scholarly journals Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

2022 ◽  
Vol 2022 ◽  
pp. 1-13
Author(s):  
Ka Yan Luk ◽  
Hui Xi Ouyang ◽  
Marco Yiu Chung Pang
Keyword(s):  
Upper Limb ◽  
Cortical Excitability ◽  
Motor Task ◽  
Low Frequency ◽  
Interhemispheric Asymmetry ◽  
Stroke Patients ◽  
Upper Limb Function ◽  
Subacute Stroke ◽  
Task Practice ◽  
Experimental Group

Objective. To determine the long-term effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional M1 preceding motor task practice on the interhemispheric asymmetry of the cortical excitability and the functional recovery in subacute stroke patients with mild to moderate arm paresis. Methods. Twenty-four subacute stroke patients were randomly allocated to either the experimental or control group. The experimental group underwent rTMS over the contralesional M1 (1 Hz), immediately followed by 30 minutes of motor task practice (10 sessions within 2 weeks). The controls received sham rTMS and the same task practice. Following the 2-week intervention period, the task practice was continued twice weekly for another 10 weeks in both groups. Outcomes were evaluated at baseline (T0), at the end of the 2-week stimulation period (T1), and at 12-week follow-up (T2). Results. The MEP (paretic hand) and interhemispheric asymmetry, Fugl-Meyer motor assessment, Action Research Arm Test, and box and block test scores improved more in the experimental group than controls at T1 ( p < 0.05 ). The beneficial effects were largely maintained at T2. Conclusion. LF-rTMS over the contralesional M1 preceding motor task practice was effective in enhancing the ipsilesional cortical excitability and upper limb function with reducing interhemispheric asymmetry in subacute stroke patients with mild to moderate arm paresis. Significance. Adding LF-rTMS prior to motor task practice may reduce interhemispheric asymmetry of cortical excitabilities and promote upper limb function recovery in subacute stroke with mild to moderate arm paresis.

scholarly journals The effect of virtual reality on motor anticipation and hand function in patients with subacute stroke: A randomised trial on movement-related potential.

2020 ◽  
Author(s):  
Ling Chen ◽  
Yi Chen ◽  
Wai Leung Ambrose Lo
Keyword(s):  
Virtual Reality ◽  
Reaction Time ◽  
Upper Limb ◽  
Cortical Excitability ◽  
Control Group ◽  
Post Intervention ◽  
Limb Function ◽  
Upper Limb Function ◽  
Subacute Stroke ◽  
Vr Training

Abstract Background: Impaired cognitive ability to anticipate the required control may affect functional recovery. The cortical excitability of task related motor anticipation for upper limb movement induced by virtual reality (VR) training is unknown. Aims: To investigate the changes of motor anticipation, cortical excitability and upper limb function induced by VR training in subacute stroke survivors. Methods: Upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 6 months were recruited. Participants were randomly allocated to conventional therapy or VR intervention. Electroencephalogram (EEG) and electromyography (EMG) were simultaneously recorded during palmar grasp motion. Outcome measures of contingent negative variation (CNV) latency, mean peak amplitude, electromyography (EMG) reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA) and the Action Research Arm Test (ARAT) were recorded pre and post intervention. The EEG and EMG differences between the two groups were assessed by mixed model ANOVA (p=0.05). The differences in UL-FMA and ARAT were assessed Wilcoxon signed-rank test (p=0.05). Results: The reduction in EMG reaction time difference, CNV latency and mean peak amplitude were significantly lower in the VR group than the control group when executing movement with the paretic hand. ARAT and UL-FMA scores were significantly higher in the VR group than the control group post intervention. Conclusions: The findings indicated a reduction in brain computational demand during palmar grasp task. Improvements in clinical function in the VR group suggested that VR intervention may be more beneficial in improving upper limb function patients with subacute stroke. Improvement in upper limb function may be related to improvement of the neural anticipatory process. Trial registration: Chinese Clinical Trial Registry (Registration No.: ChiCTR-IOC-15006064). Registered on 11 May 2015. Retrospectively registered. http://www.chictr.org.cn/searchprojen.aspx

P250: Cortical excitability modifications in subacute stroke patients after upper limb rehabilitative treatment

2014 ◽  
Vol 125 ◽  
pp. S114-S115
Author(s):  
C. Chisari ◽  
G. Lamola ◽  
F. Aprigliano ◽  
C. Fanciullacci ◽  
B. Rossi
Keyword(s):  
Upper Limb ◽  
Cortical Excitability ◽  
Stroke Patients ◽  
Rehabilitative Treatment ◽  
Subacute Stroke

Virtual reality on motor anticipation and hand function in patients with subacute stroke : A study on movement-related potential.

2020 ◽  
Author(s):  
Ling Chen ◽  
Yi Chen ◽  
Wai Leung Ambrose Lo
Keyword(s):  
Virtual Reality ◽  
Reaction Time ◽  
Upper Limb ◽  
Cortical Excitability ◽  
Control Group ◽  
Post Intervention ◽  
Limb Function ◽  
Upper Limb Function ◽  
Subacute Stroke ◽  
Vr Training

Abstract Background: Impaired cognitive ability to anticipate the required control may affect functional recovery. The cortical excitability of task related motor anticipation for upper limb movement induced by virtual reality (VR) training is unknown. Aims: To investigate the changes of motor anticipation, cortical excitability and upper limb function induced by VR training in subacute stroke survivors.Methods: Upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 6 months were recruited. Participants were randomly allocated to conventional therapy or VR intervention. Electroencephalogram (EEG) and electromyography (EMG) were simultaneously recorded during parlmar grasp motion. Outcome measures of contingent negative variation (CNV) latency, mean peak amplitude, electromyography (EMG) reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA) and the Action Research Arm Test (ARAT) were recorded pre and post intervention. The EEG and EMG differences between the two groups were assessed by mixed model ANOVA (p=0.05). The differences in UL-FMA and ARAT were assessed Wilcoxon signed-rank test (p=0.05). Results: The reduction in EMG reaction time difference, CNV latency and mean peak amplitude were significantly lower in the VR group than the control group when executing movement with the paretic hand. ARAT and UL-FMA scores were significantly higher in the VR group than the control group post intervention. Conclusions: The findings indicated a reduction in brain computational demand during palmar grasp task. Improvements in clinical function in the VR group suggested that VR intervention may be more beneficial in improving upper limb function patients with subacute stroke. Improvement in upper limb function may be related to improvement of the neural anticipatory process.

scholarly journals A RANDOMIZED CONTROLLED TRIAL ON THE EFFECTS OF OCCUPATIONAL THERAPY INTERVENTIONS USING PATIENT-CENTERED ROBOT-ASSISTED REHABILITATION FOR FUNCTIONAL IMPROVEMENT IN SUBACUTE STROKE PATIENTS

2021 ◽  
pp. 2140040
Author(s):  
DAESEOK YOON ◽  
SEUNGBOK LEE ◽  
SANG-HYUN CHO ◽  
HAEYEAN PARK ◽  
JONGBAE KIM
Keyword(s):  
Upper Limb ◽  
Controlled Trial ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Patient Centered ◽  
Limb Function ◽  
Randomized Controlled ◽  
Upper Limb Function ◽  
Experimental Group ◽  
Adl Performance

The objective of this research study was to investigate the effect of patient-centered robot-assisted intervention for upper limb function improvement in stroke patients. Design: A double-blind randomized controlled trial. Intervention: Subjectively preferred areas of need for performing daily activities were identified by pre-interviewing and applied as target goals in the experimental group using a robotic device. Control-1 underwent a program focused on the robot system involving movements of upper limb joints. Control-2 participated in a conventional rehabilitation program. Methods: Forty-five participants engaged in 60 min of daily therapy, five times weekly for 3 weeks. The experimental group used the Canadian occupational performance measure (COPM) to identify subjectively preferred “patient-centered” focus needed areas to perform robotic device aided daily activities. Control-1 used a robot device-focused rehabilitation involving upper limb joint movements. Control-2 participated in conventional rehabilitation. Pre-post intervention measurements of hand, grip, power, and upper limb ROM were acquired by FMA-UE, MFT, and K-MBI. Results: A significant increase of function in the experimental group was observed in each subclass of function and activities of daily living (ADL) performance. Control-1 showed an increase in function without ADL improvement. Control-2 showed an increase in ADL and proximal areas of upper limb function without an increase in other areas. Conclusion: The “patient-centered” approach significantly improved upper limb function and ADL performance compared to “robot-centered” rehabilitation. Further studies are warranted to confirm these results and for generalizability in clinical application.

scholarly journals Low-Frequency rTMS and Intensive Occupational Therapy Improve Upper Limb Motor Function and Cortical Reorganization Assessed by Functional Near-Infrared Spectroscopy in a Subacute Stroke Patient

2018 ◽  
Vol 10 (2) ◽  
pp. 223-231 ◽  
Author(s):  
Naoki Urushidani ◽  
Shoji Kinoshita ◽  
Takatsugu Okamoto ◽  
Hiroaki Tamashiro ◽  
Masahiro Abo
Keyword(s):  
Upper Limb ◽  
Stroke Patient ◽  
Near Infrared ◽  
Brain Activity ◽  
Low Frequency ◽  
Motor Recovery ◽  
Interhemispheric Asymmetry ◽  
Functional Near Infrared Spectroscopy ◽  
Subacute Stroke ◽  
Low Frequency Rtms

There is still no agreement on the most suitable time and modality for application of repetitive transcranial magnetic stimulation (rTMS) to improve motor recovery in subacute stroke patients. The underlying mechanism of motor recovery following low-frequency rTMS is considered to be modulation of the interhemispheric asymmetry. On the other hand, the cortical balance of brain activity during the acute to chronic phase of stroke is reported to be unstable. Therefore, we conducted this study to clarify the time course of the interhemispheric asymmetry and the effect of application of low-frequency rTMS combined with occupational therapy on motor recovery and cortical imbalance of brain activity in a subacute stroke patient. The interhemispheric asymmetry in this patient with new-onset subcortical cerebral infarction and upper limb hemiparesis was evaluated longitudinally using functional near-infrared spectroscopy with finger tasks. A nonlesional hemisphere-dominant activation pattern was observed on day 28 after onset. On day 56 after onset, a bilaterally eminent activation pattern was observed. Low-frequency rTMS was applied on day 109 after stroke onset when the cortical activity shifted to the nonlesional hemisphere. The treatment resulted in improvement in motor function of the affected upper limb and a shift in brain activation to the lesional hemisphere. Our report is the first to describe the therapeutic benefits of low-frequency rTMS as assessed by longitudinal neuroimaging for functional recovery and interhemispheric asymmetry in a subacute stroke patient.

The effect of clinical application of transcranial direct current stimulation combined with non-immersive virtual reality rehabilitation in stroke patients

2021 ◽  
pp. 1-11
Author(s):  
SiA Lee ◽  
HyunGyu Cha
Keyword(s):  
Executive Function ◽  
Upper Limb ◽  
Control Group ◽  
Stroke Patients ◽  
Limb Function ◽  
Upper Limb Function ◽  
Intervention Method ◽  
Post Test ◽  
Vr Training ◽  
Experimental Group

BACKGROUND: The ability to manipulate the upper limbs and fingers of stroke patients is very important for independent daily life. Among the latest approaches for upper limb rehabilitation training, transcranial direct current stimulation (tDCS) is a non-invasive stimulation method that stimulates the cranial nerves by attaching electrodes to the scalp. In addition, virtual reality (VR) is an intervention method that provides an environment similar to reality and can help restore function by performing body movements as if playing a game. In addition, VR is an intervention method that provides an environment similar to reality and helps to recover functions by performing body movements as if playing a game. OBJECTIVE: This study was conducted to investigate the effect of anodal tDCS applied to the ipsilateral primary motor cortex (M1) during VR training on the upper limb function, cognition, and executive function of stroke patients. METHODS: After 20 patients were randomly assigned to the experimental group and the control group, the experimental group received tDCS and VR, and the control group received sham tDCS and VR for 20 minutes a day, 5 days a week, for a total of 4 weeks. Participants were evaluated for upper limb function using Box and Block Test (BBT) and Jebsen-Taylor Hand Function Test (JTHFT), and cognitive and executive function using the Stroop Test (ST) and Trail Making Test (TMT). RESULTS: In the experimental group, significant differences were found in the pre- and post-test for the all variance (p< 0.05). Control group is significant differences were found in the pre- and post-test for BBT, ST, TMT (p< 0.05). There were significant differences between the two groups in the post test of BBT and ST (p< 0.05). CONCLUSION: The results of this study suggest that anodal tDCS applied to the ipsilateral M1 during VR training is effective for upper limb function, cognitive function, and executive function in stroke patients.

Low frequency transcranial magnetic stimulation in subacute ischemic stroke: Number of sessions that altered cortical excitability

2020 ◽  
Vol 47 (4) ◽  
pp. 427-434
Author(s):  
Mohammed S. El-Tamawy ◽  
Moshera H. Darwish ◽  
Saly H. Elkholy ◽  
Engy BadrEldin S. Moustafa ◽  
Shimaa T. Abulkassem ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transcranial Magnetic Stimulation ◽  
Physical Therapy ◽  
Upper Limb ◽  
Magnetic Stimulation ◽  
Cortical Excitability ◽  
Low Frequency ◽  
Cortical Reorganization ◽  
Therapy Program ◽  
Physical Therapy Program

BACKGROUND: Cortical reorganization between both cerebral hemispheres plays an important role in regaining the affected upper extremity motor function post-stroke. OBJECTIVES: The purpose of the current study was to investigate the recommended number of contra-lesion low frequency repetitive transcranial magnetic stimulation (LF-rTMS) sessions that could enhance cortical reorganization post-stroke. METHODS: Forty patients with right hemiparetic subacute ischemic stroke with an age range between 50–65 yrs were randomly assigned into two equal groups: control (GA) and study (GB) groups. Both groups were treated with a selected physical therapy program for the upper limb. Sham and real contra-lesion LF-rTMS was conducted for both groups daily for two consecutive weeks. Sequential changes of cortical excitability were calculated by the end of each session. RESULTS: The significant enhancement in the cortical excitability was observed at the fourth session in favor of the study group (GB). Sequential rate of change in cortical excitability was significant for the first eight sessions. From the ninth session onwards, no difference could be detected between groups. CONCLUSION: The pattern of recovery after stroke is extensive and not all factors could be controlled. Application of LF-rTMS in conjugation with a selected physical therapy program for the upper limb from four to eight sessions seems to be efficient.

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