scholarly journals Upper and Lower Limb Motor Function Correlates with Ipsilesional Corticospinal Tract and Red Nucleus Structural Integrity in Chronic Stroke: A Cross-Sectional, ROI-Based MRI Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Denise M. Peters ◽  
Julius Fridriksson ◽  
Jessica D. Richardson ◽  
Jill C. Stewart ◽  
Chris Rorden ◽  
...  
Keyword(s):  
Motor Function ◽  
Lower Limb ◽  
Gait Speed ◽  
Motor Performance ◽  
Corticospinal Tract ◽  
Structural Integrity ◽  
Red Nucleus ◽  
Chronic Stroke ◽  
Neural Basis ◽  
Motor Tracts

Background. Structural integrity of the ipsilesional corticospinal tract (CST) is important for upper limb motor recovery after stroke. However, additional neuromechanisms associated with motor function poststroke are less well understood, especially regarding the lower limb. Objective. To investigate the neural basis of upper/lower limb motor deficits poststroke by correlating measures of motor function with diffusion tensor imaging-derived indices of white matter integrity (fractional anisotropy (FA), mean diffusivity (MD)) in primary and secondary motor tracts/structures. Methods. Forty-three individuals with chronic stroke (time poststroke, 64.4 ± 58.8 months) underwent a comprehensive motor assessment and MRI scanning. Correlation and multiple regression analyses were performed to examine relationships between FA/MD in a priori motor tracts/structures and motor function. Results. FA in the ipsilesional CST and red nucleus (RN) was positively correlated with motor function of both the affected upper and lower limb ( r = 0.36 ‐ 0.55 , p ≤ 0.01 ), while only ipsilesional RN FA was associated with gait speed ( r = 0.50 ). Ipsilesional CST FA explained 37.3% of the variance in grip strength ( p < 0.001 ) and 31.5% of the variance in Arm Motricity Index ( p = 0.004 ). Measures of MD were not predictors of motor performance. Conclusions. Microstructural integrity of the ipsilesional CST is associated with both upper and lower limb motor function poststroke, but appears less important for gait speed. Integrity of the ipsilesional RN was also associated with motor performance, suggesting increased contributions from secondary motor areas may play a role in supporting chronic motor function and could become a target for interventions.

scholarly journals Changes in Diffusion Metrics of the Red Nucleus in Chronic Stroke Patients With Severe Corticospinal Tract Injury: A Preliminary Study

2018 ◽  
Vol 42 (3) ◽  
pp. 396-405 ◽  
Author(s):  
Hanjun Kim ◽  
Hoyoung Lee ◽  
Kwang-Ik Jung ◽  
Suk Hoon Ohn ◽  
Woo-Kyoung Yoo
Keyword(s):  
Corticospinal Tract ◽  
Red Nucleus ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Preliminary Study

Deep Repetitive Transcranial Magnetic Stimulation With H-coil on Lower Limb Motor Function in Chronic Stroke: A Pilot Study

2014 ◽  
Vol 95 (6) ◽  
pp. 1141-1147 ◽  
Author(s):  
Raffaella Chieffo ◽  
Serena De Prezzo ◽  
Elise Houdayer ◽  
Arturo Nuara ◽  
Giovanni Di Maggio ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Pilot Study ◽  
Motor Function ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Chronic Stroke

scholarly journals Effectiveness of combined modified constraint-induced movement therapy for upper and lower limb in stroke rehabilitation: a study protocol for randomized controlled trial (Preprint)

2018 ◽  
Author(s):  
Lawan Umar
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Gait Speed ◽  
Stride Length ◽  
Controlled Trial ◽  
Stroke Survivors ◽  
Hrqol Score ◽  
Randomized Controlled ◽  
Post Hoc

BACKGROUND Background: The translation of neuroscientific research into care has led to new approaches and renewed promise. Stroke survivors with hemiparesis often exhibit impaired balance, ambulation dysfunction and asymmetrical weight distribution leading to physical dysfunction and decreased Health-Related Quality of Life (HRQoL).Constraint-induced movement therapy (CIMT) approach could be translated into a clinical protocol for gait rehabilitation. Modified CIMT for upper limb and lower limb when applied singly improve lower limb motor function, balance, gait and HRQoL of stroke survivors OBJECTIVE However, effects of combined modified CIMT for upper and lower limbs (CoMCIMTULL) have not been investigated. Therefore, the effects of four-week CoMCIMTULL was compared with Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) among hemiparetic stroke survivors in this study. METHODS This single-blind randomized controlled trial involved random assignment of 56 consecutive stroke survivors to three groups: CoMCIMTULL (n=19), MCIMTLL (n=20), and MCIMTUL (n=17). The CoMCIMTULL group received both upper and lower limb CIMT for the reduced use of the upper limb and maladaptive use of the lower limb. The MCIMTLL group used the affected lower limb to lead weight bearing activities and exercises while the MCIMTUL group used the affected upper limbs for motor task practice following the unaffected hand’s restraining in a special splint. These treatments were administared in the clinic for two hours daily, five times per week for four consecutive weeks. Lower Limb Motor Function (LLMF) and balance were assessed using Fugyl Meyer Motor Assessement Scale, Lower Limb Use (LLU) with Lower Extremity Motor Activity Log, balance confidence using Activities-specific Balance Confidence Scale, Weight Asymmetry Ratio (WAR) using two weighing scales, spatiotemporal gait parameters [gait speed (m/s) and stride length (m)] using foot print method and HRQoL using the Stroke Impact Scale. These assessments were done at baseline, ends of weeks two and four. Data were analysed using descriptive statistics, ANOVA with post-hoc, Kruskal-Wallis with post-hoc and Wilcoxon Signed Rank at ᾳ0.05. RESULTS MBetween-group comparisons showed that the differences were significant in CoMCIMTULL (HRQoL score=70.00(10.00) ; LLMF = 29.00(5.00); gait speed=0.650(0.70)m/s ; Stride length=0.60(0.30)m ; and WAR=0.90(0.80) ) compared to MCIMTLL (HRQoL score=80.00(17.50); LLMF =29.50(2.50) ; gait speed=0.80(0.28)m/s; Stride length=0.65(0.40)m; and WAR=0.85(0.40) and MCIMTUL (HRQoL score= 60.00(10.00; LLMF =26.00(4.00) ; gait speed= 0.60(0.20)m/s;Stride length= 0.40(0.40)m; and WAR= 0.80(0.40) CONCLUSIONS It is expected, the outcome of this study will clarify whether the effect of combined modified CIMT upper and lower limb (CoMCIMTULL), Modified CIMT Lower Limb (MCIMTLL) and Modified CIMT Upper Limb (MCIMTUL) will leads to better recovery of motor function in stroke survivors. CLINICALTRIAL This study has been approved by both Health Research Ethics Committee of Universty of Ibadan/University College Hospital (UI/EC/14/0101) and the Murtala Muhammad Specialist Hospital, Kano (HMB/GEN/488/VOL.I)(Nigeria). Additionaly, the study employed a randomized controlled clinical trial design, registered with Pan Africa Clinical Trial Registry PACTR 201611001646207, available on www.pactr.org.

scholarly journals Gait Performance and Lower-Limb Muscle Strength Improved in Both Upper-Limb and Lower-Limb Isokinetic Training Programs in Individuals with Chronic Stroke

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Marie-Hélène Milot ◽  
Sylvie Nadeau ◽  
Denis Gravel ◽  
Daniel Bourbonnais
Keyword(s):  
Training Program ◽  
Upper Limb ◽  
Lower Limb ◽  
Gait Speed ◽  
Chronic Stroke ◽  
Control Group ◽  
Positive Power ◽  
Gait Performance ◽  
Lower Limb Muscles ◽  
Limb Muscles

Background. Limited improvement in gait performance has been noted after training despite a significant increase in strength of the affected lower-limb muscles after stroke. A mismatch between the training program and the requirements of gait could explain this finding. Objective. To compare the impact of a training program, matching the requirements of the muscle groups involved in the energy generation of gait, to a control intervention, on gait performance and strength. Methods. 30 individuals with chronic stroke were randomly assigned into two groups (n = 15), each training three times/week for six weeks. The experimental group trained the affected plantarflexors, hip flexors, and extensors, while the control group trained the upper-limb muscles. Baseline and posttraining values of gait speed, positive power (muscles’ concentric action during gait), and strength were retained and compared between groups. Results. After training, both groups showed a similar and significant increase in gait speed, positive power of the hip muscles, and plantarflexors strength. Conclusion. A training program targeting the lower-limb muscles involved in the energy generation of gait did not lead to a greater improvement in gait performance and strength than a training program of the upper-limb muscles. Attending the training sessions might have been a sufficient stimulus to generate gains in the control group.

Effects of home-based dual-hemispheric transcranial direct current stimulation combined with exercise on upper and lower limb motor performance in patients with chronic stroke

2021 ◽  
pp. 1-12
Author(s):  
Thatchaya Prathum ◽  
Pagamas Piriyaprasarth ◽  
Benchaporn Aneksan ◽  
Vimonwan Hiengkaew ◽  
Thitinat Pankhaew ◽  
...  
Keyword(s):  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Lower Limb ◽  
Motor Performance ◽  
Chronic Stroke ◽  
Direct Current Stimulation ◽  
Home Based

scholarly journals Walking with robot-generated haptic forces in a virtual environment: a new approach to analyze lower limb coordination

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Gianluca U. Sorrento ◽  
Philippe S. Archambault ◽  
Joyce Fung
Keyword(s):  
Angular Velocity ◽  
Phase Diagrams ◽  
Virtual Environment ◽  
Lower Limb ◽  
Gait Speed ◽  
Sobolev Norm ◽  
Chronic Stroke ◽  
Intersegmental Coordination ◽  
Norm Values ◽  
Limb Coordination

Abstract Background Walking with a haptic tensile force applied to the hand in a virtual environment (VE) can induce adaptation effects in both chronic stroke and non-stroke individuals. These effects are reflected in spatiotemporal outcomes such as gait speed. However, the concurrent kinematic changes occurring in bilateral lower limb coordination have yet to be explored. Methods Chronic stroke participants were stratified based on overground gait speed into lower functioning (LF < 0.8 m/s, N = 7) and higher functioning (HF ≥ 0.8 m/s, N = 7) subgroups. These subgroups and an age-matched control group (N = 14, CG) walked on a self-paced treadmill in a VE with either robot-generated haptic leash forces delivered to the hand and then released or with an instrumented cane. Walking in both leash (10 and 15 N) and cane conditions were compared to pre-force baseline values to evaluate changes in lower limb coordination outcomes. Results All groups showed some kinematic changes in thigh, leg and foot segments when gait speed increased during force and post-force leash as well as cane walking. These changes were also reflected in intersegmental coordination and 3D phase diagrams, which illustrated increased intersegmental trajectory areas (p < 0.05) and angular velocity. These increases could also be observed when the paretic leg transitions from stance to swing phases while walking with the haptic leash. The Sobolev norm values accounted for both angular position and angular velocity, providing a single value for potentially quantifying bilateral (i.e. non-paretic vs paretic) coordination during walking. These values tended to increase (p < 0.05) proportionally for both limbs during force and post-force epochs as gait speed tended to increase. Conclusions Individuals with chronic stroke who increased their gait speed when walking with tensile haptic forces and immediately after force removal, also displayed moderate concurrent changes in lower limb intersegmental coordination patterns in terms of angular displacement and velocity. Similar results were also seen with cane walking. Although symmetry was less affected, these findings appear favourable to the functional recovery of gait. Both the use of 3D phase diagrams and assigning Sobolev norm values are potentially effective for detecting and quantifying these coordination changes.

scholarly journals Predicting Motor Sequence Learning in Individuals With Chronic Stroke

2016 ◽  
Vol 31 (1) ◽  
pp. 95-104 ◽  
Author(s):  
Katie P. Wadden ◽  
Kristopher De Asis ◽  
Cameron S. Mang ◽  
Jason L. Neva ◽  
Sue Peters ◽  
...  
Keyword(s):  
Motor Function ◽  
Sequence Learning ◽  
Motor Skill ◽  
Retention Test ◽  
Motor Performance ◽  
Individual Performance ◽  
Chronic Stroke ◽  
Superior Performance ◽  
Motor Sequence Learning ◽  
Motor Sequence

Background. Conventionally, change in motor performance is quantified with discrete measures of behavior taken pre- and postpractice. As a high degree of movement variability exists in motor performance after stroke, pre- and posttesting of motor skill may lack sensitivity to predict potential for motor recovery. Objective. Evaluate the use of predictive models of motor learning based on individual performance curves and clinical characteristics of motor function in individuals with stroke. Methods. Ten healthy and fourteen individuals with chronic stroke performed a continuous joystick-based tracking task over 6 days, and at a 24-hour delayed retention test, to assess implicit motor sequence learning. Results. Individuals with chronic stroke demonstrated significantly slower rates of improvements in implicit sequence-specific motor performance compared with a healthy control (HC) group when root mean squared error performance data were fit to an exponential function. The HC group showed a positive relationship between a faster rate of change in implicit sequence-specific motor performance during practice and superior performance at the delayed retention test. The same relationship was shown for individuals with stroke only after accounting for overall motor function by including Wolf Motor Function Test rate in our model. Conclusion. Nonlinear information extracted from multiple time points across practice, specifically the rate of motor skill acquisition during practice, relates strongly with changes in motor behavior at the retention test following practice and could be used to predict optimal doses of practice on an individual basis.

scholarly journals Self-modulation of motor cortex activity after stroke alters behavior and corticospinal tract structure: a randomized controlled trial

2021 ◽  
Author(s):  
Zeena-Britt Sanders ◽  
Melanie K Fleming ◽  
Tom Smejka ◽  
Marilien C Marzolla ◽  
Catharina Zich ◽  
...  
Keyword(s):  
White Matter ◽  
Motor Cortex ◽  
Real Time ◽  
Motor Performance ◽  
Structural Changes ◽  
Corticospinal Tract ◽  
Brain Activity ◽  
Controlled Trial ◽  
Chronic Stroke ◽  
Stroke Survivors

Real-time functional magnetic resonance imaging (fMRI) neurofeedback allows individuals to self-modulate their ongoing brain activity. This may be a useful tool in clinical disorders which are associated with altered brain activity patterns. Motor impairment after stroke has previously been associated with decreased laterality of motor cortex activity. Here we examined whether chronic stroke survivors were able to use real-time fMRI neurofeedback to increase laterality of motor cortex activity and assessed effects on motor performance and on brain structure and function. We carried out a randomized, double-blind, sham-controlled trial in which 24 chronic stroke survivors with mild to moderate upper limb impairment experienced three training days of either Real (n=12) or Sham (n=12) neurofeedback. Stroke survivors were able to use Real neurofeedback to increase laterality of motor cortex activity within, but not across, training days. Improvement in gross hand motor performance assessed by the Jebsen Taylor Test (JTT) was observed in the Real neurofeedback group compared to Sham. However, there were no improvements on the Action Research Arm Test (ARAT) or the Upper Extremity Fugl-Meyer (UE-FM) score. Additionally, decreased white-matter asymmetry of the corticospinal tracts was detected 1-week after neurofeedback training, indicating that the tracts become more similar with Real neurofeedback. Changes in the affected corticospinal tract was positively correlated with neurofeedback performance. Therefore, here we demonstrate that chronic stroke survivors are able to use fMRI neurofeedback to self-modulate motor cortex activity, and that training is associated with improvements in hand motor performance and with white matter structural changes.

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