Abstract 11: Targeted Training of a Motor-parietal Circuit Improves Its Behavioral Output

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Steven C Cramer ◽  
Robert Zhou ◽  
Morgan Ingemanson ◽  
John J Choi ◽  
Katherine M Wu ◽  
...  
Keyword(s):  
Primary Motor Cortex ◽  
Brain Connectivity ◽  
Secondary Analysis ◽  
Visuomotor Learning ◽  
Visuomotor Tracking ◽  
Home Based ◽  
Eeg Connectivity ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
High Beta

Introduction: Emerging brain mapping methods measure function of individual brain circuits and have the potential to predict a patient’s gains and needs in the context of stroke rehabilitation. We recently described a motor-parietal circuit underlying visuomotor tracking and defined an EEG coherence measure (reflecting connectivity) that predicts visuomotor learning. Here we test the hypothesis that this EEG metric predicts visuomotor learning after stroke. Methods: After baseline dense-array resting EEG, patients with chronic hemiparetic stroke were provided with a home-based gaming system. During 9 half-hour training sessions, patients played games in which the stroke-affected arm tracked objects moving on the tabletop. Games were implemented using augmented reality, which we have found has advantages for motor training and in which virtual objects are projected into the real world and modified during game play. Results: Subjects (n=12) had affected arm Box&Blocks score of 15±12 and were 35±26 mo post-stroke. Visuomotor tracking improved significantly: on a standardized visuomotor test using the gaming system, scores increased from 60.5±11.5% to 74.0±3.2% (p=0.003). Gains were specific, as other behaviors were unchanged. Individual gains in visuomotor tracking score were predicted by the EEG connectivity metric from our prior study, coherence between leads overlying ipsilesional primary motor cortex (M1i) and ipsilesional lateral parietal region in the high beta (20-30 Hz) range, with higher connectivity predicting greater visuomotor tracking gains (r=0.61, p=0.037). This too was specific, as connectivity between M1i and other brain areas did not predict gains. Secondary analysis found that baseline visuomotor tracking scores correlated with several EEG connectivity measures, all inversely and all between M1i and contralesional regions. Conclusions: We found that (1) training that targets a specific brain circuit improves behavioral output of that circuit, and (2) an EEG measure of brain connectivity within that circuit predicts these behavioral gains--both with specificity. This approach may be useful for many neural circuits and their respective rehabilitation-related behaviors.

scholarly journals A Home-Based Telerehabilitation Program for Patients With Stroke

2017 ◽  
Vol 31 (10-11) ◽  
pp. 923-933 ◽  
Author(s):  
Lucy Dodakian ◽  
Alison L. McKenzie ◽  
Vu Le ◽  
Jill See ◽  
Kristin Pearson-Fuhrhop ◽  
...  
Keyword(s):  
Stroke Prevention ◽  
Computer Literacy ◽  
Free Play ◽  
Motor Deficits ◽  
Home Based ◽  
Access Cost ◽  
Computer Based ◽  
Stroke Education ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke

Background. Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke. Methods. Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play. Results. Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age ( r = −0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge ( P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later ( r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system ( r = 0.99; P < .0001). Conclusions. This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

The NIH Stroke Scale Lacks Validity in Chronic Hemiparetic Stroke

2015 ◽  
Vol 96 (10) ◽  
pp. e35
Author(s):  
Heather Tanksley Peters ◽  
Susan White ◽  
Stephen Page
Keyword(s):  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke

scholarly journals Evidence for Increased Activation of Persistent Inward Currents in Individuals With Chronic Hemiparetic Stroke

2008 ◽  
Vol 100 (6) ◽  
pp. 3236-3243 ◽  
Author(s):  
Jacob G. McPherson ◽  
Michael D. Ellis ◽  
C. J. Heckman ◽  
Julius P. A. Dewald
Keyword(s):  
Repeated Measures ◽  
Afferent Feedback ◽  
Joint Torque ◽  
Emg Activity ◽  
Tonic Vibration Reflex ◽  
Stretch Reflexes ◽  
Persistent Inward Currents ◽  
Inward Currents ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke

Despite the prevalence of hyperactive stretch reflexes in the paretic limbs of individuals with chronic hemiparetic stroke, the fundamental pathophysiological mechanisms responsible for their expression remain poorly understood. This study tests whether the manifestation of hyperactive stretch reflexes following stroke is related to the development of persistent inward currents (PICs) leading to hyperexcitability of motoneurons innervating the paretic limbs. Because repetitive volleys of 1a afferent feedback can elicit PICs, this investigation assessed motoneuronal excitability by evoking the tonic vibration reflex (TVR) of the biceps muscle in 10 awake individuals with chronic hemiparetic stroke and measuring the joint torque and electromyographic (EMG) responses of the upper limbs. Elbow joint torque and the EMG activity of biceps, brachioradialis, and the long and lateral heads of triceps brachii were recorded during 8 s of 112-Hz biceps vibration (evoking the TVR) and for 5 s after cessation of stimulation. Repeated-measures ANOVA tests revealed significantly ( P ≤ 0.05) greater increases in elbow flexion torque and EMG activity in the paretic as compared with the nonparetic limbs, both during and up to 5 s following biceps vibration. The finding of these augmentations exclusively in the paretic limb suggests that contralesional motoneurons may become hyperexcitable and readily invoke PICs following stroke. An enhanced tendency to evoke PICs may be due to an increased subthreshold depolarization of motoneurons, an increased monoaminergic input from the brain stem, or both.

scholarly journals Biomechanical parameters of the elbow stretch reflex in chronic hemiparetic stroke

2018 ◽  
Vol 237 (1) ◽  
pp. 121-135 ◽  
Author(s):  
Jacob G. McPherson ◽  
Arno H. A. Stienen ◽  
Brian D. Schmit ◽  
Julius P. A. Dewald
Keyword(s):  
Stretch Reflex ◽  
Biomechanical Parameters ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke

scholarly journals Lower Extremity Motor Impairments in Ambulatory Chronic Hemiparetic Stroke: Evidence for Lower Extremity Weakness and Abnormal Muscle and Joint Torque Coupling Patterns

2017 ◽  
Vol 31 (9) ◽  
pp. 814-826 ◽  
Author(s):  
Natalia Sánchez ◽  
Ana Maria Acosta ◽  
Roberto Lopez-Rosado ◽  
Arno H. A. Stienen ◽  
Julius P. A. Dewald
Keyword(s):  
Lower Extremity ◽  
Degrees Of Freedom ◽  
Joint Torque ◽  
Motor Impairments ◽  
Lower Extremity Weakness ◽  
Joint Torques ◽  
Hemiparetic Stroke ◽  
Chronic Hemiparetic Stroke ◽  
Hip Extension ◽  
Flexion And Extension

Although global movement abnormalities in the lower extremity poststroke have been studied, the expression of specific motor impairments such as weakness and abnormal muscle and joint torque coupling patterns have received less attention. We characterized changes in strength, muscle coactivation and associated joint torque couples in the paretic and nonparetic extremity of 15 participants with chronic poststroke hemiparesis (age 59.6 ± 15.2 years) compared with 8 age-matched controls. Participants performed isometric maximum torques in hip abduction, adduction, flexion and extension, knee flexion and extension, ankle dorsi- and plantarflexion and submaximal torques in hip extension and ankle plantarflexion. Surface electromyograms (EMGs) of 10 lower extremity muscles were measured. Relative weakness (paretic extremity compared with the nonparetic extremity) was measured in poststroke participants. Differences in EMGs and joint torques associated with maximum voluntary torques were tested using linear mixed effects models. Results indicate significant poststroke torque weakness in all degrees of freedom except hip extension and adduction, adductor coactivation during extensor tasks, in addition to synergistic muscle coactivation patterns. This was more pronounced in the paretic extremity compared with the nonparetic extremity and with controls. Results also indicated significant interjoint torque couples during maximum and submaximal hip extension in both extremities of poststroke participants and in controls only during maximal hip extension. Additionally, significant interjoint torque couples were identified only in the paretic extremity during ankle plantarflexion. A better understanding of these motor impairments is expected to lead to more effective interventions for poststroke gait and posture.

Self-directed usage of an in-home exergame after a supervised telerehabilitation training program for older adults with lower-limb amputation

2020 ◽  
Vol 44 (2) ◽  
pp. 52-59
Author(s):  
Gordon Tao ◽  
William C Miller ◽  
Janice J Eng ◽  
Heather Lindstrom ◽  
Bita Imam ◽  
...  
Keyword(s):  
Clinical Supervision ◽  
Lower Limb ◽  
Secondary Analysis ◽  
Exercise Duration ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Experimental Session ◽  
Supervised Training ◽  
Session Time ◽  
Home Based

Background: While home-based exergames help overcome accessibility barriers to rehabilitation, it is unclear what constitutes effective intervention design in using exergames to support self-efficacy and engagement. Objective: Examine usage of an in-home exergame, compared to control, unsupervised after supervised training by older persons with lower-limb amputation. Study design: Secondary analysis of a multi-site parallel evaluator-masked randomized control trial. Methods: WiiNWalk uses the WiiFit and teleconferencing for in-home group-based exergame therapy with clinical supervision. Participants engaged in a 4-week supervised training phase followed by a 4-week unsupervised phase in experimental (WiiNWalk) and attention control groups. Usage between phases and between groups was compared using unsupervised/supervised ratio of session count (over 4 weeks) and session time (mean min/session over 4 weeks) for each phase. Results: Participants: n=36 experimental, n=28 control, unilateral lower-limb amputation, age > 50 years, prosthesis usage ≥ 2 hours/day. Session count ratio unsupervised/supervised, median and interquartile range (IQR), was less than parity ( p<0.01) for experimental (0.25, IQR 0.00 -0.68) and control (0.18, IQR 0.00 -0.67) groups, with no different between groups ( p=0.92). Experimental session time unsupervised/supervised showed consistency (1.12, IQR 0.80 -1.41) between phases ( p=0.24); control showed lower (0.76, IQR 0.57 -1.08) ratios compared to experimental ( p=0.027). Conclusions: Unsupervised exercise duration remained consistent with supervised, but frequency was reduced. Social and clinical guidance features may remain necessary for sustained lower-limb amputation exergame engagement at home. Clinical relevance This study provides context regarding when prosthesis users are more likely to use exergames such as Wii Fit for exercise therapy. Clinicians may consider our results when applying exergames in their practice or when developing new exergame intervention strategies.

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