The effects of the functional tone management (FTM) arm training program on upper extremity motor control on chronic post-stroke individuals

Introduction: Visual abnormalities and manual motor control have been studied extensively after stroke, but an understanding of oculomotor control post-stroke has not. Recent studies have revealed that in visually guided reaches arm movements are planned during eye movement execution, which may contribute to increased task complexity. In fact, in healthy controls during visually guided reaches, the onset of eye movement is delayed, its velocity reduced, and endpoint errors are larger relative to isolated eye movements. Our objective in this experiment was to examine the temporal properties of eye movement execution for stroke patients with no diagnosed visual impairment. The goal is to improve understanding of oculomotor control in stroke relative to normal function, and ultimately further understand its coordination with manual motor control during joint eye and hand movements. We hypothesized that stroke patients would show abnormal initiation or onset latency for saccades made in an eye movement task, as compared to healthy controls. Methods: We measured the kinematics of eye movements during point-to-point saccades; there was an initial static, fixation point and the stimulus was a flashed target on a computer monitor. We used a video-based eye tracker for objective recording of the eye at a sampling frequency of 2000 Hz (SR Research, Eyelink). 10 stroke subjects, over 4 months from injury and with no diagnosed visual impairment, and 10 healthy controls completed 432 saccades in a serial fashion. Results: Stroke patients had significantly faster onset latencies as compared to healthy controls during saccades (99.5ms vs. 245.2ms, p=0.00058). Conclusion: A better understanding of the variations in oculomotor control post-stroke, which may go unnoticed during clinical assessment, may improve understanding of how eye control synchronizes with arm or manual motor control. This knowledge could assist in tailoring rehabilitative strategies to amplify motor recovery. For next steps, we will perform objective eye and hand recordings during visually guided reaches post-stroke to better understand the harmonization or lack thereof after neurologic insult.

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Efficacy of Constraint-Induced Movement Therapy for Post-Stroke Upper Extremity Hemiparesis Patients Attending a Day-Care Center

Rigakuryoho Kagaku ◽

10.1589/rika.24.929 ◽

2009 ◽

Vol 24 (6) ◽

pp. 929-933

Author(s):

Taichi KURAYAMA ◽

Anna WATANABE ◽

Minami TAKAMOTO ◽

Nami SHIGETA ◽

Yuki HASEGAWA ◽

...

Keyword(s):

Upper Extremity ◽

Day Care ◽

Care Center ◽

Movement Therapy ◽

Day Care Center ◽

Post Stroke ◽

Constraint Induced Movement Therapy

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Abstract 13: Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽

10.1161/str.51.suppl_1.13 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

David J Lin ◽

Alison M Cloutier ◽

Kimberly S Erler ◽

Jessica M Cassidy ◽

Samuel B Snider ◽

...

Keyword(s):

Acute Stroke ◽

Upper Extremity ◽

Corticospinal Tract ◽

Standard Of Care ◽

Major Effect ◽

Motor Recovery ◽

Post Stroke ◽

Stroke Imaging ◽

Recovery Potential ◽

Structural Injury

Introduction: Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods: Patients (N = 48) with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer (FM) during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using four different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict delta FM. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results: 48 patients were enrolled 4.2 ± 2.7 days post-stroke and completed this study. CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with AUC values ranging from 0.75 to 0.8. In addition, CST injury explained ~20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing four different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions: Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in post-stroke upper extremity motor recovery.

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Muscle torques and joint accelerations provide more sensitive measures of post-stroke movement deficits than joint angles.

Journal of Neurophysiology ◽

10.1152/jn.00149.2021 ◽

2021 ◽

Author(s):

Ariel B Thomas ◽

Erienne V Olesh ◽

Amelia Adcock ◽

Valeriya Gritsenko

Keyword(s):

Motor Control ◽

Motion Capture ◽

Reaching Movements ◽

Motor Deficits ◽

Joint Angles ◽

Active Joint ◽

Joint Torques ◽

Post Stroke ◽

Muscle Moments ◽

Muscle Torques

The whole repertoire of complex human motion is enabled by forces applied by our muscles and controlled by the nervous system. The impact of stroke on the complex multi-joint motor control is difficult to quantify in a meaningful way that informs about the underlying deficit in the active motor control and intersegmental coordination. We tested whether post-stroke deficit can be quantified with high sensitivity using motion capture and inverse modeling of a broad range of reaching movements. Our hypothesis is that muscle moments estimated based on active joint torques provide a more sensitive measure of post-stroke motor deficits than joint angles. The motion of twenty-two participants was captured while performing reaching movements in a center-out task, presented in virtual reality. We used inverse dynamics analysis to derive active joint torques that were the result of muscle contractions, termed muscle torques, that caused the recorded multi-joint motion. We then applied a novel analysis to separate the component of muscle torque related to gravity compensation from that related to intersegmental dynamics. Our results show that muscle torques characterize individual reaching movements with higher information content than joint angles do. Moreover, muscle torques enable distinguishing the individual motor deficits caused by aging or stroke from the typical differences in reaching between healthy individuals. Similar results were obtained using metrics derived from joint accelerations. This novel quantitative assessment method may be used in conjunction with home-based gaming motion-capture technology for remote monitoring of motor deficits and inform the development of evidence-based robotic therapy interventions.

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Robotic Table and Serious Games for Integrative Rehabilitation Early Post-Stroke: Two Case Reports (Preprint)

10.2196/preprints.26990 ◽

2021 ◽

Author(s):

Grigore Burdea ◽

Nam H. Kim ◽

Kevin Polistico ◽

Ashwin Kadaru ◽

Namrata Grampurohit ◽

...

Keyword(s):

Upper Extremity ◽

Serious Games ◽

Case Reports ◽

Upper Extremities ◽

Pinch Strength ◽

Robotic Rehabilitation ◽

Standardized Measures ◽

Post Stroke ◽

Active Flexion ◽

Rehabilitation System

BACKGROUND BrightArm Compact is a new rehabilitation system for upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with serious games. OBJECTIVE To design and test a robotic rehabilitation table-based virtual rehabilitation system for training upper extremities early post-stroke. METHODS A new robotic rehabilitation table, controllers and adaptive games were developed. Participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity motor impairment and function, depression severity, and cognitive function were administered pre- and post-intervention. Non-standardized measures included game variables and subjective evaluations. RESULTS Two case study participants attained high total arm repetitions per session (504 and 957, respectively), and achieved high grasp and finger extension counts. Training intensity contributed to marked improvements in affected arm shoulder strength (225% and 100%, respectively), grasp strength (27% and 16% increase), 3-finger pinch strength (31% and 15% increase). Shoulder active flexion range increased 17% and 18%, respectively, and elbow active supination was larger by 75% and 58%, respectively. Improvements in motor function were at/above Minimal Clinically Important Difference for Fugl-Meyer Assessment (11 and 10 points), Chedoke Inventory (11 and 14 points) and Upper Extremity Functional Index (19 and 23 points). Cognitive/emotive outcomes were mixed. CONCLUSIONS The design of the robotic rehabilitation table was successfully tested on two participants early post-stroke. Results are encouraging. CLINICALTRIAL ClinicalTrials.gov NCT04252170

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Implementation of a Shoulder Program for Post-Stroke Upper Extremity Complications in Inpatient Rehabilitation

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2019.08.260 ◽

2019 ◽

Vol 100 (10) ◽

pp. e89-e90

Author(s):

Priyanka Kapoor ◽

Joanna Allbright ◽

Librada Callender ◽

Molly Trammell

Keyword(s):

Upper Extremity ◽

Inpatient Rehabilitation ◽

Post Stroke

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Ability of people with post-stroke hemiplegia to self-administer FES-assisted hand therapy video games at home: An exploratory case series

Journal of Rehabilitation and Assistive Technologies Engineering ◽

10.1177/2055668319854000 ◽

2019 ◽

Vol 6 ◽

pp. 205566831985400 ◽

Cited By ~ 2

Author(s):

Michael J Fu ◽

Mary Y Harley ◽

Terri Hisel ◽

Robyn Busch ◽

Richard Wilson ◽

...

Keyword(s):

Electrical Stimulation ◽

Video Games ◽

Upper Extremity ◽

Functional Electrical Stimulation ◽

Video Game ◽

Cognitive Outcomes ◽

Hand Therapy ◽

Post Stroke ◽

Game Therapy ◽

At Home

Introduction This article describes the development and initial clinical testing of an innovative home-based treatment for upper extremity hemiplegia that integrates contralaterally controlled functional electrical stimulation with hand therapy video games. Methods We explored the ability of seven participants with moderate-to-severe hand impairment to self-administer 12 weeks of contralaterally controlled functional electrical stimulation video game therapy at home for 10 h/week and in-lab with a therapist for four h/week. Clinical suitability was assessed by device usage logs, qualitative surveys, and clinical motor and cognitive outcomes. Results Three participants completed the study with > 95% compliance and four did not. Factors linked to incompletion included development of trigger finger in the non-paretic hand, acceptance of a new full-time job, residence relocation, and persistence of drowsiness from anti-spasticity medication. Those who completed the treatment perceived qualitative benefits and experienced gains in motor and cognitive outcomes. Conclusion Individuals with moderate-to-severe chronic post-stroke upper extremity hemiplegia can self-administer contralaterally controlled functional electrical stimulation video game therapy for up to 90 min/day at home. We also identified social and physiological factors that may preclude its use for daily home treatment. Further studies are warranted and are in progress to estimate treatment effect and optimal dose of this intervention.

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