scholarly journals Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?

2018 ◽  
Vol 32 (8) ◽  
pp. 682-690 ◽  
Author(s):  
Maurits H. J. Hoonhorst ◽  
Rinske H. M. Nijland ◽  
Peter J. S. van den Berg ◽  
Cornelis H. Emmelot ◽  
Boudewijn J. Kollen ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Upper Limb ◽  
Predictive Value ◽  
Magnetic Stimulation ◽  
Prognostic Value ◽  
Motor Evoked Potentials ◽  
Added Value ◽  
Shoulder Abduction ◽  
Limb Function ◽  
Upper Limb Function

Background. The added prognostic value of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) to clinical modeling for the upper limb is still unknown early poststroke. Objective. To determine the added prognostic value of TMS of the adductor digiti minimi (TMS-ADM) to the clinical model based on voluntary shoulder abduction (SA) and finger extension (FE) during the first 48 hours and at 11 days after stroke. Methods. This was a prospective cohort study with 3 logistic regression models, developed to predict upper-limb function at 6 months poststroke. The first model showed the predictive value of SA and FE measured within 48 hours and at 11 days poststroke. The second model included TMS-ADM, whereas the third model combined clinical and TMS-ADM information. Differences between derived models were tested with receiver operating characteristic curve analyses. Results. A total of 51 patients with severe, first-ever ischemic stroke were included. Within 48 hours, no significant added value of TMS-ADM to clinical modeling was found ( P = .369). Both models suffered from a relatively low negative predictive value within 48 hours poststroke. TMS-ADM combined with SA and FE (SAFE) showed significantly more accuracy than TMS-ADM alone at 11 days poststroke ( P = .039). Conclusion. TMS-ADM showed no added value to clinical modeling when measured within first 48 hours poststroke, whereas optimal prediction is achieved by SAFE combined with TMS-ADM at 11 days poststroke. Our findings suggest that accuracy of predicting upper-limb motor function by TMS-ADM is mainly determined by the time of assessment early after stroke onset.

scholarly journals Comparison of TMS-induced arm activation and upper limb functional tests in hemiparetic stroke

2013 ◽  
Vol 21 (1) ◽  
pp. 43-47
Author(s):  
Ina Tarkka
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Upper Limb ◽  
Magnetic Stimulation ◽  
Motor Evoked Potentials ◽  
Voluntary Activation ◽  
Western World ◽  
Functional Tests ◽  
Limb Function ◽  
Objective Evidence ◽  
Hemiparetic Stroke

Stroke has a major impact in the total cost of healthcare in the Western world as stroke is the most common cause of long-term disability [1]. In attempts to enhance motor recovery after stroke effective treatment strategies have been developed in recent years. Appropriate evaluation of the intervention programs requires comprehensive and accurate assessment of the residual abnormal function. In the present study we compare two well-known clinical functional scoring tests developed for the assessment of hemiparetic upper limb function due to stroke and navigated transcranial magnetic stimulation (nTMS), which measures involuntary target muscle response to cortical stimulation. The aim is to investigate the equivalence of these methods and thus add objective evidence of the limb function to strengthen evidence-based practice. In addition to functional tests, four muscles of both arms were studied in twenty chronic stroke patients. Those patients without motor evoked potentials (MEP) to nTMS in the affected upper limb had significantly lower total score in Action Research Arm Test and Wolf Motor Function Test and longer performance time than those patients with MEP. Patients, in whom MEP in each of the four target muscles was elicitable, had better than average scores in clinical functional tests while patients, in whom no MEP was elicitable in any target muscle, had worse than average scores. Transcranial magnetic stimulation adds crucial information when clinical assessment based on voluntary activation by command is challenging, e.g. in patients suffering from cognitive deficits.

scholarly journals Effects of Excitatory Transcranial Magnetic Stimulation of the Anterior Intraparietal Area in Chronic Stroke Patients

2018 ◽  
Author(s):  
Ronaldo Luis da Silva ◽  
Angela Maria Costa de Souza ◽  
Francielly Ferreira Santos ◽  
Sueli Toshie Inoue ◽  
Johanne Higgins ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Motor Function ◽  
Upper Limb ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Sensory Function ◽  
Stroke Patients ◽  
Chronic Patients ◽  
Upper Limb Function ◽  
Stimulation Of

1) Objective: to evaluate the effects of excitatory transcranial magnetic stimulation of the anterior intraparietal area in chronic patients with a frontal lesion and parietal sparing due to stroke on the impaired upper (UL) and lower limb (LL) as measured by Fugl-Meyer Assessment (FMA). 2) Methods: three patients (P1: 49.83/2.75, P2: 53.17/3.83, P3:63.33/3.08 years-old at stroke/years post-stroke, respectively) received two weeks (five days/ week) of rTMS at 10 Hz of the left anterior intraparietal area (AIP). A patient was treated in similar conditions with a sham coil (56.58/4.33) No complimentary therapy was delivered during the study. Patients were evaluated before, after- and two-months post-treatment (A1, A2 and A3, respectively). 3) Results: We found increased scores for lower limb in motor function subsection for P1 and P3 and in sensory function for P2 by A2 that remained at A3. We also found an increased score for upper limb motor function for P2 and P3, but the score decreased by A3 for P2. P3 score for upper limb ROM increased by A3 compared to A1 and A2. 4) Conclusion: AIP excitatory rTMS increased the FMA scores for lower and upper limb function, showing a broader effect when compared to M1 stimulation.

scholarly journals Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks

2021 ◽  
Vol 8 ◽  
Author(s):  
Anne Schwarz ◽  
Janne M. Veerbeek ◽  
Jeremia P. O. Held ◽  
Jaap H. Buurke ◽  
Andreas R. Luft
Keyword(s):  
Upper Limb ◽  
Elbow Flexion ◽  
Shoulder Abduction ◽  
Kinematic Parameters ◽  
Limb Function ◽  
Interjoint Coordination ◽  
Upper Limb Function ◽  
Shoulder Flexion ◽  
Flexion Extension ◽  
Median Slope

Background: Deficits in interjoint coordination, such as the inability to move out of synergy, are frequent symptoms in stroke subjects with upper limb impairments that hinder them from regaining normal motor function. Kinematic measurements allow a fine-grained assessment of movement pathologies, thereby complementing clinical scales, like the Fugl–Meyer Motor Assessment of the Upper Extremity (FMMA-UE). The study goal was to investigate the effects of the performed task, the tested arm, the dominant affected hand, upper limb function, and age on spatiotemporal parameters of the elbow, shoulder, and trunk. The construct validity of the metrics was examined by relating them with each other, the FMMA-UE, and its arm section.Methods: This is a cross-sectional observational study including chronic stroke patients with mild to moderate upper limb motor impairment. Kinematic measurements were taken using a wearable sensor suit while performing four movements with both upper limbs: (1) isolated shoulder flexion, (2) pointing, (3) reach-to-grasp a glass, and (4) key insertion. The kinematic parameters included the joint ranges of shoulder abduction/adduction, shoulder flexion/extension, and elbow flexion/extension; trunk displacement; shoulder–elbow correlation coefficient; median slope; and curve efficiency. The effects of the task and tested arm on the metrics were investigated using a mixed-model analysis. The validity of metrics compared to clinically measured interjoint coordination (FMMA-UE) was done by correlation analysis.Results: Twenty-six subjects were included in the analysis. The movement task and tested arm showed significant effects (p < 0.05) on all kinematic parameters. Hand dominance resulted in significant effects on shoulder flexion/extension and curve efficiency. The level of upper limb function showed influences on curve efficiency and the factor age on median slope. Relations with the FMMA-UE revealed the strongest and significant correlation for curve efficiency (r = 0.75), followed by shoulder flexion/extension (r = 0.68), elbow flexion/extension (r = 0.53), and shoulder abduction/adduction (r = 0.49). Curve efficiency additionally correlated significantly with the arm subsection, focusing on synergistic control (r = 0.59).Conclusion: The kinematic parameters of the upper limb after stroke were influenced largely by the task. These results underpin the necessity to assess different relevant functional movements close to real-world conditions rather than relying solely on clinical measures.Study Registration: clinicaltrials.gov, identifier NCT03135093 and BASEC-ID 2016-02075.

scholarly journals Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Chengyuan Yang ◽  
Ping Chen ◽  
Wenjie Du ◽  
Qingmei Chen ◽  
Huilin Yang ◽  
...  
Keyword(s):  
Upper Limb ◽  
Magnetic Stimulation ◽  
Contralateral Side ◽  
Control Group ◽  
Ipsilateral Side ◽  
Limb Function ◽  
Lesser Tuberosity ◽  
Upper Limb Function ◽  
The Difference ◽  
Musculoskeletal Ultrasonography

Background. Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related. Objective. Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke. Methods. The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients’ bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function. Results. 30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t=8.595, P<0.01], ALT [t=11.435, P<0.01], AHD [t=8.375, P<0.01], SST [t=15.394, P<0.01], and DMT [t=24.935, P<0.01], and FMA score increased [t=-13.315, P<0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t=2.161, P<0.05], ALT [t=3.332, P<0.01], AHD [t=8.768, P<0.01], SST [t=6.244, P<0.01], and the DMT [t=3.238, P<0.01], and FMA score increased more significantly in FMS group [t=7.194, P<0.01]. Conclusion. The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.

scholarly journals Comparison of Repetitive Transcranial Magnetic Stimulation and Transcranial Direct Current Stimulation on Upper Limb Recovery Among Patients With Recent Stroke

2020 ◽  
Vol 44 (6) ◽  
pp. 428-437
Author(s):  
Ka Ying Doris Miu ◽  
Ching Kok ◽  
Sau Shan Leung ◽  
Elaine Y. L. Chan ◽  
Elaine Wong
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Motor Performance ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Direct Current Stimulation ◽  
Upper Limb Function ◽  
Significant Difference

Objective To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) on upper limb function recovery among patients who recently had stroke.Methods Subjects with recent stroke (within 1 month) were randomized to rTMS (n=25) and tDCS (n=26) applied over the non-lesioned hemisphere for three sessions per week, followed by tailored upper limb rehabilitation training for a total of 2 weeks. The primary outcomes were changes in the Motor Assessment Scale (MAS), Fugl-Meyer arm score test, Nine-Hole Peg Test (9HPT), hand grip strength, and modified Barthel Index at weeks 2 and 4. Both therapists responsible for training and assessment were blinded to the intervention allocated.Results There was an improvement in all the motor performance scales among both groups (p<0.001). These improvements persisted at discharge. However, there was no significant difference in any of the assessment scales between the two groups. The rTMS group showed a statistically non-significant greater improvement in MAS, 9HPT, and handgrip strength than the tDCS group.Conclusion Both interventions produce a statistically significant improvement in upper limb function. There was no statistically significant difference between the two intervention methods with respect to motor performance. It is suggested that a larger study may help to clarify the superiority of either methods.

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