Camera-Based Mirror Visual Input for Priming Promotes Motor Recovery, Daily Function, and Brain Network Segregation in Subacute Stroke Patients

Background. Camera technique–based mirror visual feedback (MVF) is an optimal interface for mirror therapy. However, its efficiency for stroke rehabilitation and the underlying neural mechanisms remain unclear. Objective. To investigate the possible treatment benefits of camera-based MVF (camMVF) for priming prior to hand function exercise in subacute stroke patients, and to reveal topological reorganization of brain network in response to the intervention. Methods. Twenty subacute stroke patients were assigned randomly to the camMVF group (MG, N = 10) or a conventional group (CG, N = 10). Before, and after 2 and 4 weeks of intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA_UL), the Functional Independence Measure (FIM), the modified Ashworth Scale (MAS), manual muscle testing (MMT), and the Berg Balance Scale (BBS) were measured. Resting-state electroencephalography (EEG) signals were recorded before and after 4-week intervention. Results. The MG showed more improvements in the FMA_UL, the FMA_WH (wrist and hand), and the FIM than the CG. The clustering coefficient (CC) of the resting EEG network in the alpha band was increased globally in the MG after intervention but not in the CG. Nodal CC analyses revealed that the CC in the MG tended to increase in the ipsilesional occipital and temporal areas, and the bilateral central and parietal areas, suggesting improved local efficiency of communication in the visual, somatosensory, and motor areas. The changes of nodal CC at TP8 and PO8 were significantly positively correlated with the motor recovery. Conclusions. The camMVF-based priming could improve the motor recovery, daily function, and brain network segregation in subacute stroke patients.

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Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study

Brain Sciences ◽

10.3390/brainsci11030290 ◽

2021 ◽

Vol 11 (3) ◽

pp. 290

Author(s):

Mauro Mancuso ◽

Serena Di Tondo ◽

Enza Costantini ◽

Alessio Damora ◽

Patrizio Sale ◽

...

Keyword(s):

Upper Limb ◽

Action Observation ◽

Functional Independence Measure ◽

Functional Independence ◽

Motor Recovery ◽

Control Group ◽

Stroke Patients ◽

Rehabilitative Treatment ◽

Subacute Stroke ◽

The Moment

Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke patients. The aim of the present study was to evaluate the potential efficacy of AOT, both in upper limb recovery and in functional outcomes when compared to patients treated with task oriented training (TOT). Both treatments were added to traditional rehabilitative treatment. Thirty-two acute stroke patients at 15.6 days (±8.3) from onset, with moderate to severe upper limb impairment at baseline following their first-ever stroke, were enrolled and randomized into two groups: 16 in the experimental group (EG) and 16 in the control group (CG). The EG underwent 30 min sessions of AOT, and the CG underwent 30 min sessions of TOT. All participants received 20 sessions of treatment for four consecutive weeks (five days/week). The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) were administered at baseline (T0) and at the end of treatment (T1). No statistical differences were found at T0 for inclusion criteria between the CG and EG, whereas both groups improved significantly at T1. After the treatment period, the rehabilitative gain was greater in the EG compared to the CG for FMA-UE and FIM (all p < 0.05). Our results suggest that AOT can contribute to increased motor recovery in subacute stroke patients with moderate to severe upper limb impairment in the early phase after stroke. The improvements presented in this article, together with the lack of adverse events, confirm that the use of AOT should be broadened out to larger pools of subacute stroke patients.

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Associated Mirror Therapy Enhances Motor Recovery of the Upper Extremity and Daily Function after Stroke: A Randomized Control Study

Neural Plasticity ◽

10.1155/2021/7266263 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Jin-Yang Zhuang ◽

Li Ding ◽

Bei-Bei Shu ◽

Dan Chen ◽

Jie Jia

Keyword(s):

Upper Extremity ◽

Controlled Trial ◽

Motor Impairment ◽

Functional Independence Measure ◽

Functional Independence ◽

Motor Recovery ◽

Control Group ◽

Mirror Therapy ◽

Stroke Patients ◽

Daily Function

Bimanual cooperation plays a vital role in functions of the upper extremity and daily activities. Based on the principle of bilateral movement, mirror therapy could provide bimanual cooperation training. However, conventional mirror therapy could not achieve the isolation of the mirror. A novel paradigm mirror therapy called associated mirror therapy (AMT) was proposed to achieve bimanual cooperation task-based mirror visual feedback isolating from the mirror. The study was aimed at exploring the feasibility and effectiveness of AMT on stroke patients. We conducted a single-blind, randomized controlled trial. Thirty-six eligible patients were equally assigned into the experimental group (EG) receiving AMT and the control group (CG) receiving bimanual training without mirroring for five days/week, lasting four weeks. The Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) for upper extremity motor impairment was used as the primary outcome. The secondary outcomes were the Box and Block Test (BBT) and Functional Independence Measure (FIM) for motor and daily function. All patients participated in trials throughout without adverse events or side effects. The scores of FMA-UL and FIM improved significantly in both groups following the intervention. Compared to CG, the scores of FMA-UL and FIM were improved more significantly in EG after the intervention. The BBT scores were improved significantly for EG following the intervention, but no differences were found in the BBT scores of CG after the intervention. However, no differences in BBT scores were observed between the two groups. In summary, our study suggested that AMT was a feasible and practical approach to enhance the motor recovery of paretic arms and daily function in stroke patients. Furthermore, AMT may improve manual dexterity for poststroke rehabilitation.

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Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients

Current Neurovascular Research ◽

10.2174/1567202617666200603150901 ◽

2020 ◽

Vol 17 (4) ◽

pp. 437-445

Author(s):

Irene Ciancarelli ◽

Giovanni Morone ◽

Marco Iosa ◽

Stefano Paolucci ◽

Loris Pignolo ◽

...

Keyword(s):

Outcome Measures ◽

Functional Recovery ◽

Functional Independence Measure ◽

Functional Independence ◽

Enzyme Linked Immunosorbent Assay ◽

Stroke Patients ◽

Rehabilitation Outcomes ◽

Before And After ◽

Forward Stepwise ◽

Clinical Measures

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

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Impact of structured physical therapy intervention on functional recovery in a patient with CAPOS syndrome: a case report

Bulletin of Faculty of Physical Therapy ◽

10.1186/s43161-021-00026-y ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Shailesh Gardas ◽

Aishwarya Mahajan

Keyword(s):

Functional Performance ◽

Functional Independence Measure ◽

Functional Independence ◽

Measurement Scale ◽

Manual Muscle Testing ◽

Trunk Control ◽

Control Measurement ◽

Muscle Testing ◽

Post Test ◽

Capos Syndrome

Abstract Background CAPOS syndrome (cerebellar ataxia, areflexia, pescavus, optic atrophy, and sensorineural hearing loss) is a rare congenital autosomal dominant disorder. The resulting neurological sequelae of impairments are progressive in nature and may interfere with functional independence, performing activities of daily living (ADL’s), and subsequently, affecting the quality of life (QOL). Since it is an extremely rare disorder, there is a severe dearth in the literature about how specific physiotherapy interventions may affect their functional status. Therefore, our objective was to investigate the effects of proprioceptive neuromuscular facilitation (PNF) and Frenkel’s coordination exercises on functional recovery in a patient with CAPOS syndrome. Case presentation We herein present a case of a 25-year-old Indian male with complaints of generalized body weakness, difficulty visualizing distant objects, nystagmus, progressive sensorineural deafness, and ataxia. He was rehabilitated with a structured/customized physiotherapy protocol consisting of PNF approach and coordination exercises for 4 weeks, 6 days/week, 60 min daily. An improvement in overall functional performance of patient as per post-intervention scores of manual muscle testing, trunk control measurement scale, functional independence measure (components of self-care, transfers, and locomotion), and decline in severity of ataxia on scale for assessment and rating of ataxia scale was observed. Conclusion PNF and Frenkel’s exercises resulted in an improvement in overall functional performance of the patient. Improvement was observed in post-test scores of Manual Muscle Testing (MMT), Trunk Control Measurement Scale (TCMS), and Functional Independence Measure (FIM) for the components of self-care, transfers, and locomotion. Additionally, results also showed a decline in severity of ataxia on post-test scores of scale for the assessment and rating of ataxia (SARA) scale (i.e., from severe to moderate).

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Altered Functional Connectivity after Epileptic Seizure Revealed by Scalp EEG

Neural Plasticity ◽

10.1155/2020/8851415 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Yi Liang ◽

Chunli Chen ◽

Fali Li ◽

Dezhong Yao ◽

Peng Xu ◽

...

Keyword(s):

Functional Connectivity ◽

Brain Activity ◽

Epileptic Seizures ◽

Local Area ◽

Brain Network ◽

Fuzzy Entropy ◽

Clustering Coefficient ◽

Characteristic Path Length ◽

Functional Brain Network ◽

Before And After

Epileptic seizures are considered to be a brain network dysfunction, and chronic recurrent seizures can cause severe brain damage. However, the functional brain network underlying recurrent epileptic seizures is still left unveiled. This study is aimed at exploring the differences in a related brain activity before and after chronic repetitive seizures by investigating the power spectral density (PSD), fuzzy entropy, and functional connectivity in epileptic patients. The PSD analysis revealed differences between the two states at local area, showing postseizure energy accumulation. Besides, the fuzzy entropies of preseizure in the frontal, central, and temporal regions are higher than that of postseizure. Additionally, attenuated long-range connectivity and enhanced local connectivity were also found. Moreover, significant correlations were found between network metrics (i.e., characteristic path length and clustering coefficient) and individual seizure number. The PSD, fuzzy entropy, and network analysis may indicate that the brain is gradually impaired along with the occurrence of epilepsy, and the accumulated effect of brain impairment is observed in individuals with consecutive epileptic bursts. The findings of this study may provide helpful insights into understanding the network mechanism underlying chronic recurrent epilepsy.

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Effects of anodal transcranial direct current stimulation over the contralesional hemisphere on motor recovery in subacute stroke patients with severe upper extremity hemiparesis

Medicine ◽

10.1097/md.0000000000019495 ◽

2020 ◽

Vol 99 (14) ◽

pp. e19495

Author(s):

Stephanie Hyeyoung Lee ◽

Won-Seok Kim ◽

Jihong Park ◽

Junsik Kim ◽

Nam-Jong Paik

Keyword(s):

Upper Extremity ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Motor Recovery ◽

Stroke Patients ◽

Direct Current Stimulation ◽

Subacute Stroke

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Mechanisms of Motor Recovery in Chronic and Subacute Stroke Patients Following a Robot-Aided Training

IEEE Transactions on Haptics ◽

10.1109/toh.2013.73 ◽

2014 ◽

Vol 7 (2) ◽

pp. 175-180 ◽

Cited By ~ 10

Author(s):

S. Mazzoleni ◽

L. Puzzolante ◽

L. Zollo ◽

P. Dario ◽

F. Posteraro

Keyword(s):

Motor Recovery ◽

Stroke Patients ◽

Subacute Stroke

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Longitudinal Brain Functional Connectivity Changes of the Cortical Motor-Related Network in Subcortical Stroke Patients with Acupuncture Treatment

Neural Plasticity ◽

10.1155/2017/5816263 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Yongxin Li ◽

Ya Wang ◽

Chenxi Liao ◽

Wenhua Huang ◽

Ping Wu

Keyword(s):

Functional Connectivity ◽

Western Medicine ◽

Primary Motor Cortex ◽

Brain Connectivity ◽

Effective Means ◽

Brain Network ◽

Stroke Patients ◽

Rehabilitation Therapy ◽

Cortical Motor ◽

Before And After

In clinical practice, the effectiveness of the rehabilitation therapy such as acupuncture combining conventional Western medicine (AG) on stroke people’s motor-related brain network and their behaviors has not been systematically studied. In the present study, seventeen adult ischemic patients were collected and divided into two groups: the conventional Western medicine treatment group (CG) and the AG. The neurological deficit scores (NDS) and resting-state functional MRI data were collected before and after treatment. Compared with the CG patients, AG patients exhibited a significant enhancement of the percent changes of NDS from pre- to posttreatment intervention. All patients showed significant changes of functional connectivity (FC) between the pair of cortical motor-related regions. After treatment, both patient groups showed a recovery of brain connectivity to the nearly normal level compared with the controls in these pairs. Moreover, a significant correlation between the percent changes of NDS and the pretreatment FC values of bilateral primary motor cortex (M1) in all patients was found. In conclusion, our results showed that AG therapy can be an effective means for ischemic stroke patients to recover their motor function ability. The FC strengths between bilateral M1 of stroke patients can predict stroke patients’ treatment outcome after rehabilitation therapy.

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