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 TMS-Induced Central Motor Conduction Time at the Non-Infarcted Hemisphere is Associated with Spontaneous Motor Recovery of the Paretic Upper Limb after Severe Stroke

2021 ◽  
Vol 11 (5) ◽  
pp. 648
Author(s):  
Maurits Hoonhorst ◽  
Rinske Nijland ◽  
Cornelis Emmelot ◽  
Boudewijn Kollen ◽  
Gert Kwakkel
Keyword(s):  
Ischemic Stroke ◽  
Upper Limb ◽  
Normative Data ◽  
Motor Impairment ◽  
Motor Recovery ◽  
Conduction Time ◽  
Stroke Patients ◽  
Severe Stroke ◽  
Central Motor Conduction Time ◽  
Post Stroke

Background: Stroke affects the neuronal networks of the non-infarcted hemisphere. The central motor conduction time (CMCT) induced by transcranial magnetic stimulation (TMS) could be used to determine the conduction time of the corticospinal tract of the non-infarcted hemisphere after a stroke. Objectives: Our primary aim was to demonstrate the existence of prolonged CMCT in the non-infarcted hemisphere, measured within the first 48 h when compared to normative data, and secondly, if the severity of motor impairment of the affected upper limb was significantly associated with prolonged CMCTs in the non-infarcted hemisphere when measured within the first 2 weeks post stroke. Methods: CMCT in the non-infarcted hemisphere was measured in 50 patients within 48 h and at 11 days after a first-ever ischemic stroke. Patients lacking significant spontaneous motor recovery, so-called non-recoverers, were defined as those who started below 18 points on the FM-UE and showed less than 6 points (10%) improvement within 6 months. Results: CMCT in the non-infarcted hemisphere was prolonged in 30/50 (60%) patients within 48 h and still in 24/49 (49%) patients at 11 days. Sustained prolonged CMCT in the non-infarcted hemisphere was significantly more frequent in non-recoverers following FM-UE. Conclusions: The current study suggests that CMCT in the non-infarcted hemisphere is significantly prolonged in 60% of severely affected, ischemic stroke patients when measured within the first 48 h post stroke. The likelihood of CMCT is significantly higher in non-recoverers when compared to those that show spontaneous motor recovery early post stroke.

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 Whole Brain White Matter Microstructure and Upper Limb Function: Longitudinal Changes in Fractional Anisotropy and Axial Diffusivity in Post-Stroke Patients

2019 ◽  
Vol 11 ◽  
pp. 117957351986342
Author(s):  
Nicodemus Edrick Oey ◽  
Geoffrey Sithamparapillai Samuel ◽  
Joseph Kai Wei Lim ◽  
Antonius MJ VanDongen ◽  
Yee Sien Ng ◽  
...  
Keyword(s):  
White Matter ◽  
Fractional Anisotropy ◽  
Upper Limb ◽  
Case Series ◽  
Elbow Flexion ◽  
Motor Recovery ◽  
Stroke Patients ◽  
Axial Diffusivity ◽  
Post Stroke ◽  
Kinematic Measures

Background: Diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) measuring fractional anisotropy (FA) and axial diffusivity (AD) may be a useful biomarker for monitoring changes in white matter after stroke, but its associations with upper-limb motor recovery have not been well studied. We aim to describe changes in the whole-brain FA and AD in five post-stroke patients in relation to kinematic measures of elbow flexion to better understand the relationship between FA and AD changes and clinico-kinematic measures of upper limb motor recovery. Methods: We performed DTI MRI at two timepoints during the acute phase of stroke, measuring FA and AD across 48 different white matter tract regions in the brains of five hemiparetic patients with infarcts in the cortex, pons, basal ganglia, thalamus, and corona radiata. We tracked the progress of these patients using clinical Fugl-Meyer Assessments and kinematic measures of elbow flexion at the acute phase within 14 (mean: 9.4 ± 2.49) days of stroke symptom onset and at a follow-up appointment 2 weeks later (mean: 16 ± 1.54) days. Results: Changes in FA and AD in 48 brain regions occurring during stroke rehabilitation are described in relation to motor recovery. In this case series, one patient with a hemipontine infarct showed an increase in FA of the ipsilateral and contralateral corticospinal tract, whereas other patients with lesions involving the corona radiata and middle cerebral artery showed widespread decreases in perilesional FA. On the whole, FA and AD seemed to behave inversely to each other. Conclusions: This case series describes longitudinal changes in perilesional and remote FA and AD in relation to kinematic parameters of elbow flexion at the subacute post-stroke period. Although studies with larger sample sizes are needed, our findings indicate that longitudinally measured changes in DTI-based measurements of white matter microstructural integrity may aid in the prognostication of patients affected by motor stroke.

scholarly journals Translational effects of robot-mediated therapy in subacute stroke patients: an experimental evaluation of upper limb motor recovery

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5544 ◽  
Author(s):  
Eduardo Palermo ◽  
Darren Richard Hayes ◽  
Emanuele Francesco Russo ◽  
Rocco Salvatore Calabrò ◽  
Alessandra Pacilli ◽  
...  
Keyword(s):  
Upper Limb ◽  
Effective Means ◽  
Post Treatment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Optoelectronic System ◽  
Clinical Scales ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Kinematic Assessment

Robot-mediated therapies enhance the recovery of post-stroke patients with motor deficits. Repetitive and repeatable exercises are essential for rehabilitation following brain damage or other disorders that impact the central nervous system, as plasticity permits to reorganize its neural structure, fostering motor relearning. Despite the fact that so many studies claim the validity of robot-mediated therapy in post-stroke patient rehabilitation, it is still difficult to assess to what extent its adoption improves the efficacy of traditional therapy in daily life, and also because most of the studies involved planar robots. In this paper, we report the effects of a 20-session-rehabilitation project involving the Armeo Power robot, an assistive exoskeleton to perform 3D upper limb movements, in addition to conventional rehabilitation therapy, on 10 subacute stroke survivors. Patients were evaluated through clinical scales and a kinematic assessment of the upper limbs, both pre- and post-treatment. A set of indices based on the patients’ 3D kinematic data, gathered from an optoelectronic system, was calculated. Statistical analysis showed a remarkable difference in most parameters between pre- and post-treatment. Significant correlations between the kinematic parameters and clinical scales were found. Our findings suggest that 3D robot-mediated rehabilitation, in addition to conventional therapy, could represent an effective means for the recovery of upper limb disability. Kinematic assessment may represent a valid tool for objectively evaluating the efficacy of the rehabilitation treatment.

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.

Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study

2020 ◽  
pp. 1-11
Author(s):  
Gloria Perini ◽  
Rita Bertoni ◽  
Rune Thorsen ◽  
Ilaria Carpinella ◽  
Tiziana Lencioni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Standard Care ◽  
Experimental Treatment ◽  
Stroke Patients ◽  
Rehabilitation Care ◽  
Post Stroke ◽  
Robotic Therapy ◽  
Arm Rehabilitation ◽  
Point Increase ◽  
Task Oriented

BACKGROUND: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement and robotic therapy which allows many repetitions of movements. OBJECTIVE: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS: Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upperextremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS: The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10 point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37–0.56). CONCLUSIONS: Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.

scholarly journals Effect of post-stroke spasticity on voluntary movement of the upper limb

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hadar Lackritz ◽  
Yisrael Parmet ◽  
Silvi Frenkel-Toledo ◽  
Melanie C. Baniña ◽  
Nachum Soroker ◽  
...  
Keyword(s):  
Upper Limb ◽  
Target Location ◽  
Distance Measure ◽  
Movement Time ◽  
Motor Impairment ◽  
Reach To Grasp ◽  
Motion Patterns ◽  
Post Stroke ◽  
The Impact ◽  
Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

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