scholarly journals Explicit motor sequence learning after stroke: a neuropsychological study

2021 ◽  
Author(s):  
Cristina Russo ◽  
Laura Veronelli ◽  
Carlotta Casati ◽  
Alessia Monti ◽  
Laura Perucca ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Motor Learning ◽  
Upper Limb ◽  
Motor Recovery ◽  
Finger Tapping ◽  
Control Group ◽  
Stroke Severity ◽  
Motor Sequence ◽  
Stroke Patients ◽  
Motor Practice

AbstractMotor learning interacts with and shapes experience-dependent cerebral plasticity. In stroke patients with paresis of the upper limb, motor recovery was proposed to reflect a process of re-learning the lost/impaired skill, which interacts with rehabilitation. However, to what extent stroke patients with hemiparesis may retain the ability of learning with their affected limb remains an unsolved issue, that was addressed by this study. Nineteen patients, with a cerebrovascular lesion affecting the right or the left hemisphere, underwent an explicit motor learning task (finger tapping task, FTT), which was performed with the paretic hand. Eighteen age-matched healthy participants served as controls. Motor performance was assessed during the learning phase (i.e., online learning), as well as immediately at the end of practice, and after 90 min and 24 h (i.e., retention). Results show that overall, as compared to the control group, stroke patients, regardless of the side (left/right) of the hemispheric lesion, do not show a reliable practice-dependent improvement; consequently, no retention could be detected in the long-term (after 90 min and 24 h). The motor learning impairment was associated with subcortical damage, predominantly affecting the basal ganglia; conversely, it was not associated with age, time elapsed from stroke, severity of upper-limb motor and sensory deficits, and the general neurological condition. This evidence expands our understanding regarding the potential of post-stroke motor recovery through motor practice, suggesting a potential key role of basal ganglia, not only in implicit motor learning as previously pointed out, but also in explicit finger tapping motor tasks.

scholarly journals Behavioral and neural correlates of speech motor sequence learning in stuttering and neurotypical speakers: an fMRI investigation

2020 ◽  
Author(s):  
Matthew Masapollo
Keyword(s):  
Basal Ganglia ◽  
Motor Learning ◽  
Brain Activity ◽  
Neurodevelopmental Disorder ◽  
Motor Planning ◽  
Theoretical Models ◽  
Neural Correlates ◽  
Motor Sequence ◽  
Motor Practice ◽  
Speech Motor

Stuttering is a neurodevelopmental disorder characterized by impaired execution of articulatory movements needed for fluent speech production. Existing theoretical models propose that these deficits reflect a malfunction in the cortico-basal-ganglia-thalamocortical (cortico-BG) loop that is responsible for selecting and initiating speech motor programs. However, the cortico-BG loop has also been hypothesized to play a role in speech motor learning. To distinguish motor execution impairments from motor learning impairments in stuttering, the authors examined the behavioral and neural correlates of learning to produce novel phoneme sequences in adults who stutter (AWS) and neurotypical controls. Participants intensively practiced producing pseudowords containing non-native consonant clusters over two days. Results showed that, behaviorally, both AWS and controls produced the words with increased speed and accuracy following motor practice, and the rate of improvement was comparable for the two groups. Using functional magnetic resonance imaging (fMRI), the authors compared brain activity during articulation of the practiced words and a set of novel pseudowords (matched in phonetic complexity). FMRI analyses revealed no differences between AWS and controls in cortical or subcortical regions; both groups showed comparable increases in activation in left-lateralized brain areas implicated in phonological working memory and speech motor planning during production of the novel sequences compared to the practiced sequences. Moreover, activation in left-lateralized basal ganglia sites was negatively correlated with stuttering severity in AWS. Collectively, these findings indicate that AWS exhibit no deficit in learning novel speech sequences but do show impaired execution of these sequences prior to and after learning.

EFFECT OF ACTION OBSERVATION THERAPY ON IMPROVING UPPER LIMB FUNCTIONS IN ACUTE STROKE PATIENTS: AN EXPERIMENTAL STUDY

2021 ◽  
pp. 33-36
Author(s):  
Sudha Desale
Keyword(s):  
Acute Stroke ◽  
Upper Limb ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Recovery ◽  
P Value ◽  
Daily Routine ◽  
Motor Sequence ◽  
Stroke Patients ◽  
Observation Training

BACKGROUND & PURPOSE: The most common disabling motor decit following stroke is the loss of upper limb function. 5-20% of patients presenting an upper limb paralysis at onset may improve the motor impairment overtime. Action observation training is a novel rehabilitation approach exploiting this mirror mechanism and its potential role in motor learning for motor recovery. Aim of this study was to examine the effects of action observation therapy on upper limb functions in acute stroke patients. METHODOLOGY: Stroke survivors (N= 50) were consecutively recruited 22 days (±5) after a rst-ever stroke and participants watched video footage of daily routine tasks (actions). Each action based on some relevant ADLs motor sequence display in order of ascending difculty and lasting for 3 minutes and therapist prompted the patient to perform the same movement for 2 minutes. At the end of each sequence, patients were given conventional physiotherapy and AOT 1 hour daily for 5 days/week for 4 weeks. RESULTS: Upper Limb part of FMA, Modied Ashworth Scale scores & nine-hole peg test were taken at baseline and after 4 weeks as outcome measure. Paired 't' test and Wilcoxon's signed-rank has been used for analysis of Fugl Meyer scale, Modied Ashwarth Scale and Nine-hole peg pre and post treatment scores respectively (p value<0.05) So, a statistically signicant difference was found after treatment for all variables. CONCLUSION: The nding of this study is suggesting that Action observation training programs contribute to improve motor recovery in acute stroke patients.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

2021 ◽  
Author(s):  
Phassakorn Klinkwan ◽  
Chalunda Kongmaroeng ◽  
Sombat Muengtaweepongsa ◽  
Wiroj Limtrakarn
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Home Exercise ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

scholarly journals Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study

2021 ◽  
Vol 11 (3) ◽  
pp. 290
Author(s):  
Mauro Mancuso ◽  
Serena Di Tondo ◽  
Enza Costantini ◽  
Alessio Damora ◽  
Patrizio Sale ◽  
...  
Keyword(s):  
Upper Limb ◽  
Action Observation ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Motor Recovery ◽  
Control Group ◽  
Stroke Patients ◽  
Rehabilitative Treatment ◽  
Subacute Stroke ◽  
The Moment

Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke patients. The aim of the present study was to evaluate the potential efficacy of AOT, both in upper limb recovery and in functional outcomes when compared to patients treated with task oriented training (TOT). Both treatments were added to traditional rehabilitative treatment. Thirty-two acute stroke patients at 15.6 days (±8.3) from onset, with moderate to severe upper limb impairment at baseline following their first-ever stroke, were enrolled and randomized into two groups: 16 in the experimental group (EG) and 16 in the control group (CG). The EG underwent 30 min sessions of AOT, and the CG underwent 30 min sessions of TOT. All participants received 20 sessions of treatment for four consecutive weeks (five days/week). The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) were administered at baseline (T0) and at the end of treatment (T1). No statistical differences were found at T0 for inclusion criteria between the CG and EG, whereas both groups improved significantly at T1. After the treatment period, the rehabilitative gain was greater in the EG compared to the CG for FMA-UE and FIM (all p < 0.05). Our results suggest that AOT can contribute to increased motor recovery in subacute stroke patients with moderate to severe upper limb impairment in the early phase after stroke. The improvements presented in this article, together with the lack of adverse events, confirm that the use of AOT should be broadened out to larger pools of subacute stroke patients.

scholarly journals Motor Sequences - Separating The Sequence From The Motor. A longitudinal rsfMRI Study

2021 ◽  
Author(s):  
ATP Jäger ◽  
JM Huntenburg ◽  
SA Tremblay ◽  
U Schneider ◽  
S Grahl ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Motor Learning ◽  
Resting State ◽  
Primary Motor Cortex ◽  
Control Group ◽  
Motor Execution ◽  
Motor Sequence ◽  
Resting State Functional Connectivity ◽  
Fast Learning ◽  
Slow Learning

AbstractIn motor learning, sequence-specificity, i.e. the learning of specific sequential associations, has predominantly been studied using task-based fMRI paradigms. However, offline changes in resting state functional connectivity after sequence-specific motor learning are less well understood. Previous research has established that plastic changes following motor learning can be divided into stages including fast learning, slow learning and retention. A description of how resting state functional connectivity after sequence-specific motor sequence learning (MSL) develops across these stages is missing. This study aimed to identify plastic alterations in whole-brain functional connectivity after learning a complex motor sequence by contrasting an active group who learned a complex sequence with a control group who performed a control task matched for motor execution. Resting state fMRI and behavioural performance were collected in both groups over the course of 5 consecutive training days and at follow-up after 12 days to encompass fast learning, slow learning, overall learning and retention. Between-group interaction analyses showed sequence-specific increases in functional connectivity during fast learning in the sensorimotor territory of the internal segment of right globus pallidus (GPi), and sequence-specific decreases in right supplementary motor area (SMA) in overall learning. We found that connectivity changes in key regions of the motor network including the superior parietal cortex (SPC) and primary motor cortex (M1) were not a result of sequence-specific learning but were instead linked to motor execution. Our study confirms the sequence-specific role of SMA and GPi that has previously been identified in online task-based learning studies in humans and primates, and extends it to resting state network changes after sequence-specific MSL. Finally, our results shed light on a timing-specific plasticity mechanism between GPi and SMA following MSL.

P183 Usefulness of robotics for improving and monitoring upper limb motor recovery in stroke patients

2008 ◽  
Vol 119 ◽  
pp. S117
Author(s):  
Fabrizio Pisano ◽  
Carmen Delconte ◽  
Danilo Pianca ◽  
Maria Antonietta Tommasi ◽  
Alessandra Mazzone ◽  
...  
Keyword(s):  
Upper Limb ◽  
Motor Recovery ◽  
Stroke Patients

scholarly journals A cutlery set for stroke

2021 ◽  
Author(s):  
◽  
Lin Chen
Keyword(s):  
Assistive Technology ◽  
Upper Limb ◽  
Stroke Patient ◽  
The United States ◽  
Stroke Severity ◽  
Muscle Control ◽  
Stroke Patients ◽  
Muscle Contracture ◽  
And Function

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997).  After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function.  AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life.  The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians.  Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design.  The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant.  The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

scholarly journals Efficiency of Leg Exoskeleton Use in Rehabilitation of Cerebral Stroke Patients

2021 ◽  
Vol 22 (3) ◽  
pp. 257-264
Author(s):  
Sergey V. Kotov ◽  
Alexander I. Romanov ◽  
Ekaterina V. Silina ◽  
Victor A. Stupin ◽  
Elena V. Isakova ◽  
...  
Keyword(s):  
Recovery Period ◽  
Rehabilitation Program ◽  
Control Group ◽  
Cerebral Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Early Recovery ◽  
Lower Limb Exoskeleton ◽  
Group 2 ◽  
Early Recovery Period

Abstract The study aimed to evaluate the effectiveness of functional and motor activity restoration, including the walking function, in patients after an ischemic stroke using the ExoAtlet lower limb exoskeleton. Patients and methods. A clinical study was carried out on 42 patients who had undergone a cerebral infarction in the mid cerebral artery system with a post-stroke paresis of the leg, and who had undergone a rehabilitation course in a round-theclock hospital during the early recovery period. Patients were randomized into two equal groups comparable in terms of the stroke severity: the patients in group 1 were receiving a standard rehabilitation program (control group), the patients in group 2 were additionally receiving a course of gait rehabilitation using the ExoAtlet exoskeleton - 10 sessions, 5 sessions per week for 14 days. Results. The study demonstrated the effectiveness of the ExoAtlet exoskeleton used in the rehabilitation of stroke patients over the standard course of rehabilitation. The advantages include a decrease in the hemiparesis degree, an increase in the muscle strength of the paretic limb, an improvement in balance, an improvement and acceleration of the walking process. The obtained results of the instrumental study confirmed the benefits of physical training on the Exoskeleton, which was demonstrated through an increase in stability and balance, as well as through a decrease in the energy consumption index for maintaining the stable verticalization. Conclusion. The usage of the ExoAtlet exoskeleton increases the effectiveness of rehabilitation measures and improves motor and functional activities of patients who have suffered a cerebral stroke.

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