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Babazadeh-Zavieh SS, Ansari NN, Ghotbi N, Naghdi S, Jafar Haeri SM, Shaw BS, Shaw I. Effects of dry needling and exercise therapy on post-stroke spasticity and motor function- protocol of randomized clinical trial. Contemp Clin Trials Commun 2022; 28:100921. [PMID: 35586475 PMCID: PMC9108468 DOI: 10.1016/j.conctc.2022.100921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/19/2022] [Accepted: 05/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke. METHODS We will use a single-blind randomized controlled trial (RCT) in accordance with the CONSORT guidelines. A total of 24 patients with stroke will be included from the University Rehabilitation Clinics. The outcome measures will include Modified Modified Ashworth Scale, Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test, Fugl-Meyer Assessment, and wrist extension active and passive range of motion. Patients in the DN and exercise therapy group will undergo 4 sessions of deep DN in flexor carpi radialis and flexor carpi ulnaris muscles on the affected upper limb and exercise therapy. Participants in the DN group will only receive DN for target muscles. Clinical and neurophysiological tests will be performed at baseline, after four therapy sessions, and at three weeks' follow-up. DISCUSSION This study will provide evidence for additional effects of exercise therapy to DN in comparison to DN alone on wrist flexors spasticity, motor neuron excitability, upper-limb motor function, and ROM in patients with chronic stroke.
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Affiliation(s)
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghotbi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Corresponding author.
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Brandon S. Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
| | - Ina Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, 3886, South Africa
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, Essex, United Kingdom
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Lench DH, Hutchinson S, Woodbury ML, Hanlon CA. Kinematic Measures of Bimanual Performance are Associated With Callosum White Matter Change in People With Chronic Stroke. Arch Rehabil Res Clin Transl 2021; 2:100075. [PMID: 33543100 PMCID: PMC7853365 DOI: 10.1016/j.arrct.2020.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the relationship between bimanual performance deficits measured using kinematics and callosum (CC) white matter changes that occur in people with chronic stroke. Design Cross-sectional, observational study of participants with chronic stroke and age-matched controls. Setting Recruitment and assessments occurred at a stroke recovery research center. Behavioral assessments were performed in a controlled laboratory setting. Magnetic resonance imaging scans were performed at the Center for Biomedical Imaging. Participants Individuals were enrolled and completed the study (N=39; 21 participants with chronic stroke; 18 age-matched controls with at least 2 stroke risk factors). Main Outcome Measures Diffusion imaging metrics were obtained for each individual’s CC and corticospinal tract (CST), including mean kurtosis (MK) and fractional anisotropy (FA). A battery of motor assessments, including bimanual kinematics, were collected from individuals while performing bimanual reaching. Results Participants with stroke had lower FA and MK in the CST of the lesioned hemisphere when compared with the non-lesioned hemisphere. The FA and MK values in the CST were correlated with measures of unimanual hand performance. In addition, participants with stroke had significantly lower FA and MK in the CC than matched controls. CC diffusion metrics positively correlated with hand asymmetry and trunk displacement during bimanual performance, even when correcting for age and lesion volume. Conclusions These data confirm previous studies that linked CST integrity to unimanual performance and provide new data demonstrating a link between CC integrity and both bimanual motor deficits and compensatory movements. Fractional anisotropy and mean kurtosis in the corpus callosum are lower in participants with stroke. Hand position symmetry and trunk displacement are disrupted during bimanual tasks. Corpus callosum white matter correlated with bimanual kinematics in participants with stroke.
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Key Words
- ANOVA, analysis of variance
- ARAT, Action Research Arm Test
- CC, corpus callosum
- CST, corticospinal tract
- DKI, diffusion kurtosis imaging
- DTI, diffusion tensor imaging
- Diffusion
- FA, fractional anisotropy
- FMA, Fugl-Meyer Assessment
- M1, primary motor cortex
- MK, mean kurtosis
- MRI, magnetic resonance imaging
- Motor Activity
- Pyramidal Tracts
- ROI, region of interest
- Rehabilitation
- SMA, supplementary motor area
- Stroke
- UE, upper extremity
- WMFT, Wolf Motor Function Test
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Affiliation(s)
- Daniel H. Lench
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott Hutchinson
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Michelle L. Woodbury
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Colleen A. Hanlon
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Department of Cancer Biology, College of Medicine, Wake Forest Health Sciences, Winston-Salem, NC
- Corresponding author Colleen A. Hanlon, PhD, 1 Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157.
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Powell ES, Westgate PM, Goldstein LB, Sawaki L. Absence of Motor-Evoked Potentials Does Not Predict Poor Recovery in Patients With Severe-Moderate Stroke: An Exploratory Analysis. Arch Rehabil Res Clin Transl 2019; 1:100023. [PMID: 33543054 PMCID: PMC7853378 DOI: 10.1016/j.arrct.2019.100023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective To better understand the role of the presence or absence of motor-evoked potentials (MEPs) in predicting functional outcomes following a severe-moderate stroke. Design Retrospective exploratory analysis. We compared the effects of the stimulation condition (active or sham), MEP status (+ or −), and a combination of stimulation condition and MEP status on outcome. Within-group and between-group changes were assessed with longitudinal repeated measures analysis of variance and longitudinal repeated measures analysis of covariance, respectively. The proportions of participants who achieved minimal clinically important differences (MCIDs) for the main outcome measures were calculated. Setting University research laboratory within a rehabilitation hospital. Participants A total of 129 subjects with severe-moderate stroke-related motor impairments who participated in previous studies combining neuromodulation and motor training Interventions Neuromodulation (active or sham) and motor training. Main Outcome Measures Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Results When participants were grouped by stimulation condition or MEP status, all groups improved from baseline to immediate postintervention and follow-up evaluations (all P<.05). Analysis by stimulation condition and MEP status found that the MEP−/active group improved by 4.2 points on FMA (P<.0001) and 1.8 on ARAT (P=.003) post intervention. The MEP+/active group improved by 5.7 points on FMA (P<.0001) and 3.9 points on ARAT (P<.0001) post intervention. There were no between-group differences (P>.05). Regarding MCIDs, in the MEP−/active group, 14.5% of individuals reached MCID on FMA and 8.3% on ARAT post intervention. In the MEP+/active group, 33.3% of individuals reached MCID on FMA and 27.3% on ARAT post intervention. Conclusion As expected, the MEP+ group had the greatest improvement in motor function. However, it was shown that individuals without MEPs can also achieve meaningful changes, as reflected by MCID, when neuromodulation is paired with motor training. To our knowledge, this is the first study to differentiate the effects of neuromodulation by MEP status.
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Affiliation(s)
- Elizabeth S Powell
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Larry B Goldstein
- Department of Neurology, University of Kentucky, Lexington, Kentucky
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
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Carrico C, Annichiarico N, Powell ES, Westgate PM, Sawaki L. Chronicity of Stroke Does Not Affect Outcomes of Somatosensory Stimulation Paired With Task-Oriented Motor Training: A Secondary Analysis of a Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2019; 1:100005. [PMID: 33543045 PMCID: PMC7853359 DOI: 10.1016/j.arrct.2019.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To determine whether chronicity influences outcomes of somatosensory stimulation paired with task-oriented motor training for participants with severe-to-moderate upper extremity hemiparesis. Design Spearman correlations were used to retrospectively analyze outcomes of a randomized trial. Setting University research laboratory at a rehabilitation hospital. Participants Adults, ranging between 3 and 12 months poststroke (N=55). Interventions About 18 sessions pairing either 2 hours of active (n=33) or sham (n=22) somatosensory stimulation with 4 hours of intensive task-oriented motor training. Main Outcome Measures The Wolf Motor Function Test (primary), Action Research Arm Test, Stroke Impact Scale, and Fugl-Meyer Assessment were collected as outcome measures. Analyses evaluated whether within-group chronicity correlated with pre-post changes on primary and secondary outcome measures of motor performance. Results Both groups exhibited improvements on all outcome measures. No significant correlations between chronicity poststroke and the amount of motor recovery were found. Conclusion Somatosensory stimulation improved motor recovery compared with sham treatment in cases of severe-to-moderate hemiparesis between 3 and 12 months poststroke; and the extent of recovery did not correlate with baseline levels of stroke chronicity. Future studies should investigate a wider period of inclusion, patterns of corticospinal reorganization, differences between cortical and subcortical strokes, and include long-term follow-up periods.
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Affiliation(s)
- Cheryl Carrico
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
| | - Nicholas Annichiarico
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
| | - Elizabeth Salmon Powell
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, Kentucky.,Cardinal Hill Rehabilitation Hospital, Lexington, Kentucky.,Department of Neurology, Wake Forest University, Winston-Salem, North Carolina
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Valkenborghs SR, Visser MM, Dunn A, Erickson KI, Nilsson M, Callister R, van Vliet P. AExaCTT - Aerobic Exercise and Consecutive Task-specific Training for the upper limb after stroke: Protocol for a randomised controlled pilot study. Contemp Clin Trials Commun 2017; 7:179-185. [PMID: 29696183 PMCID: PMC5898578 DOI: 10.1016/j.conctc.2017.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 07/02/2017] [Accepted: 07/20/2017] [Indexed: 11/23/2022] Open
Abstract
Motor function may be enhanced if aerobic exercise is paired with motor training. One potential mechanism is that aerobic exercise increases levels of brain-derived neurotrophic factor (BDNF), which is important in neuroplasticity and involved in motor learning and motor memory consolidation. This study will examine the feasibility of a parallel-group assessor-blinded randomised controlled trial investigating whether task-specific training preceded by aerobic exercise improves upper limb function more than task-specific training alone, and determine the effect size of changes in primary outcome measures. People with upper limb motor dysfunction after stroke will be allocated to either task-specific training or aerobic exercise and consecutive task-specific training. Both groups will perform 60 hours of task-specific training over 10 weeks, comprised of 3 × 1 hour sessions per week with a therapist and 3 × 1 hours of home-based self-practice per week. The combined intervention group will also perform 30 minutes of aerobic exercise (70-85%HRmax) immediately prior to the 1 hour of task-specific training with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events will be recorded. Clinical outcome measures will be performed pre-randomisation at baseline, at completion of the training program, and at 1 and 6 months follow-up. Primary clinical outcome measures will be the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT). If aerobic exercise prior to task-specific training is acceptable, and a future phase 3 randomised controlled trial seems feasible, it should be pursued to determine the efficacy of this combined intervention for people after stroke.
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Key Words
- 6MWT, Six Minute Walk Test
- ARAT, Action Research Arm Test
- Aerobic exercise
- BDNF, brain-derived neurotrophic factor
- CERT, Consensus on Exercise Reporting Template
- CM, centimetre
- CONSORT, Consolidated Standards of Reporting Trials
- ECG, electrocardiography
- ELISA, enzyme-linked immunosorbent assay
- FAS, Fatigue Assessment Scale
- GP, general practitioner
- HRmax, age-predicted maximal heart rate maximum
- HRpeak, peak heart rate
- IPAQ, International Physical Activity Questionnaire
- MAL, Motor Activity Log
- MRI, magnetic resonance imaging
- MS, Microsoft
- Motor function
- NAA, N-acetyl Aspartate
- PD, Peak Deceleration
- PV, Peak Velocity
- REDCap, Research Electronic Data Capture
- RPE, rating of perceived exertion
- RPM, revolutions per minute
- SIS, Stroke Impact Scale
- Stroke
- Task-specific training
- VO2, oxygen uptake
- VO2peak, peak oxygen uptake
- WMFT, Wolf Motor Function Test
- m/s, millimetres per second
- mL.kg−1.min−1, millilitres per kilogram per minute
- reps, repetitions
- s, seconds
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Affiliation(s)
- Sarah R. Valkenborghs
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Milanka M. Visser
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Ashlee Dunn
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kirk I. Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael Nilsson
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Paulette van Vliet
- Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia
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