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Alhwoaimel NA, Alenazi AM, Alhowimel AS, Alqahtani BA, Alshehri MM. Effects of trunk exercises using virtual reality technology on trunk performance and impairment post stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2024; 31:399-408. [PMID: 37753784 DOI: 10.1080/10749357.2023.2261701] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To systematically explore the effects of trunk exercises using virtual reality technology compared to conventional exercises for trunk impairment in patients with subacute and chronic strokes. METHODS A comprehensive search of literature published from inception until December 2022 was conducted using PubMed, Cochrane Library, Web of Science, Scopus, IEEE, and the Physiotherapy Evidence Database (PEDro). The inclusion criteria encompassed all randomized controlled trials (RCT) published in the English language involving adults who had had strokes and the evaluation of the effectiveness of virtual reality -based trunk exercises in reducing trunk impairment post stroke as measured by the trunk control test (TCT) and/or the trunk impairment scale (TIS) compared to conventional trunk exercises. RESULT A total of 397 studies were retrieved, and six studies were included in the current analysis. A random-effects meta-analysis of six studies indicated that video games had a very large, significant effect (SMD = 1.11; 95%, P < 0.0001) on the delivery of trunk exercises to reduce trunk impairment post stroke at both the subacute and chronic stages. CONCLUSION The study findings indicate that trunk exercises using virtual reality have a highly significant effect on reducing trunk impairment in patients with subacute and chronic stroke. Large RCTs are needed to study the effects of virtual reality trunk exercises on the acute, subacute, and chronic stages of stroke.
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Affiliation(s)
- Norah A Alhwoaimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmad S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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Lamessa A, Birhanu A, Mekonnen G, Mohammed A, Woyimo TG, Asefa ET. Ischemic stroke as the first clinical manifestation of an initially undiagnosed case of Takayasu arteritis in a young woman from Ethiopia: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241241190. [PMID: 38585421 PMCID: PMC10999126 DOI: 10.1177/2050313x241241190] [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: 08/11/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Takayasu arteritis (TAK) is a rare large-vessel vasculitis of unknown etiology that leads to arterial wall thickening, stenosis, and occlusion, which may complicate cerebrovascular ischemic events. Ischemic stroke is a potentially devastating complication of TAK at a young age, but the occurrence is still rarely reported in Ethiopia. Although it occurs late in the course of the condition, it may be the initial presentation and suggest an unfavorable prognosis. Herein, we address the case of a 25-year-old woman who presented to a university hospital while on follow-up after 2 years of stroke with deterioration in clinical symptoms, absent brachial artery pulses, and unrecordable blood pressure in both arms. At the time of admission in 2021, the contrast brain computed tomography scan revealed an ischemic infarction in the right middle cerebral artery territory. However, the etiology of the stroke could not be defined at that time due to ambiguity in the clinical picture and the inability of clinicians to incorporate TAK into the differential diagnosis, resulting in a delay in the early diagnosis of the case. Two years later, in 2023, she underwent computed tomography angiography and was diagnosed to have TAK based on American College of Rheumatology criteria, with Numano type IIb angiographic extent of disease, ischemic stroke, and stage II systemic hypertension. The patient was treated by a field of experts. This case highlights the need to consider TAK in the differential diagnosis of stroke in young patients in the absence of traditional risk factors; appropriate tests should be performed to confirm or rule out this diagnosis, and management should be modified accordingly.
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Affiliation(s)
- Adugna Lamessa
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Abdi Birhanu
- School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Krishnan C, Augenstein TE, Claflin ES, Hemsley CR, Washabaugh EP, Ranganathan R. Rest the Brain to Learn New Gait Patterns after Stroke. medRxiv 2024:2024.04.01.24304938. [PMID: 38633786 PMCID: PMC11023642 DOI: 10.1101/2024.04.01.24304938] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background The ability to relearn a lost skill is critical to motor recovery after a stroke. Previous studies indicate that stroke typically affects the processes underlying motor control and execution but not the learning of those skills. However, these prior studies could have been confounded by the presence of significant motor impairments and/or have not focused on motor acuity tasks (i.e., tasks focusing on the quality of executed actions) that have direct functional relevance to rehabilitation. Methods Twenty-five participants (10 stroke; 15 controls) were recruited for this prospective, case-control study. Participants learned a novel foot-trajectory tracking task on two consecutive days while walking on a treadmill. On day 1, participants learned a new gait pattern by performing a task that necessitated greater hip and knee flexion during the swing phase of the gait. On day 2, participants repeated the task with their training leg to test retention. An average tracking error was computed to determine online and offline learning and was compared between stroke survivors and uninjured controls. Results Stroke survivors were able to improve their tracking performance on the first day (p=0.033); however, the amount of learning in stroke survivors was lower in comparison with the control group on both days (p≤0.05). Interestingly, the offline gains in motor learning were higher in stroke survivors when compared with uninjured controls (p=0.011). Conclusions The results suggest that even high-functioning stroke survivors may have difficulty acquiring new motor skills related to walking, which may be related to the underlying neural damage caused at the time of stroke. Furthermore, it is likely that stroke survivors may require longer training with adequate rest to acquire new motor skills, and rehabilitation programs should target motor skill learning to improve outcomes after stroke.
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Affiliation(s)
- Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Robotics, University of Michigan
- Department of Mechanical Engineering, University of Michigan
- School of Kinesiology, University of Michigan
- Biomedical Engineering, University of Michigan
- Department of Physical Therapy, University of Michigan-Flint
| | - Thomas E. Augenstein
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Robotics, University of Michigan
| | - Edward S. Claflin
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
| | | | - Edward P. Washabaugh
- Department of Physical Medicine and Rehabilitation, Michigan Medicine
- Department of Biomedical Engineering, Wayne State University
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Arya KN, Pandian S, Joshi AK, Chaudhary N, Agarwal GG, Ahmed SS. Sensory deficits of the paretic and non-paretic upper limbs relate with the motor recovery of the poststroke subjects. Top Stroke Rehabil 2024; 31:281-292. [PMID: 37690032 DOI: 10.1080/10749357.2023.2253629] [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] [Received: 03/16/2023] [Accepted: 08/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role. OBJECTIVE To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects. METHODS The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA). RESULTS The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side. CONCLUSION In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Akshay Kumar Joshi
- Department of Occupational therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Neera Chaudhary
- Department of Neurology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - G G Agarwal
- Department of Statistics, Lucknow University, Lucknow, India
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Toader C, Covache-Busuioc RA, Bratu BG, Glavan LA, Popa AA, Ciurea AV. Successful Surgical Treatment of a Giant Intraventricular Meningioma: A Case Report and Literature Review. Medicina (Kaunas) 2024; 60:560. [PMID: 38674205 PMCID: PMC11052000 DOI: 10.3390/medicina60040560] [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] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/24/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
In our study, we document the case of a 48-year-old patient who presented at our clinic with various neurological disturbances. Magnetic Resonance Imaging revealed the presence of an intraventricular meningioma located in the body of the left lateral ventricle measuring 60 mm in diameter. This tumor was classified as a giant meningioma, accompanied by a significant amount of digitiform-type edema. A surgical procedure was conducted, resulting in a gross total resection of the tumor. Histopathological analysis identified the tumor as a fibrous meningioma. Postoperative assessments, as well as follow-ups conducted at 3 months and 1 year post-surgery, indicated considerable neurological improvement. The patient exhibited a remission of hemiparesis and gait disturbances along with a marginal improvement in the status of expressive aphasia. This case report underscores the significance of achieving total and safe resection of the tumor and includes an analysis of various cases from the literature, particularly focusing on those that describe minimally invasive surgical approaches and highlight the benefits of radiosurgery in the treatment of giant intraventricular meningiomas.
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Affiliation(s)
- Corneliu Toader
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
- Department of Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Luca Andrei Glavan
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Andrei Adrian Popa
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery “Carol Davila”, University of Medicine and Pharmacy, 020021 Bucharest, Romania; (C.T.); (B.-G.B.); (L.A.G.); (A.A.P.); (A.V.C.)
- Department of Neurosurgery, Sanador Clinical Hospital, 010991 Bucharest, Romania
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Kato PJ, Kato J, Napier JA, Khorfan R, Aziz A. Unstable Carotid Artery Thrombus in a Patient With COVID-19 Infection. Vasc Endovascular Surg 2024:15385744241240543. [PMID: 38498941 DOI: 10.1177/15385744241240543] [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: 03/20/2024]
Abstract
We present a case of an unvaccinated, 43-year-old African American female patient with COVID-19 infection and clinical evidence of a left hemispheric stroke. A non-occlusive thrombus with a radiographic target lesion was identified on computed tomography angiography (CTA). A multi-disciplinary discussion regarding concern for embolization was provided due to its unstable nature, as well as evidence of recent stroke. Given her acute COVID-19 infection, symptomatology, and radiographic findings, it was concluded that the etiology of her stroke appeared most consistent with a hypercoagulable-related embolism rather than an atheroembolic event. The patient underwent left carotid artery thrombectomy with bovine patch angioplasty. Operative findings included: left carotid thrombus, minimal plaque after evacuation of the thrombus, and a small proximal internal carotid artery diameter. Given concern for stenosis with primary repair a bovine pericardial patch angioplasty was performed. We present a paradigm for extracranial carotid thrombectomy with therapeutic anticoagulation for COVID-related spontaneous arterial thrombosis.
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Affiliation(s)
- Patrick J Kato
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, USA
| | - Jesse Kato
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, USA
| | - Jarred A Napier
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, USA
| | - Rhami Khorfan
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, USA
| | - Abdulhameed Aziz
- Department of Surgery, Section of Vascular and Endovascular Surgery, Trinity Health Ann Arbor, Ypsilanti, MI, USA
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Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB, de Freitas SF, Miyuki Kawamura C, Fernandes Lopes JA, Faber J, Arida RM. Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity - Constraint Induced Movement Therapy: a randomized controlled clinical trial. Brain Inj 2024:1-10. [PMID: 38469745 DOI: 10.1080/02699052.2024.2328808] [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: 12/19/2022] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To evaluate the effects of Lower Extremity - Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients. METHODS Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity - Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity - Motor Activity Log. RESULTS LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity - Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters. CONCLUSION The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.
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Affiliation(s)
- Elaine Menezes-Oliveira
- Neurology/Neuroscience program, Federal University, UNIFESP, São Paulo, Brazil
- Adult Physiotherapy Department at Associação de Assistência à Criança com Deficiência, São Paulo, Brazil
| | - Gabriela da Silva Matuti
- Adult Physiotherapy Department at Associação de Assistência à Criança com Deficiência, São Paulo, Brazil
| | | | - Simone Ferreira de Freitas
- Adult Physiotherapy Department at Associação de Assistência à Criança com Deficiência, São Paulo, Brazil
| | - Catia Miyuki Kawamura
- Gait Analysis Laboratory at Associação de Assistência à Criança com Deficiência, São Paulo, Brazil
| | | | - Jean Faber
- Neurology/Neuroscience program, Federal University, UNIFESP, São Paulo, Brazil
| | - Ricardo Mario Arida
- Physiology Department, Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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Ankar P, Samal S, Singh S. Optimising Rehabilitation Strategies for Primary Central Nervous System Neoplasm-Related Neurological Deficits Using a Comprehensive Multimodality Approach Including Robotic Gloves Technology: A Comprehensive Case Report. Cureus 2024; 16:e56221. [PMID: 38618374 PMCID: PMC11016241 DOI: 10.7759/cureus.56221] [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: 01/14/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
This case study examines the rehabilitation strategy for a 51-year-old farmer with primary neoplasm of the central nervous system (CNS)-related hemiparesis, balance issues, and cognitive impairment. Primary neoplasm of the CNS is a rare type of cancer that affects the brain, spinal cord, and other parts of the CNS. Hemiparesis, which is weakness on one side of the body, is a common symptom of primary neoplasm of the CNS. The tumour can cause inflammation and swelling in the brain, which can further contribute to weakness. Symptoms include headaches, confusion, seizures, and changes in vision or speech. The patient underwent surgical excision, chemotherapy, and radiation therapy but faced challenges in physiotherapy. The patient's initial assessment revealed asymmetries and impairments on the right side, including muscle weakness, flexor synergy, trunk imbalance, gait abnormalities, and cognitive impairment. A tailored physiotherapy protocol was implemented, focusing on improving muscle strength, synergy patterns, balance, gait, motor control, speech, and cognitive function. Innovative robotic gloves technology was incorporated to enhance hand functionality. This case study contributes to the growing body of evidence supporting the effectiveness of comprehensive rehabilitation strategies, including innovative technologies, in optimising recovery for individuals with CNS lymphoma-related neurological deficits. Further research and exploration could further validate their benefits and enhance the overall rehabilitation journey for such patients.
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Affiliation(s)
- Prajyot Ankar
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Snehal Samal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swarna Singh
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhong Yang L, Ngoo QZ, Viswanathan S, Sudarno R. A Rare Case of Isolated Abducens Nerve Palsy With Contemporaneous Thalamic Infarct. Cureus 2024; 16:e56268. [PMID: 38623103 PMCID: PMC11017794 DOI: 10.7759/cureus.56268] [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] [Accepted: 03/15/2024] [Indexed: 04/17/2024] Open
Abstract
We report a case of isolated left abducens nerve palsy accompanying a right thalamic infarct. The patient, a 43-year-old Malay male with newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, initially reported binocular diplopia on left lateral gaze persisting for five weeks. Subsequently, he experienced acute left-sided body weakness and slurred speech for over one day. Clinical examination revealed restricted left eye lateral gaze (-3) with no relative afferent pupillary defect. Additionally, decreased power (4/5) was noted in the left upper and lower limbs. Brain magnetic resonance imaging (MRI) revealed restricted diffusion in the right thalamus extending to the right posterior internal capsule, left anterior cingulate gyrus, and left caudate nucleus. The patient was initiated on antiplatelet, antihypertensive, and oral hypoglycemic agents, resulting in symptom improvement. This rare neuroophthalmological finding has not been reported previously.
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Affiliation(s)
- Lai Zhong Yang
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, MYS
| | - Qi Zhe Ngoo
- Department of Ophthalmology, Universiti Sains Malaysia, Kota Bharu, MYS
| | | | - Rafidah Sudarno
- Department of Ophthalmology, Hospital Tengku Ampuan Rahimah, Klang, MYS
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Page SJ, Levine P. Pediatric Constraint-Induced Therapy: Checking under the Hood Before Jumping on the Bandwagon. J Pediatr 2024; 270:113998. [PMID: 38431195 DOI: 10.1016/j.jpeds.2024.113998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Stephen J Page
- RehabLab™, Columbus, OH; Neurorecovery Unlimited, LLC™, Columbus, OH.
| | - Peter Levine
- Deceased; formerly affiliated with Synapse Together, LLC, Cincinnati, OH
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Fujimoto K, Ueno M, Etoh S, Shimodozono M. Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial. Front Neurol 2024; 15:1356732. [PMID: 38456153 PMCID: PMC10919145 DOI: 10.3389/fneur.2024.1356732] [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: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. Methods This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. Results All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. Discussion The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.
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Affiliation(s)
- Koya Fujimoto
- Department of Rehabilitation, Kirishima Sugiyasu Hospital, Kirishima, Kagoshima, Japan
| | - Makoto Ueno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Maillard B, Boutaayamou M, Cassol H, Pirnay L, Kaux JF. Gait Analysis of Hemiparetic Adult Patients with a Quadripod Cane and a Rolling Cane. Healthcare (Basel) 2024; 12:464. [PMID: 38391839 PMCID: PMC10888135 DOI: 10.3390/healthcare12040464] [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: 12/26/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024] Open
Abstract
Stroke consequences include hemiparesis and difficulty walking. Several types of canes exist to overcome these alterations, but little data compares the quadripod cane and the rolling cane in hemiparetic patients. The objective of this work is twofold: to determine whether the gait speed-the most often used parameter to assess gait performance-depends on the type of cane, and to establish which spatiotemporal parameters have the most influence. Thirty-four hemiparetic patients performed 10 m walking tests at comfortable and fast speed conditions, using both canes on two different days. To objectively analyze their gait patterns, we used a tri-axial Inertial Measurement Units (IMU)-based system to record the walking signals from which we extracted the gait spatiotemporal parameters. We particularly examined the speed, stride length, and durations of stance, swing, and double support phases. The results showed that hemiparetic patients walked faster with the rolling cane during both speed conditions. These speed increases could be explained by the decrease in the stance phase duration of the affected leg, the decrease in the double support duration, and the increase in cadence. Our findings suggest that the rolling cane allows safe and faster walking.
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Affiliation(s)
- Bérengère Maillard
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University Hospital of Liège, 4000 Liège, Belgium
| | - Mohamed Boutaayamou
- Department of Electrical Engineering and Computer Science, University of Liège, 4000 Liège, Belgium
- Laboratory of Movement Analysis (LAM-Motion Lab), University of Liège, 4000 Liège, Belgium
| | - Helena Cassol
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University Hospital of Liège, 4000 Liège, Belgium
| | - Laurence Pirnay
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University Hospital of Liège, 4000 Liège, Belgium
| | - Jean-François Kaux
- Physical Medicine, Rehabilitation and Sports Traumatology Department, University Hospital of Liège, 4000 Liège, Belgium
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Caraballo R, Guzman A, Beltrán L, Espeche A. Cerebral hemiatrophy and hemiparesis following hemiclonic status epilepticus in Dravet syndrome. Epileptic Disord 2024; 26:121-125. [PMID: 37815756 DOI: 10.1002/epd2.20170] [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] [Received: 07/21/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/11/2023]
Abstract
Dravet syndrome is currently considered as an developmental and epileptic encephalopathy and, recently, mandatory, alert, and exclusionary criteria have been proposed. Here, we describe three patients with Dravet syndrome with the typical early presentation including febrile and afebrile alternating hemiclonic seizures due to loss-of-function SCN1A variants. Subsequently, they developed episodes of febrile focal status epilepticus (SE) associated with hemiparesis and cerebral hemiatrophy with posterior focal seizures, as a consequence of Dravet syndrome. This sequence of events has been previously published in patients with Dravet syndrome and does not contradict the recent classification by the International League Against Epilepsy (ILAE). The ILAE guidance identifies "Focal neurological findings" as alert criteria and "MRI showing a causal focal lesion" as exclusionary criteria for making an initial diagnosis of Dravet syndrome at presentation. Our three patients would correspond to a severe phenotype, similar to the well-known presentation of generalized atrophy following prolonged status epilepticus. Common genetic findings in cases of diffuse and unilateral brain involvement may help explain these clinical presentations. Further genotype-phenotype studies may provide additional insights into this electroclinical behavior.
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Affiliation(s)
- Roberto Caraballo
- Department of Neurology, Hospital de Pediatría Juan P Garrahan, Buenos Aires, Argentina
| | - Ariel Guzman
- Department of Neurology, Hospital Materno Infantil de Salta, Salta, Argentina
| | - Lucas Beltrán
- Department of Neurology, Hospital de Pediatría Avelino Castelán, Resistencia, Argentina
| | - Alberto Espeche
- Department of Neurology, Hospital Materno Infantil de Salta, Salta, Argentina
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Gandhi S, Sasun AR, Patil DS. Functional Recovery in a Patient of Abnormal Left Parieto-Occipital Encephalomalacia With Gliosis-Associated Genu Varum Deformity: A Case Report. Cureus 2024; 16:e55115. [PMID: 38558677 PMCID: PMC10979713 DOI: 10.7759/cureus.55115] [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: 11/08/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Parieto-occipital encephalomalacia is a macroscopic appearance of the brain with loss of cerebral parenchyma associated with gliosis in the brain's anatomical structures. It occurs because of the liquefaction of brain parenchymal necrosis after cerebral ischemia, infection, and haemorrhages. It is often surrounded by glial cell proliferation in response to damage. Rehabilitation after the manifestation of neurological function must be tailored, and well-coordinated intervention must be formulated. We present a case study of a 77-year-old male with parieto-occipital encephalomalacia associated with genu varum deformity with a complaint of generalized weakness, vertigo, giddiness, and fall with one episode of a seizure attack. Further, bilateral genu varum deformity was noted on the knees. Encephalomalcia is associated with vitamin D deficiency. The physiotherapy rehabilitation consisted of resolving the symptoms of the patient, along with working on strengthening weak muscles of the genu varum deformity of the patient. The proprioceptive neuromuscular facilitation (PNF) method is a popular rehabilitation strategy for regaining motor function. Numerous outcome measures were used to monitor the patient's progress. Outcome measures such as the tone grading scale (TGS), motor assessment scale (MAS), dynamic gait index (DGI), Barthel index (BI), and world health-related quality-of-life (WHORQOL) scales were used. The rehabilitation lasted for six weeks. Tele-rehabilitation also plays a crucial impact in the recovery of patients. By the end of our rehabilitation, the patient significantly improved in performing activities of daily living and improved his quality of life. Tele-rehabilitation helped us stay connected with the patient.
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Affiliation(s)
- Sejal Gandhi
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anam R Sasun
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Deepali S Patil
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ali AS, Kumaran DS, Unni A, Sardesai S, Prabhu V, Nirmal P, Pai AR, Guddattu V, Arumugam A. Effectiveness of an Intensive, Functional, and Gamified Rehabilitation Program on Upper Limb Function in People With Stroke (EnteRtain): A Multicenter Randomized Clinical Trial. Neurorehabil Neural Repair 2024:15459683231222921. [PMID: 38284559 DOI: 10.1177/15459683231222921] [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: 01/30/2024]
Abstract
BACKGROUND1 Despite a growing interest in gaming rehabilitation for upper limb (UL) recovery post-stroke, studies investigating the effects of game-based rehabilitation incorporating functional games are lacking. OBJECTIVE To investigate the efficacy of an intensive, functional, gamified rehabilitation program compared to task-based training on UL motor function in acute/sub-acute stroke survivors. METHODS This randomized, multicenter, single-blind, clinical trial comprises 120 participants with unilateral stroke who were randomized to receive either gamified training (n = 64) using the ArmAble™ [experimental group (EG)] or task-based training (n = 56) in conjunction with conventional therapy for 2 hours per day, 6 days per week for 2 weeks, followed by UL rehabilitation for another 4 weeks at home. Primary outcomes evaluated by a blinded assessor included the Fugl-Meyer Assessment-Upper Extremity (FM-UE), and Action Research Arm Test (ARAT). Data were analyzed using a linear mixed-effect regression model. RESULTS The mean (standard deviation) age of the participants was 54.4 ± 11.7 years (78.1% men) in the EG and 57.7 ± 10.9 years (73.2% men) in the comparator group (CG). The median (interquartile range) time since stroke was 30.0 (54.0) days in the EG and 22.5 (45.0) days in the CG. Following the 2-week intervention, a statistically significant improvement was observed in the EG for the FM-UE [between-group mean differences (95% confidence interval): -3.9 (-6.5, -1.3); P = .003]; but not for the ARAT [-2.9 (-5.8, 0.0); P = .051]. Gains at 6 weeks were significantly greater in the EG for both FM-UE [-3.9 (-6.5, -1.3); P = .003]; and ARAT [-3.0 (-5.9, -0.0); P = .046]. CONCLUSION Gamified rehabilitation using the ArmAble™ device has shown immediate and short-term improvement in UL function after acute/sub-acute stroke. CLINICAL TRIALS REGISTRY NUMBER CTRI/2020/09/027651.
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Affiliation(s)
- A Sulfikar Ali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - D Senthil Kumaran
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Amritha Unni
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sanjukta Sardesai
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Prabhu
- Department of Physiotherapy, SDM Ayurveda Hospital, Udupi, Karnataka, India
| | - Punitha Nirmal
- Department of Physiotherapy, Poovanthi Institute of Rehabilitation and Elder care, Poovanthi, Tamil Nadu, India
| | - Aparna R Pai
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vasudeva Guddattu
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashokan Arumugam
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS-Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah, UAE
- Sustainable Engineering Asset Management Research Group, RISE-Research Institute of Sciences and Engineering, University of Sharjah, Sharjah, UAE
- Adjunct Faculty, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Rojo A, Castrillo Calvillo A, López C, Raya R, Moreno JC. Effects of a Virtual Reality Cycling Platform on Lower Limb Rehabilitation in Patients With Ataxia and Hemiparesis: Pilot Randomized Controlled Trial. JMIR Serious Games 2024; 12:e39286. [PMID: 38180843 PMCID: PMC10786335 DOI: 10.2196/39286] [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: 05/05/2022] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 01/07/2024] Open
Abstract
Background New interventions based on motor learning principles and neural plasticity have been tested among patients with ataxia and hemiparesis. Therapies of pedaling exercises have also shown their potential to induce improvements in muscle activity, strength, and balance. Virtual reality (VR) has been demonstrated as an effective tool for improving the adherence to physical therapy, but it is still undetermined if it promotes greater improvements than conventional therapy. Objective Our objective was to compare the effect on lower limb range of motion (ROM) when using VR technology for cycling exercise versus not using VR technology. Methods A randomized controlled trial with 20 patients with ataxia and hemiparesis was carried out. The participants were divided into 2 groups: the experimental group (n=10, 50%) performed pedaling exercises using the VR system and the control group (n=10, 50%) performed pedaling exercises without using VR. Measurements of the active and passive ROM of the hip and knee joint were taken before and after a cycling intervention, which consisted of 3 sessions of the same duration but with progressively increasing speeds (4, 5, and 6 km/h). Repeated measures ANOVAs were conducted to compare the preintervention (Ti) and postintervention (Te) assessments within each group. Additionally, the improvement effect of using the VR system was analyzed by comparing the variation coefficient (Δ = 1 - [Te / Ti]) between the preintervention and postintervention assessments for each group. Group comparisons were made using independent 1-tailed t tests. Results Significant improvements were shown in active left hip flexion (P=.03) over time, but there was no group-time interaction effect (P=.67). Passive left hip flexion (P=.93) did not show significant improvements, and similar results were observed for active and passive right hip flexion (P=.39 and P=.83, respectively). Neither assessments of knee flexion (active left: P=.06; passive left: P=.76; active right: P=.34; passive right: P=.06) nor knee extension showed significant changes (active left: P=.66; passive left: P=.92; active right: P=.12; passive right: P=.38). However, passive right knee extension (P=.04) showed a significant improvement over time. Overall, although active and passive ROM of the knee and hip joints showed a general improvement, no statistically significant differences were found between the groups. Conclusions In this study, participants who underwent the cycling intervention using the VR system showed similar improvement in lower limb ROM to the participants who underwent conventional training. Ultimately, the VR system can be used to engage participants in physical activity.
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Affiliation(s)
- Ana Rojo
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
- Neural Rehabilitation Group, Spanish National Research Council, Cajal Institute, Madrid, Spain
| | | | | | - Rafael Raya
- Departamento de Tecnologías de la Información, Escuela Politécnica Superior, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | - Juan C Moreno
- Neural Rehabilitation Group, Spanish National Research Council, Cajal Institute, Madrid, Spain
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Hussain A, Singh A, Arora S, Gupta V, Mallimala PR. Late Presentation of β-Thalassemia Major Patient With Left Hemiparesis: A Case Report. Cureus 2024; 16:e52280. [PMID: 38357056 PMCID: PMC10864937 DOI: 10.7759/cureus.52280] [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] [Accepted: 01/14/2024] [Indexed: 02/16/2024] Open
Abstract
Thalassemia is a hereditary autosomal recessive disorder that is distinguished by a diminished rate of hemoglobin (Hb) synthesis arising from an anomaly in the synthesis of α or β globin chains. Classical symptoms of β-thalassemia are frequently observed in patients who present late for blood transfusion (BT), which is typical among South Asian countries in light of their limited resources. This case report is an uncommon instance of a typical occurrence that has been infrequently reported in the South Asian region. The reporting of this case will assist healthcare workers in managing cases appropriately. We present a 12-year-old female child diagnosed with β-thalassemia major with a late presentation than usual accompanied by an unusual finding of left hemiparesis at a young age of five years. The patient had been lost to follow-up, presented with easy fatiguability, poor weight gain, and growth restriction, all of which are classic symptoms of β-thalassemia. The patient was treated with a BT and continued to be monitored for transfusion and iron overload management.
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Affiliation(s)
- Ashwaq Hussain
- Hematology, Thalassemia and Sickle Cell Society, Kurnool, IND
| | - Ajay Singh
- Internal Medicine, Sri Ram Murti Smarak Institute of Medical Sciences, Bareilly, IND
| | - Sanjiya Arora
- Internal Medicine, Rohilkhand Medical College and Hospital, Bareilly, IND
| | - Varnika Gupta
- Internal Medicine, Lala Lajpat Rai Memorial Medical College, Meerut, IND
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18
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Oh Y, Choi SA, Shin Y, Jeong Y, Lim J, Kim S. Investigating Activity Recognition for Hemiparetic Stroke Patients Using Wearable Sensors: A Deep Learning Approach with Data Augmentation. Sensors (Basel) 2023; 24:210. [PMID: 38203072 PMCID: PMC10781277 DOI: 10.3390/s24010210] [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] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/23/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
Measuring the daily use of an affected limb after hospital discharge is crucial for hemiparetic stroke rehabilitation. Classifying movements using non-intrusive wearable sensors provides context for arm use and is essential for the development of a home rehabilitation system. However, the movement classification of stroke patients poses unique challenges, including variability and sparsity. To address these challenges, we collected movement data from 15 hemiparetic stroke patients (Stroke group) and 29 non-disabled individuals (ND group). The participants performed two different tasks, the range of motion (14 movements) task and the activities of daily living (56 movements) task, wearing five inertial measurement units in a home setting. We trained a 1D convolutional neural network and evaluated its performance for different training groups: ND-only, Stroke-only, and ND and Stroke jointly. We further compared the model performance with data augmentation from axis rotation and investigated how the performance varied based on the asymmetry of movements. The joint training of ND + Stroke yielded an increased F1-score by a margin of 31.6% and 10.6% compared to ND-only training and Stroke-only training, respectively. Data augmentation further enhanced F1-scores across all conditions by an average of 11.3%. Finally, asymmetric movements decreased the F1-score by 25.9% compared to symmetric movements in the Stroke group, indicating the importance of asymmetry in movement classification.
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Affiliation(s)
- Youngmin Oh
- School of Computing, Gachon University, Seongnam 13120, Republic of Korea;
| | - Sol-A Choi
- Department of Physical Therapy, Jeonju University, Jeonju 55069, Republic of Korea; (S.-A.C.); (Y.S.); (Y.J.)
| | - Yumi Shin
- Department of Physical Therapy, Jeonju University, Jeonju 55069, Republic of Korea; (S.-A.C.); (Y.S.); (Y.J.)
| | - Yeonwoo Jeong
- Department of Physical Therapy, Jeonju University, Jeonju 55069, Republic of Korea; (S.-A.C.); (Y.S.); (Y.J.)
| | - Jongkuk Lim
- Department of Computer Engineering, Dankook University, Yongin 16890, Republic of Korea;
| | - Sujin Kim
- Department of Physical Therapy, Jeonju University, Jeonju 55069, Republic of Korea; (S.-A.C.); (Y.S.); (Y.J.)
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Ota H, Mukaino M, Inoue Y, Matsuura S, Yagi S, Kanada Y, Saitoh E, Otaka Y. Movement Component Analysis of Reaching Strategies in Individuals With Stroke: Preliminary Study. JMIR Rehabil Assist Technol 2023; 10:e50571. [PMID: 38051570 PMCID: PMC10731574 DOI: 10.2196/50571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. OBJECTIVE This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. METHODS A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. RESULTS A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5%, SD 24.5% vs mean 85.2%, SD 4.5%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0%, SD 28.5% vs mean 3.0%, SD 2.8%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8%, SD 23.7% vs mean 90.7%, SD 11.8%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5%, SD 5.7% vs mean 6.5%, SD 3.0%; P=.02 and mean 16.5%, SD 18.7% vs mean 3.0%, SD 10.4%; P=.02, respectively). CONCLUSIONS Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation.
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Affiliation(s)
- Hirofumi Ota
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yukari Inoue
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Shoh Matsuura
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Senju Yagi
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan
| | - Yoshikiyo Kanada
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Eiichi Saitoh
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Hanakawa T, Hotta F, Nakamura T, Shindo K, Ushiba N, Hirosawa M, Yamazaki Y, Moriyama Y, Takagi S, Mizuno K, Liu M. Macrostructural Cerebellar Neuroplasticity Correlates With Motor Recovery After Stroke. Neurorehabil Neural Repair 2023; 37:775-785. [PMID: 37882368 DOI: 10.1177/15459683231207356] [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: 10/27/2023]
Abstract
BACKGROUND Motor recovery varies across post-stroke individuals, some of whom require a better rehabilitation strategy. We hypothesized that macrostructural neuroplasticity of the motor control network including the cerebellum might underlie individual differences in motor recovery. Objectives. To gain insight into the macrostructural neuroplasticity after stroke, we examined 52 post-stroke individuals using both the Fugl-Meyer assessment and structural magnetic resonance imaging. METHODS We performed voxel-based lesion symptom mapping and cross-sectional voxel-based morphometry to correlate the motor scores with the lesion location and the gray matter volume (GMV), respectively. Longitudinal data were available at ~8 and/or 15 weeks after admission from 43 individuals with supratentorial lesions. We performed a longitudinal VBM analysis followed by a multiple regression analysis to correlate between the changes of the motor assessment scores and those of GMV overtime. RESULTS We found a cross-sectional correlation of residual motor functioning with GMV in the ipsilesional cerebellum and contralesional parietal cortex. Longitudinally, we found increases in GMV in the ipsilesional supplementary motor area, and the ipsilesional superior and inferior cerebellar zones, along with a GMV decrease in the ipsilesional thalamus. The motor recovery was correlated with the GMV changes in the superior and inferior cerebellar zones. The regaining of upper-limb motor functioning was correlated with the GMV changes of both superior and inferior cerebellum while that of lower-limb motor functioning with the GMV increase of the inferior cerebellum only. CONCLUSIONS The present findings support the hypothesis that macrostructural cerebellar neuroplasticity is correlated with individual differences in motor recovery after stroke.
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Affiliation(s)
- Takashi Hanakawa
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Fujiko Hotta
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Tatsuhiro Nakamura
- Department of Integrated Neuroanatomy and Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Keiichiro Shindo
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Hikarigaoka Hospital, Takaoka, Japan
| | - Naoko Ushiba
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
- Department of Rehabilitation Medicine, Setagaya Memorial Hospital, Tokyo, Japan
| | | | | | | | - Syota Takagi
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Physical Rehabilitation, National Center Hospital, National Center of Neurology and Psychiatry Hospital, Kodaira, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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21
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Kipnis D, Kruusamäe H, King M, Schreier AR, Quinn L, Shih HJS. Dance interventions for individuals post-stroke - a scoping review. Top Stroke Rehabil 2023; 30:768-785. [PMID: 35968809 DOI: 10.1080/10749357.2022.2107469] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/24/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND There is a growing body of literature assessing the potential benefits of dance for individuals post-stroke. OBJECTIVES We conducted a scoping review mapping the state of the literature on feasibility, intervention procedures, and efficacy of dance to improve health-related outcomes for individuals post-stroke. ELIGIBILITY CRITERIA Included studies were original research that described the use of a dance intervention for individuals post-stroke, included any health-related outcome, and were written in English. SOURCES OF EVIDENCE Databases selected were Pubmed, Scopus, Google Scholar, Proquest, MedRxiv, and CINHAL. CHARTING METHODS Two reviewers extracted relevant data and results were organized into themes and categories determined by all authors through discussion. RESULTS We searched electronic databases were in February 2021. We included 18 publications from 14 studies. Ten were quantitative, five were qualitative, one was mixed-methods, and two were community project descriptions. Twelve publications evaluated in-person dance classes and six evaluated dance exergaming. Based on the limited studies included, evidence suggests dance is a feasible and potentially effective intervention for individuals post-stroke. Studies demonstrate dance may facilitate changes in balance and fall risk, encourage confidence, promote comfort with the changed body, increase rehabilitation motivation, and facilitate community reintegration. Evidence is limited by number of studies, design (lack of control groups and blinded assessments), intervention descriptions, and outcomes reporting. CONCLUSIONS There is growing interest in dance for stroke interventions. Further research should focus on rigorous study design, optimal intervention timing, consistency of reporting outcomes, key elements of dance classes, and the impact of cultural dance styles.
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Affiliation(s)
- Danielle Kipnis
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY, USA
| | - Helena Kruusamäe
- Institute of Sport Sciences and Physiotherapy, University of Tartu
- Estonian Military Academy
| | - Miriam King
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY, USA
| | - Abigail R Schreier
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY, USA
- Department of Rehabilitation and Regenerative Medicine (Physical Therapy), Columbia University Irving Medical Center
| | - Hai-Jung Steffi Shih
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York City, NY, USA
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22
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Ohtsuka K, Mukaino M, Yamada J, Fumihiro M, Tanikawa H, Tsuchiyama K, Teranishi T, Saitoh E, Otaka Y. Effects of ankle-foot orthosis on gait pattern and spatiotemporal indices during treadmill walking in hemiparetic stroke. Int J Rehabil Res 2023; 46:316-324. [PMID: 37755385 PMCID: PMC10619636 DOI: 10.1097/mrr.0000000000000602] [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] [Received: 05/24/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023]
Abstract
Ankle-foot orthosis (AFO) is known to correct abnormal gait patterns and improve walking stability and speed in patients with hemiparesis. To quantify these benefits in post-stroke gait, a three-dimensional motion analysis of gait pattern was conducted. Forty patients with hemiparesis were enrolled. A three-dimensional motion analysis system was used to analyze patients' treadmill walking with/without an AFO. Outcome measures were 12 abnormal gait indices (forefoot contact, knee extensor thrust, retropulsion of the hip, flexed-knee gait, medial whip in the stance phase, circumduction gait, hip hiking, insufficient knee flexion during the swing phase, excessive lateral shifting of the trunk, contralateral vaulting, excessive hip external rotation, and posterior pelvic tilt), calculated using kinematic data and spatiotemporal indices, and the symmetry index of double-stance and single-stance time and step length. Forefoot contact (without AFO vs. with AFO: 71.0 vs. 65.8, P < 0.001), circumduction gait (65.0 vs. 57.9, P < 0.001), and contralateral vaulting (78.2 vs. 72.2, P = 0.003) were significantly reduced, whereas excessive hip external rotation (53.7 vs. 62.8, P = 0.003) significantly increased during walking with an AFO. Hip hiking (77.1 vs. 71.7) showed marginal reduction with the use of AFO ( P = 0.096). The absolute symmetry index of double-stance time (21.9 vs. 16.1, P = 0.014) significantly decreased during walking with an AFO. AFO effectively mitigates abnormal gait patterns typical of hemiparetic gait. A 3D motion analysis system with clinically oriented indices can help assess intervention efficacy for gait abnormalities.
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Affiliation(s)
- Kei Ohtsuka
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Masahiko Mukaino
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Hokkaido
| | - Junya Yamada
- Department of Rehabilitation, Fujita Health University Hospital
| | - Matsuda Fumihiro
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Hiroki Tanikawa
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Kazuhiro Tsuchiyama
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | - Toshio Teranishi
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi
| | | | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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23
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Knutson JS, Fu MJ, Cunningham DA, Hisel TZ, Friedl AS, Gunzler DD, Plow EB, Busch RM, Pundik S. Contralaterally controlled functional electrical stimulation video game therapy for hand rehabilitation after stroke: a randomized controlled trial. Disabil Rehabil 2023:1-10. [PMID: 37962171 DOI: 10.1080/09638288.2023.2278174] [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: 04/27/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To estimate the effect of integrating custom-designed hand therapy video games (HTVG) with contralaterally controlled functional electrical stimulation (CCFES) therapy. METHODS Fifty-two stroke survivors with chronic (>6 months) upper limb hemiplegia were randomized to 12 weeks of CCFES or CCFES + HTVG. Treatment involved self-administration of technology-mediated therapy at home plus therapist-administered CCFES-assisted task practice in the lab. Pre- and post-treatment assessments were made of hand dexterity, upper limb impairment and activity limitation, and cognitive function. RESULTS No significant between-group differences were found on any outcome measure, and the average magnitudes of improvement within both groups were small. The incidence of technical problems with study devices at home was greater for the CCFES + HTVG group. This negatively affected adherence and may partially explain the absence of effect of HTVG. At end-of-treatment, large majorities of both treatment groups had positive perceptions of treatment efficacy and expressed enthusiasm for the treatments. CONCLUSION This study makes an important contribution to the research literature on the importance of environmental factors, concomitant impairments, and technology simplification when designing technology-based therapies intended to be self-administered at home. This study failed to show any added benefit of HTVG to CCFES therapy.Clinicaltrials.gov (NCT03058796).
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Affiliation(s)
- Jayme S Knutson
- Research Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Fu
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - David A Cunningham
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA
| | - Terri Z Hisel
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Amy S Friedl
- Department of Physical Medicine and Rehabilitation, The MetroHealth System, Cleveland, OH, USA
| | - Douglas D Gunzler
- Center for Healthcare Research and Policy, The MetroHealth System, Cleveland, OH, USA
- Population Health and Equity Research Institute, The MetroHealth System, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Rehabilitation Hospitals, Cleveland, OH, USA
| | - Robyn M Busch
- Departments of Neurology and Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Svetlana Pundik
- Neurology Service, Louis Stokes Cleveland VA Medical Center, Veterans Affairs Northeast OH Healthcare System, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
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24
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Zhang Z, Chi J, Xu Z, Hadeed M, Knox H, Cui Q. Outcomes Following Hemiarthroplasty for Femoral Neck Fracture in Patients Who Have Hemiparesis. J Arthroplasty 2023; 38:2342-2346.e1. [PMID: 37271234 DOI: 10.1016/j.arth.2023.05.051] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Hemiparesis increases the risk of femoral neck fracture (FNF) in the elderly, which frequently necessitates hemiarthroplasty. There are limited reports on the outcomes of hemiarthroplasty in patients who have hemiparesis. The purpose of this study was to evaluate hemiparesis as a potential risk factor for medical and surgical complications following hemiarthroplasty. METHODS Hemiparetic patients who have concomitant FNF and underwent hemiarthroplasty with at least 2 years of follow-up were identified using a national insurance database. A 10:1 matched control cohort of patients who did not have hemiparesis was created for comparison. There were 1,340 patients who have and 12,988 patients who did not have hemiparesis undergoing hemiarthroplasty for FNF. Multivariate logistic regression analyses were used to evaluate rates of medical and surgical complications between the 2 cohorts. RESULTS Aside from increased rates of medical complications including cerebrovascular accident (P < .001), urinary tract infection (P = .020), sepsis (P = .002), and myocardial infarction (P < .001), patients who have hemiparesis also experienced higher rates of dislocation within 1 and 2 years (Odds Ratio (OR) 1.54, P = .009; OR 1.52, P = .010). Hemiparesis was not associated with higher risk of wound complications, periprosthetic joint infection, aseptic loosening, and periprosthetic fracture, but was associated with higher incidence of 90-day ED-visits (OR 1.16, P = .031) and 90-day readmission (OR 1.32, P < .001). CONCLUSION While patients who have hemiparesis do not have increased risk of implant-related complications other than dislocation, they are at increased risk of developing medical complications following hemiarthroplasty for FNF.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia; Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhixiu Xu
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Weihui, Henan, China
| | - Michael Hadeed
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Haeli Knox
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
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25
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Uehara S, Yuasa A, Ushizawa K, Kitamura S, Yamazaki K, Otaka E, Otaka Y. Direction-dependent differences in the quality and quantity of horizontal reaching in people after stroke. J Neurophysiol 2023; 130:861-870. [PMID: 37667840 PMCID: PMC10649833 DOI: 10.1152/jn.00455.2022] [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: 11/02/2022] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/06/2023] Open
Abstract
Arm reaching is often impaired in individuals with stroke. Nonetheless, how aiming directions influence reaching performance and how such differences change with motor recovery over time remain unclear. Here, we elucidated kinematic parameters of reaching toward various directions in people with poststroke hemiparesis in the subacute phase. A total of 13 and 15 participants with mild and moderate-to-severe hemiparesis, respectively, performed horizontal reaching in eight directions with their more-affected and less-affected sides using an exoskeleton robotic device at the time of admission to and discharge from the rehabilitation ward of the hospital. The movement time, path length, and number of velocity peaks were computed for the mild group (participants able to reach toward all eight directions). In addition, the total amount of displacement (i.e., movement quantity) toward two simplified directions (mediolateral or anteroposterior) was evaluated for the moderate-to-severe group (participants who showed difficulty in completing the reaching task). Motor recovery was evaluated using the Fugl-Meyer assessment. The mild group showed worse values of movement parameters during reaching in the anteroposterior direction, irrespective of the side of the arm or motor recovery achieved. The moderate-to-severe group exhibited less movement toward the anteroposterior direction than toward the mediolateral direction at admission; however, this direction-dependent bias in movement quantity decreased, with the movement expanding toward the anteroposterior direction with motor recovery at discharge. These results suggest that direction-dependent differences in the quality and quantity of reaching performance exist in people after stroke, regardless of the presence or severity of hemiparesis. This highlights the need to consider the task work area when designing rehabilitative training.NEW & NOTEWORTHY Arm reaching, a fundamental function required for the upper extremities, is often impaired after stroke due to muscle weakness and abnormal synergies. Nonetheless, how aiming directions influence performance remains unclear. Here, we report that direction-dependent differences in the quality and quantity of reaching performance exist, surprisingly regardless of the presence or severity of hemiparesis. This result highlights the need to consider the task work area when designing rehabilitative training.
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Affiliation(s)
- Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kazuki Ushizawa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shin Kitamura
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Toyoake, Aichi, Japan
| | - Kotaro Yamazaki
- Department of Rehabilitation Medicine, Takekawa Hospital, Itabashi, Tokyo, Japan
| | - Eri Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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26
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Grosse L, Meuche AC, Parzefall B, Börner C, Schnabel JF, Späh MA, Klug P, Sollmann N, Klich L, Hösl M, Heinen F, Berweck S, Schröder SA, Bonfert MV. Functional Repetitive Neuromuscular Magnetic Stimulation (frNMS) Targeting the Tibialis Anterior Muscle in Children with Upper Motor Neuron Syndrome: A Feasibility Study. Children (Basel) 2023; 10:1584. [PMID: 37892247 PMCID: PMC10605892 DOI: 10.3390/children10101584] [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] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/29/2023]
Abstract
Non-invasive neurostimulation as an adjunctive intervention to task-specific motor training is an approach to foster motor performance in patients affected by upper motor neuron syndrome (UMNS). Here, we present first-line data of repetitive neuromuscular magnetic stimulation (rNMS) in combination with personalized task-specific physical exercises targeting the tibialis anterior muscle to improve ankle dorsiflexion (functional rNMS (frNMS)). The main objective of this pilot study was to assess the feasibility in terms of adherence to frNMS, safety and practicability of frNMS, and satisfaction with frNMS. First, during 10 training sessions, only physical exercises were performed (study period (SP) A). After a 1 week break, frNMS was delivered during 10 sessions (SPC). Twelve children affected by UMNS (mean age 8.9 ± 1.6 years) adhered to 93% (SPA) and 94% (SPC) of the sessions, and omittance was not related to the intervention itself in any case. frNMS was safe (no AEs reported in 88% of sessions, no AE-related discontinuation). The practicability of and satisfaction with frNMS were high. Patient/caregiver-reported outcomes revealed meaningful benefits on the individual level. The strength of the ankle dorsiflexors (MRC score) clinically meaningfully increased in four participants as spasticity of ankle plantar flexors (Tardieu scores) decreased in four participants after SPC. frNMS was experienced as a feasible intervention for children affected by UMNS. Together with the beneficial effects achieved on the individual level in some participants, this first study supports further real-world, large-scale, sham-controlled investigations to investigate the specific effects and distinct mechanisms of action of frNMS.
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Affiliation(s)
- Leonie Grosse
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Anne C. Meuche
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Barbara Parzefall
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Corinna Börner
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Julian F. Schnabel
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Malina A. Späh
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Pia Klug
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany
| | - Luisa Klich
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Matthias Hösl
- Gait and Motion Analysis Laboratory, Schoen Clinic Vogtareuth, Krankenhausstr. 20, 83569 Vogtareuth, Germany
| | - Florian Heinen
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Steffen Berweck
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- Specialist Center for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, 83569 Vogtareuth, Germany
| | - Sebastian A. Schröder
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
| | - Michaela V. Bonfert
- Division of Pediatric Neurology and Developmental Medicine, Department of Pediatrics—Dr. von Hauner Children’s Hospital, LMU Hospital, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
- LMU Center for Children with Medical Complexity—iSPZ Hauner, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
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Sasaki T, Murakami K, Saito A, Haryu S, Kameyama M, Takahashi Y, Takamuro S, Kato N, Endo T. Usefulness of Transcranial Motor Evoked Potential in Clipping Surgery for Cerebral Aneurysms-Introduction of a New Protocol for Stable Monitoring. Neurol Med Chir (Tokyo) 2023; 63:409-419. [PMID: 37380449 PMCID: PMC10556210 DOI: 10.2176/jns-nmc.2023-0007] [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] [Received: 01/21/2023] [Accepted: 04/17/2023] [Indexed: 06/30/2023] Open
Abstract
The usefulness of transcranial motor evoked potentials (Tc-MEPs) in clipping surgery has been reported. However, numerous false positive and false negative cases were reported. We report the usefulness of a new protocol compared with direct cortical MEP (Dc-MEP).Materials were 351 patients who underwent aneurysmal clipping under simultaneous monitoring of Tc- and Dc-MEPs. A total of 337 patients without hemiparesis and 14 with hemiparesis were separately analyzed. Intraoperative changes of Tc-MEP thresholds were examined in the first 50 patients without hemiparesis. The stimulation strength of Tc-MEP was set at +20% of the stimulation threshold. As thresholds changed intraoperatively, thresholds were examined every 10 min and changed stimulation strength.Stimulation thresholds of Tc-MEP were significantly decreased after craniotomy and significantly increased after CSF aspiration. The recording ratios of Tc- and Dc-MEPs were 98.8% and 90.5%, respectively. Out of 304 patients without MEP change, 5 patients developed transient or mild hemiparesis with infarction of the territory of the perforating artery arising from the posterior communicating artery. Out of 31 patients whose MEP transiently disappeared, 3 patients developed transient or mild hemiparesis. The other two patients without MEP recovery manifested persistent hemiparesis. In 14 patients with preoperative hemiparesis, 3 patients whose healthy/affected ratio of Tc-MEP was large developed severe persistent hemiparesis.We clarified the intraoperative changes of Tc-MEP thresholds for the first time. A new protocol of Tc-MEP that followed thresholds and changed stimulation strength to +20% of thresholds is useful for stable monitoring. The usefulness of Tc-MEP is the same as that or better than that of Dc-MEP.
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Affiliation(s)
- Tatsuya Sasaki
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University
| | | | | | - Shinya Haryu
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University
| | - Masayuki Kameyama
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University
| | | | - Satoru Takamuro
- School of Medicine, Tohoku Medical and Pharmaceutical University
| | - Nana Kato
- School of Medicine, Tohoku Medical and Pharmaceutical University
| | - Toshiki Endo
- Division of Neurosurgery, Tohoku Medical and Pharmaceutical University
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Patel RS, Bartoletta JJ, Munaretto NF, Tagliero AJ, Rhee PC. Nonoperative Management of Humerus Fractures in Patients With Ispilateral Hemiparesis or Hemiplegia. Hand (N Y) 2023; 18:1027-1036. [PMID: 35189735 PMCID: PMC10470230 DOI: 10.1177/15589447211073835] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Patients with upper limb dysfunction from a brain injury often have different goals of treatment and expectations following a fracture of the upper extremity. This study retrospectively reviewed outcomes of nonoperative management of acute humerus fractures in patients with severe ipsilateral hemiparesis or hemiplegia. METHODS Patients who had sustained an acute humerus fracture managed nonoperatively, greater than 1 year following an upper motor neuron (UMN) injury resulting in ipsilateral severe hemiparesis or hemiplegia at a single tertiary care center from 1988 to 2019, were reviewed. Fractures were classified using the AO-Müller/Orthopaedic Trauma Association and/or Neer classifications. Primary outcome measures included House classification level of function, pain, achievement of and time to radiographic union, and the need for subsequent surgical procedures. RESULTS Ten distinct nonoperatively managed humerus fractures-3 proximal (11A23), 5 mid-shaft (12A2b = 1, 12A2c = 2, 12A3a = 1, 12A2b = 1), and 2 distal (13A2 = 1, 13 C1 = 1)-were identified in 8 patients (6 women and 2 men) with ipsilateral hemiparesis or hemiplegia. The median radiographic follow-up was 20 months (range: 78 days to 12 years). The median clinical follow-up was 33.5 months (range: 100 days to 12 years). All patients presented with severe pain that was absent at final follow-up. Radiographic union was achieved in all patients with a mean time to union of 90.9 ± 39.3 days (range: 35-185 days). No patients required operative management. CONCLUSIONS Nonoperative management of humerus fractures in patients with an ipsilateral UMN injury might result in reliable pain relief and union without the need for further surgical intervention. Management of humerus fractures in this patient population should be individualized toward their goals of care.
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Affiliation(s)
| | | | | | | | - Peter C. Rhee
- Mayo Clinic, Rochester, MN, USA
- Travis Air Force Base, CA, USA
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29
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Hutin E, Ghédira M, Vinti M, Tazi S, Gracies JM, Decq P. Comparing the Effect of Implanted Peroneal Nerve Stimulation and Ankle-Foot Orthosis on Gait Kinematics in Chronic Hemiparesis: A Randomized Controlled Trial. J Rehabil Med 2023; 55:jrm7130. [PMID: 37548420 PMCID: PMC10424098 DOI: 10.2340/jrm.v55.7130] [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] [Received: 01/11/2023] [Accepted: 05/31/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Impaired ankle dorsiflexion in hemiparesis may be treated with ankle-foot orthosis or functional electrical stimulation. Semi-implanted selective functional electrical stimulation uses independent stimulations of deep and superficial peroneal nerves. The aim of this study was to compare gait kinematics using ankle-foot orthosis or semi-implanted selective functional electrical stimulation over 6 months in hemiparesis. METHODS Subjects with chronic hemiparesis, randomized into ankle-foot orthosis or semi-implanted selective functional electrical stimulation groups, underwent comfortable gait analysis without and with device OFF and ON, before, and 3 and 6 months after treatment onset. The effects of condition, visit and group on gait kinematics (analysis of variance; ANOVA) were analysed. RESULTS A total of 27 subjects were included (ankle-foot orthosis, n = 13; semi-implanted selective functional electrical stimulation, n = 14). The only between-group difference in changes from OFF to ON conditions was a deteriorated ankle dorsiflexion speed with ankle-foot orthosis at month 6 (condition*group, p = 0.04; ankle-foot orthosis, -60%, p = 0.02; semi-implanted selective functional electrical stimulation, non significant). Both groups pooled, from OFF to ON gait speed (+ 0.07 m/s; + 10%), cadence (+ 4%), step length (+ 6%) and peak ankle dorsiflexion (+ 6°) increased, and peak ankle inversion (-5°) and peak knee flexion (-2°) decreased (p < 0.001); finally, peak knee flexion in the OFF condition increased (+ 2°, p = 0.03). CONCLUSION Semi-implanted selective functional electrical stimulation and ankle-foot orthosis similarly impacted gait kinematics in chronic hemiparesis after 6 months of use. Ankle dorsiflexion speed in swing deteriorated markedly with ankle-foot orthosis.
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Affiliation(s)
- Emilie Hutin
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France.
| | - Mouna Ghédira
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Maria Vinti
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France
| | - Sanaa Tazi
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Jean-Michel Gracies
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France
| | - Philippe Decq
- Laboratoire Analyse et Restauration du Mouvement, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France; Service de Neurochirurgie, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil; Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Université Paris XIII, Paris, France
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Marzooq FA. Pediatric Antiphospholipid Syndrome Presenting as a Massive Stroke: A Case Report. Cureus 2023; 15:e43834. [PMID: 37736449 PMCID: PMC10511209 DOI: 10.7759/cureus.43834] [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] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Pediatric strokes are infrequent yet impactful occurrences with distinct challenges due to their unique pathophysiology and diagnostic complexities. Antiphospholipid syndrome, an autoimmune disorder characterized by antiphospholipid antibodies, can lead to prothrombotic states causing vascular occlusions. Here, we present the case of a previously healthy two-year-old girl who presented with sudden right-sided hemiparesis and altered consciousness. Comprehensive assessments and evaluations revealed a diagnosis of a massive left middle cerebral artery ischemic stroke secondary to antiphospholipid syndrome. The patient received intensive care, antiplatelet therapy, and supportive measures. Gradual improvement in neurological status and motor skills was observed during hospitalization, and the patient underwent comprehensive rehabilitation. This case emphasizes the importance of vigilance, thorough diagnostic evaluation, and tailored treatment strategies. Anticoagulation therapy plays a pivotal role, necessitating a delicate balance between thrombosis prevention and bleeding risk. The significance of multidisciplinary approaches and specialized care for pediatric stroke cases is underscored.
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Hong W, Zhang X, Liu Z, Li M, Yu Z, Zhao G, Wang Y, Sun C, Yang B, Xu R, Zhao Z. MRI Assessment of the Relationship Between Cortical Morphological Features and Hemiparetic Motor-Related Outcomes in Chronic Subcortical Stroke Patients. J Magn Reson Imaging 2023; 58:571-580. [PMID: 36440811 DOI: 10.1002/jmri.28542] [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] [Received: 09/20/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND It is unclear which cortical regions are specific to or commonly associated with the impairments of the upper/lower limbs and the activities of daily life (ADL) in stroke patients. PURPOSE To investigate the relationships between MRI-assessed surface-based morphometry (SBM) features and motor function as well as ADL in participants with chronic stroke. STUDY TYPE Prospective. SUBJECTS Thirty-five participants with subcortical stroke more than 3 months from the first-onset (age: 56.44 ± 9.56 years; 32 male). FIELD STRENGTH/SEQUENCE T1 -weighted images, 3.0 T, three-dimensional fast field-echo sequence. ASSESSMENT FreeSurfer (6.0) was used to parcellate each hemisphere into 34 regions based on the Desikan-Killiany atlas and to extract the surface area, volume, thickness, and curvature. The motor function and ADL were assessed by the Fugl-Meyer Assessment for the Upper/Lower Extremity (FMA-UE/FMA-LE) and the Chinese version of the Modified Barthel Index (MBI-C), respectively. STATISTICAL TESTS A linear mixed-effect model was applied to evaluate the relationship between the morphological features and the FMA-UE, FMA-LE, and MBI-C. A false discovery rate corrected P value < 0.05 was considered statistically significant. RESULTS Correlations between the size of stroke lesion and MRI measurements did not pass the FDR correction (adjusted P > 0.05). SBM features in motor-related and high-order cognitive cortical regions showed significant correlations with FMA-UE and FMA-LE, respectively. Moreover, the thickness in the prefrontal cortex significantly positively correlated, while the surface area in the right supramarginal gyrus significantly negatively correlated, with both FMA-UE, FMA-LE, and MBI-C. The thickness in the left frontal lobe significantly positively correlated with both FMA-UE and MBI-C. DATA CONCLUSION This study's findings suggest that different hemiparetic motor-related outcomes in participants with subcortical stroke which suffered a corticospinal tract-related injury show specific, but also share common, associations with several cortical regions. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Wenjun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zaixing Liu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ming Li
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhixuan Yu
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Guanchun Zhao
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuxin Wang
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Cuiyun Sun
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Yang
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Rong Xu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
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DeLuca SC, Trucks MR, Wallace D, Ramey SL. Evidence for Using ACQUIRE Therapy in the Clinical Application of Intensive Therapy: A Framework to Guide Therapeutic Interactions. Behav Sci (Basel) 2023; 13:484. [PMID: 37366736 DOI: 10.3390/bs13060484] [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: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
Intensive therapies have become increasingly popular for children with hemiparesis in the last two decades and are specifically recommended because of high levels of scientific evidence associated with them, including multiple randomized controlled trials and systematic reviews. Common features of most intensive therapies that have documented efficacy include: high dosages of therapy hours; active engagement of the child; individualized goal-directed activities; and the systematic application of operant conditioning techniques to elicit and progress skills with an emphasis on success-oriented play. However, the scientific protocols have not resulted in guiding principles designed to aid clinicians with understanding the complexity of applying these principles to a heterogeneous clinical population, nor have we gathered sufficient clinical data using intensive therapies to justify their widespread clinical use beyond hemiparesis. We define a framework for describing moment-by-moment therapeutic interactions that we have used to train therapists across multiple clinical trials in implementing intensive therapy protocols. We also document outcomes from the use of this framework during intensive therapies provided clinically to children (7 months-20 years) from a wide array of diagnoses that present with motor impairments, including hemiparesis and quadriparesis. Results indicate that children from a wide array of diagnostic categories demonstrated functional improvements.
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Affiliation(s)
- Stephanie C DeLuca
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
- The School of Neuroscience, Virginia Tech, Blacksburg, VA 24061, USA
- The Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA 24016, USA
| | - Mary Rebekah Trucks
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
| | - Dorian Wallace
- The Fralin Biomedical Research Institute's Neuromotor Clinic, Roanoke, VA 24016, USA
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Ko MJ, Chuang YC, Ou-Yang LJ, Cheng YY, Tsai YL, Lee YC. The Application of Soft Robotic Gloves in Stroke Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Brain Sci 2023; 13:900. [PMID: 37371378 DOI: 10.3390/brainsci13060900] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Wearable robotic devices have been strongly put into use in both the clinical and research fields of stroke rehabilitation over the past decades. This study aimed to explore the effectiveness of soft robotic gloves (SRGs) towards improving the motor recovery and functional abilities in patients with post-stroke hemiparesis. Five major bibliographic databases, PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, were all reviewed for enrollment regarding comparative trials prior to 7 March 2023. We included adults with stroke and compared their rehabilitation using SRGs to conventional rehabilitation (CR) on hand function in terms of the Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE), Fugl-Meyer Distal Upper Extremity Motor Assessment (FMA-distal UE), box and blocks test score, grip strength test, and the Jebsen-Taylor hand function test (JTT). A total of 8 studies, comprising 309 participants, were included in the analysis. Compared to CR, rehabilitation involving SRGs achieved better FMA-UE (MD 6.52, 95% CI: 3.65~9.39), FMA-distal UE (MD 3.27, 95% CI: 1.50~5.04), and JJT (MD 13.34, CI: 5.16~21.53) results. Subgroup analysis showed that stroke latency of more than 6 months and training for more than 30 min offered a better effect as well. In conclusion, for patients with stroke, rehabilitation using SRGs is recommended to promote the functional abilities of the upper extremities.
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Affiliation(s)
- Ming-Jian Ko
- Department of Education, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Ya-Chi Chuang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Liang-Jun Ou-Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan 333423, Taiwan
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yu-Chun Lee
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung 404401, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407224, Taiwan
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Affiliation(s)
- Bruce H Dobkin
- Department of Neurology, Neurologic Rehabilitation and Research Program, Geffen School of Medicine at UCLA, Reed Neurologic Research Center, Los Angeles, CA (B.H.D.)
| | - Ania Busza
- Department of Neurology, University of Rochester School of Medicine, NY (A.B.)
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Dantas MTAP, Fernani DCGL, Silva TDD, Assis ISAD, Carvalho ACD, Silva SB, Abreu LCD, Barbieri FA, Monteiro CBDM. Gait Training with Functional Electrical Stimulation Improves Mobility in People Post-Stroke. Int J Environ Res Public Health 2023; 20:ijerph20095728. [PMID: 37174247 PMCID: PMC10178257 DOI: 10.3390/ijerph20095728] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
(1) Background: Stroke is one of the leading causes of disability. To identify the best treatment strategies for people with stroke (PwS), the aim of the current study was to compare the effects of training on a treadmill with functional electrical stimulation (TT-FES) with training on a treadmill (TT), and to analyze the effects of sequence of training on mobility and the parameters of walking ability. (2) Methods: Prospective, longitudinal, randomized and crossover study, in which 28 PwS were distributed into groups, namely the A-B Group (TT-FES followed by TT) and B-A Group (TT followed by TT-FES), using the foot drop stimulator, and were measured with functional tests. (3) Results: We found improved mobility, balance, non-paretic limb coordination, and endurance only in the group that started with TT-FES. However, sensorimotor function improved regardless of the order of training, and paretic limb coordination only improved in the B-A Group, but after TT-FES. These data indicate that the order of the protocols changed the results. (4) Conclusions: Although biomechanical evaluation methods were not used, which can be considered a limitation, our results showed that TT-FES was superior to isolated training on a treadmill with regard to balance, endurance capacity, and coordination of the non-paretic limb.
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Affiliation(s)
- Maria Tereza Artero Prado Dantas
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo (EACH/USP), São Paulo 03828-000, Brazil
- Course of Physiotherapy, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Deborah Cristina Gonçalves Luiz Fernani
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- Course of Physiotherapy, University of West Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Talita Dias da Silva
- Postgraduate Program in Medicine (Cardiology) at Paulista School of Medicine, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04024-002, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Iramaia Salomão Alexandre de Assis
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | | | - Sidney Benedito Silva
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
| | - Luiz Carlos de Abreu
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- Department of Integrated Health Education, Federal University of Espírito Santo (UFES), Vitória 29040-090, Brazil
| | - Fabio Augusto Barbieri
- Department of Physical Education, Human Movement Research Laboratory (MOVI-LAB), São Paulo State University (UNESP), Bauru 17033-360, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Laboratory Design and Scientific Writing, Department of Basic Sciences, ABC Faculty of Medicine, Santo André 09060-650, Brazil
- School of Arts, Sciences and Humanities, University of São Paulo (EACH/USP), São Paulo 03828-000, Brazil
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Pila O, Duret C, Koeppel T, Jamin P. Performance-Based Robotic Training in Individuals with Subacute Stroke: Differences between Responders and Non-Responders. Sensors (Basel) 2023; 23:s23094304. [PMID: 37177508 PMCID: PMC10181678 DOI: 10.3390/s23094304] [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] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/17/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
The high variability of upper limb motor recovery with robotic training (RT) in subacute stroke underscores the need to explore differences in responses to RT. We explored differences in baseline characteristics and the RT dose between responders (ΔFugl-Meyer Assessment (FMA) score ≥ 9 points; n = 20) and non-responders (n = 16) in people with subacute stroke (mean [SD] poststroke time at baseline, 54 (26) days, baseline FMA score, 23 (17) points) who underwent 16 RT sessions combined with conventional therapies. Baseline characteristics were compared between groups. During RT sessions, the actual practice time (%), number of movements performed, and total distance covered (cm) in assisted and unassisted modalities were compared between groups. At baseline, participant characteristics and FMA scores did not differ between groups. During the RT, non-responders increased practice time (+15%; p = 0.02), performed more movements (+285; p = 0.004), and covered more distance (+4037 cm; p < 10-3), with no difference between physical modalities. In contrast, responders decreased practice time (-21%; p = 0.01) and performed fewer movements (-338; p = 0.03) in the assisted modality while performing more movements (+328; p < 0.05) and covering a greater distance (+4779 cm; p = 0.01) in unassisted modalities. Despite a large amount of motor practice, motor outcomes did not improve in non-responders compared to responders: the difficulty level in RT may have been too low for them. Future studies should combine robot-based parameters to describe the treatment dose, especially in people with severe-to-moderate arm paresis, to optimize the RT and improve the recovery prognosis.
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Affiliation(s)
- Ophélie Pila
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France
| | - Christophe Duret
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France
| | - Typhaine Koeppel
- Centre de Rééducation Fonctionnelle Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Neurorééducation, 77310 Boissise-Le-Roi, France
| | - Pascal Jamin
- Institut Robert Merle d'Aubigné, Rééducation et Appareillage, 94460 Valenton, France
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Maloney SR, Beckmann M, Wenger U, Widmer M, Odermatt U. Vascular dialysis access created in a paretic arm of a patient with a history of cerebral stroke: A case report. J Vasc Access 2023:11297298231168673. [PMID: 37070171 DOI: 10.1177/11297298231168673] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
A patent vascular access is of crucial importance for patients on dialysis. There is no literature describing the success rate and complications of creating dialysis fistulae in a paretic arm. In addition, the risk for non-maturation of dialysis fistula is thought to be high due to the inactivity, muscle atrophy, vascular changes, and higher risk of thrombosis in paretic limbs. Here we describe a case of a successful creation and maturation of a native dialysis fistula.
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Affiliation(s)
| | - Marianne Beckmann
- Department of Angiology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Ursula Wenger
- Department of Vascular Surgery, Luzerner Kantonsspital, Luzern, Switzerland
| | - Matthias Widmer
- Department of Vascular Surgery, University Hospital of Bern, Bern, Switzerland
| | - Urs Odermatt
- Department of Nephrology, Luzerner Kantonsspital, Luzern, Switzerland
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Murakami Y, Honaga K, Kono H, Haruyama K, Yamaguchi T, Tani M, Isayama R, Takakura T, Tanuma A, Hatori K, Wada F, Fujiwara T. New Artificial Intelligence-Integrated Electromyography-Driven Robot Hand for Upper Extremity Rehabilitation of Patients With Stroke: A Randomized, Controlled Trial. Neurorehabil Neural Repair 2023:15459683231166939. [PMID: 37039319 DOI: 10.1177/15459683231166939] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND An artificial intelligence (AI)-integrated electromyography (EMG)-driven robot hand was devised for upper extremity (UE) rehabilitation. This robot detects patients' intentions to perform finger extension and flexion based on the EMG activities of 3 forearm muscles. OBJECTIVE This study aimed to assess the effect of this robot in patients with chronic stroke. METHODS This was a single-blinded, randomized, controlled trial with a 4-week follow-up period. Twenty patients were assigned to the active (n = 11) and control (n = 9) groups. Patients in the active group received 40 minutes of active finger training with this robot twice a week for 4 weeks. Patients in the control group received passive finger training with the same robot. The Fugl-Meyer assessment of UE motor function (FMA), motor activity log-14 amount of use score (MAL-14 AOU), modified Ashworth scale (MAS), H reflex, and reciprocal inhibition were assessed before, post, and post-4 weeks (post-4w) of intervention. RESULTS FMA was significantly improved at both post (P = .011) and post-4w (P = .021) in the active group. The control group did not show significant improvement in FMA at the post. MAL-14 AOU was improved at the post in the active group (P = .03). In the active group, there were significant improvements in wrist MAS at post (P = .024) and post-4w (P = .026). CONCLUSIONS The AI-integrated EMG-driven robot improved UE motor function and spasticity, which persisted for 4 weeks. This robot hand might be useful for UE rehabilitation of patients with stroke.Clinical Trial Registry Name: The effect of robotic rehabilitation using XMM-HR2 for the paretic upper extremity among hemiparetic patients with stroke.Clinical Trial Registration-URL: https://jrct.niph.go.jp/Unique Identifier: jRCTs032200045.
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Affiliation(s)
- Yuhei Murakami
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hidemi Kono
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Koshiro Haruyama
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Juntendo University Faculty of Health Science, Tokyo, Japan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Juntendo University Faculty of Health Science, Tokyo, Japan
| | - Mami Tani
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Reina Isayama
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akira Tanuma
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Futoshi Wada
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Juntendo University Faculty of Health Science, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Juntendo University Faculty of Health Science, Tokyo, Japan
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Awad LN, Knarr BA, Kudzia P, Buchanan TS. The Interplay Between Walking Speed, Economy, and Stability After Stroke. J Neurol Phys Ther 2023; 47:75-83. [PMID: 36867550 PMCID: PMC10033356 DOI: 10.1097/npt.0000000000000431] [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] [Indexed: 03/04/2023]
Abstract
BACKGROUND AND PURPOSE Energy minimization is thought to underlie the naturally selected, preferred walking speed; however, people post-stroke walk slower than their most economical speed, presumably to optimize other objectives, such as stability. The purpose of this study was to examine the interplay between walking speed, economy, and stability. METHODS Seven individuals with chronic hemiparesis walked on a treadmill at 1 of 3 randomized speeds: slow, preferred, and fast. Concurrent measurements of speed-induced changes in walking economy (ie, the energy needed to move 1 kg of bodyweight 1 ml O 2 /kg/m) and stability were made. Stability was quantified as the regularity and divergence of the mediolateral motion of the pelvic center of mass (pCoM) during walking, as well as pCoM motion relative to the base of support. RESULTS Slower walking speeds were more stable (ie, pCoM motion was 10% ± 5% more regular and 26% ± 16% less divergent) but 12% ± 5% less economical. Conversely, faster walking speeds were 9% ± 8% more economical, but also less stable (ie, pCoM motion was 17% ± 5% more irregular). Individuals with slower walking speeds had an enhanced energetic benefit when walking faster ( rs = 0.96, P < 0.001). Individuals with greater neuromotor impairment had an enhanced stability benefit when walking slower ( rs = 0.86, P = 0.01). DISCUSSION AND CONCLUSIONS People post-stroke appear to prefer walking speeds that are faster than their most stable speed but slower than their most economical speed. The preferred walking speed after stroke appears to balance stability and economy. To encourage faster and more economical walking, deficits in the stable control of the mediolateral motion of the pCoM may need to be addressed.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A416 ).
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Affiliation(s)
- Louis N Awad
- Department of Physical Therapy, Boston University, Boston, Massachusetts, and Department of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts (L.N.A.); Department of Biomechanics, University of Nebraska at Omaha, Omaha (B.A.K.); Department of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada (P.K.); and Department of Mechanical Engineering, University of Delaware, Newark (T.S.B.)
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Alexander Muacevic, John R Adler. Selective Dorsal Rhizotomy For Treatment of Spasticity After Hemispherectomy In Children: A Case Report. Cureus; 15:e36945. [PMID: 37009349 PMCID: PMC10064527 DOI: 10.7759/cureus.36945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Performing a hemispherotomy or hemispherectomy is known to treat medically intractable epilepsy successfully, yet contralateral hemiparesis and increased muscle tone follow the epilepsy surgery. Spasticity and coexisting dystonia presumably cause the increased muscle tone in the lower extremity on the opposite side of epilepsy surgery. However, the extent of the role of spasticity and dystonia in high muscle tone is unknown. A selective dorsal rhizotomy is performed to reduce spasticity. If a selective dorsal rhizotomy is performed in the affected patient and muscle tone is reduced, the high muscle tone is not due to dystonia. Two children, who previously underwent a hemispherectomy or hemispherotomy, had a selective dorsal rhizotomy (SDR) performed in our clinic. Both children underwent orthopedic surgery to treat heel cord contractures. To study the extent of the role of spasticity and dystonia in high muscle tone, the mobility of the two children was examined pre- and post-SDR. The children had follow-ups 12 months and 56 months after SDR to study long-term effects. Before SDR, both children showed signs of spasticity. The SDR procedure removed spasticity, and muscle tone in the lower extremity became normal. Importantly, dystonia did not surface after SDR. Patients started independent walking less than two weeks after SDR. Sitting, standing, walking, and balance improved. They could walk longer distances while experiencing less fatigue. Running, jumping, and other more vigorous physical activities became possible. Notably, one child showed voluntary foot dorsiflexion that was absent before SDR. The other child showed improvement in voluntary foot dorsiflexion that was present before SDR. Both children maintained the progress at the 12 and 56-month follow-up visits. The SDR procedure normalized muscle tone and improved ambulation by removing spasticity. The high muscle tone following the epilepsy surgery was not due to dystonia.
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Ofir‐Geva S, Meilijson I, Frenkel‐Toledo S, Soroker N. Use of multi-perturbation Shapley analysis in lesion studies of functional networks: The case of upper limb paresis. Hum Brain Mapp 2023; 44:1320-1343. [PMID: 36206326 PMCID: PMC9921264 DOI: 10.1002/hbm.26105] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 11/07/2022] Open
Abstract
Understanding the impact of variation in lesion topography on the expression of functional impairments following stroke is important, as it may pave the way to modeling structure-function relations in statistical terms while pointing to constraints for adaptive remapping and functional recovery. Multi-perturbation Shapley-value analysis (MSA) is a relatively novel game-theoretical approach for multivariate lesion-symptom mapping. In this methodological paper, we provide a comprehensive explanation of MSA. We use synthetic data to assess the method's accuracy and perform parameter optimization. We then demonstrate its application using a cohort of 107 first-event subacute stroke patients, assessed for upper limb (UL) motor impairment (Fugl-Meyer Assessment scale). Under the conditions tested, MSA could correctly detect simulated ground-truth lesion-symptom relationships with a sensitivity of 75% and specificity of ~90%. For real behavioral data, MSA disclosed a strong hemispheric effect in the relative contribution of specific regions-of-interest (ROIs): poststroke UL motor function was mostly contributed by damage to ROIs associated with movement planning (supplementary motor cortex and superior frontal gyrus) following left-hemispheric damage (LHD) and by ROIs associated with movement execution (primary motor and somatosensory cortices and the ventral brainstem) following right-hemispheric damage (RHD). Residual UL motor ability following LHD was found to depend on a wider array of brain structures compared to the residual motor ability of RHD patients. The results demonstrate that MSA can provide a unique insight into the relative importance of different hubs in neural networks, which is difficult to obtain using standard univariate methods.
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Affiliation(s)
- Shay Ofir‐Geva
- Department of Neurological RehabilitationLoewenstein Rehabilitation Medical CenterRaananaIsrael
- Department of Rehabilitation Medicine, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Isaac Meilijson
- School of Mathematical SciencesTel Aviv UniversityTel AvivIsrael
| | | | - Nachum Soroker
- Department of Neurological RehabilitationLoewenstein Rehabilitation Medical CenterRaananaIsrael
- Department of Rehabilitation Medicine, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Carlson HL, Giuffre A, Ciechanski P, Kirton A. Electric field simulations of transcranial direct current stimulation in children with perinatal stroke. Front Hum Neurosci 2023; 17:1075741. [PMID: 36816507 PMCID: PMC9932338 DOI: 10.3389/fnhum.2023.1075741] [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: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Perinatal stroke (PS) is a focal vascular brain injury and the leading cause of hemiparetic cerebral palsy. Motor impairments last a lifetime but treatments are limited. Transcranial direct-current stimulation (tDCS) may enhance motor learning in adults but tDCS effects on motor learning are less studied in children. Imaging-based simulations of tDCS-induced electric fields (EF) suggest differences in the developing brain compared to adults but have not been applied to common pediatric disease states. We created estimates of tDCS-induced EF strength using five tDCS montages targeting the motor system in children with PS [arterial ischemic stroke (AIS) or periventricular infarction (PVI)] and typically developing controls (TDC) aged 6-19 years to explore associates between simulation values and underlying anatomy. Methods Simulations were performed using SimNIBS https://simnibs.github.io/simnibs/build/html/index.html using T1, T2, and diffusion-weighted images. After tissue segmentation and tetrahedral mesh generation, tDCS-induced EF was estimated based on the finite element model (FEM). Five 1mA tDCS montages targeting motor function in the paretic (non-dominant) hand were simulated. Estimates of peak EF strength, EF angle, field focality, and mean EF in motor cortex (M1) were extracted for each montage and compared between groups. Results Simulations for eighty-three children were successfully completed (21 AIS, 30 PVI, 32 TDC). Conventional tDCS montages utilizing anodes over lesioned cortex had higher peak EF strength values for the AIS group compared to TDC. These montages showed lower mean EF strength within target M1 regions suggesting that peaks were not necessarily localized to motor network-related targets. EF angle was lower for TDC compared to PS groups for a subset of montages. Montages using anodes over lesioned cortex were more sensitive to variations in underlying anatomy (lesion and tissue volumes) than those using cathodes over non-lesioned cortex. Discussion Individualized patient-centered tDCS EF simulations are prudent for clinical trial planning and may provide insight into the efficacy of tDCS interventions in children with PS.
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Affiliation(s)
- Helen L. Carlson
- Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada,Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, University of Calgary, Calgary, AB, Canada,*Correspondence: Helen L. Carlson,
| | - Adrianna Giuffre
- Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada,Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Patrick Ciechanski
- Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada,Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children’s Hospital, Calgary, AB, Canada,Alberta Children’s Hospital Research Institute (ACHRI), Calgary, AB, Canada,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada,Department of Pediatrics, University of Calgary, Calgary, AB, Canada,Department of Clinical Neuroscience and Radiology, University of Calgary, Calgary, AB, Canada
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Patel S, Bhakta A, Wortsman J, Aryal BB, Shrestha DB, Joshi T. Pontine Infarct Resulting in Millard-Gubler Syndrome: A Case Report. Cureus 2023; 15:e34869. [PMID: 36923200 PMCID: PMC10010748 DOI: 10.7759/cureus.34869] [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: 12/06/2022] [Accepted: 01/29/2023] [Indexed: 02/13/2023] Open
Abstract
Millard-Gubler syndrome is a crossed brainstem syndrome involving the facial nerve, abducens nerve, and the pyramidal tracts, typically resulting in ipsilateral facial weakness and contralateral hemiparesis. Here we report the case of a 76-year-old female with no pertinent past medical history who presented to the emergency department with acute left-sided facial droop and right upper extremity sensory loss. A pontine infarction was identified on imaging and she was managed medically with complete recovery. Pontine infarction can result in Millard-Gubler syndrome and present with facial weakness and subtle contralateral limb symptoms.
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Affiliation(s)
- Shivangi Patel
- Internal Medicine, Ross University School of Medicine Barbados Campus, Barbados, BRB
| | - Ashika Bhakta
- Internal Medicine, Ross University School of Medicine Barbados Campus, Barbados, BRB
| | - Joshua Wortsman
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Barun B Aryal
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | | | - Tilak Joshi
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
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Ganvir SS, Mishra SA, Harishchandre M, Khare AB, Ganvir SD. A Case Report on Dyke-Davidoff-Masson Syndrome: A Rare Cause of Hemiparesis. Cureus 2023; 15:e34637. [PMID: 36895536 PMCID: PMC9989697 DOI: 10.7759/cureus.34637] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/07/2023] Open
Abstract
Infantile hemiparesis resulting from Dyke-Davidoff-Masson syndrome (DDMS) is an uncommon condition, especially in patients with no positive natal history. The age of presentation is dependent on when the neurologic insult occurred, and distinctive alterations may not appear until puberty. The left hemisphere and the male gender are more frequently involved. Common findings that can be seen are seizures, hemiparesis, mental retardation, and facial changes. Characteristic MRI findings are dilation of the lateral ventricles, hemiatrophy of the cerebrum, frontal sinus hyperpneumatization, and compensatory hypertrophy of the skull. Here, we report a 17-year-old female patient who reported physiotherapy treatment after the attack of epilepsy, with the complaint of inability to use the right hand for functional activities and gait deviations. Patient examination revealed typical chronic hemiparesis of the right side with mild cognitive affection. Brain investigation confirms the diagnosis of DDMS.
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Affiliation(s)
- Suvarna S Ganvir
- Neurophysiotherapy, Dr. Vithalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar, IND
| | - Simran A Mishra
- Neurophysiotherapy, Dr. Vithalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar, IND
| | - Maheshwari Harishchandre
- Neurophysiotherapy, Dr. Vithalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar, IND
| | - Akhilendra B Khare
- Internal Medicine, Dr. Vithalrao Vikhe Patil Foundation's Medical College and Hospital, Ahmednagar, IND
| | - Shyam D Ganvir
- Community Physiotherapy, Dr. Vithalrao Vikhe Patil Foundation's College of Physiotherapy, Ahmednagar, IND
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Ii T, Hirano S, Imoto D, Otaka Y. Effect of gait training using Welwalk on gait pattern in individuals with hemiparetic stroke: a cross-sectional study. Front Neurorobot 2023; 17:1151623. [PMID: 37139264 PMCID: PMC10149761 DOI: 10.3389/fnbot.2023.1151623] [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: 01/26/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction We aimed to explore the effect of gait training using Welwalk on gait patterns by comparing differences in gait patterns between robotic-assisted gait training using Welwalk and gait training using an orthosis in individuals with hemiparetic stroke. Methods This study included 23 individuals with hemiparetic stroke who underwent gait training with Welwalk combined with overground gait training using an orthosis. Three-dimensional motion analysis on a treadmill was performed under two conditions for each participant: during gait training with Welwalk and with the ankle-foot orthosis. The spatiotemporal parameters and gait patterns were compared between the two conditions. Results The affected step length was significantly longer, the step width was significantly wider, and the affected single support phase ratio was significantly higher in the Welwalk condition than in the orthosis condition. The index values of abnormal gait patterns were significantly lower while using Welwalk than in the orthosis condition. The following four indices were lower in the Welwalk condition: contralateral vaulting, insufficient knee flexion, excessive hip external rotation during the paretic swing phase, and paretic forefoot contact. Discussion Gait training using Welwalk increased the affected step length, step width, and single support phase while suppressing abnormal gait patterns as compared to gait training using the ankle-foot orthosis. This study suggests that gait training using Welwalk may promote a more efficient gait pattern reacquisition that suppresses abnormal gait patterns. Trial registration Prospectively registered in the Japan Registry of Clinical Trials (https://jrct.niph.go.jp; jRCTs042180152).
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Affiliation(s)
- Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Satoshi Hirano
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
- *Correspondence: Satoshi Hirano
| | - Daisuke Imoto
- Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Pradines M, Poitou T, Gál O, Hoskovcová M, Bayle N, Baude M, Gracies JM. Where is the zero of Tardieu for proximal trans-joint lower limb muscles? The relevance for the estimation of muscle shortening and weakness. Front Neurol 2023; 14:1108535. [PMID: 37188305 PMCID: PMC10175661 DOI: 10.3389/fneur.2023.1108535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Affiliation(s)
- Maud Pradines
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
- *Correspondence: Maud Pradines
| | - Tymothée Poitou
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Ota Gál
- Department of Neurology, Charles University, Prague, Czechia
| | | | - Nicolas Bayle
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Marjolaine Baude
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Jean-Michel Gracies
- UR 7377 BIOingénierie Tissus Neuroplasticité (BIOTN), Faculté de Santé, Université Paris-Est Créteil, Créteil, France
- Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Proulx CE, Higgins J, Vincent C, Vaughan T, Hewko M, Gagnon DH. User-centered development process of an operating interface to couple a robotic glove with a virtual environment to optimize hand rehabilitation following a stroke. J Rehabil Assist Technol Eng 2023; 10:20556683231166574. [PMID: 37077202 PMCID: PMC10107379 DOI: 10.1177/20556683231166574] [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: 09/26/2022] [Accepted: 03/14/2023] [Indexed: 04/21/2023] Open
Abstract
Introduction Task-specific neurorehabilitation is crucial to optimize hand recovery shortly after a stroke, but intensive neurorehabilitation remains limited in resource-constrained healthcare systems. This has led to a growing interest in the use of robotic gloves as an adjunct intervention to intensify hand-specific neurorehabilitation. This study aims to develop and assess the usability of an operating interface supporting such a technology coupled with a virtual environment through a user-centered design approach. Methods Fourteen participants with hand hemiparesis following a stroke were invited to don the robotic glove before browsing through the operating interface and its functionalities, and perform two mobility exercises in a virtual environment. Feedback was collected for improving technology usability. Participants completed the System Usability Scale and ABILHAND questionnaires and their recommendations were gathered and prioritized in a Pugh Matrix. Results The System Usability Scale (SUS) score for the operating interface was excellent (M = 87.0 SD = 11.6). A total of 74 recommendations to improve the user interface, calibration process, and exercise usability were identified. Conclusion The application of a full cycle of user-centred design approach confirms the high level of usability of the system which is perceived by end users as acceptable and useful for intensifying neurorehabilitation.
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Affiliation(s)
- CE Proulx
- School of Rehabilitation, Faculty
of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la
Réadaptation en Déficience Physique de Montréal, CIUSSS
Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - J Higgins
- School of Rehabilitation, Faculty
of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la
Réadaptation en Déficience Physique de Montréal, CIUSSS
Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - C Vincent
- Department of Rehabilitation, Université Laval, Quebec, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation and Social Integration, Centre Intégré Universitaire de Santé
et de Services Sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - T Vaughan
- Simulation and Digital Health,
Medical Devices Research Centre, National Research Council
Canada, Boucherville, QC, Canada
| | - M Hewko
- Simulation and Digital Health,
Medical Devices Research Centre, National Research Council Canada,
Winnipeg, Winnipeg, MB, Canada
| | - DH Gagnon
- School of Rehabilitation, Faculty
of Medicine, Université de Montréal, Montreal, QC, Canada
- Center for Interdisciplinary
Research in Rehabilitation of Greater Montreal, Institut Universitaire sur la
Réadaptation en Déficience Physique de Montréal, CIUSSS
Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
- DH Gagnon, School of Rehabilitation,
Université de Montréal-Pavillon Ave du Parc, C.P. 6128, succursale Centre-Ville,
Montreal, QC H3C 3J7, Canada.
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Stuerner J, Sehle A, Liepert J. Extrinsic feedback facilitates mental chronometry abilities in stroke patients. NeuroRehabilitation 2023; 53:347-354. [PMID: 37927280 PMCID: PMC10741321 DOI: 10.3233/nre-230093] [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] [Received: 05/12/2023] [Accepted: 09/10/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Motor imagery (MI) can serve as a treatment for stroke rehabilitation. MI abilities can be assessed by testing mental chronometry (MC) as the degree of conformity between imagined and real performance of a task. A good MC performance is supposed to indicate good MI capacities. OBJECTIVE To explore if MC abilities can be modified by extrinsic feedback in stroke patients. METHODS 60 subacute stroke patients were randomized into three groups. MC was evaluated by executing a modified version of the Box and Block Test (BBT) mentally and in real before and after a training session. For Groups 1 and 2 the training consisted of repeated performance of the BBT in a mental and then a real version. The time needed to complete each task was measured. Only participants of Group 1 received feedback about how well mental and real performance matched. Group 3 executed the same number of BBTs but without MI. RESULTS MC ability only improved in Group 1. The improvement lasted for at least 24 hours. In all groups, BBT real performance was improved post-training. CONCLUSION External feedback was able to enhance MC capability which might be an approach for improving MI abilities.
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Affiliation(s)
- Jana Stuerner
- Department of Neurological Rehabilitation, Lurija Institute, Kliniken Schmieder, Allensbach, Germany
| | - Aida Sehle
- Department of Neurological Rehabilitation, Lurija Institute, Kliniken Schmieder, Allensbach, Germany
| | - Joachim Liepert
- Department of Neurological Rehabilitation, Lurija Institute, Kliniken Schmieder, Allensbach, Germany
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Nomoto M, Miyata K, Kohno Y. White matter hyperintensity predicts independent walking function at 6 months after stroke: A retrospective cohort study. NeuroRehabilitation 2023; 53:557-565. [PMID: 38143395 DOI: 10.3233/nre-230225] [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: 12/26/2023]
Abstract
BACKGROUND White matter hyperintensity (WMH) is reported to have a potential prevalence in healthy people and is a predictor of walking disability. However, WMH has not been adequately considered as a predictor of independent walking after stroke. OBJECTIVE To investigate the effects of WMH severity on walking function in patients with acute stroke. METHODS The retrospective cohort study included 422 patients with acute stroke. The WMH severity from magnetic resonance images was evaluated using the Fazekas scale. Age, type of stroke, Fazekas scale, Brunnstrom motor recovery stage, Motricity Index, and Mini-Mental State Examination were used as independent variables. Multivariable logistic regression analysis was conducted on the factors of independent walking at discharge and 6 months after onset, respectively. RESULTS Multivariable analysis revealed that the Fazekas scale is not a predictive factor of independent walking at discharge (odds ratio [OR] = 0.89, 95% confidence intervals [CI] = 0.65-1.22), but at 6 months (OR = 0.54, 95% CI = 0.34-0.86). CONCLUSION The WMH severity was a predictive factor of independent walking in patients with acute stroke after 6 months. WMH is a factor that should be considered to improve the accuracy of predicting long-term walking function in patients with stroke.
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Affiliation(s)
- Masahiro Nomoto
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
- Graduate School of Health Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Kazuhiro Miyata
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Yutaka Kohno
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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Sano T, Adler JR. Chronic Shoulder Dislocation on the Unaffected Side of a Patient With Hemiparesis. Cureus 2023; 15:e34358. [PMID: 36874756 PMCID: PMC9975288 DOI: 10.7759/cureus.34358] [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] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Chronic shoulder dislocation has been noted to be difficult to cure due to concomitant injuries of the soft tissue, articular cartilage, and bone. The present study reports a rare case of a patient with hemiparesis suffering chronic shoulder dislocation on the unaffected side. The patient was a 68-year-old female. She developed left hemiparesis due to cerebral bleeding at 36 years of age. Her right shoulder was dislocated for three months. A computed tomography scan and magnetic resonance imaging (MRI) showed a significant anterior glenoid defect, and the subscapularis, supraspinatus, and infraspinatus were atrophic. An open reduction with transfer of the coracoid, Latarjet's method was performed. The rotator cuffs were simultaneously repaired using McLaughlin's method. The glenohumeral joint was temporarily fixed with Kirschner wires for three weeks. There was no redislocation during the 50-month follow-up period. Even though radiographs noted progression of osteoarthritis in the glenohumeral joint, the patient reacquired shoulder function for ativities of daily living including weight-bearing ability.
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Affiliation(s)
- Tomohiko Sano
- Department of Orthopaedics, Owase General Hospital, Owase, JPN
| | - John R Adler
- Department of Orthopaedics, Owase General Hospital, Owase, JPN
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