Stepwise intervention for proximal and distal upper extremity motor function in patients with chronic stroke: A report of 2 cases

Abstract Background Ischemic cerebrovascular stroke is defined as an acute neurological dysfunction caused by focal cerebral infarction after decrease in the blood supply of the brain either by stenosis or occlusion leading to gross physical impairment or disability lasting more than 24 hours. Objective To assess correlation between site of infarction and upper extremity ( UE) function in chronic stroke patients. Methodology A cross sectional study with (30) Patients with chronic ischemic stroke ( >3 months) suffering from persistent UE motor function impairment, MRI brain done to assess the site of infarction. UE motor function assessment using the Fugl Meyer Assessment (FMA-UE) Scale. Results The current study found that no significant correlation between the site of infarction and UE motor function. Conclusion We concluded that the site of infarction not correlated with UE motor function in chronic stroke patients.

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The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2018.0124 ◽

2019 ◽

Vol 26 (10) ◽

pp. 1-12

Author(s):

Thanchanok Pumprasart ◽

Noppol Pramodhyakul ◽

Pagamas Piriyaprasarth

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Upper Limb ◽

Muscle Tone ◽

Chronic Stroke ◽

Rank Test ◽

Limb Function ◽

Function Test ◽

Wolf Motor Function Test ◽

Therapy Programme

Background/Aims The Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits. Methods A pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test. Results Almost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved. Conclusions The 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.

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Modulation of cortical and spinal inhibition with functional recovery of upper extremity motor function among patients with chronic stroke

Restorative Neurology and Neuroscience ◽

10.3233/rnn-150547 ◽

2015 ◽

Vol 33 (6) ◽

pp. 883-894 ◽

Cited By ~ 9

Author(s):

Toshiyuki Fujiwara ◽

Kaoru Honaga ◽

Michiyuki Kawakami ◽

Atsuko Nishimoto ◽

Kaoru Abe ◽

...

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Functional Recovery ◽

Chronic Stroke ◽

Spinal Inhibition

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Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS

Neurorehabilitation and Neural Repair ◽

10.1177/1545968309338195 ◽

2009 ◽

Vol 23 (8) ◽

pp. 775-783 ◽

Cited By ~ 52

Author(s):

Albert C. Lo ◽

Peter Guarino ◽

Hermano I. Krebs ◽

Bruce T. Volpe ◽

Christopher T. Bever ◽

...

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Controlled Trial ◽

Chronic Stroke ◽

Robot Assisted ◽

Anterior Circulation ◽

Multicenter Randomized Controlled Trial ◽

Index Stroke ◽

Wolf Motor Function Test ◽

Upper Extremity Impairment

Background. Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period. Objective. To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke. Methods. The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment ≥6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. Results. A total of 127 participants were randomized: 49 to RT, 50 to ICT, and 28 to UC. The majority of participants were male (96%), with a mean age of 65 years. The primary stroke type was ischemic (85%), and 58% of strokes occurred in the anterior circulation. Twenty percent of the participants reported a stroke in addition to their index stroke. The average time from the index stroke to enrollment was 56 months (range, 6 months to 24 years). The mean Fugl-Meyer score at entry was 18.9. Conclusions. VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice. The results are expected in early 2010.

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Predictors and brain connectivity changes associated with arm motor function improvement from intensive robotic practice in chronic stroke

F1000Research ◽

10.12688/f1000research.8603.1 ◽

2016 ◽

Vol 5 ◽

pp. 2119 ◽

Cited By ~ 3

Author(s):

George F. Wittenberg ◽

Lorie G. Richards ◽

Lauren M. Jones-Lush ◽

Steven R. Roys ◽

Rao P. Gullapalli ◽

...

Keyword(s):

Clinical Trial ◽

Functional Connectivity ◽

Motor Cortex ◽

Upper Extremity ◽

Fractional Anisotropy ◽

Motor Function ◽

Chronic Stroke ◽

Blood Oxygenation ◽

Robotic Arm ◽

Affected Side

Background and Purpose: The brain changes that underlie therapy-induced improvement in motor function after stroke remain obscure. This study sought to demonstrate the feasibility and utility of measuring motor system physiology in a clinical trial of intensive upper extremity rehabilitation in chronic stroke-related hemiparesis. Methods: This was a substudy of two multi-center clinical trials of intensive robotic arm therapy in chronic, significantly hemiparetic, stroke patients. Transcranial magnetic stimulation was used to measure motor cortical output to the biceps and extensor digitorum communus muscles. Magnetic resonance imaging (MRI) was used to determine the cortical anatomy, as well as to measure fractional anisotropy, and blood oxygenation (BOLD) during an eyes-closed rest state. Region-of-interest time-series correlation analysis was performed on the BOLD signal to determine interregional connectivity. Functional status was measured with the upper extremity Fugl-Meyer and Wolf Motor Function Test. Results: Motor evoked potential (MEP) presence was associated with better functional outcomes, but the effect was not significant when considering baseline impairment. Affected side internal capsule fractional anisotropy was associated with better function at baseline. Affected side primary motor cortex (M1) activity became more correlated with other frontal motor regions after treatment. Resting state connectivity between affected hemisphere M1 and dorsal premotor area (PMAd) predicted recovery. Conclusions: Presence of motor evoked potentials in the affected motor cortex and its functional connectivity with PMAd may be useful in predicting recovery. Functional connectivity in the motor network shows a trends towards increasing after intensive robotic or non-robotic arm therapy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: CT00372411 & NCT00333983.

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Predictors and brain connectivity changes associated with arm motor function improvement from intensive practice in chronic stroke

F1000Research ◽

10.12688/f1000research.8603.2 ◽

2017 ◽

Vol 5 ◽

pp. 2119 ◽

Cited By ~ 3

Author(s):

George F. Wittenberg ◽

Lorie G. Richards ◽

Lauren M. Jones-Lush ◽

Steven R. Roys ◽

Rao P. Gullapalli ◽

...

Keyword(s):

Clinical Trial ◽

Functional Connectivity ◽

Motor Cortex ◽

Upper Extremity ◽

Fractional Anisotropy ◽

Motor Function ◽

Primary Motor Cortex ◽

Chronic Stroke ◽

Blood Oxygenation ◽

Affected Side

Background and Purpose: The brain changes that underlie therapy-induced improvement in motor function after stroke remain obscure. This study sought to demonstrate the feasibility and utility of measuring motor system physiology in a clinical trial of intensive upper extremity rehabilitation in chronic stroke-related hemiparesis. Methods: This was a substudy of two multi-center clinical trials of intensive robotic and intensive conventional therapy arm therapy in chronic, significantly hemiparetic, stroke patients. Transcranial magnetic stimulation was used to measure motor cortical output to the biceps and extensor digitorum communus muscles. Magnetic resonance imaging (MRI) was used to determine the cortical anatomy, as well as to measure fractional anisotropy, and blood oxygenation (BOLD) during an eyes-closed rest state. Region-of-interest time-series correlation analysis was performed on the BOLD signal to determine interregional connectivity. Functional status was measured with the upper extremity Fugl-Meyer and Wolf Motor Function Test. Results: Motor evoked potential (MEP) presence was associated with better functional outcomes, but the effect was not significant when considering baseline impairment. Affected side internal capsule fractional anisotropy was associated with better function at baseline. Affected side primary motor cortex (M1) activity became more correlated with other frontal motor regions after treatment. Resting state connectivity between affected hemisphere M1 and dorsal premotor area (PMAd) predicted recovery. Conclusions: Presence of motor evoked potentials in the affected motor cortex and its functional connectivity with PMAd may be useful in predicting recovery. Functional connectivity in the motor network shows a trends towards increasing after intensive robotic or non-robotic arm therapy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00372411 \& NCT00333983.

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The Effect of Priming on Outcomes of Task-Oriented Training for the Upper Extremity in Chronic Stroke: A Systematic Review and Meta-analysis

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320912760 ◽

2020 ◽

Vol 34 (6) ◽

pp. 479-504

Author(s):

Erika Shirley Moreira da Silva ◽

Gabriela Nagai Ocamoto ◽

Gabriela Lopes dos Santos-Maia ◽

Roberta de Fátima Carreira Moreira Padovez ◽

Claudia Trevisan ◽

...

Keyword(s):

Upper Extremity ◽

Motor Function ◽

Effect Size ◽

Action Observation ◽

Chronic Stroke ◽

Upper Extremities ◽

Body Function ◽

Task Oriented ◽

Activity Domain ◽

Quality Evidence

Background. Priming results in a type of implicit memory that prepares the brain for a more plastic response, thereby changing behavior. New evidence in neurorehabilitation points to the use of priming interventions to optimize functional gains of the upper extremity in poststroke individuals. Objective. To determine the effects of priming on task-oriented training on upper extremity outcomes (body function and activity) in chronic stroke. Methods. The PubMed, CINAHL, Web of Science, EMBASE, and PEDro databases were searched in October 2019. Outcome data were pooled into categories of measures considering the International Classification Functional (ICF) classifications of body function and activity. Means and standard deviations for each group were used to determine group effect sizes by calculating mean differences (MDs) and 95% confidence intervals via a fixed effects model. Heterogeneity among the included studies for each factor evaluated was measured using the I2 statistic. Results. Thirty-six studies with 814 patients undergoing various types of task-oriented training were included in the analysis. Of these studies, 17 were associated with stimulation priming, 12 with sensory priming, 4 with movement priming, and 3 with action observation priming. Stimulation priming showed moderate-quality evidence of body function. Only the Wolf Motor Function Test (time) in the activity domain showed low-quality evidence. However, gains in motor function and in use of extremity members were measured by the Fugl-Meyer Assessment (UE-FMA). Regarding sensory priming, we found moderate-quality evidence and effect size for UE-FMA, corresponding to the body function domain (MD 4.77, 95% CI 3.25-6.29, Z = 6.15, P < .0001), and for the Action Research Arm Test, corresponding to the activity domain (MD 7.47, 95% CI 4.52-10.42, Z = 4.96, P < .0001). Despite the low-quality evidence, we found an effect size (MD 8.64, 95% CI 10.85-16.43, Z = 2.17, P = .003) in movement priming. Evidence for action observation priming was inconclusive. Conclusion. Combining priming and task-oriented training for the upper extremities of chronic stroke patients can be a promising intervention strategy. Studies that identify which priming techniques combined with task-oriented training for upper extremity function in chronic stroke yield effective outcomes in each ICF domain are needed and may be beneficial for the recovery of upper extremities poststroke.

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