Electrophysiological Predictors of Lower Limb Motor Recovery: The Rehabilitation Perspective

Background The association between somatosensory impairments and outcome after stroke remains unclear. Purpose The aim of this study was to systematically review the available literature on the relationship between somatosensory impairments in the upper limb and outcome after stroke. Data Sources The electronic databases PubMed, CINAHL, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from inception until July 2013. Study Selection Studies were included if adult patients with stroke (minimum n=10) were examined with reliable and valid measures of somatosensation in the upper limb to investigate the relationship with upper limb impairment, activity, and participation measures. Exclusion criteria included measures of somatosensation involving an overall score for upper and lower limb outcome and articles including only lower limb outcomes. Data Extraction Eligibility assessment, data extraction, and quality evaluation were completed by 2 independent reviewers. A cutoff score of ≥65% of the maximal quality score was used for further inclusion in this review. Data Synthesis Six articles met all inclusion criteria. Two-point discrimination was shown to be predictive for upper limb dexterity, and somatosensory evoked potentials were shown to have predictive value in upper limb motor recovery. Proprioception was significantly correlated with perceived level of physical activity and social isolation and had some predictive value in functional movements of the upper limb. Finally, the combination of light touch and proprioception impairment was shown to be significantly related to upper limb motor recovery as well as handicap situations during activities of daily living. Limitations Heterogeneity of the included studies warrants caution when interpreting results. Conclusions Large variation in results was found due to heterogeneity of the studies. However, somatosensory deficits were shown to have an important role in upper limb motor and functional performance after stroke.

Download Full-text

Predictors of volitional motor recovery with epidural stimulation in individuals with chronic spinal cord injury

Brain ◽

10.1093/brain/awaa423 ◽

2020 ◽

Author(s):

Samineh Mesbah ◽

Tyler Ball ◽

Claudia Angeli ◽

Enrico Rejc ◽

Nicholas Dietz ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Lower Extremity ◽

Lower Limb ◽

Motor Recovery ◽

Cervical Cord ◽

Voluntary Movements ◽

Epidural Stimulation ◽

Cord Injury ◽

Complete Spinal Cord Injury

Abstract Spinal cord epidural stimulation (scES) has enabled volitional lower extremity movements in individuals with chronic and clinically motor complete spinal cord injury and no clinically detectable brain influence. The aim of this study was to understand whether the individuals’ neuroanatomical characteristics or positioning of the scES electrode were important factors influencing the extent of initial recovery of lower limb voluntary movements in those with clinically motor complete paralysis. We hypothesized that there would be significant correlations between the number of joints moved during attempts with scES prior to any training interventions and the amount of cervical cord atrophy above the injury, length of post-traumatic myelomalacia and the amount of volume coverage of lumbosacral enlargement by the stimulation electrode array. The clinical and imaging records of 20 individuals with chronic and clinically motor complete spinal cord injury who underwent scES implantation were reviewed and analysed using MRI and X-ray integration, image segmentation and spinal cord volumetric reconstruction techniques. All individuals that participated in the scES study (n = 20) achieved, to some extent, lower extremity voluntary movements post scES implant and prior to any locomotor, voluntary movement or cardiovascular training. The correlation results showed that neither the cross-section area of spinal cord at C3 (n = 19, r = 0.33, P = 0.16) nor the length of severe myelomalacia (n = 18, r = −0.02, P = 0.93) correlated significantly with volitional lower limb movement ability. However, there was a significant, moderate correlation (n = 20, r = 0.59, P = 0.006) between the estimated percentage of the lumbosacral enlargement coverage by the paddle electrode as well as the position of the paddle relative to the maximal lumbosacral enlargement and the conus tip (n = 20, r = 0.50, P = 0.026) with the number of joints moved volitionally. These results suggest that greater coverage of the lumbosacral enlargement by scES may improve motor recovery prior to any training, possibly because of direct modulatory effects on the spinal networks that control lower extremity movements indicating the significant role of motor control at the level of the spinal cord.

Download Full-text

Effects of mirror therapy on walking ability, balance and lower limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

Clinical Rehabilitation ◽

10.1177/0269215518766642 ◽

2018 ◽

Vol 32 (8) ◽

pp. 1007-1021 ◽

Cited By ~ 4

Author(s):

Yi Li ◽

Qingchuan Wei ◽

Wei Gou ◽

Chengqi He

Keyword(s):

Lower Limb ◽

Walking Speed ◽

Meta Analysis ◽

Motor Recovery ◽

Controlled Trials ◽

Walking Ability ◽

Balance Function ◽

Mirror Therapy ◽

Randomized Controlled ◽

Lower Limb Function

Objective: To investigate the effects of mirror therapy on walking ability, balance and lower limb motor recovery in patients with stroke. Method: MEDLINE, EMBASE, Web of Science, CENTRAL, PEDro Database, CNKI, VIP, Wan Fang, ClinicalTrials.gov, Current controlled trials and Open Grey were searched for randomized controlled trials that investigated the effects of mirror therapy on lower limb function through January 2018. The primary outcomes included were walking speed, mobility and balance function. Secondary outcomes included lower limb motor recovery, spasticity and range of motion. Quality assessments were performed with the PEDro scale. Results: A total of 13 studies ( n = 572) met the inclusion criteria. A meta-analysis demonstrated a significant effect of mirror therapy on walking speed (mean difference (MD) 0.1 m/s, 95% confidence interval (CI): 0.08 to 0.12, P < 0.00001), balance function (standard mean difference (SMD) 0.66, 95% CI: 0.43 to 0.88, P < 0.00001), lower limb motor recovery (SMD 0.83, 95% CI: 0.62 to 1.05, P < 0.00001) and passive range of motion of ankle dorsiflexion (MD 2.07°, 95% CI: 082 to 3.32, P = 0.001), without improving mobility (SMD 0.43, 95% CI: −0.12 to 0.98, P = 0.12) or spasticity of ankle muscles (MD −0.14, 95% CI: −0.43 to 0.15, P = 0.35). Conclusion: The systematic review demonstrates that the use of mirror therapy in addition to some form of rehabilitation appears promising for some areas of lower limb function, but there is not enough evidence yet to suggest when and how to approach this therapy.

Download Full-text

Pelvic alignment in standing, and its relationship with trunk control and motor recovery of lower limb after stroke

Neurology and Clinical Neuroscience ◽

10.1111/ncn3.12092 ◽

2016 ◽

Vol 5 (1) ◽

pp. 22-28 ◽

Cited By ~ 8

Author(s):

Suruliraj Karthikbabu ◽

Mahabala Chakrapani ◽

Sailakshmi Ganesan ◽

Ratnavalli Ellajosyla

Keyword(s):

Lower Limb ◽

Motor Recovery ◽

Trunk Control

Download Full-text