scholarly journals Language as a Predictor of Motor Recovery: The Case for a More Global Approach to Stroke Rehabilitation

2019 ◽  
Vol 33 (3) ◽  
pp. 167-178 ◽  
Author(s):  
Deanna Anderlini ◽  
Guy Wallis ◽  
Welber Marinovic
Keyword(s):  
Stroke Rehabilitation ◽  
Current Trend ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Motor Deficits ◽  
Common Site ◽  
Stroke Patients ◽  
Patients Experience ◽  
Developed World ◽  
Choice Of Therapy

Stroke is the third leading cause of death in the developed world and the primary cause of adult disability. The most common site of stroke is the middle cerebral artery (MCA), an artery that supplies a range of areas involved in both language and motor function. As a consequence, many stroke patients experience a combination of language and motor deficits. Indeed, those suffering from Broca’s aphasia have an 80% chance of also suffering hemiplegia. Despite the prevalence of multifaceted disability in patients, the current trend in both clinical trials and clinical practice is toward compartmentalization of dysfunction. In this article, we review evidence that aphasia and hemiplegia do not just coexist, but that they interact. We review a number of clinical reports describing how therapies for one type of deficit can improve recovery in the other and vice versa. We go on to describe how language deficits should be seen as a warning to clinicians that the patient is likely to experience motor impairment and slower motor recovery, aiding clinicians to optimize their choice of therapy. We explore these findings and offer a tentative link between language and arm function through their shared need for sequential action, which we term fluency. We propose that area BA44 (part of Broca’s area) acts as a hub for fluency in both movement and language, both in terms of production and comprehension.

scholarly journals Time Course of Wrist Hyper-Resistance in Relation to Upper Limb Motor Recovery Early Post Stroke

2020 ◽  
Vol 34 (8) ◽  
pp. 690-701
Author(s):  
Aukje Andringa ◽  
Carel Meskers ◽  
Ingrid van de Port ◽  
Erwin van Wegen ◽  
Gert Kwakkel
Keyword(s):  
Upper Limb ◽  
Mixed Models ◽  
Time Course ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Post Stroke ◽  
Resistance Components ◽  
Finger Extension

Background. Patients with an upper limb motor impairment are likely to develop wrist hyper-resistance during the first months post stroke. The time course of wrist hyper-resistance in terms of neural and biomechanical components, and their interaction with motor recovery, is poorly understood. Objective. To investigate the time course of neural and biomechanical components of wrist hyper-resistance in relation to upper limb motor recovery in the first 6 months post stroke. Methods. Neural (NC), biomechanical elastic (EC), and viscous (VC) components of wrist hyper-resistance (NeuroFlexor device), and upper limb motor recovery (Fugl-Meyer upper extremity scale [FM-UE]), were assessed in 17 patients within 3 weeks and at 5, 12, and 26 weeks post stroke. Patients were stratified according to the presence of voluntary finger extension (VFE) at baseline. Time course of wrist hyper-resistance components and assumed interaction effects were analyzed using linear mixed models. Results. On average, patients without VFE at baseline (n = 8) showed a significant increase in NC, EC, and VC, and an increase in FM-UE from 13 to 26 points within the first 6 months post stroke. A significant increase in NC within 5 weeks preceded a significant increase in EC between weeks 12 and 26. Patients with VFE at baseline (n = 9) showed, on average, no significant increase in components from baseline to 6 months whereas FM-UE scores improved from 38 to 60 points. Conclusion. Our findings suggest that the development of neural and biomechanical wrist hyper-resistance components in patients with severe baseline motor deficits is determined by lack of spontaneous neurobiological recovery early post stroke.

scholarly journals 2190 Longitudinal changes in EEG power envelope connectivity are proportional to motor recovery in chronic stroke patients

2018 ◽  
Vol 2 (S1) ◽  
pp. 17-17
Author(s):  
Joseph B. Humphries ◽  
David T. Bundy ◽  
Eric C. Leuthardt ◽  
Thy N. Huskey
Keyword(s):  
Motor Cortex ◽  
Motor Imagery ◽  
Stroke Rehabilitation ◽  
Brain Computer Interface ◽  
Chronic Stroke ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Computer Interface ◽  
Beta Band ◽  
Stroke Patients

OBJECTIVES/SPECIFIC AIMS: The objective of this study is to determine the degree to which the use of a contralesionally-controlled brain-computer interface for stroke rehabilitation drives change in interhemispheric motor cortical activity. METHODS/STUDY POPULATION: Ten chronic stroke patients were trained in the use of a brain-computer interface device for stroke recovery. Patients perform motor imagery to control the opening and closing of a motorized hand orthosis. This device was sent home with patients for 12 weeks, and patients were asked to use the device 1 hour per day, 5 days per week. The Action Research Arm Test (ARAT) was performed at 2-week intervals to assess motor function improvement. Before the active motor imagery task, patients were asked to quietly rest for 90 seconds before the task to calibrate recording equipment. EEG signals were acquired from 2 electrodes—one each centered over left and right primary motor cortex. Signals were preprocessed with a 60 Hz notch filter for environmental noise and referenced to the common average. Power envelopes for 1 Hz frequency bands (1–30 Hz) were calculated through Gabor wavelet convolution. Correlations between electrodes were then calculated for each frequency envelope on the first and last 5 runs, thus generating one correlation value per subject, per run. The chosen runs approximately correspond to the first and last week of device usage. These correlations were Fisher Z-transformed for comparison. The first and last 5 run correlations were averaged separately to estimate baseline and final correlation values. A difference was then calculated between these averages to determine correlation change for each frequency. The relationship between beta-band correlation changes (13–30 Hz) and the change in ARAT score was determined by calculating a Pearson correlation. RESULTS/ANTICIPATED RESULTS: Beta-band inter-electrode correlations tended to decrease more in patients achieving greater motor recovery (Pearson’s r=−0.68, p=0.031). A similar but less dramatic effect was observed with alpha-band (8–12 Hz) correlation changes (Pearson’s r=−0.42, p=0.22). DISCUSSION/SIGNIFICANCE OF IMPACT: The negative correlation between inter-electrode power envelope correlations in the beta frequency band and motor recovery indicates that activity in the motor cortex on each hemisphere may become more independent during recovery. The role of the unaffected hemisphere in stroke recovery is currently under debate; there is conflicting evidence regarding whether it supports or inhibits the lesioned hemisphere. These findings may support the notion of interhemispheric inhibition, as we observe less in common between activity in the 2 hemispheres in patients successfully achieving recovery. Future neuroimaging studies with greater spatial resolution than available with EEG will shed further light on changes in interhemispheric communication that occur during stroke rehabilitation.

scholarly journals Eye Gaze Correlates of Motor Impairment in VR Observation of Motor Actions

2016 ◽  
Vol 55 (01) ◽  
pp. 79-83 ◽  
Author(s):  
A. Vourvopoulos ◽  
A. Bernardino ◽  
i Bermúdez Badia ◽  
J. Alves
Keyword(s):  
Virtual Reality ◽  
Smooth Pursuit ◽  
Healthy Subjects ◽  
Eye Gaze ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Motor Actions ◽  
Healthy Participants

Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objective: Identify eye gaze correlates of motor impairment in a virtual reality motor observation task in a study with healthy participants and stroke patients. Methods: Participants consisted of a group of healthy subjects (N = 20) and a group of stroke survivors (N = 10). Both groups were required to observe a simple reach-and-grab and place-and-release task in a virtual environment. Additionally, healthy subjects were required to observe the task in a normal condition and a constrained movement condition. Eye movements were recorded during the observation task for later analysis. Results: For healthy participants, results showed differences in gaze metrics when comparing the normal and arm-constrained conditions. Differences in gaze metrics were also found when comparing dominant and non-dominant arm for saccades and smooth pursuit events. For stroke patients, results showed longer smooth pursuit segments in action observation when observing the paretic arm, thus providing evidence that the affected circuitry may be activated for eye gaze control during observation of the simulated motor action. Conclusions: This study suggests that neural motor circuits are involved, at multiple levels, in observation of motor actions displayed in a virtual reality environment. Thus, eye tracking combined with action observation tasks in a virtual reality display can be used to monitor motor deficits derived from stroke, and consequently can also be used for re -habilitation of stroke patients.

CONSTRAINT INDUCED MOVEMENT THERAPY FOR MOTOR RECOVERY IN CHRONIC STROKE PATIENT IN RURAL INDIA

2020 ◽  
Vol 4 (5) ◽  
Author(s):  
Anchit Gugnani
Keyword(s):  
Positive Reinforcement ◽  
Spontaneous Recovery ◽  
Recovery Of Function ◽  
Motor Recovery ◽  
Rural India ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Constraint Induced Movement Therapy ◽  
Recovery Stroke ◽  
Do So

A possible explanation for the substantial remaining motor deficits in stroke patients might be the occurrence of learned nonuse, a phenomenon first described by Taub. Stroke patients who initially attempt to use the affected extremity find themselves unable to do so because the process of spontaneous recovery of function has not yet proceeded sufficiently far. This results in the experience of failure or punishment for attempts to move the extremity and in positive reinforcement for compensatory movements by the unaffected extremity-a learning process that might be supported by the teaching of compensatory activity during rehabilitation. Keywords: CIMT, Motor recovery, Stroke patients

scholarly journals Noninvasive Brain Stimulation for Motor Recovery after Stroke: Mechanisms and Future Views

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Naoyuki Takeuchi ◽  
Shin-Ichi Izumi
Keyword(s):  
Brain Stimulation ◽  
Neural Plasticity ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Recovery ◽  
Cortical Reorganization ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Noninvasive Brain Stimulation ◽  
Interhemispheric Competition ◽  
Underlying Mechanisms

Repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive brain stimulation (NIBS) techniques that can alter excitability of the human cortex. Considering the interhemispheric competition occurring after stroke, improvement in motor deficits can be achieved by increasing the excitability of the affected hemisphere or decreasing the excitability of the unaffected hemisphere. Many reports have shown that NIBS application improves motor function in stroke patients by using their physiological peculiarity. For continuous motor improvement, it is important to impart additional motor training while NIBS modulates the neural network between both hemispheres and remodels the disturbed network in the affected hemisphere. NIBS can be an adjuvant therapy for developed neurorehabilitation strategies for stroke patients. Moreover, recent studies have reported that bilateral NIBS can more effectively facilitate neural plasticity and induce motor recovery after stroke. However, the best NIBS pattern has not been established, and clinicians should select the type of NIBS by considering the NIBS mechanism. Here, we review the underlying mechanisms and future views of NIBS therapy and propose rehabilitation approaches for appropriate cortical reorganization.

scholarly journals Motor improvement estimation and task adaptation for personalized robot-aided therapy: a feasibility study

2019 ◽  
Author(s):  
Christian Giang ◽  
Elvira Pirondini ◽  
Nawal Kinany ◽  
Camilla Pierella ◽  
Alessandro Panarese ◽  
...  
Keyword(s):  
Motor Impairment ◽  
Motor Deficits ◽  
Pilot Test ◽  
Stroke Patients ◽  
Rehabilitation Therapy ◽  
Model Based ◽  
Link Type ◽  
Upper Limb Exoskeleton ◽  
Subacute Stroke ◽  
Motor Improvement

AbstractBackgroundIn the past years, robotic systems have become increasingly popular in both upper and lower limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches.MethodsHere, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions and comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper limb exoskeleton and tested it with seventeen healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test.ResultsThe experiments illustrated the model’s capability to differentiate distinct motor improvement progressions among subjects and subtasks. The model suggested personalized training schedules based on motor improvement estimations for each movement in different directions. Patients’ motor performances were retained when training movements were reintroduced at a later stage.ConclusionsOur results demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing auspicious results for the applicability in clinical settings.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02770300, registered 30 March 2016, https://clinicaltrials.gov/ct2/show/NCT02770300).

EFFECT OF ACTION OBSERVATION THERAPY ON IMPROVING UPPER LIMB FUNCTIONS IN ACUTE STROKE PATIENTS: AN EXPERIMENTAL STUDY

2021 ◽  
pp. 33-36
Author(s):  
Sudha Desale
Keyword(s):  
Acute Stroke ◽  
Upper Limb ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Recovery ◽  
P Value ◽  
Daily Routine ◽  
Motor Sequence ◽  
Stroke Patients ◽  
Observation Training

BACKGROUND & PURPOSE: The most common disabling motor decit following stroke is the loss of upper limb function. 5-20% of patients presenting an upper limb paralysis at onset may improve the motor impairment overtime. Action observation training is a novel rehabilitation approach exploiting this mirror mechanism and its potential role in motor learning for motor recovery. Aim of this study was to examine the effects of action observation therapy on upper limb functions in acute stroke patients. METHODOLOGY: Stroke survivors (N= 50) were consecutively recruited 22 days (±5) after a rst-ever stroke and participants watched video footage of daily routine tasks (actions). Each action based on some relevant ADLs motor sequence display in order of ascending difculty and lasting for 3 minutes and therapist prompted the patient to perform the same movement for 2 minutes. At the end of each sequence, patients were given conventional physiotherapy and AOT 1 hour daily for 5 days/week for 4 weeks. RESULTS: Upper Limb part of FMA, Modied Ashworth Scale scores & nine-hole peg test were taken at baseline and after 4 weeks as outcome measure. Paired 't' test and Wilcoxon's signed-rank has been used for analysis of Fugl Meyer scale, Modied Ashwarth Scale and Nine-hole peg pre and post treatment scores respectively (p value<0.05) So, a statistically signicant difference was found after treatment for all variables. CONCLUSION: The nding of this study is suggesting that Action observation training programs contribute to improve motor recovery in acute stroke patients.

scholarly journals Influence of bimanual exercise on muscle activation in post-stroke patients

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Matti Itkonen ◽  
Álvaro Costa ◽  
Hiroshi Yamasaki ◽  
Shotaro Okajima ◽  
Fady Alnajjar ◽  
...  
Keyword(s):  
Brain Damage ◽  
Stroke Rehabilitation ◽  
Muscle Activation ◽  
Neural Circuits ◽  
Surface Emg ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Post Stroke ◽  
Task Conditions ◽  
Phase Motion

Abstract Brain damage due to stroke often leaves survivors with lateral functional motor deficits. Bimanual rehabilitation of the paretic arm is an active field of research aimed at restoring normal functionality by making use of the complex neural bindings that exist between the arms. In search of an effective rehabilitation method, we introduced a group of post-stroke rehabilitation patients to a set of bimanual motion tasks with inter-manual coupling and phasing. The surface EMG profiles of the patients were compared in order to understand the effect of the motion conditions. The paretic arms of the patients were more strongly affected by the task conditions compared with the non-paretic arms. These results suggest that in-phase motion may activate neural circuits that trigger recovery. Coupling also had an effect on behavior, but the response of patients was divided between those whom coupling helped or hindered.

Does Proprioceptive Loss Influence Recovery of the Upper Extremity After Stroke?

1999 ◽  
Vol 13 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Debbie Rand ◽  
Patrice L. (Tamar) Weiss ◽  
Daniel Gottlieb
Keyword(s):  
Upper Extremity ◽  
Detrimental Effect ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Functional Abilities ◽  
Stroke Patients ◽  
Motor Paralysis ◽  
Significant Difference ◽  
Localization Test ◽  
Pure Motor

Stroke patients with motor paralysis and proprioceptive deficits are considered to have a worse functional outcome than those with pure motor paralysis, but the mechanism of this detrimental effect is not clear. In order to clarify it, we compared the motor and functional recovery of the affected upper extremity in stroke patients having pure motor paralysis with that of such patients with both motor and proprioceptive deficits. Forty patients undergoing stroke rehabilitation were studied: 20 with pure motor deficits and 20 also with proprioceptive deficits. They were assessed on four occasions during the first six weeks of rehabilitation. Motor impairment was assessed with the Fugl-Meyer subscale of the upper extremity, disability with the Frenchay Arm Test, and proprio ception by the Thumb Localization Test. Significant within-group improvement of the motor and functional abilities was demonstrated in both groups, between admission to six weeks later (p < 0.001, either group). However, no significant difference was found between the two groups, although pure motor patients had a slightly better outcome. It was concluded that the proprioception deficit did not influence limb recovery in the first six weeks of rehabilitation. Therefore, the upper extremity of all patients should be treated and given a similar chance because significant improvement can be expected in all cases. Key Words: Upper Extremity—Stroke—Proprioception—Rehabilitation.

scholarly journals Toward a More Comprehensive Assessment of School Age Children with Hemiplegic Cerebral Palsy

2021 ◽  
Vol 10 ◽  
pp. 117957272110105
Author(s):  
Catherine R Hoyt ◽  
Sarah K Sherman ◽  
Shelby K Brown ◽  
Dillan J Newbold ◽  
Ryland L Miller ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Brain Injury ◽  
Motor Impairment ◽  
School Age Children ◽  
Motor Deficits ◽  
Normal Limits ◽  
Hemiplegic Cerebral Palsy ◽  
Behavioral Assessments ◽  
Therapeutic Needs ◽  
Patients Experience

Background: Cerebral palsy (CP) is the leading cause of disability in children. While motor deficits define CP, many patients experience behavioral and cognitive deficits which limit participation. The purpose of this study was to contribute to our understanding of developmental delay and how to measure these deficits among children with CP. Methods: Children 5 to 15 years with hemiplegic CP were recruited. Cognition and motor ability were assessed. The brain injury associated with observed motor deficits was identified. Accelerometers measured real-world bilateral upper extremity movement and caregivers completed behavioral assessments. Results: Eleven children participated, 6 with presumed perinatal stroke. Four children scored below average intelligence quotient while other measures of cognition were within normal limits (except processing speed). Motor scores confirmed asymmetrical deficits. Approximately one third of scores indicated deficits in attention, behavior, or depression. Conclusions: Our findings corroborate that children with CP experience challenges that are broader than motor impairment alone. Despite the variation in brain injury, all participants completed study procedures. Implications: Our findings suggest that measuring behavior in children with CP may require a more comprehensive approach and that caregivers are amenable to using online collection tools which may assist in addressing the therapeutic needs of children with CP.

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