Optimal stimulation site for rTMS to improve motor function: Anatomical hand knob vs. hand motor hotspot

Introduction: Individuals living with chronic stroke have weakness and increased neuromuscular fatigue in the paretic leg, which can limit walking ability and endurance. In cardiac and healthy populations, ischemic preconditioning (IPC) is a widely studied, effective, non-invasive stimulus which not only improves vascular function, but also motor performance. IPC occurs when the tissue of interest is exposed to repeated, short bouts of ischemia, which can improve motor function by enhancing vascular, neural and muscle function. IPC has not been tested as a method to improve motor function in individuals post-stroke. Hypothesis: Two weeks of IPC training on the paretic leg will improve leg strength and time-to-task failure (TTF) during a fatiguing muscle contraction. Methods: A feasibility study of 4 individuals (3 female, 1 male) with chronic stroke (20 ± 4 years) was conducted. A Biodex dynamometer was used to assess paretic leg knee extensor maximal voluntary contraction (MVC). To assess muscle fatigability, subjects maintained a sustained contraction equal to 30% of their MVC until failure using visual feedback. After baseline testing, subjects made six visits to the laboratory over a two week period to have IPC performed on their paretic leg. A blood pressure cuff was inflated on the thigh to 225 mmHg for five, five-minute bouts per session. Five minutes of rest was given between inflation cycles. After the last session, subjects returned within 48 hours to have MVC and TTF reassessed. Results: Three subjects completed all study procedures. One subject withdrew for medical reasons unrelated to the study. The IPC procedure was well tolerated by all subjects. After two-week IPC training, knee extensor MVC increased in the paretic leg (45.0 ± 2.7 Nm vs. 52.6 ± 5.7 Nm). Fatigability of the muscles was dramatically reduced after IPC training as TTF tripled (359 ± 180 seconds vs. 1097 ± 343 seconds). Conclusions: We are the first group to show that IPC is a well-tolerated and effective stimulus to improve paretic leg strength and reduce muscle fatigability in subjects with chronic stroke. The results of this pilot study warrant a larger study to determine whether IPC improves muscle performance post-stroke through neural, vascular, or muscle-related mechanisms.

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Technology to enhance arm and hand function

Oxford Textbook of Neurorehabilitation ◽

10.1093/med/9780198824954.003.0033 ◽

2020 ◽

pp. 445-460

Author(s):

Arthur Prochazka

Keyword(s):

Motor Function ◽

Exercise Therapy ◽

Hand Function ◽

Neuromuscular Control ◽

Home Exercise ◽

Clinical Environment ◽

Implanted Electrodes ◽

Improve Motor Function ◽

Widespread Availability ◽

Robotic Devices

About 2% of people have weak or paralysed upper limbs (ULs) due to stroke or spinal cord injury (SCI). Physiotherapy involving exercise can improve motor function in many such cases, but the time and resources required are often unavailable. Adherence to repeated intensive exercise tends to decline, especially after participants leave the clinical environment. There is a need for technology that can restore neuromuscular control and improve motivation by making exercise therapy enjoyable, and that extends the therapy into the home with the use of remote communication (e.g. ‘tele-coaching’). Over the last 20 years many devices have been developed and tested. Neuroprostheses (NPs) that activate UL muscles with functional electrical stimulation (FES) either via surface or implanted electrodes are now commercially available or in clinical trials. The use of robotic devices to enhance exercise therapy has been an active area of research and development. Recent studies indicate that improvements in motor function depend largely on the efforts made by the participant. This chapter reviews conventional exercise therapy, FES, and robotic and passive exercise devices that improve motor function and enhance engagement in UL rehabilitation. It is suggested that important developments in the next few years will include the widespread availability of affordable FES and in-home exercise devices, and the gradual adoption of tele-coaching over the internet.

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Nonsteroidal Anti-Inflammatory Drugs and Their Neuroprotective Role After an Acute Spinal Cord Injury: A Systematic Review of Animal Models

Global Spine Journal ◽

10.1177/2192568220901689 ◽

2020 ◽

pp. 219256822090168

Author(s):

Mark J. Lambrechts ◽

James L. Cook

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Animal Models ◽

Motor Function ◽

Spinal Cord Injuries ◽

Inclusion Criteria ◽

Improve Motor Function ◽

Cord Injury ◽

Inflammatory Drugs ◽

Anti Inflammatory

Study Design: Systematic review. Objective: Spinal cord injuries (SCIs) resulting in motor deficits can be devastating injuries resulting in millions of health care dollars spent per incident. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a potential class of drugs that could improve motor function after an SCI. This systematic review utilizes PRISMA guidelines to evaluate the effectiveness of NSAIDs for SCI. Methods: PubMed/MEDLINE, CINAHL, PsycINFO, Embase, and Scopus were reviewed linking the keywords of “ibuprofen,” “meloxicam,” “naproxen,” “ketorolac,” “indomethacin,” “celecoxib,” “ATB-346,” “NSAID,” and “nonsteroidal anti-inflammatory drug” with “spinal.” Results were reviewed for relevance and included if they met inclusion criteria. The SYRCLE checklist was used to assess sources of bias. Results: A total of 2960 studies were identified in the PubMed/MEDLINE database using the above-mentioned search criteria. A total of 461 abstracts were reviewed in Scopus, 340 in CINAHL, 179 in PsycINFO, and 7632 in Embase. A total of 15 articles met the inclusion criteria. Conclusions: NSAIDs’ effectiveness after SCI is largely determined by its ability to inhibit Rho-A. NSAIDs are a promising therapeutic option in acute SCI patients because they appear to decrease cord edema and inflammation, increase axonal sprouting, and improve motor function with minimal side effects. Studies are limited by heterogeneity, small sample size, and the use of animal models, which might not replicate the therapeutic effects in humans. There are no published human studies evaluating the safety and efficacy of these drugs after a traumatic cord injury. There is a need for well-designed prospective studies evaluating ibuprofen or indomethacin after adult spinal cord injuries.

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ID 29 – Focal lesion on the hand knob re-localizes motor function laterally compared to the unaffected hemisphere

Clinical Neurophysiology ◽

10.1016/j.clinph.2015.11.220 ◽

2016 ◽

Vol 127 (3) ◽

pp. e66

Author(s):

E. Kallioniemi ◽

L. Säisänen ◽

P. Julkunen ◽

M. Könönen ◽

R. Vanninen ◽

...

Keyword(s):

Motor Function ◽

Focal Lesion ◽

Hand Knob

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The concept of “normal” movement and its consequences for therapy

Behavioral and Brain Sciences ◽

10.1017/s0140525x00041601 ◽

1996 ◽

Vol 19 (1) ◽

pp. 79-79

Author(s):

Jürgen Konczak ◽

Johannes Dichgans

Keyword(s):

Motor Function ◽

Motor Performance ◽

Adaptive Changes ◽

Normal Movement ◽

Improve Motor Function

AbstractThe guideline for therapy should be the improvement of the individual's functionality, not the acquisition of the ill-defined “goldstandard” of normal movement. However, Latash & Anson's suggestion that only primary causes of dysfunction should be treated is problematic for two reasons: First, the distinction between genuine and adaptive changes in motor performance is not always possible, and second, adaptive changes do not necessarily improve motor function, but may actually be detrimental to the system's performance.

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