K7L 3N6, Canada
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Department of Medicine, Queen's University, Kingston, ON, Canada
- Providence Care Hospital, Queen's University, Kingston, ON, Canada
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11
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Hung SH, Tierney C, Klassen TD, Schneeberg A, Bayley MT, Dukelow SP, Hill MD, Krassioukov A, Pooyania S, Poulin MJ, Yao J, Eng JJ. Blood pressure trajectory of inpatient stroke rehabilitation patients from the Determining Optimal Post-Stroke Exercise (DOSE) trial over the first 12 months post-stroke. Front Neurol 2023; 14:1245881. [PMID: 37794879 PMCID: PMC10546336 DOI: 10.3389/fneur.2023.1245881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023] Open
Abstract
Background High blood pressure (BP) is the primary risk factor for recurrent strokes. Despite established clinical guidelines, some stroke survivors exhibit uncontrolled BP over the first 12 months post-stroke. Furthermore, research on BP trajectories in stroke survivors admitted to inpatient rehabilitation hospitals is limited. Exercise is recommended to reduce BP after stroke. However, the effect of high repetition gait training at aerobic intensities (>40% heart rate reserve; HRR) during inpatient rehabilitation on BP is unclear. We aimed to determine the effect of an aerobic gait training intervention on BP trajectory over the first 12 months post-stroke. Methods This is a secondary analysis of the Determining Optimal Post-Stroke Exercise (DOSE) trial. Participants with stroke admitted to inpatient rehabilitation hospitals were recruited and randomized to usual care (n = 24), DOSE1 (n = 25; >2,000 steps, 40-60% HRR for >30 min/session, 20 sessions over 4 weeks), or DOSE2 (n = 25; additional DOSE1 session/day) groups. Resting BP [systolic (SBP) and diastolic (DBP)] was measured at baseline (inpatient rehabilitation admission), post-intervention (near inpatient discharge), 6- and 12-month post-stroke. Linear mixed-effects models were used to examine the effects of group and time (weeks post-stroke) on SBP, DBP and hypertension (≥140/90 mmHg; ≥130/80 mmHg, if diabetic), controlling for age, stroke type, and baseline history of hypertension. Results No effect of intervention group on SBP, DBP, or hypertension was observed. BP increased from baseline to 12-month post-stroke for SBP (from [mean ± standard deviation] 121.8 ± 15.0 to 131.8 ± 17.8 mmHg) and for DBP (74.4 ± 9.8 to 78.5 ± 10.1 mmHg). The proportion of hypertensive participants increased from 20.8% (n = 15/72) to 32.8% (n = 19/58). These increases in BP were statistically significant: an effect [estimation (95%CI), value of p] of time was observed on SBP [0.19 (0.12-0.26) mmHg/week, p < 0.001], DBP [0.09 (0.05-0.14) mmHg/week, p < 0.001], and hypertension [OR (95%CI): 1.03 (1.01-1.05), p = 0.010]. A baseline history of hypertension was associated with higher SBP by 13.45 (8.73-18.17) mmHg, higher DBP by 5.57 (2.02-9.12) mmHg, and 42.22 (6.60-270.08) times the odds of being hypertensive at each timepoint, compared to those without. Conclusion Blood pressure increased after inpatient rehabilitation over the first 12 months post-stroke, especially among those with a history of hypertension. The 4-week aerobic gait training intervention did not influence this trajectory.
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Affiliation(s)
- Stanley H. Hung
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Center for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | | | - Tara D. Klassen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Amy Schneeberg
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Mark T. Bayley
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Andrei Krassioukov
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, Canada
| | - Marc J. Poulin
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer Yao
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, Center for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
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12
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Robles CM, Anderson B, Dukelow SP, Striemer CL. Assessment and recovery of visually guided reaching deficits following cerebellar stroke. Neuropsychologia 2023; 188:108662. [PMID: 37598808 DOI: 10.1016/j.neuropsychologia.2023.108662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
The cerebellum is known to play an important role in the coordination and timing of limb movements. The present study focused on how reach kinematics are affected by cerebellar lesions to quantify both the presence of motor impairment, and recovery of motor function over time. In the current study, 12 patients with isolated cerebellar stroke completed clinical measures of cognitive and motor function, as well as a visually guided reaching (VGR) task using the Kinarm exoskeleton at baseline (∼2 weeks), as well as 6, 12, and 24-weeks post-stroke. During the VGR task, patients made unassisted reaches with visual feedback from a central 'start' position to one of eight targets arranged in a circle. At baseline, 6/12 patients were impaired across several parameters of the VGR task compared to a Kinarm normative sample (n = 307), revealing deficits in both feed-forward and feedback control. The only clinical measures that consistently demonstrated impairment were the Purdue Pegboard Task (PPT; 9/12 patients) and the Montreal Cognitive Assessment (6/11 patients). Overall, patients who were impaired at baseline showed significant recovery by the 24-week follow-up for both VGR and the PPT. A lesion overlap analysis indicated that the regions most commonly damaged in 5/12 patients (42% overlap) were lobule IX and Crus II of the right cerebellum. A lesion subtraction analysis comparing patients who were impaired (n = 6) vs. unimpaired (n = 6) on the VGR task at baseline showed that the region most commonly damaged in impaired patients was lobule VIII of the right cerebellum (40% overlap). Our results lend further support to the notion that the cerebellum is involved in both feedforward and feedback control during reaching, and that cerebellar patients tend to recover relatively quickly overall. In addition, we argue that future research should study the effects of cerebellar damage on visuomotor control from a perception-action theoretical framework to better understand how the cerebellum works with the dorsal stream to control visually guided action.
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Affiliation(s)
- Chella M Robles
- Department of Psychology, MacEwan University, Edmonton, Alberta, Canada
| | - Britt Anderson
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Christopher L Striemer
- Department of Psychology, MacEwan University, Edmonton, Alberta, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
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13
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Smith DB, Scott SH, Semrau JA, Dukelow SP. Impairments of the ipsilesional upper-extremity in the first 6-months post-stroke. J Neuroeng Rehabil 2023; 20:106. [PMID: 37580751 PMCID: PMC10424459 DOI: 10.1186/s12984-023-01230-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Ipsilesional motor impairments of the arm are common after stroke. Previous studies have suggested that severity of contralesional arm impairment and/or hemisphere of lesion may predict the severity of ipsilesional arm impairments. Historically, these impairments have been assessed using clinical scales, which are less sensitive than robot-based measures of sensorimotor performance. Therefore, the objective of this study was to characterize progression of ipsilesional arm motor impairments using a robot-based assessment of motor function over the first 6-months post-stroke and quantify their relationship to (1) contralesional arm impairment severity and (2) stroke-lesioned hemisphere. METHODS A total of 106 participants with first-time, unilateral stroke completed a unilateral assessment of arm motor impairment (visually guided reaching task) using the Kinarm Exoskeleton. Participants completed the assessment along with a battery of clinical measures with both ipsilesional and contralesional arms at 1-, 6-, 12-, and 26-weeks post-stroke. RESULTS Robotic assessment of arm motor function revealed a higher incidence of ipsilesional arm impairment than clinical measures immediately post-stroke. The incidence of ipsilesional arm impairments decreased from 47 to 14% across the study period. Kolmogorov-Smirnov tests revealed that ipsilesional arm impairment severity, as measured by our task, was not related to which hemisphere was lesioned. The severity of ipsilesional arm impairments was variable but displayed moderate significant relationships to contralesional arm impairment severity with some robot-based parameters. CONCLUSIONS Ipsilesional arm impairments were variable. They displayed relationships of varying strength with contralesional impairments and were not well predicted by lesioned hemisphere. With standard clinical care, 86% of ipsilesional impairments recovered by 6-months post-stroke.
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Affiliation(s)
- Donovan B Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th Street NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer A Semrau
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, USA
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 1403 29th Street NW, Foothills Medical Centre, South Tower, Room 905, Calgary, AB, T2N 2T9, Canada.
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14
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Chilvers MJ, Rajashekar D, Low TA, Scott SH, Dukelow SP. Clinical, Neuroimaging and Robotic Measures Predict Long-Term Proprioceptive Impairments following Stroke. Brain Sci 2023; 13:953. [PMID: 37371431 DOI: 10.3390/brainsci13060953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/04/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Proprioceptive impairments occur in ~50% of stroke survivors, with 20-40% still impaired six months post-stroke. Early identification of those likely to have persistent impairments is key to personalizing rehabilitation strategies and reducing long-term proprioceptive impairments. In this study, clinical, neuroimaging and robotic measures were used to predict proprioceptive impairments at six months post-stroke on a robotic assessment of proprioception. Clinical assessments, neuroimaging, and a robotic arm position matching (APM) task were performed for 133 stroke participants two weeks post-stroke (12.4 ± 8.4 days). The APM task was also performed six months post-stroke (191.2 ± 18.0 days). Robotics allow more precise measurements of proprioception than clinical assessments. Consequently, an overall APM Task Score was used as ground truth to classify proprioceptive impairments at six months post-stroke. Other APM performance parameters from the two-week assessment were used as predictive features. Clinical assessments included the Thumb Localisation Test (TLT), Behavioural Inattention Test (BIT), Functional Independence Measure (FIM) and demographic information (age, sex and affected arm). Logistic regression classifiers were trained to predict proprioceptive impairments at six months post-stroke using data collected two weeks post-stroke. Models containing robotic features, either alone or in conjunction with clinical and neuroimaging features, had a greater area under the curve (AUC) and lower Akaike Information Criterion (AIC) than models which only contained clinical or neuroimaging features. All models performed similarly with regard to accuracy and F1-score (>70% accuracy). Robotic features were also among the most important when all features were combined into a single model. Predicting long-term proprioceptive impairments, using data collected as early as two weeks post-stroke, is feasible. Identifying those at risk of long-term impairments is an important step towards improving proprioceptive rehabilitation after a stroke.
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Affiliation(s)
- Matthew J Chilvers
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Deepthi Rajashekar
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Trevor A Low
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queens University, Kingston, ON K7L 3N6, Canada
- Centre for Neuroscience Studies, Queens University, Kingston, ON K7L 3N6, Canada
- Providence Care Hospital, Kingston, ON K7L 3N6, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada
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15
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Peters S, Lohse KR, Klassen TD, Liu-Ambrose T, Dukelow SP, Bayley MT, Hill MD, Pooyania S, Yao J, Eng JJ. Higher intensity walking improves global cognition during inpatient rehabilitation: a secondary analysis of a randomized control trial. Front Neurol 2023; 14:1023488. [PMID: 37360352 PMCID: PMC10289188 DOI: 10.3389/fneur.2023.1023488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Cognitive deficits are common poststroke. Cognitive rehabilitation is typically used to improve cognitive deficits. It is unknown whether higher doses of exercise to promote motor recovery influence cognitive outcomes. Our recent trial, Determining Optimal Post-Stroke Exercise (DOSE), shows more than double the steps and aerobic minutes can be achieved during inpatient rehabilitation versus usual care, and translates to improved long-term walking outcomes. Thus, the secondary analysis aim was to determine the effect of the DOSE protocol on cognitive outcomes over 1-year poststroke. The DOSE protocol progressively increased step number and aerobic minutes during inpatient stroke rehabilitation over 20 sessions. The Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), and Trail Making Test B were completed at baseline, post-intervention, and 6- and 12-months poststroke, administered using standardized guidelines. Using the DOSE data, we used mixed-effect spline regression to model participants' trajectories of cognitive recovery, controlling for relevant covariates. Participants (Usual Care n = 25, DOSE n = 50) were 56.7(11.7) years old, and 27(10) days post stroke. For the MoCA, there were statistically significant Group × Trajectory(p = 0.019), and Group × ΔTrajectory (p = 0.018) interactions with a substantial clinically meaningful difference, from +5.44 points/month improvement of the DOSE group compared to +1.59 points/month improvement with Usual Care during the 4-week intervention. The DSST and Trails B improved over time but were not different between groups. Taking advantage of this early difference may lend support to continued efforts to increase intensity, during and after discharge from inpatient rehabilitation, to improve cognition. Clinical trial registration: www.clinicaltrials.gov, NCT01915368.
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Affiliation(s)
- Sue Peters
- School of Physical Therapy, University of Western Ontario, London, ON, Canada
| | - Keith R. Lohse
- Program in Physical Therapy and Department of Neurology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Tara D. Klassen
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Mark T. Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Michael D. Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer Yao
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver, BC, Canada
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16
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Dukelow SP. Challenging Historic Views in Stroke Recovery of the Upper Extremity: Out on a Limb. Neurology 2023:WNL.0000000000207499. [PMID: 37268434 DOI: 10.1212/wnl.0000000000207499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 06/04/2023] Open
Affiliation(s)
- Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB.
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17
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Reid LN, Dukelow SP, Scott SH. Impairments of the arm and hand are highly correlated during subacute stroke. J Rehabil Med 2023; 55:jrm2174. [PMID: 37219403 DOI: 10.2340/jrm.v55.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/27/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND The classical description of poststroke upper limb impairment follows a proximalto-distal impairment gradient. Previous studies are equivocal on whether the hand is more impaired than the arm. OBJECTIVE To compare impairment of the arm and hand during subacute stroke. METHOD A total of 73 individuals were evaluated for impairment of the upper limb within 30 days (early subacute) and within 90-150 days (late subacute) of stroke. Impairments were quantified using the Chedoke-McMaster Stroke Assessment (CMSA) for the arm and hand, Purdue Pegboard task, and a robotic Visually Guided Reaching task. RESULTS In the early phase 42% of participants in the early phase and 59% in the late phase received the same CMSA score for the arm and hand, with 88% and 95% of participants in the early and late phases, respectively, receiving a 1-point difference. Strong correlations exist between the CMSA arm and hand scores (early r = 0.79, late r = 0.75), and moderate - strong correlations exist between CMSA arm and hand scores and Purdue Pegboard and Visually Guided Reaching performances (r = 0.66-0.81). No systematic differences were found between the arm and hand. CONCLUSION Impairments in the arm and hand during subacute stroke are highly correlated and do not support the presence of a proximal-to-distal gradient.
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Affiliation(s)
- Lydia N Reid
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario.
| | - Sean P Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario; Department of Biomedical and Molecular Science, Queen's University, Kingston, Ontario; Providence Care Hospital, Kingston, Ontario, Canada
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18
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Swytink-Binnema CA, Rockel CP, Martino D, Dukelow SP, Pike GB, Kiss ZHT. Limb Preference Changes after Focused-Ultrasound Thalamotomy for Tremor. Mov Disord 2023. [PMID: 36947685 DOI: 10.1002/mds.29350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/30/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused-ultrasound (MRgFUS) thalamotomy is an effective treatment for essential and other tremors. It targets the ventrointermedius (Vim) nucleus, which is the thalamic relay in a proprioceptive pathway, and contains kinesthetic cells. Although MRgFUS thalamotomy reduces some risks associated with more invasive surgeries, it still has side effects, such as balance and gait disturbances; these may be caused by the lesion impacting proprioception. OBJECTIVES Our aim was to quantitatively measure the effects of MRgFUS on proprioception and limb use in essential tremor patients. We hypothesized that this thalamotomy alters proprioception, because the sensorimotor Vim thalamus is lesioned. METHODS Proprioception was measured using the Kinarm exoskeleton robot in 18 patients. Data were collected pre-operatively, and then 1 day, 3 months, and 1 year after surgery. Patients completed four tasks, assessing motor coordination and postural control, goal-directed movement and bimanual planning, position sense, and kinesthesia. RESULTS Immediately after surgery there were changes in posture speed (indicating tremor improvement), and in bimanual hand use, with the untreated limb being preferred. However, these measures returned to pre-operative baseline over time. There were no changes in parameters related to proprioception. None of these measures correlated with lesion size or lesion-overlap with the dentato-rubro-thalamic tract. CONCLUSIONS This is the first quantitative assessment of proprioception and limb preference following MRgFUS thalamotomy. Our results suggest that focused-ultrasound lesioning of the Vim thalamus does not degrade proprioception but alters limb preference. This change may indicate a required "relearning" in the treated limb, because the effect is transient. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Catherine A Swytink-Binnema
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Conrad P Rockel
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - G Bruce Pike
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zelma H T Kiss
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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19
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Park K, Chilvers MJ, Low TA, Dukelow SP, Scott SH. Directional and general impairments in initiating motor responses after stroke. Brain Commun 2023; 5:fcad066. [PMID: 37056474 PMCID: PMC10087022 DOI: 10.1093/braincomms/fcad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/13/2022] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Abstract
Visuospatial neglect is a disorder characterized by an impairment of attention, most commonly to the left side of space in individuals with stroke or injury to the right hemisphere. Clinical diagnosis is largely based on performance on pen and paper examinations that are unable to accurately measure the speed of processing environmental stimuli – important for interacting in our dynamic world. Numerous studies of impairment after visuospatial neglect demonstrate delayed reaction times when reaching to the left. However, little is known of the visuospatial impairment in other spatial directions and, further, the influence of the arm being assessed.
In this study, we quantify the ability of a large cohort of 204 healthy control participants (females = 102) and 265 individuals with stroke (right hemisphere damage = 162, left hemisphere damage = 103; mean age 62) to generate goal-directed reaches. Participants used both their contralesional and ipsilesional arms to perform a centre-out visually guided reaching task in the horizontal plane.
We found the range of visuospatial impairment can vary dramatically across individuals with some individuals displaying reaction time impairments restricted to a relatively small portion of the workspace, whereas others displayed reaction time impairments in all spatial directions. Reaction time impairments were observed in individuals with right or left hemisphere lesions (48% and 30%, respectively). Directional impairments commonly rotated clockwise when reaching with the left versus the right arms. Impairment in all spatial directions were more prevalent in right than left hemisphere lesions (32% and 12%, respectively). Behavioral Inattention Test scores significantly correlated (r = -0.49, p < 0.005) with reaction time impairments but a large portion of individuals not identified as having visuospatial neglect on the Behavioral Inattention Test still displayed reaction time impairments (35%). MRI and CT scans identified distinct white matter and cortical regions of damage for individuals with directional (insula, inferior frontal occipital fasciculus, and inferior longitudinal fasciculus) and general (superior and middle temporal gyri) visuospatial impairment.
This study highlights the prevalence and diversity of visuospatial impairments that can occur following stroke.
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Affiliation(s)
- Kayne Park
- Centre for Neuroscience Studies, Queen’s University , Kingston, ON , Canada
| | - Matthew J Chilvers
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary , Calgary, AB , Canada
| | - Trevor A Low
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary , Calgary, AB , Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary , Calgary, AB , Canada
| | - 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
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20
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Moulton RH, Rudie K, Dukelow SP, Benson BW, Scott SH. Capacity Limits Lead to Information Bottlenecks in Ongoing Rapid Motor Behaviors. eNeuro 2023; 10:ENEURO.0289-22.2023. [PMID: 36858823 PMCID: PMC10012325 DOI: 10.1523/eneuro.0289-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/16/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023] Open
Abstract
Studies of ongoing, rapid motor behaviors have often focused on the decision-making implicit in the task. Here, we instead study how decision-making integrates with the perceptual and motor systems and propose a framework of limited-capacity, pipelined processing with flexible resources to understand rapid motor behaviors. Results from three experiments show that human performance is consistent with our framework: participants perform objectively worse as task difficulty increases, and, surprisingly, this drop in performance is largest for the most skilled performers. As well, our analysis shows that the worst-performing participants can perform equally well under increased task demands, which is consistent with flexible neural resources being allocated to reduce bottleneck effects and improve overall performance. We conclude that capacity limits lead to information bottlenecks and that processes like attention help reduce the effects that these bottlenecks have on maximal performance.
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Affiliation(s)
- Richard Hugh Moulton
- Department of Electrical and Computer Engineering, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada
| | - Karen Rudie
- Department of Electrical and Computer Engineering, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada
- School of Computing, Queen's University, Kingston, Ontario, ON K7L 2N8, Canada
- Ingenuity Labs Research Institute, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, AB T2N 1N4, Canada
| | - Brian W Benson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, AB T2N 1N4, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, AB T2N 1N4, Canada
- Benson Concussion Institute, Calgary, Alberta, AB T3B 6B7, Canada
- Canadian Sport Institute Calgary, Calgary, Alberta, AB T3B 5R5, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, ON K7L 3N6, Canada
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21
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Hossain D, Scott SH, Cluff T, Dukelow SP. The use of machine learning and deep learning techniques to assess proprioceptive impairments of the upper limb after stroke. J Neuroeng Rehabil 2023; 20:15. [PMID: 36707846 PMCID: PMC9881388 DOI: 10.1186/s12984-023-01140-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/18/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Robots can generate rich kinematic datasets that have the potential to provide far more insight into impairments than standard clinical ordinal scales. Determining how to define the presence or absence of impairment in individuals using kinematic data, however, can be challenging. Machine learning techniques offer a potential solution to this problem. In the present manuscript we examine proprioception in stroke survivors using a robotic arm position matching task. Proprioception is impaired in 50-60% of stroke survivors and has been associated with poorer motor recovery and longer lengths of hospital stay. We present a simple cut-off score technique for individual kinematic parameters and an overall task score to determine impairment. We then compare the ability of different machine learning (ML) techniques and the above-mentioned task score to correctly classify individuals with or without stroke based on kinematic data. METHODS Participants performed an Arm Position Matching (APM) task in an exoskeleton robot. The task produced 12 kinematic parameters that quantify multiple attributes of position sense. We first quantified impairment in individual parameters and an overall task score by determining if participants with stroke fell outside of the 95% cut-off score of control (normative) values. Then, we applied five machine learning algorithms (i.e., Logistic Regression, Decision Tree, Random Forest, Random Forest with Hyperparameters Tuning, and Support Vector Machine), and a deep learning algorithm (i.e., Deep Neural Network) to classify individual participants as to whether or not they had a stroke based only on kinematic parameters using a tenfold cross-validation approach. RESULTS We recruited 429 participants with neuroimaging-confirmed stroke (< 35 days post-stroke) and 465 healthy controls. Depending on the APM parameter, we observed that 10.9-48.4% of stroke participants were impaired, while 44% were impaired based on their overall task score. The mean performance metrics of machine learning and deep learning models were: accuracy 82.4%, precision 85.6%, recall 76.5%, and F1 score 80.6%. All machine learning and deep learning models displayed similar classification accuracy; however, the Random Forest model had the highest numerical accuracy (83%). Our models showed higher sensitivity and specificity (AUC = 0.89) in classifying individual participants than the overall task score (AUC = 0.85) based on their performance in the APM task. We also found that variability was the most important feature in classifying performance in the APM task. CONCLUSION Our ML models displayed similar classification performance. ML models were able to integrate more kinematic information and relationships between variables into decision making and displayed better classification performance than the overall task score. ML may help to provide insight into individual kinematic features that have previously been overlooked with respect to clinical importance.
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Affiliation(s)
- Delowar Hossain
- grid.22072.350000 0004 1936 7697Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- grid.410356.50000 0004 1936 8331Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Tyler Cluff
- grid.22072.350000 0004 1936 7697Faculty of Kinesiology, University of Calgary, Calgary, AB Canada
| | - Sean P. Dukelow
- grid.22072.350000 0004 1936 7697Department of Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
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22
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Low TA, Lindland K, Kirton A, Carlson HL, Harris AD, Goodyear BG, Monchi O, Hill MD, Dukelow SP. Repetitive transcranial magnetic stimulation (rTMS) combined with multi-modality aphasia therapy for chronic post-stroke non-fluent aphasia: A pilot randomized sham-controlled trial. Brain Lang 2023; 236:105216. [PMID: 36525719 DOI: 10.1016/j.bandl.2022.105216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 10/22/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) shows promise in improving speech production in post-stroke aphasia. Limited evidence suggests pairing rTMS with speech therapy may result in greater improvements. Twenty stroke survivors (>6 months post-stroke) were randomized to receive either sham rTMS plus multi-modality aphasia therapy (M-MAT) or rTMS plus M-MAT. For the first time, we demonstrate that rTMS combined with M-MAT is feasible, with zero adverse events and minimal attrition. Both groups improved significantly over time on all speech and language outcomes. However, improvements did not differ between rTMS or sham. We found that rTMS and sham groups differed in lesion location, which may explain speech and language outcomes as well as unique patterns of BOLD signal change within each group. We offer practical considerations for future studies and conclude that while combination therapy of rTMS plus M-MAT in chronic post-stroke aphasia is safe and feasible, personalized intervention may be necessary.
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Affiliation(s)
- Trevor A Low
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Lindland
- Department of Allied Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Helen L Carlson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ashley D Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bradley G Goodyear
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Oury Monchi
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada; Division of Physical Medicine and Rehabilitation, University of Calgary, Calgary, Alberta, Canada.
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23
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Peters S, Lim SB, Bayley MT, Best K, Connell LA, Corriveau H, Donkers SJ, Dukelow SP, Klassen TD, Milot MH, Sakakibara BM, Sheehy L, Wong H, Yao J, Eng JJ. Implementation of increased physical therapy intensity for improving walking after stroke: Walk 'n watch protocol for a multisite stepped-wedge cluster-randomized controlled trial. Int J Stroke 2023; 18:117-122. [PMID: 36129364 PMCID: PMC9806455 DOI: 10.1177/17474930221129982] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
RATIONALE Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n = 75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality-of-life measures over usual care. Research therapists progressed the intensity of exercise by using heart rate and step counters worn by the participants with stroke during therapy. To have the greatest impact, our next step is to undertake an implementation trial to change practice across stroke units where we enable the entire unit to use the protocol as part of standard of care. AIMS What is the effect of introducing structured, progressive exercise (termed the Walk 'n Watch protocol) to the standard of care on the primary outcome of walking in adult participants with stroke over the hospital inpatient rehabilitation period? Secondary outcomes will be evaluated and include quality of life. METHODS AND SAMPLE SIZE ESTIMATES This national, multisite clinical trial will randomize 12 sites using a stepped-wedge design where each site will be randomized to deliver Usual Care initially for 4, 8, 12, or 16 months (three sites for each duration). Then, each site will switch to the Walk 'n Watch phase for the remaining duration of a total 20-month enrolment period. Each participant will be exposed to either Usual Care or Walk 'n Watch. The trial will enroll a total of 195 participants with stroke to achieve a power of 80% with a Type I error rate of 5%, allowing for 20% dropout. Participants will be medically stable adults post-stroke and able to take five steps with a maximum physical assistance from one therapist. The Walk 'n Watch protocol focuses on completing a minimum of 30 min of weight-bearing, walking-related activities (at the physical therapists' discretion) that progressively increase in intensity informed by activity trackers measuring heart rate and step number. STUDY OUTCOME(S) The primary outcome will be the change in walking endurance, measured by the 6-Minute Walk Test, from baseline (T1) to 4 weeks (T2). This change will be compared across Usual Care and Walk 'n Watch phases using a linear mixed-effects model. Additional physical, cognitive, and quality of life outcomes will be measured at T1, T2, and 12 months post-stroke (T3) by a blinded assessor. DISCUSSION The implementation of stepped-wedge cluster-randomized trial enables the protocol to be tested under real-world conditions, involving all clinicians on the unit. It will result in all sites and all clinicians on the unit to gain expertise in protocol delivery. Hence, a deliberate outcome of the trial is facilitating changes in best practice to improve outcomes for participants with stroke in the trial and for the many participants with stroke admitted after the trial ends.
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Affiliation(s)
- Sue Peters
- School of Physical Therapy, University
of Western Ontario, London, ON, Canada,Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada
| | - Shannon B Lim
- Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada
| | - Mark T Bayley
- Division of Physical Medicine and
Rehabilitation, University of Toronto and KITE Research Institute University Health
Network, Toronto, ON, Canada
| | - Krista Best
- Intégré Universitaire de Santé et de
Services Sociaux de La Capitale-Nationale and Department of Rehabilitation,
Université Laval, Quebec, QC, Canada
| | - Louise A Connell
- Allied Health Research Unit, University
of Central Lancashire, Preston, UK,Rakehead Rehabilitation Centre, Burnley
General Teaching Hospital, East Lancashire Hospitals NHS Trust, Burnley, UK
| | - Hélène Corriveau
- School of Rehabilitation, Faculté de
médecine et des sciences de la santé and Research Center on Aging, Université de
Sherbrooke, Sherbrooke, QC, Canada
| | - Sarah J Donkers
- School of Rehabilitation Science,
College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences,
University of Calgary, Calgary, AB, Canada
| | - Tara D Klassen
- Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada
| | - Marie-Hélène Milot
- School of Rehabilitation, Faculté de
médecine et des sciences de la santé and Research Center on Aging, Université de
Sherbrooke, Sherbrooke, QC, Canada
| | - Brodie M Sakakibara
- Department of Occupational Science
and Occupational Therapy, University of British Columbia, Vancouver, BC,
Canada,Centre for Chronic Disease Prevention
and Management, University of British Columbia, Kelowna, BC, Canada
| | - Lisa Sheehy
- Bruyère Research Institute, Ottawa,
ON, Canada
| | - Hubert Wong
- School of Population and Public
Health, University of British Columbia and Centre for Health Evaluation &
Outcomes Sciences, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Jennifer Yao
- Division of Physical Medicine and
Rehabilitation, University of British Columbia and G.F. Strong Rehabilitation
Centre, Vancouver, BC, Canada
| | - Janice J Eng
- Rehabilitation Research Program, G.F.
Strong Rehabilitation Centre and Department of Physical Therapy, University of
British Columbia, Vancouver, BC, Canada,Janice J Eng, Rehabilitation Research
Program, G.F. Strong Rehabilitation Centre and Department of Physical Therapy,
University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC V6T 1Z3,
Canada.
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24
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Yan C, McClure N, Dukelow SP, Mann B, Round J. Optimal Planning of Health Services through Genetic Algorithm and Discrete Event Simulation: A Proposed Model and Its Application to Stroke Rehabilitation Care. MDM Policy Pract 2022; 7:23814683221134098. [PMID: 36310567 PMCID: PMC9597031 DOI: 10.1177/23814683221134098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Background. Increasing demand for provision of care to stroke survivors creates challenges for health care planners. A key concern is the optimal alignment of health care resources between provision of acute care, rehabilitation, and among different segments of rehabilitation, including inpatient rehabilitation, early supported discharge (ESD), and outpatient rehabilitation (OPR). We propose a novel application of discrete event simulation (DES) combined with a genetic algorithm (GA) to identify the optimal configuration of rehabilitation that maximizes patient benefits subject to finite health care resources. Design. Our stroke rehabilitation optimal model (sROM) combines DES and GA to identify an optimal solution that minimizes wait time for each segment of rehabilitation by changing care capacity across different segments. sROM is initiated by generating parameters for DES. GA is used to evaluate wait time from DES. If wait time meets specified stopping criteria, the search process stops at a point at which optimal capacity is reached. If not, capacity estimates are updated, and an additional iteration of the DES is run. To parameterize the model, we standardized real-world data from medical records by fitting them into probability distributions. A meta-analysis was conducted to determine the likelihood of stroke survivors flowing across rehabilitation segments. Results. We predict that rehabilitation planners in Alberta, Canada, have the potential to improve services by increasing capacity from 75 to 113 patients per day for ESD and from 101 to 143 patients per day for OPR. Compared with the status quo, optimal capacity would provide ESD to 138 (s = 29.5) more survivors and OPR to 262 (s = 45.5) more annually while having an estimated net annual cost savings of $25.45 (s = 15.02) million. Conclusions. The combination of DES and GA can be used to estimate optimal service capacity. HIGHLIGHTS We created a hybrid model combining a genetic algorithm and discrete event simulation to search for the optimal configuration of health care service capacity that maximizes patient outcomes subject to finite health system resources.We applied a probability distribution fitting process to standardize real-world data to probability distributions. The process consists of choosing the distribution type and estimating the parameters of that distribution that best reflects the data. Standardizing real-word data to a best-fitted distribution can increase model generalizability.In an illustrative study of stroke rehabilitation care, resource allocation to stroke rehabilitation services under an optimal configuration allows provision of care to more stroke survivors who need services while reducing wait time.Resources needed to expand rehabilitation services could be reallocated from the savings due to reduced wait time in acute care units. In general, the predicted optimal configuration of stroke rehabilitation services is associated with a net cost savings to the health care system.
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Affiliation(s)
- Charles Yan
- Charles Yan, Institute of Health Economics,
1200-10405 Jasper Ave, Edmonton, AB T5J 3N4, Canada;
()
| | - Nathan McClure
- Institute of Health Economics; School of
Publish Health, University of Alberta, Edmonton, AB, Canada
| | - Sean P. Dukelow
- Division of Physical Medicine and
Rehabilitation, Department of Clinical Neuroscience, University of Calgary
and Stroke Rehabilitation, Calgary, AB, Canada
| | - Balraj Mann
- Cardiovascular Health and Stroke Strategic
Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Jeff Round
- Institute of Health Economics, Edmonton, AB,
Canada,Department of Pediatrics, Faculty of Medicine
and Dentistry, University of Alberta, Edmonton, AB, Canada
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25
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Pinky NN, Debert CT, Dukelow SP, Benson BW, Harris AD, Yeates KO, Emery CA, Goodyear BG. Multimodal magnetic resonance imaging of youth sport-related concussion reveals acute changes in the cerebellum, basal ganglia, and corpus callosum that resolve with recovery. Front Hum Neurosci 2022; 16:976013. [PMID: 36337852 PMCID: PMC9626521 DOI: 10.3389/fnhum.2022.976013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022] Open
Abstract
Magnetic resonance imaging (MRI) can provide a number of measurements relevant to sport-related concussion (SRC) symptoms; however, most studies to date have used a single MRI modality and whole-brain exploratory analyses in attempts to localize concussion injury. This has resulted in highly variable findings across studies due to wide ranging symptomology, severity and nature of injury within studies. A multimodal MRI, symptom-guided region-of-interest (ROI) approach is likely to yield more consistent results. The functions of the cerebellum and basal ganglia transcend many common concussion symptoms, and thus these regions, plus the white matter tracts that connect or project from them, constitute plausible ROIs for MRI analysis. We performed diffusion tensor imaging (DTI), resting-state functional MRI, quantitative susceptibility mapping (QSM), and cerebral blood flow (CBF) imaging using arterial spin labeling (ASL), in youth aged 12-18 years following SRC, with a focus on the cerebellum, basal ganglia and white matter tracts. Compared to controls similar in age, sex and sport (N = 20), recent SRC youth (N = 29; MRI at 8 ± 3 days post injury) exhibited increased susceptibility in the cerebellum (p = 0.032), decreased functional connectivity between the caudate and each of the pallidum (p = 0.035) and thalamus (p = 0.021), and decreased diffusivity in the mid-posterior corpus callosum (p < 0.038); no changes were observed in recovered asymptomatic youth (N = 16; 41 ± 16 days post injury). For recent symptomatic-only SRC youth (N = 24), symptom severity was associated with increased susceptibility in the superior cerebellar peduncles (p = 0.011) and reduced activity in the cerebellum (p = 0.013). Fewer days between injury and MRI were associated with reduced cerebellar-parietal functional connectivity (p < 0.014), reduced activity of the pallidum (p = 0.002), increased CBF in the caudate (p = 0.005), and reduced diffusivity in the central corpus callosum (p < 0.05). Youth SRC is associated with acute cerebellar inflammation accompanied by reduced cerebellar activity and cerebellar-parietal connectivity, as well as structural changes of the middle regions of the corpus callosum accompanied by functional changes of the caudate, all of which resolve with recovery. Early MRI post-injury is important to establish objective MRI-based indicators for concussion diagnosis, recovery assessment and prediction of outcome.
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Affiliation(s)
- Najratun Nayem Pinky
- Department of Biomedical Engineering, University of Calgary, Calgary, AB, Canada
| | - Chantel T. Debert
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian W. Benson
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Canadian Sport Institute Calgary, University of Calgary, Calgary, AB, Canada
- Benson Concussion Institute, University of Calgary, Calgary, AB, Canada
| | - Ashley D. Harris
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Keith O. Yeates
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Carolyn A. Emery
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Sports Injury Prevention Research Centre, University of Calgary, Calgary, AB, Canada
| | - Bradley G. Goodyear
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Seaman Family MR Research Centre, University of Calgary, Calgary, AB, Canada
- *Correspondence: Bradley G. Goodyear,
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26
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Raess L, Hawe RL, Metzler M, Zewdie E, Condliffe E, Dukelow SP, Kirton A. Robotic Rehabilitation and Transcranial Direct Current Stimulation in Children With Bilateral Cerebral Palsy. Front Rehabil Sci 2022; 3:843767. [PMID: 36188922 PMCID: PMC9397997 DOI: 10.3389/fresc.2022.843767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 01/28/2022] [Indexed: 11/26/2022]
Abstract
Aim To identify challenges of combining robotic upper extremity rehabilitation with tDCS in children with upper extremity bilateral cerebral palsy (CP) by assessing feasibility, tolerability and safety. Methods This was an unblinded, open-label, pilot clinical trial. Participants completed 10 × 1 h sessions of robotic rehabilitation combined with motor cortex anodal tDCS. Feasibility, acceptability and practicality, were assessed including the number of participants completing the protocol, factors limiting participation, time required for sessions, and completion of functional assessments and tolerability scales. To assess safety, standardized clinical and robotic measures of sensorimotor function were performed. The trial was registered at clinicaltrials.gov (NCT04233710). Results Eight children were recruited (mean age 8y ± 1.8y, range 6–11 years) and 5 completed the intervention. There were no serious adverse events. One child developed focal seizures 6 weeks after the trial that were deemed to be unrelated. Barriers to completion included time and scheduling demands and patient factors, specifically cognitive/behavioral impairments and dyskinesia. No decline in clinical function was appreciated. Conclusions Robotic upper extremity rehabilitation combined with tDCS may be feasible in children with bilateral CP. Careful participant selection, family engagement, and protocol adaptations are recommended to better understand the feasibility and tolerability of future trials.
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Affiliation(s)
- Liliane Raess
- University Children's Hospital Zurich, Zurich, Switzerland.,Clinical Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada
| | - Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Megan Metzler
- Clinical Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Condliffe
- Clinical Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Clinical Neurosciences, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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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: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Moulton RH, Rudie K, Dukelow SP, Scott SH. Quantitatively assessing aging effects in rapid motor behaviours: a cross-sectional study. J Neuroeng Rehabil 2022; 19:82. [PMID: 35883179 PMCID: PMC9327262 DOI: 10.1186/s12984-022-01035-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An individual's rapid motor skills allow them to perform many daily activities and are a hallmark of physical health. Although age and sex are both known to affect motor performance, standardized methods for assessing their impact on upper limb function are limited. METHODS Here we perform a cross-sectional study of 643 healthy human participants in two interactive motor tasks developed to quantify sensorimotor abilities, Object-Hit (OH) and Object-Hit-and-Avoid (OHA). The tasks required participants to hit virtual objects with and without the presence of distractor objects. Velocities and positions of hands and objects were recorded by a robotic exoskeleton, allowing a variety of parameters to be calculated for each trial. We verified that these tasks are viable for measuring performance in healthy humans and we examined whether any of our recorded parameters were related to age or sex. RESULTS Our analysis shows that both OH and OHA can assess rapid motor behaviours in healthy human participants. It also shows that while some parameters in these tasks decline with age, those most associated with the motor system do not. Three parameters show significant sex-related effects in OH, but these effects disappear in OHA. CONCLUSIONS This study suggests that the underlying effect of aging on rapid motor behaviours is not on the capabilities of the motor system, but on the brain's capacity for processing inputs into motor actions. Additionally, this study provides a baseline description of healthy human performance in OH and OHA when using these tasks to investigate age-related declines in sensorimotor ability.
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Affiliation(s)
- Richard Hugh Moulton
- Department of Electrical and Computer Engineering, Queen's University, Kingston, ON, Canada.
| | - Karen Rudie
- Department of Electrical and Computer Engineering, Queen's University, Kingston, ON, Canada
- School of Computing, Queen's University, Kingston, ON, Canada
- Ingenuity Labs Research Institute, Queen's University, Kingston, ON, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Department of Medicine, Queen's University, Kingston, ON, Canada
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Hayward KS, Ferris JK, Lohse KR, Borich MR, Borstad A, Cassidy JM, Cramer SC, Dukelow SP, Findlater SE, Hawe RL, Liew SL, Neva JL, Stewart JC, Boyd LA. Observational Study of Neuroimaging Biomarkers of Severe Upper Limb Impairment After Stroke. Neurology 2022; 99:e402-e413. [PMID: 35550551 PMCID: PMC9421772 DOI: 10.1212/wnl.0000000000200517] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES It is difficult to predict poststroke outcome for individuals with severe motor impairment because both clinical tests and corticospinal tract (CST) microstructure may not reliably indicate severe motor impairment. Here, we test whether imaging biomarkers beyond the CST relate to severe upper limb (UL) impairment poststroke by evaluating white matter microstructure in the corpus callosum (CC). In an international, multisite hypothesis-generating observational study, we determined if (1) CST asymmetry index (CST-AI) can differentiate between individuals with mild-moderate and severe UL impairment and (2) CC biomarkers relate to UL impairment within individuals with severe impairment poststroke. We hypothesized that CST-AI would differentiate between mild-moderate and severe impairment, but CC microstructure would relate to motor outcome for individuals with severe UL impairment. METHODS Seven cohorts with individual diffusion imaging and motor impairment (Fugl-Meyer Upper Limb) data were pooled. Hand-drawn regions-of-interest were used to seed probabilistic tractography for CST (ipsilesional/contralesional) and CC (prefrontal/premotor/motor/sensory/posterior) tracts. Our main imaging measure was mean fractional anisotropy. Linear mixed-effects regression explored relationships between candidate biomarkers and motor impairment, controlling for observations nested within cohorts, as well as age, sex, time poststroke, and lesion volume. RESULTS Data from 110 individuals (30 with mild-moderate and 80 with severe motor impairment) were included. In the full sample, greater CST-AI (i.e., lower fractional anisotropy in the ipsilesional hemisphere, p < 0.001) and larger lesion volume (p = 0.139) were negatively related to impairment. In the severe subgroup, CST-AI was not reliably associated with impairment across models. Instead, lesion volume and CC microstructure explained impairment in the severe group beyond CST-AI (p's < 0.010). DISCUSSION Within a large cohort of individuals with severe UL impairment, CC microstructure related to motor outcome poststroke. Our findings demonstrate that CST microstructure does relate to UL outcome across the full range of motor impairment but was not reliably associated within the severe subgroup. Therefore, CC microstructure may provide a promising biomarker for severe UL outcome poststroke, which may advance our ability to predict recovery in individuals with severe motor impairment after stroke.
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Affiliation(s)
- Kathryn S Hayward
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia.
| | - Jennifer K Ferris
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Keith R Lohse
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Michael R Borich
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Alexandra Borstad
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Jessica M Cassidy
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Steven C Cramer
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Sean P Dukelow
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Sonja E Findlater
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Rachel L Hawe
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Sook-Lei Liew
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Jason L Neva
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Jill C Stewart
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
| | - Lara A Boyd
- From the Departments of Physiotherapy (K.S.H.), Medicine and Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia; Rehabilitation Sciences Graduate Research Program (J.K.F., L.A.B.), University of British Columbia, Vancouver, British Columbia, Canada; Physical Therapy and Neurology (K.R.L.), Washington University School of Medicine in Saint Louis, MO; Division of Physical Therapy (M.R.B.), Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; School of Health Sciences (A.B.), Department of Physical Therapy, College of St. Scholastica, Duluth, MN; Department of Allied Health Sciences (J.M.C.), University of North Carolina at Chapel Hill, NC; Department of Neurology (S.C.C.), University of California Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles, California; Department of Clinical Neurosciences (S.P.D., S.E.F.), Cumming School of Medicine, University of Calgary, Alberta, Canada; School of Kinesiology (R.L.H.), University of Minnesota, Minneapolis; Chan Division of Occupational Science and Occupational Therapy (S.-L.L.), Biokinesiology and Physical Therapy, Biomedical Engineering, and Neurology, USC Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles; Université de Montréal (J.L.N.), École de Kinésiologie et des Sciences de l'activité Physique, Faculté de Médecine, and Centre de recherche de l'institut universitaire de gériatrie de Montréal, Quebec, Canada; and Physical Therapy Program (J.C.S.), Department of Exercise Science, University of South Carolina, Columbia
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Little CE, Dukelow SP, Schneider KJ, Emery CA. Using a Prism Paradigm to Identify Sensorimotor Impairment in Youth Following Concussion. J Head Trauma Rehabil 2022; 37:189-198. [PMID: 34145153 DOI: 10.1097/htr.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The study assesses the intrarater reliability and utility of a prism paradigm to identify sensorimotor impairment following sports-related concussion in youth, (recent and history of concussion) compared with youth with no concussion. SETTING University of Calgary. PARTICIPANTS Three groups of 40 ice hockey players ranging in age from 11 to 17 years were included: (1) no concussion; (2) recent concussion, mean number of days since last concussion 5 (95% CI, 4-6); and (3) history of concussion, mean number of days since last concussion 631 (95% CI, 505-730). DESIGN Cross-sectional study. MAIN MEASURES The vestibulo-ocular reflex is a fundamental reflex of the central nervous system that stabilizes the position of the eyes during head movement and adapts when sensory input is altered (the bend of the light on the retina by prism glasses). The prism adaptation measure was the number of throws taken to adapt to wearing prism glasses while throwing balls at a central target. RESULTS The intraclass correlation coefficient (0.73; 95% CI, 0.55-0.84) and the Bland-Altman 95% levels of agreement (lower limit -18.5; 95% CI, -22.4 to -14.6); and upper limit 16.6; 95% CI, 12.7-20.5) reflected good intrarater reliability. Prism adaptation measures were significantly different across groups ( F2,119 = 51.9, P < .001, r = 0.52, power of 90%), with the mean number of throws for youth (aged 11-17 years) in each group as follows: 10 (95% CI, 8-12) no concussion history; 25 (95% CI, 23-27) recent concussion (1-11 days); and 17 (95% CI, 15-20) history of concussion (90-1560 days). CONCLUSION Use of a prism paradigm as a clinical measurement tool has the potential to alter concussion management in youth. The prism paradigm is objective, is readily translatable to the clinical arena, has minimal associated costs, and is easily administered, reliable, and portable.
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Affiliation(s)
- C Elaine Little
- Faculty of Kinesiology (Drs Little, Schneider, and Emery), Department of Clinical Neurosciences (Dr Dukelow), and Cumming School of Medicine (Drs Dukelow and Emery), University of Calgary, Calgary, Alberta, Canada
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Moore RT, Piitz MA, Singh N, Dukelow SP, Cluff T. Assessing Impairments in Visuomotor Adaptation After Stroke. Neurorehabil Neural Repair 2022; 36:415-425. [PMID: 35616370 PMCID: PMC9198391 DOI: 10.1177/15459683221095166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Motor impairment in the arms is common after stroke and many individuals participate in therapy to improve function. It is assumed that individuals with stroke can adapt and improve their movements using feedback that arises from movement or is provided by a therapist. Here we investigated visuomotor adaptation in individuals with sub-acute and chronic stroke. Objective: We examined the impact of the stroke-affected arm (dominant or non-dominant), time post-stroke, and relationships with clinical measures of motor impairment and functional independence. Methods: Participants performed reaching movements with their arm supported in a robotic exoskeleton. We rotated the relationship between the motion of the participant’s hand and a feedback cursor displayed in their workspace. Outcome measures included the amount that participants adapted their arm movements and the number of trials they required to adapt. Results: Participants with stroke (n = 36) adapted less and required more trials to adapt than controls (n = 29). Stroke affecting the dominant arm impaired the amount of adaptation more than stroke affecting the non-dominant arm. Overall, 53% of participants with stroke were impaired in one or more measures of visuomotor adaptation. Initial adaptation was weakly correlated with time post-stroke, and the amount of adaptation correlated moderately with clinical measures of motor impairment and functional independence. Conclusion: Our findings reveal impairments in visuomotor adaptation that are associated with motor impairment and function after stroke. Longitudinal studies are needed to understand the relationship between adaptation and recovery attained in a therapy setting.
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Affiliation(s)
- Robert T Moore
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Mark A Piitz
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Nishita Singh
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Tyler Cluff
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Faculty of Kinesiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Lowrey CR, Dukelow SP, Bagg SD, Ritsma B, Scott SH. Impairments in Cognitive Control Using a Reverse Visually Guided Reaching Task Following Stroke. Neurorehabil Neural Repair 2022; 36:449-460. [PMID: 35576434 PMCID: PMC9198399 DOI: 10.1177/15459683221100510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive and motor function must work together quickly and seamlessly to allow us to interact with a complex world, but their integration is difficult to assess directly. Interactive technology provides opportunities to assess motor actions requiring cognitive control. OBJECTIVE To adapt a reverse reaching task to an interactive robotic platform to quantify impairments in cognitive-motor integration following stroke. METHODS Participants with subacute stroke (N=59) performed two tasks using the Kinarm: Reverse Visually Guided Reaching (RVGR) and Visually Guided Reaching (VGR). Tasks required subjects move a cursor "quickly and accurately" to virtual targets. In RVGR, cursor motion was reversed compared to finger motion (i.e., hand moves left, cursor moves right). Task parameters and Task Scores were calculated based on models developed from healthy controls, and accounted for the influence of age, sex, and handedness. RESULTS Many stroke participants (86%) were impaired in RVGR with their affected arm (Task Score > 95% of controls). The most common impairment was increased movement time. Seventy-three percent were also impaired with their less affected arm. The most common impairment was larger initial direction angles of reach. Impairments in RVGR improved over time, but 71% of participants tested longitudinally were still impaired with the affected arm ∼6 months post-stroke. Importantly, although 57% were impaired with the less affected arm at 6 months, these individuals were not impaired in VGR. CONCLUSIONS Individuals with stroke were impaired in a reverse reaching task but many did not show similar impairments in a standard reaching task, highlighting selective impairment in cognitive-motor integration.
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Affiliation(s)
- Catherine R Lowrey
- Centre for Neuroscience Studies, 4257Queen's University, Kingston, ON, Canada
| | - Sean P Dukelow
- Hotchkiss Brain Institute, 2129University of Calgary, Calgary, AB, Canada
| | - Stephen D Bagg
- Department of Physical Medicine and Rehabilitation, 4257Queen's University, Kingston, ON, Canada.,School of Medicine, 4257Queen's University, Kingston, ON, Canada
| | - Benjamin Ritsma
- Department of Physical Medicine and Rehabilitation, 4257Queen's University, Kingston, ON, Canada.,School of Medicine, 4257Queen's University, Kingston, ON, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, 4257Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, 4257Queen's University, Kingston, ON, Canada.,Department of Medicine, 4257Queen's University, Kingston, ON, Canada
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Bonkhoff AK, Hope T, Bzdok D, Guggisberg AG, Hawe RL, Dukelow SP, Chollet F, Lin DJ, Grefkes C, Bowman H. Recovery after stroke: the severely impaired are a distinct group. J Neurol Neurosurg Psychiatry 2022; 93:369-378. [PMID: 34937750 DOI: 10.1136/jnnp-2021-327211] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Stroke causes different levels of impairment and the degree of recovery varies greatly between patients. The majority of recovery studies are biased towards patients with mild-to-moderate impairments, challenging a unified recovery process framework. Our aim was to develop a statistical framework to analyse recovery patterns in patients with severe and non-severe initial impairment and concurrently investigate whether they recovered differently. METHODS We designed a Bayesian hierarchical model to estimate 3-6 months upper limb Fugl-Meyer (FM) scores after stroke. When focusing on the explanation of recovery patterns, we addressed confounds affecting previous recovery studies and considered patients with FM-initial scores <45 only. We systematically explored different FM-breakpoints between severe/non-severe patients (FM-initial=5-30). In model comparisons, we evaluated whether impairment-level-specific recovery patterns indeed existed. Finally, we estimated the out-of-sample prediction performance for patients across the entire initial impairment range. RESULTS Recovery data was assembled from eight patient cohorts (n=489). Data were best modelled by incorporating two subgroups (breakpoint: FM-initial=10). Both subgroups recovered a comparable constant amount, but with different proportional components: severely affected patients recovered more the smaller their impairment, while non-severely affected patients recovered more the larger their initial impairment. Prediction of 3-6 months outcomes could be done with an R2=63.5% (95% CI=51.4% to 75.5%). CONCLUSIONS Our work highlights the benefit of simultaneously modelling recovery of severely-to-non-severely impaired patients and demonstrates both shared and distinct recovery patterns. Our findings provide evidence that the severe/non-severe subdivision in recovery modelling is not an artefact of previous confounds. The presented out-of-sample prediction performance may serve as benchmark to evaluate promising biomarkers of stroke recovery.
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Affiliation(s)
- Anna K Bonkhoff
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tom Hope
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada.,Mila - Quebec Artificial Intelligence Institute, Montreal, Québec, Canada.,Canadian Institute for Advanced Research (CIFAR), Montreal, Québec, Canada
| | - Adrian G Guggisberg
- Department of Clinical Neurosciences, Hopitaux Universitaires de Geneve Hopital de Beau-Sejour, Geneva, Switzerland
| | - Rachel L Hawe
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - François Chollet
- Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - David J Lin
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christian Grefkes
- Department of Neurology, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Howard Bowman
- School of Psychology, University of Birmingham, Birmingham, UK.,School of Computing, University of Kent, Canterbury, UK
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Simpson LA, Barclay R, Bayley MT, Dukelow SP, MacIntosh BJ, MacKay-Lyons M, Menon C, Mortenson WB, Peng TH, Pollock CL, Pooyania S, Teasell R, Yang CL, Yao J, Eng JJ. Correction: Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device. Trials 2022; 23:207. [PMID: 35277187 PMCID: PMC8915457 DOI: 10.1186/s13063-022-06134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto and KITE Research Institute University Health Network, Toronto, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | - Carlo Menon
- Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - W Ben Mortenson
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Tzu-Hsuan Peng
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Courtney L Pollock
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Robert Teasell
- Schulich School of Medicine & Dentistry, Western University and Parkwood Institute Research, Lawson Health Research Institute, London, Canada
| | - Chieh-Ling Yang
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jennifer Yao
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada. .,International Collaboration on Repair Discoveries, Vancouver, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, Canada. .,University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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35
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Simpson LA, Barclay R, Bayley MT, Dukelow SP, MacIntosh BJ, McKay-Lyons M, Menon C, Mortenson WB, Peng TH, Pollock CL, Pooyania S, Teasell R, Yang CL, Yao J, Eng JJ. Virtual Arm Boot Camp (V-ABC): study protocol for a mixed-methods study to increase upper limb recovery after stroke with an intensive program coupled with a grasp count device. Trials 2022; 23:129. [PMID: 35135585 PMCID: PMC8822776 DOI: 10.1186/s13063-022-06047-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background Encouraging upper limb use and increasing intensity of practice in rehabilitation are two important goals for optimizing upper limb recovery post stroke. Feedback from novel wearable sensors may influence practice behaviour to promote achieving these goals. A wearable sensor can potentially be used in conjunction with a virtually monitored home program for greater patient convenience, or due to restrictions that preclude in-person visits, such as COVID-19. This trial aims to (1) determine the efficacy of a virtual behaviour change program that relies on feedback from a custom wearable sensor to increase use and function of the upper limb post stroke; and (2) explore the experiences and perceptions of using a program coupled with wearable sensors to increase arm use from the perspective of people with stroke. Methods This mixed-methods study will utilize a prospective controlled trial with random allocation to immediate or 3-week delayed entry to determine the efficacy of a 3-week behaviour change program with a nested qualitative description study. The intervention, the Virtual Arm Boot Camp (V-ABC) features feedback from a wearable device, which is intended to increase upper limb use post stroke, as well as 6 virtual sessions with a therapist. Sixty-four adults within 1-year post stroke onset will be recruited from seven rehabilitation centres. All outcomes will be collected virtually. The primary outcome measure is upper limb use measured by grasp counts over 3 days from the wearable sensor (TENZR) after the 3-week intervention. Secondary outcomes include upper limb function (Arm Capacity and Movement Test) and self-reported function (Hand Function and Strength subscale from the Stroke Impact Scale). Outcome data will be collected at baseline, post-intervention and at 2 months retention. The qualitative component will explore the experiences and acceptability of using a home program with a wearable sensor for increasing arm use from the point of view of individuals with stroke. Semi-structured interviews will be conducted with participants after they have experienced the intervention. Qualitative data will be analysed using content analysis. Discussion This study will provide novel information regarding the efficacy and acceptability of virtually delivered programs to improve upper extremity recovery, and the use of wearable sensors to assist with behaviour change. Trial registration ClinicalTrials.govNCT04232163. January 18, 2020.
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Affiliation(s)
- Lisa A Simpson
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto and KITE Research Institute University Health Network, Toronto, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | | | - Carlo Menon
- Department of Health Sciences and Technology, ETH, Zurich, Switzerland
| | - W Ben Mortenson
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada.,International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Tzu-Hsuan Peng
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada
| | - Courtney L Pollock
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada
| | - Robert Teasell
- Schulich School of Medicine & Dentistry, Western University and Parkwood Institute Research, Lawson Health Research Institute, London, Canada
| | - Chieh-Ling Yang
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jennifer Yao
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada.,Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, Canada. .,International Collaboration on Repair Discoveries, Vancouver, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, Canada. .,University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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36
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Rajashekar D, Wilms M, MacDonald ME, Schimert S, Hill MD, Demchuk A, Goyal M, Dukelow SP, Forkert ND. Lesion-symptom mapping with NIHSS sub-scores in ischemic stroke patients. Stroke Vasc Neurol 2021; 7:124-131. [PMID: 34824139 PMCID: PMC9067270 DOI: 10.1136/svn-2021-001091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Lesion-symptom mapping (LSM) is a statistical technique to investigate the population-specific relationship between structural integrity and post-stroke clinical outcome. In clinical practice, patients are commonly evaluated using the National Institutes of Health Stroke Scale (NIHSS), an 11-domain clinical score to quantitate neurological deficits due to stroke. So far, LSM studies have mostly used the total NIHSS score for analysis, which might not uncover subtle structure–function relationships associated with the specific sub-domains of the NIHSS evaluation. Thus, the aim of this work was to investigate the feasibility to perform LSM analyses with sub-score information to reveal category-specific structure–function relationships that a total score may not reveal. Methods Employing a multivariate technique, LSM analyses were conducted using a sample of 180 patients with NIHSS assessment at 48-hour post-stroke from the ESCAPE trial. The NIHSS domains were grouped into six categories using two schemes. LSM was conducted for each category of the two groupings and the total NIHSS score. Results Sub-score LSMs not only identify most of the brain regions that are identified as critical by the total NIHSS score but also reveal additional brain regions critical to each function category of the NIHSS assessment without requiring extensive, specialised assessments. Conclusion These findings show that widely available sub-scores of clinical outcome assessments can be used to investigate more specific structure–function relationships, which may improve predictive modelling of stroke outcomes in the context of modern clinical stroke assessments and neuroimaging. Trial registration number NCT01778335.
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Affiliation(s)
- Deepthi Rajashekar
- Biomedical Engineering Graduate Program, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada .,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Matthias Wilms
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - M Ethan MacDonald
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Electrical and Computer Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Serena Schimert
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Hill
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Demchuk
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Nils Daniel Forkert
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Chilvers MJ, Hawe RL, Scott SH, Dukelow SP. Investigating the neuroanatomy underlying proprioception using a stroke model. J Neurol Sci 2021; 430:120029. [PMID: 34695704 DOI: 10.1016/j.jns.2021.120029] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
Neuroanatomical investigations have associated cortical areas, beyond Primary Somatosensory Cortex (S1), with impaired proprioception. Cortical regions have included temporoparietal (TP) regions (supramarginal gyrus, superior temporal gyrus, Heschl's gyrus) and insula. Previous approaches have struggled to account for concurrent damage across multiple brain regions. Here, we used a targeted lesion analysis approach to examine the impact of specific combinations of cortical and sub-cortical lesions and quantified the prevalence of proprioceptive impairments when different regions are damaged or spared. Seventy-seven individuals with stroke (49 male; 28 female) were identified meeting prespecified lesion criteria based on MRI/CT imaging: 1) TP lesions without S1, 2) TP lesions with S1, 3) isolated S1 lesions, 4) isolated insula lesions, and 5) lesions not impacting these regions (other regions group). Initially, participants meeting these criteria (1-4) were grouped together into right or left lesion groups and compared to each other, and the other regions group (5), on a robotic Arm Position Matching (APM) task and a Kinesthesia (KIN) task. We then examined the behaviour of individuals that met each specific criteria (groups 1-5). Proprioceptive impairments were more prevalent following right hemisphere lesions than left hemisphere lesions. The extent of damage to TP regions correlated with performance on both robotic tasks. Even without concurrent S1 lesions, TP and insular lesions were associated with impairments on the APM and KIN tasks. Finally, lesions not impacting these regions were much less likely to result in impairments. This study highlights the critical importance of TP and insular regions for accurate proprioception. SIGNIFICANCE STATEMENT: This work advances our understanding of the neuroanatomy of human proprioception. We validate the importance of regions, beyond the dorsal column medial lemniscal pathway and S1, for proprioception. Further, we provide additional evidence of the importance of the right hemisphere for human proprioception. Improved knowledge on the neuroanatomy of proprioception is crucial for advancing therapeutic approaches which target individuals with proprioceptive impairments following neurological injury or with neurological disorders.
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Affiliation(s)
- Matthew J Chilvers
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
| | - Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; School of Kinesiology, University of Minnesota, 1900 University Ave SE, Minneapolis, MN 55455, United States
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queens University, Kingston, ON K7L 3N6, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Wanner ZR, Southam CG, Sanghavi P, Boora NS, Paxman EJ, Dukelow SP, Benson BW, Montina T, Metz GAS, Debert CT. Alterations in Urine Metabolomics Following Sport-Related Concussion: A 1H NMR-Based Analysis. Front Neurol 2021; 12:645829. [PMID: 34489846 PMCID: PMC8416667 DOI: 10.3389/fneur.2021.645829] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/25/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: Millions of sport-related concussions (SRC) occur annually in North America, and current diagnosis of concussion is based largely on clinical evaluations. The objective of this study was to determine whether urinary metabolites are significantly altered post-SRC compared to pre-injury. Setting: Outpatient sports medicine clinic. Participants: Twenty-six male youth sport participants. Methods: Urine was analyzed pre-injury and after SRC by 1H NMR spectroscopy. Data were analyzed using multivariate statistics, pairwise t-test, and metabolic pathway analysis. Variable importance analysis based on random variable combination (VIAVC) was applied to the entire data set and resulted in a panel of 18 features. Partial least square discriminant analysis was performed exploring the separation between pre-injury and post-SRC groups. Pathway topography analysis was completed to identify biological pathway involvement. Spearman correlations provide support for the relationships between symptom burden and length of return to play and quantifiable metabolic changes in the human urinary metabolome. Results: Phenylalanine and 3-indoxysulfate were upregulated, while citrate, propylene glycol, 1-methylhistidine, 3-methylhistidine, anserine, and carnosine were downregulated following SRC. A receiver operator curve (ROC) tool constructed using the 18-feature classifier had an area under the curve (AUC) of 0.887. A pairwise t-test found an additional 19 altered features, 7 of which overlapped with the VIAVC analysis. Pathway topology analysis indicated that aminoacyl-tRNA biosynthesis and beta-alanine metabolism were the two pathways most significantly changed. There was a significant positive correlation between post-SRC 2-hydroxybutyrate and the length of return to play (ρ = 0.482, p = 0.02) as well as the number of symptoms and post-SRC lactose (ρ = 0.422, p = 0.036). Conclusion: We found that 1H NMR metabolomic urinary analysis can identify a set of metabolites that can correctly classify SRC with an accuracy of 81.6%, suggesting potential for a more objective method of characterizing SRC. Correlations to both the number of symptoms and length of return to play indicated that 2-hydroxybutyrate and lactose may have potential applications as biomarkers for sport-related concussion.
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Affiliation(s)
- Zachary R Wanner
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Cormac G Southam
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Prachi Sanghavi
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Naveenjyote S Boora
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Eric J Paxman
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brian W Benson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Winsport Medicine Clinic, Calgary, AB, Canada
| | - Tony Montina
- Department of Chemistry and Biochemistry, University of Lethbridge, Lethbridge, AB, Canada
| | - Gerlinde A S Metz
- Department of Neuroscience, Canadian Centre for Behavioural Neuroscience, University of Lethbridge, Lethbridge, AB, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Hill MD, Dukelow SP. Poststroke Selective Serotonin Reuptake Inhibitors-Do They Work for Anything? JAMA Neurol 2021; 78:1053-1054. [PMID: 34338719 DOI: 10.1001/jamaneurol.2021.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael D Hill
- Department of Clinical Neurosciences (Neurology) and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences (Neurology) and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences (Physiatry) and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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40
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Yu S, Lam C, Shinde S, Kuczynski AM, Carlson HL, Dukelow SP, Brooks BL, Kirton A. Perilesional Gliosis Is Associated with Outcome after Perinatal Stroke. Journal of Pediatric Neurology 2021. [DOI: 10.1055/s-0041-1728687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractPerinatal ischemic stroke results in focal brain injury and life-long disability. Hemiplegic cerebral palsy and additional sequelae are common. With no prevention strategies, improving outcomes depends on understanding brain development. Reactive astrogliosis is a hallmark of brain injury that has been associated with outcomes but is unstudied in perinatal stroke. In this article, we hypothesized that gliosis was quantifiable and its extent would inversely correlate with clinical motor function. This was a population-based, retrospective, and cross-sectional study. Children with perinatal arterial ischemic stroke (AIS) or periventricular venous infarction (PVI) with magnetic resonance (MR) imaging were included. An image thresholding technique based on image intensity was utilized to quantify the degree of chronic gliosis on T2-weighted sequences. Gliosis scores were corrected for infarct volume and compared with the Assisting Hand and Melbourne Assessments (AHA and MA), neuropsychological profiles, and robotic measures. In total, 42 children were included: 25 with AIS and 17 with PVI (median = 14.0 years, range: 6.3–19 years, 63% males). Gliosis was quantifiable in all scans and scores were highly reliable. Gliosis scores as percentage of brain volume ranged from 0.3 to 3.2% and were comparable between stroke types. Higher gliosis scores were associated with better motor function for all three outcomes in the AIS group, but no association was observed for PVI. Gliosis can be objectively quantified in children with perinatal stroke. Associations with motor outcome in arterial but not venous strokes suggest differing glial responses may play a role in tissue remodeling and developmental plasticity following early focal brain injury.
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Affiliation(s)
- Sabrina Yu
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Charissa Lam
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Siddharth Shinde
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | | | - Helen L. Carlson
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
| | - Brian L. Brooks
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Adam Kirton
- Department of Pediatrics, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neuroscience, University of Calgary, Calgary, Canada
- Department of Radiology, University of Calgary, Calgary, Canada
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41
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Kuczynski AM, Kirton A, Semrau JA, Dukelow SP. Relative independence of upper limb position sense and reaching in children with hemiparetic perinatal stroke. J Neuroeng Rehabil 2021; 18:80. [PMID: 33980254 PMCID: PMC8117512 DOI: 10.1186/s12984-021-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies using clinical measures have suggested that proprioceptive dysfunction is related to motor impairment of the upper extremity following adult stroke. We used robotic technology and clinical measures to assess the relationship between position sense and reaching with the hemiparetic upper limb in children with perinatal stroke. METHODS Prospective term-born children with magnetic resonance imaging-confirmed perinatal ischemic stroke and upper extremity deficits were recruited from a population-based cohort. Neurotypical controls were recruited from the community. Participants completed two tasks in the Kinarm robot: arm position-matching (three parameters: variability [Varxy], contraction/expansion [Areaxy], systematic spatial shift [Shiftxy]) and visually guided reaching (five parameters: posture speed [PS], reaction time [RT], initial direction error [IDE], speed maxima count [SMC], movement time [MT]). Additional clinical assessments of sensory (thumb localization test) and motor impairment (Assisting Hand Assessment, Chedoke-McMaster Stroke Assessment) were completed and compared to robotic measures. RESULTS Forty-eight children with stroke (26 arterial, 22 venous, mean age: 12.0 ± 4.0 years) and 145 controls (mean age: 12.8 ± 3.9 years) completed both tasks. Position-matching performance in children with stroke did not correlate with performance on the visually guided reaching task. Robotic sensory and motor measures correlated with only some clinical tests. For example, AHA scores correlated with reaction time (R = - 0.61, p < 0.001), initial direction error (R = - 0.64, p < 0.001), and movement time (R = - 0.62, p < 0.001). CONCLUSIONS Robotic technology can quantify complex, discrete aspects of upper limb sensory and motor function in hemiparetic children. Robot-measured deficits in position sense and reaching with the contralesional limb appear to be relatively independent of each other and correlations for both with clinical measures are modest. Knowledge of the relationship between sensory and motor impairment may inform future rehabilitation strategies and improve outcomes for children with hemiparetic cerebral palsy.
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Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada. .,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
| | - Adam Kirton
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Jennifer A Semrau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sean P Dukelow
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
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42
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Wood MD, Simmatis LER, Jacobson JA, Dukelow SP, Boyd JG, Scott SH. Principal Components Analysis Using Data Collected From Healthy Individuals on Two Robotic Assessment Platforms Yields Similar Behavioral Patterns. Front Hum Neurosci 2021; 15:652201. [PMID: 34025375 PMCID: PMC8134538 DOI: 10.3389/fnhum.2021.652201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Kinarm Standard Tests (KSTs) is a suite of upper limb tasks to assess sensory, motor, and cognitive functions, which produces granular performance data that reflect spatial and temporal aspects of behavior (>100 variables per individual). We have previously used principal component analysis (PCA) to reduce the dimensionality of multivariate data using the Kinarm End-Point Lab (EP). Here, we performed PCA using data from the Kinarm Exoskeleton Lab (EXO), and determined agreement of PCA results across EP and EXO platforms in healthy participants. We additionally examined whether further dimensionality reduction was possible by using PCA across behavioral tasks. METHODS Healthy participants were assessed using the Kinarm EXO (N = 469) and EP (N = 170-200). Four behavioral tasks (six assessments in total) were performed that quantified arm sensory and motor function, including position sense [Arm Position Matching (APM)] and three motor tasks [Visually Guided Reaching (VGR), Object Hit (OH), and Object Hit and Avoid (OHA)]. The number of components to include per task was determined from scree plots and parallel analysis, and rotation type (orthogonal vs. oblique) was decided on a per-task basis. To assess agreement, we compared principal components (PCs) across platforms using distance correlation. We additionally considered inter-task interactions in EXO data by performing PCA across all six behavioral assessments. RESULTS By applying PCA on a per task basis to data collected using the EXO, the number of behavioral parameters were substantially reduced by 58-75% while accounting for 76-87% of the variance. These results compared well to the EP analysis, and we found good-to-excellent agreement values (0.75-0.99) between PCs from the EXO and those from the EP. Finally, we were able to reduce the dimensionality of the EXO data across tasks down to 16 components out of a total of 76 behavioral parameters, which represents a reduction of 79% while accounting for 73% of the total variance. CONCLUSION PCA of Kinarm robotic assessment appears to capture similar relationships between kinematic features in healthy individuals and is agnostic to the robotic platform used for collection. Further work is needed to investigate the use of PCA-based data reduction for the characterization of neurological deficits in clinical populations.
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Affiliation(s)
- Michael D. Wood
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Leif E. R. Simmatis
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Jill A. Jacobson
- Department of Psychology, Queen’s University, Kingston, ON, Canada
| | - Sean P. Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | - J. Gordon Boyd
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Medicine, Queen’s University, Kingston, ON, Canada
- Department of Critical Care Medicine, Queen’s University, Kingston, ON, Canada
| | - Stephen H. Scott
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Medicine, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
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43
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Herter TM, Kurtzer I, Granat L, Crevecoeur F, Dukelow SP, Scott SH. Interjoint coupling of position sense reflects sensory contributions of biarticular muscles. J Neurophysiol 2021; 125:1223-1235. [PMID: 33502932 DOI: 10.1152/jn.00317.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Perception of limb position and motion combines sensory information from spindles in muscles that span one joint (monoarticulars) and two joints (biarticulars). This anatomical organization should create interactions in estimating limb position. We developed two models, one with only monoarticulars and one with both monoarticulars and biarticulars, to explore how biarticulars influence estimates of arm position in hand (x, y) and joint (shoulder, elbow) coordinates. In hand coordinates, both models predicted larger medial-lateral than proximal-distal errors, although the model with both muscle groups predicted that biarticulars would reduce this bias. In contrast, the two models made significantly different predictions in joint coordinates. The model with only monoarticulars predicted that errors would be uniformly distributed because estimates of angles at each joint would be independent. In contrast, the model that included biarticulars predicted that errors would be coupled between the two joints, resulting in smaller errors for combinations of flexion or extension at both joints and larger errors for combinations of flexion at one joint and extension at the other joint. We also carried out two experiments to examine errors made by human subjects during an arm position matching task in which a robot passively moved one arm to different positions and the subjects moved their other arm to mirror-match each position. Errors in hand coordinates were similar to those predicted by both models. Critically, however, errors in joint coordinates were only similar to those predicted by the model with monoarticulars and biarticulars. These results highlight how biarticulars influence perceptual estimates of limb position by helping to minimize medial-lateral errors.NEW & NOTEWORTHY It is unclear how sensory information from muscle spindles located within muscles spanning multiple joints influences perception of body position and motion. We address this issue by comparing errors in estimating limb position made by human subjects with predicted errors made by two musculoskeletal models, one with only monoarticulars and one with both monoarticulars and biarticulars. We provide evidence that biarticulars produce coupling of errors between joints, which help to reduce errors.
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Affiliation(s)
- Troy M Herter
- Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Isaac Kurtzer
- Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical Sciences, New York Institute of Technology, New York City, New York
| | - Lauren Granat
- Department of Biomedical Sciences, New York Institute of Technology, New York City, New York
| | - Frédéric Crevecoeur
- Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Institute of Communication Technologies, Electronics and Applied Mathematics, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute of Neuroscience, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Sean P Dukelow
- Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Stephen H Scott
- Center for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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44
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Keeling AB, Piitz M, Semrau JA, Hill MD, Scott SH, Dukelow SP. Robot enhanced stroke therapy optimizes rehabilitation (RESTORE): a pilot study. J Neuroeng Rehabil 2021; 18:10. [PMID: 33478563 PMCID: PMC7819212 DOI: 10.1186/s12984-021-00804-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Robotic rehabilitation after stroke provides the potential to increase and carefully control dosage of therapy. Only a small number of studies, however, have examined robotic therapy in the first few weeks post-stroke. In this study we designed robotic upper extremity therapy tasks for the bilateral Kinarm Exoskeleton Lab and piloted them in individuals with subacute stroke. Pilot testing was focused mainly on the feasibility of implementing these new tasks, although we recorded a number of standardized outcome measures before and after training. METHODS Our team developed 9 robotic therapy tasks to incorporate feedback, intensity, challenge, and subject engagement as well as addressing both unimanual and bimanual arm activities. Subacute stroke participants were assigned to a robotic therapy (N = 9) or control group (N = 10) in a matched-group manner. The robotic therapy group completed 1-h of robotic therapy per day for 10 days in addition to standard therapy. The control group participated only in standard of care therapy. Clinical and robotic assessments were completed prior to and following the intervention. Clinical assessments included the Fugl-Meyer Assessment of Upper Extremity (FMA UE), Action Research Arm Test (ARAT) and Functional Independence Measure (FIM). Robotic assessments of upper limb sensorimotor function included a Visually Guided Reaching task and an Arm Position Matching task, among others. Paired sample t-tests were used to compare initial and final robotic therapy scores as well as pre- and post-clinical and robotic assessments. RESULTS Participants with subacute stroke (39.8 days post-stroke) completed the pilot study. Minimal adverse events occurred during the intervention and adding 1 h of robotic therapy was feasible. Clinical and robotic scores did not significantly differ between groups at baseline. Scores on the FMA UE, ARAT, FIM, and Visually Guided Reaching improved significantly in the robotic therapy group following completion of the robotic intervention. However, only FIM and Arm Position Match improved over the same time in the control group. CONCLUSIONS The Kinarm therapy tasks have the potential to improve outcomes in subacute stroke. Future studies are necessary to quantify the benefits of this robot-based therapy in a larger cohort. TRIAL REGISTRATION ClinicalTrials.gov, NCT04201613, Registered 17 December 2019-Retrospectively Registered, https://clinicaltrials.gov/ct2/show/NCT04201613 .
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Affiliation(s)
- Alexa B. Keeling
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Mark Piitz
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Jennifer A. Semrau
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE USA
| | - Michael D. Hill
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
| | - Stephen H. Scott
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB Canada
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45
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Bonkhoff AK, Hope T, Bzdok D, Guggisberg AG, Hawe RL, Dukelow SP, Rehme AK, Fink GR, Grefkes C, Bowman H. Bringing proportional recovery into proportion: Bayesian modelling of post-stroke motor impairment. Brain 2020; 143:2189-2206. [PMID: 32601678 DOI: 10.1093/brain/awaa146] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 01/05/2023] Open
Abstract
Accurate predictions of motor impairment after stroke are of cardinal importance for the patient, clinician, and healthcare system. More than 10 years ago, the proportional recovery rule was introduced by promising that high-fidelity predictions of recovery following stroke were based only on the initially lost motor function, at least for a specific fraction of patients. However, emerging evidence suggests that this recovery rule is subject to various confounds and may apply less universally than previously assumed. Here, we systematically revisited stroke outcome predictions by applying strategies to avoid confounds and fitting hierarchical Bayesian models. We jointly analysed 385 post-stroke trajectories from six separate studies-one of the largest overall datasets of upper limb motor recovery. We addressed confounding ceiling effects by introducing a subset approach and ensured correct model estimation through synthetic data simulations. Subsequently, we used model comparisons to assess the underlying nature of recovery within our empirical recovery data. The first model comparison, relying on the conventional fraction of patients called 'fitters', pointed to a combination of proportional to lost function and constant recovery. 'Proportional to lost' here describes the original notion of proportionality, indicating greater recovery in case of a more severe initial impairment. This combination explained only 32% of the variance in recovery, which is in stark contrast to previous reports of >80%. When instead analysing the complete spectrum of subjects, 'fitters' and 'non-fitters', a combination of proportional to spared function and constant recovery was favoured, implying a more significant improvement in case of more preserved function. Explained variance was at 53%. Therefore, our quantitative findings suggest that motor recovery post-stroke may exhibit some characteristics of proportionality. However, the variance explained was substantially reduced compared to what has previously been reported. This finding motivates future research moving beyond solely behaviour scores to explain stroke recovery and establish robust and discriminating single-subject predictions.
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Affiliation(s)
- Anna K Bonkhoff
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany.,Queen Square Institute of Neurology, University College London, London, UK
| | - Thomas Hope
- Wellcome Centre for Human Neuroimaging, University College London, UK
| | - Danilo Bzdok
- Mila - Quebec Artificial Intelligence Institute, Montreal, Canada.,Department of Biomedical Engineering, McConnell Brain Imaging Centre, Montreal Neurological Institute, Faculty of Medicine, McGill University, Montreal, Canada
| | - Adrian G Guggisberg
- Clinical Neuroscience, University of Geneva, Medical School, 1202 Geneva, Switzerland
| | - Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Anne K Rehme
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Howard Bowman
- School of Psychology, University of Birmingham, Birmingham, UK.,School of Computing, University of Kent, Canterbury, UK
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46
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Abstract
BACKGROUND Numerous studies have found associations when change scores are regressed onto initial impairments in people with stroke (slopes ≈ 0.7). However, there are important statistical considerations that limit the conclusions we can draw about recovery from these studies. OBJECTIVE To provide an accessible checklist of conceptual and analytical issues on longitudinal measures of stroke recovery. Proportional recovery is an illustrative example, but these considerations apply broadly to studies of change over time. METHODS Using a pooled data set of n = 373 Fugl-Meyer Assessment upper extremity scores, we ran simulations to illustrate 3 considerations: (1) how change scores can be problematic in this context; (2) how "nil" and nonzero null-hypothesis significance tests can be used; and (3) how scale boundaries can create the illusion of proportionality, whereas other analytical procedures (eg, post hoc classifications) can augment this problem. RESULTS Our simulations highlight several limitations of common methods for analyzing recovery. We find that uniform recovery leads to similar group-level statistics (regression slopes) and individual-level classifications (into fitters and nonfitters) that have been claimed as evidence for the proportional recovery rule. New analyses, however, also speak to the complexities in variance about the regression slope. CONCLUSIONS Our results highlight that one cannot identify whether proportional recovery is true or not based on commonly used methods. We illustrate how these techniques, measurement tools, and post hoc classifications (eg, nonfitters) can create spurious results. Going forward, the field needs to carefully consider the influence of these factors on how we measure, analyze, and conceptualize recovery.
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47
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Cothros N, Medina A, Martino D, Dukelow SP, Hawe RL, Kirton A, Ganos C, Nosratmirshekarlou E, Pringsheim T. Children with Tic Disorders Show Greater Variability in an Arm-Position-Matching Proprioceptive Task. Mov Disord 2020; 36:782-784. [PMID: 33284995 DOI: 10.1002/mds.28413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/04/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Nicholas Cothros
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Alex Medina
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Davide Martino
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Christos Ganos
- Department of Neurology, Charité University Hospital Berlin, Berlin, Germany
| | | | - Tamara Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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48
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Mang CS, Whitten TA, Cosh MS, Dukelow SP, Benson BW. Assessment of Postural Stability During an Upper Extremity Rapid, Bimanual Motor Task After Sport-Related Concussion. J Athl Train 2020; 55:1160-1173. [PMID: 33064821 DOI: 10.4085/1062-6050-378-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Sport-related concussion (SRC) often presents with multidimensional and subtle neurologic deficits that are difficult to detect with standard clinical tests. New assessment approaches that efficiently quantify deficits across multiple neurologic domains are needed. OBJECTIVE To quantify impairments in postural movements during an assessment of rapid, bimanual motor ability in athletes within 10 days of experiencing an SRC and evaluate relationships between impairments in upper extremity and postural performance. DESIGN Cohort study. SETTING Sports medicine clinic. PATIENTS OR OTHER PARTICIPANTS Initial baseline assessments were completed for 711 athletes. Seventy-five athletes (age = 15.8 ± 3.3 years at baseline) sustained SRCs and were reassessed within 10 days. Seventy-eight athletes (age = 15.5 ± 2.0 years) completed 2 assessments in a healthy state. MAIN OUTCOME MEASURE(S) Athletes stood on force plates and performed a rapid, bimanual motor task, termed the object-hit task, delivered using a Kinesiological Instrument for Normal and Altered Reaching Movements endpoint robot. Measures of postural stability that quantified center-of-pressure movements and measures of upper extremity performance were used to characterize task performance. RESULTS Performance changes across assessments were converted to reliable change indices. We observed a difference in reliable change indices values between athletes with SRC and healthy control athletes on the combined postural measures (P = .01). Using measures to evaluate the change in postural movements from the early, easier portion of the task to the later, more difficult portion, we identified the highest levels of impairment (19%-25% of the sample impaired). We also noted a difference between individuals with concussion and healthy individuals on the combined upper extremity measures (P = .003), but these impairments were largely unrelated to those identified in the postural movements. CONCLUSIONS Measurement of postural movements during the object-hit task revealed impairments in postural stability that were not related to impairments in upper extremity performance. The findings demonstrated the benefits of using assessments that simultaneously evaluate multiple domains of neurologic function (eg, upper extremity and postural control) after SRC.
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Affiliation(s)
- Cameron S Mang
- Faculty of Kinesiology and Health Studies, University of Regina, SK, Canada
| | - Tara A Whitten
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Madeline S Cosh
- Benson Concussion Institute, Group23 Sports Medicine Clinic, Calgary, AB, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
| | - Brian W Benson
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, AB, Canada
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Klassen TD, Dukelow SP, Bayley MT, Benavente O, Hill MD, Krassioukov A, Liu-Ambrose T, Pooyania S, Poulin MJ, Schneeberg A, Yao J, Eng JJ. Higher Doses Improve Walking Recovery During Stroke Inpatient Rehabilitation. Stroke 2020; 51:2639-2648. [PMID: 32811378 DOI: 10.1161/strokeaha.120.029245] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the effect of higher therapeutic exercise doses on walking during inpatient rehabilitation, typically commencing 1 to 4 weeks poststroke. METHODS This phase II, blinded-assessor, randomized controlled trial recruited from 6 Canadian inpatient rehabilitation units, between 2014 and 2018. Subjects (n=75; 25/group) were randomized into: control (usual care) physical therapy: typically, 1 hour, 5 days/week; Determining Optimal Post-Stroke Exercise (DOSE1): 1 hour, 5 days/week, more than double the intensity of Control (based on aerobic minutes and walking steps); and DOSE2: 2 hours, 5 days/week, more than quadruple the intensity of Control, each for 4 weeks duration. The primary outcome, walking endurance at completion of the 4-week intervention (post-evaluation), was compared across these groups using linear regression. Secondary outcomes at post-evaluation, and longitudinal outcomes at 6 and 12-month evaluations, were also analyzed. RESULTS Both DOSE1 (mean change 61 m [95% CI, 9-113], P=0.02) and DOSE2 (mean change 58 m, 6-110, P=0.03) demonstrated greater walking endurance compared with Control at the post-evaluation. Significant improvements were also observed with DOSE2 in gait speed (5-m walk), and both DOSE groups in quality of life (EQ-5D-5 L) compared with Control. Longitudinal analyses revealed that improvements in walking endurance from the DOSE intervention were retained during the 1-year follow-up period over usual care. CONCLUSIONS This study provides the first preliminary evidence that patients with stroke can improve their walking recovery and quality of life with higher doses of aerobic and stepping activity within a critical time period for neurological recovery. Furthermore, walking endurance benefits achieved from a 4-week intervention are retained over the first-year poststroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01915368.
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Affiliation(s)
- Tara D Klassen
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute (S.P.D., M.D.H.)University of Calgary, Canada
| | - Mark T Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Canada (M.T.B.)
| | - Oscar Benavente
- Division of Neurology (O.B.), University of British Columbia, Vancouver, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute (S.P.D., M.D.H.)University of Calgary, Canada
| | - Andrei Krassioukov
- Division of Physical Medicine and Rehabilitation (A.K., J.Y.), University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
| | - Sepideh Pooyania
- Division of Physical Medicine and Rehabilitation, University of Manitoba (S.P.)
| | - Marc J Poulin
- Department of Physiology & Pharmacology (M.J.P.) University of Calgary, Canada
| | - Amy Schneeberg
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
| | - Jennifer Yao
- Division of Physical Medicine and Rehabilitation (A.K., J.Y.), University of British Columbia, Vancouver, Canada
| | - Janice J Eng
- Department of Physical Therapy (T.D.K., T.L.-A., A.S., J.J.E.), University of British Columbia, Vancouver, Canada
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Lowrey CR, Blazevski B, Marnet JL, Bretzke H, Dukelow SP, Scott SH. Robotic tests for position sense and movement discrimination in the upper limb reveal that they each are highly reproducible but not correlated in healthy individuals. J Neuroeng Rehabil 2020; 17:103. [PMID: 32711540 PMCID: PMC7382092 DOI: 10.1186/s12984-020-00721-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/06/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Robotic technologies for neurological assessment provide sensitive, objective measures of behavioural impairments associated with injuries or disease such as stroke. Previous robotic tasks to assess proprioception typically involve single limbs or in some cases both limbs. The challenge with these approaches is that they often rely on intact motor function and/or working memory to remember/reproduce limb position, both of which can be impaired following stroke. Here, we examine the feasibility of a single-arm Movement Discrimination Threshold (MDT) task to assess proprioception by quantifying thresholds for sensing passive limb movement without vision. We use a staircase method to adjust movement magnitude based on subject performance throughout the task in order to reduce assessment time. We compare MDT task performance to our previously-designed Arm Position Matching (APM) task. Critically, we determine test-retest reliability of each task in the same population of healthy controls. METHOD Healthy participants (N = 21, age = 18-22 years) completed both tasks in the End-Point Kinarm robot. In the MDT task the robot moved the dominant arm left or right and participants indicated the direction moved. Movement displacement was systematically adjusted (decreased after correct answers, increased after incorrect) until the Discrimination Threshold was found. In the APM task, the robot moved the dominant arm and participants "mirror-matched" with the non-dominant arm. RESULTS Discrimination Threshold for direction of arm displacement in the MDT task ranged from 0.1-1.3 cm. Displacement Variability ranged from 0.11-0.71 cm. Test-retest reliability of Discrimination Threshold based on ICC confidence intervals was moderate to excellent (range, ICC = 0.78 [0.52-0.90]). Interestingly, ICC values for Discrimination Threshold increased to 0.90 [0.77-0.96] (good to excellent) when the number of trials was reduced to the first 50. Most APM parameters had ICC's above 0.80, (range, ICC = [0.86-0.88]) with the exception of variability (ICC = 0.30). Importantly, no parameters were significantly correlated across tasks as Spearman rank correlations across parameter-pairings ranged from - 0.27 to 0.30. CONCLUSIONS The MDT task is a feasible and reliable task, assessing movement discrimination threshold in ~ 17 min. Lack of correlation between the MDT and a position-matching task (APM) indicates that these tasks assess unique aspects of proprioception that are not strongly related in young, healthy individuals.
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Affiliation(s)
- Catherine R. Lowrey
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen’s University, 18 Stuart St., Kingston, ON K7L 3N6 Canada
| | - Benett Blazevski
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen’s University, 18 Stuart St., Kingston, ON K7L 3N6 Canada
| | - Jean-Luc Marnet
- BioEngineering and Innovation in Neuroscience, University Paris Descartes, Paris, France
| | - Helen Bretzke
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen’s University, 18 Stuart St., Kingston, ON K7L 3N6 Canada
| | - Sean P. Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta Canada
| | - Stephen H. Scott
- Laboratory of Integrative Motor Behaviour, Centre for Neuroscience Studies, Queen’s University, 18 Stuart St., Kingston, ON K7L 3N6 Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON Canada
- Department of Medicine, Queen’s University, Kingston, ON Canada
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