scholarly journals Shoulder abduction-induced reductions in reaching work area following hemiparetic stroke: neuroscientific implications

2007 ◽  
Vol 183 (2) ◽  
pp. 215-223 ◽  
Author(s):  
Theresa M. Sukal ◽  
Michael D. Ellis ◽  
Julius P. A. Dewald
Keyword(s):  
Shoulder Abduction ◽  
Work Area ◽  
Hemiparetic Stroke

scholarly journals Progressive Shoulder Abduction Loading is a Crucial Element of Arm Rehabilitation in Chronic Stroke

2009 ◽  
Vol 23 (8) ◽  
pp. 862-869 ◽  
Author(s):  
Michael D. Ellis ◽  
Theresa Sukal-Moulton ◽  
Julius P. A. Dewald
Keyword(s):  
Range Of Motion ◽  
Controlled Study ◽  
Control Group ◽  
Shoulder Abduction ◽  
Crucial Element ◽  
Change Scores ◽  
Arm Rehabilitation ◽  
Work Area ◽  
Supported Work ◽  
Experimental Group

Background. Total reaching range of motion (work area) diminishes as a function of shoulder abduction loading in the paretic arm in individuals with chronic hemiparetic stroke. This occurs when reaching outward against gravity or during transport of an object. Objectives. This study implements 2 closely related impairment-based interventions to identify the effect of a subcomponent of reaching exercise thought to be a crucial element in arm rehabilitation. Methods. A total of 14 individuals with chronic moderate to severe hemiparesis participated in the participant-blinded, randomized controlled study. The experimental group progressively trained for 8 weeks to actively support the weight of the arm, up to and beyond, while reaching to various outward targets. The control group practiced the same reaching tasks with matched frequency and duration with the weight of the arm supported. Work area and isometric strength were measured before and after the intervention. Results. Change scores for work area at 9 loads were calculated for each group. Change scores were significantly larger for the experimental group indicating a larger increase in work area, especially shoulder abduction loads equivalent to those experienced during object transport. Changes in strength were not found within or between groups. Conclusions. Progressive shoulder abduction loading can be utilized to ameliorate reaching range of motion against gravity. Future work should investigate the dosage response of this intervention, as well as test whether shoulder abduction loading can augment other therapeutic techniques such as goal-directed functional task practice and behavioral shaping to enhance real-world arm function.

scholarly journals Patterns of enhancement in paretic shoulder kinematics after stroke with musical cueing

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shinil Kang ◽  
Joon-Ho Shin ◽  
In Young Kim ◽  
Jongshill Lee ◽  
Ji-Yeoung Lee ◽  
...  
Keyword(s):  
Euler Angle ◽  
The Other ◽  
Shoulder Abduction ◽  
Specific Effects ◽  
Angle Measurements ◽  
Upper Limb Movements ◽  
Measurement Units ◽  
Hemiparetic Stroke ◽  
Auditory Cueing ◽  
Shoulder Kinematics

Abstract Musical cueing has been widely utilised in post-stroke motor rehabilitation; however, the kinematic evidence on the effects of musical cueing is sparse. Further, the element-specific effects of musical cueing on upper-limb movements have rarely been investigated. This study aimed to kinematically quantify the effects of no auditory, rhythmic auditory, and melodic auditory cueing on shoulder abduction, holding, and adduction in patients who had experienced hemiparetic stroke. Kinematic data were obtained using inertial measurement units embedded in wearable bands. During the holding phase, melodic auditory cueing significantly increased the minimum Euler angle and decreased the range of motion compared with the other types of cueing. Further, the root mean square error in the angle measurements was significantly smaller and the duration of movement execution was significantly shorter during the holding phase when melodic auditory cueing was provided than when the other types of cueing were used. These findings indicated the important role of melodic auditory cueing for enhancing movement positioning, variability, and endurance. This study provides the first kinematic evidence on the effects of melodic auditory cueing on kinematic enhancement, thus suggesting the potential use of pitch-related elements in psychomotor rehabilitation.

scholarly journals Limited Capacity for Ipsilateral Secondary Motor Areas to Support Hand Function Post-Stroke

2019 ◽  
Author(s):  
Kevin B. Wilkins ◽  
Jun Yao ◽  
Meriel Owen ◽  
Haleh Karbasforoushan ◽  
Carolina Carmona ◽  
...  
Keyword(s):  
Hand Function ◽  
Shoulder Abduction ◽  
Limited Capacity ◽  
Post Stroke ◽  
Backup System ◽  
Reticulospinal Tract ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Hand Opening ◽  
Motor Areas

AbstractRecent findings have shown connections of ipsilateral cortico-reticulospinal tract (CRST), predominantly originating from secondary motor areas, to not only proximal but also distal portions of the arm. In unilateral stroke, CRST from the ipsilateral side is intact and thus has been proposed as a possible backup system for post-stroke rehabilitation even for the hand. We argue that although CRST from ipsilateral secondary motor areas can provide control for proximal joints, it is insufficient to control either hand or coordinated shoulder and hand movements due to its extensive branching compared to contralateral corticospinal tract. To address this issue, we combined MRI, high-density EEG, and robotics in 17 individuals with severe chronic hemiparetic stroke and 12 age-matched controls. We tested for changes in structural morphometry of the sensorimotor cortex and found that individuals with stroke demonstrated higher gray matter density in secondary motor areas ipsilateral to the paretic arm compared to controls. We then measured cortical activity while participants attempted to generate hand opening either supported on a table or while lifting against a shoulder abduction load. The addition of shoulder abduction during hand opening increased reliance on ipsilateral secondary motor areas in stroke, but not controls. Crucially, increased use of ipsilateral secondary motor areas was associated with decreased hand opening ability while lifting the arm due to involuntary coupling between the shoulder and wrist/finger flexors. Together, this evidence implicates a compensatory role for ipsilateral (i.e., contralesional) secondary motor areas post-stroke, but with limited capacity to support hand function.

scholarly journals Assessing the usage of indirect motor pathways following a hemiparetic stroke

2020 ◽  
Author(s):  
Runfeng Tian ◽  
Julius P.A. Dewald ◽  
Yuan Yang
Keyword(s):  
Model Simulation ◽  
Brain Activity ◽  
Shoulder Abduction ◽  
Joint Control ◽  
Motor Pathways ◽  
Co Activation ◽  
Shoulder Abductor ◽  
Hemiparetic Stroke ◽  
Muscle Connectivity ◽  
Flexion Synergy

AbstractA hallmark impairment in a hemiparetic stroke is a loss of independent joint control resulting in abnormal co-activation of shoulder abductor and elbow flexor muscles in their paretic arm, clinically known as the flexion synergy. The flexion synergy appears while generating shoulder abduction (SABD) torques as lifting the paretic arm. This likely be caused by an increased reliance on contralesional indirect motor pathways following damage to direct corticospinal projections. The assessment of functional connectivity between brain and muscle signals, i.e., brain-muscle connectivity (BMC), may provide insight into such changes to the usage of motor pathways. Our previous model simulation shows that multi-synaptic connections along the indirect motor pathway can generate nonlinear connectivity. We hypothesize that increased usage of indirect motor pathways (as increasing SABD load) will lead to an increase of nonlinear BMC. To test this hypothesis, we measured brain activity, muscle activity from shoulder abductors when stroke participants generate 20% and 40% of maximum SABD torque with their paretic arm. We computed both linear and nonlinear BMC between EEG and EMG. We found dominant nonlinear BMC at contralesional/ipsilateral hemisphere for stroke, whose magnitude increased with the SABD load. These results supported our hypothesis and indicated that nonlinear BMC could provide a quantitative indicator for determining the usage of indirect motor pathways following a hemiparetic stroke.

scholarly journals The Impact of Shoulder Abduction Loading on Volitional Hand Opening and Grasping in Chronic Hemiparetic Stroke

2017 ◽  
Vol 31 (6) ◽  
pp. 521-529 ◽  
Author(s):  
Yiyun Lan ◽  
Jun Yao ◽  
Julius P. A. Dewald
Keyword(s):  
Shoulder Abduction ◽  
Grasping Forces ◽  
Finger Flexion ◽  
Enhanced Expression ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
And Control ◽  
The Impact ◽  
Hand Opening ◽  
Flexion Synergy

Background. Up to 60% of individuals with moderate to severe chronic hemiparetic stroke experience excessive involuntary wrist/finger flexion that constrains functional hand movements including hand opening. It’s not known how stroke-induced brain injury impacts volitional hand opening and grasping forces as a result of the expression of abnormal coupling between shoulder abduction and wrist/finger flexion or the flexion synergy. Objective. The goal of this study is to understand how shoulder abduction loading affects volitional hand opening and grasping forces in individuals with moderate to severe chronic hemiparetic stroke. Methods. Thirty-six individuals (stroke, 26; control, 10) were recruited for this study. Each participant was instructed to perform maximal hand opening and grasping forces while the arm was either fully supported or lifted with a weight equal to 25% or 50% of the participant’s maximal shoulder abduction torque. Hand pentagon area, defined as the area formed by the tips of thumb and fingers, was calculated during hand opening. Forces were recorded during grasping. Results. In individuals with moderate stroke, increasing shoulder abduction loading reduced the ability to maximally open the hand. In individuals with severe stroke, who were not able to open the hand, grasping forces were generated and increased with shoulder abduction loading. Stroke individuals also showed a reduced ability to control volitional grasping forces due to the enhanced expression of flexion synergy. Conclusions. Shoulder abduction loading reduced the ability to volitionally open the hand and control grasping forces after stroke. Neural mechanisms and clinical implications of these findings are discussed.

Improving Speech and Language Services through Effective Time Management

1983 ◽  
Vol 14 (2) ◽  
pp. 86-91 ◽  
Author(s):  
Barbara W. Travers
Keyword(s):  
Time Management ◽  
Management Strategies ◽  
Federal State ◽  
Speech Language Pathologist ◽  
School Based ◽  
Work Area ◽  
Paper Work ◽  
Areas Of Concern ◽  
State And Local ◽  
Therapeutic Services

This paper presents strategies for increasing the effectiveness and efficiency of the school-based speech-language pathologist. Various time management strategies are adapted and outlined for three major areas of concern: using time, organizing the work area, and managing paper work. It is suggested that the use of such methods will aid the speech-language pathologist in coping with federal, state, and local regulations while continuing to provide quality therapeutic services.

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