Targeted tDCS Reduces the Expression of the Upper Limb Flexion Synergy in Chronic Hemiparetic Stroke

2021 ◽  
Vol 102 (10) ◽  
pp. e10
Author(s):  
Yuan Yang ◽  
Evgeny Sidorov ◽  
Julius PA Dewald
Keyword(s):  
Upper Limb ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Limb Flexion ◽  
Flexion Synergy

Virtual Rehabilitation Use for Paretic Upper Limb for Individuals with Chronic Hemiparetic Stroke

2016 ◽  
pp. 101-111
Author(s):  
Renata Cristina Magalhães Lima ◽  
Ana Paula Dias de Menezes ◽  
Maria Carolina Gomes Inácio ◽  
Silvia Moreira Amaral ◽  
Regiane Relva Romano
Keyword(s):  
Upper Limb ◽  
Virtual Rehabilitation ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke

Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients

2019 ◽  
Vol 26 (7) ◽  
pp. 1-9
Author(s):  
Luciana Protásio de Melo ◽  
Valton da Silva Costa ◽  
Júlio César Cunha da Silveira ◽  
Tatiana Catarina Albuquerque Clementino
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Functional Independence ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Number Of Patients ◽  
Limb Spasticity ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
The Impact

Background/Aims Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients. Methods In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy. Results A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105). Conclusions Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.

scholarly journals The Muscle Activation Differences in Post-Stroke Upper Limb Flexion Synergy Based on Spinal Cord Segments: A Preliminary Proof-of-Concept Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Gang Liu ◽  
Chin-hsuan Chia ◽  
Wei-ning Wang ◽  
Yue Cao ◽  
Shan Tian ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Upper Limb ◽  
Muscle Activation ◽  
Elbow Flexion ◽  
Healthy Controls ◽  
Joint Movement ◽  
Stroke Patients ◽  
Spinal Cord Segment ◽  
Limb Flexion ◽  
Flexion Synergy

Objective: This study examined the activation difference of muscles innervated by cervical cord 5-6 (C5-C6) and cervical cord 8- thoracic cord 1 (C8-T1) in upper limb flexion synergy after stroke.Methods: Surface electromyography (sEMG) signals were collected during elbow flexion in stroke patients and healthy controls. The study compared normalized activation of two pairs of muscles that could cause similar joint movement but which dominated different spinal cord segments (clavicular part of the pectoralis major, PC vs. Sternocostal part of the pectoralis major, PS; Flexor carpi radialis, FCR vs. Flexor carpi ulnaris, FCU). In each muscle pair, one muscle was innervated by the same spinal cord segment (C5-C6), dominating the elbow flexion and the other was not. The comparison of the activation of the same muscle between patients and healthy controls was undertaken after standardization based on the activation of the biceps brachii in elbow flexion.Results: There was no difference between the PC and PS's normalized activation in healthy controls while the PC's normalized activation was higher than PS in stroke patients during elbow flexion. Similarly, there was no significant difference in normalized activation between FCR and FCU in healthy controls, and the same is true for stroke patients. However, the standardized activation of both FCR and FCU in stroke patients was significantly lower than that in healthy controls.Conclusion: After stroke, the activation of the distal muscles of the upper limb decreased significantly regardless of the difference of spinal cord segments; while the activation of the proximal muscles innervated by the same spinal cord segment (C5-C6) dominating the elbow flexion showed higher activation during flexion synergy. The difference in muscle activation based on spinal cord segments may be the reason for the stereotyped joint movement of upper limb flexion synergy.

scholarly journals Volume and intramuscular fat content of upper extremity muscles in individuals with chronic hemiparetic stroke

2019 ◽  
Author(s):  
Lindsay R. P. Garmirian ◽  
Ana Maria Acosta ◽  
Ryan Schmid ◽  
Jules P. A. Dewald
Keyword(s):  
Upper Extremity ◽  
Muscle Atrophy ◽  
Upper Limb ◽  
Intramuscular Fat ◽  
Muscle Volume ◽  
Contractile Element ◽  
Paretic Limb ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Wrist Flexors

AbstractStroke survivors often experience upper extremity deficits that make activities of daily living (ADLs) like dressing, cooking and bathing difficult or impossible. Survivors experience paresis, the inability to efficiently and fully activate muscles, which combined with decreased use of the upper extremity, will lead to muscle atrophy and potentially an increase in intramuscular fat. Muscle atrophy has been linked to weakness post stroke and is an important contributor to upper extremity deficits. However, the extent of upper extremity atrophy post hemiparetic stroke is unknown and a better understanding of these changes is needed to inform the direction of intervention-based research. In this study, the volume of contractile tissue and intramuscular fat in the elbow and wrist flexors and extensors were quantified in the paretic and non-paretic upper limb using MRI and the Dixon technique for the first time. Total muscle volume (p≤0.0005) and contractile element volume (p≤0.0005) were significantly smaller in the paretic upper extremity, for all muscle groups studied. The average percent difference between limbs and across participants was 21.3% for muscle volume and 22.9% for contractile element volume. We also found that while the percent intramuscular fat was greater in the paretic limb compared to the non-paretic (p≤0.0005), however, the volume of intramuscular fat was not significantly different between upper limbs (p=0.231). The average volumes of intramuscular fat for the elbow flexors/extensors and wrist flexors/extensors were 28.1, 28.8 and 19.9, 8.8 cm3 in the paretic limb and 29.6, 27.7 and 19.7, 8.8 cm3 in the non-paretic limb. In short, these findings indicate a decrease in muscle volume and not an increase in intramuscular fat, which will contribute to the reduction in strength in the paretic upper limb.

scholarly journals Correlations between motor and sensory functions in upper limb chronic hemiparetics after stroke

2011 ◽  
Vol 69 (4) ◽  
pp. 624-629 ◽  
Author(s):  
Thais Botossi Scalha ◽  
Erica Miyasaki ◽  
Núbia Maria Freire Vieira Lima ◽  
Guilherme Borges
Keyword(s):  
Upper Limb ◽  
Visual Information ◽  
Stroke Patients ◽  
Weight Discrimination ◽  
Test Items ◽  
Hemiparetic Stroke ◽  
And Performance ◽  
Chronic Hemiparetic Stroke ◽  
Sensory Functions ◽  
Somatosensory Function

OBJECTIVE: Describe the somatosensory function of the affected upper limb of hemiparetic stroke patients and investigate the correlations between measurements of motor and sensory functions in tasks with and without visual deprivation. METHOD: We applied the Fugl-Meyer Assessment (FMA), Nottingham Sensory Assessment (NSA), and several motor and sensory tests: Paper manipulation (PM), Motor Sequences (MS), Reaching and grasping (RG) Tests Functional (TF), Tactile Discrimination (TD), Weight Discrimination (WD) and Tactile Recognition of Objects (RO). RESULTS: We found moderate correlations between the FMA motor subscale and the tactile sensation score of the NSA. Additionally, the FMA sensitivity was correlated with the NSA total; and performance on the WD test items correlated with the NSA. CONCLUSION: There was a correlation between the sensory and motor functions of the upper limb in chronic hemiparetic stroke patients. Additionally, there was a greater reliance on visual information to compensate for lost sensory-motor skills.

scholarly journals A Wrist and Finger Force Sensor Module for Use During Movements of the Upper Limb in Chronic Hemiparetic Stroke

2009 ◽  
Vol 56 (9) ◽  
pp. 2312-2317 ◽  
Author(s):  
L.C. Miller ◽  
R. Ruiz-Torres ◽  
A.H.A. Stienen ◽  
J.P.A. Dewald
Keyword(s):  
Upper Limb ◽  
Force Sensor ◽  
Finger Force ◽  
Sensor Module ◽  
Hemiparetic Stroke ◽  
Chronic 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.

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