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 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.

Effects of bilateral arm training on upper extremity function in right and left hemispheric stroke

2020 ◽  
pp. 1-9
Author(s):  
Humera Ambreen ◽  
Hina Tariq ◽  
Imran Amjad
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Recovery Of Function ◽  
Hand Function ◽  
Group Analysis ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Beneficial Effects ◽  
Significant Difference ◽  
Bilateral Arm Training

Abstract Objective: This experimental study on 24 stroke patients aimed at evaluating and comparing the effects of bilateral arm training on upper extremity (UE) motor function between right and left hemispheric chronic stroke patients. Methods: Both groups received the same intervention involving 5 functional tasks for 1 hour, 3 days per week, for a total of 6 weeks. Fugl-Meyer Assessment-Upper Extremity and Wolf-Motor Function Test were applied as outcome measures at baseline and after 6 weeks of training to assess the recovery of function in the affected area. Results: Intra-group analysis showed no significant improvement in the wrist and hand function in the left hemispheric stroke (LHS) (p>0.05), while right hemispheric stroke (RHS) patients did not improve significantly in the coordination/speed domain (p>0.05). Inter-group analysis showed no significant difference between right and left hemispheric stroke patients (p>0.05). Conclusion: Bilateral arm training showed beneficial effects in improving UE function in both RHS and LHS patients. Distal UE function in LHS and coordination and speed of movement in RHS patients did not show any significant improvement. Key Words: Stroke, Upper extremity, Recovery of function, Bilateral arm training. Continuous...

scholarly journals Effect of proprioceptive sensation and feedback required for motor learning on function, activity, and daily life behavior of patients after nerve injury

2021 ◽  
Vol 11 (3) ◽  
pp. 474-481
Author(s):  
Jung-Ho Lee
Keyword(s):  
Upper Extremity ◽  
Daily Activities ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients ◽  
Proprioceptive Sensation ◽  
Significant Difference ◽  
Upper Extremity Function ◽  
Function Activity ◽  
Experimental Group

Purpose: This study investigated the effects of modified mirror therapy and taping therapy for providing feedback on upper extremity function, activity, and daily activities of stroke patients. Methods: This study was conducted with 20 stroke patients and randomly assigned 10 subjects to the experimental group and 10 to the control group. In the experimental group, after proprioceptive neuromuscular stimulation treatment, the mirror therapy program was implemented. In the control group, upper extremity taping was performed before proprioceptive neuromuscular facilitation treatment. In this study, a prior evaluation using JTT, FIM, and MAL was performed before intervention to evaluate the patient's function and daily life behavior. Post-tests were performed after the last treatment. Results: In the paired-sample T-test used for within-group comparison of JTTs, FIM, and MAL, there was a significant difference between pre- and post-test for all groups. But there was no statistically significant difference between experimental group 1 and experimental group 2 in an independent t-test conducted to compare the effect sizes of treatments. Conclusion: In other words, by applying mirror therapy and taping therapy that can increase proprioceptive sensation and feedback information in stroke patients, upper extremity function and daily activities can be increased.

scholarly journals Machine Learning Methods Predict Individual Upper-Limb Motor Impairment Following Therapy in Chronic Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 428-439 ◽  
Author(s):  
Ceren Tozlu ◽  
Dylan Edwards ◽  
Aaron Boes ◽  
Douglas Labar ◽  
K. Zoe Tsagaris ◽  
...  
Keyword(s):  
Machine Learning ◽  
Upper Extremity ◽  
Upper Limb ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Response To Therapy ◽  
Stroke Patients ◽  
Learning Methods ◽  
Machine Learning Methods ◽  
The Difference

Background. Accurate prediction of clinical impairment in upper-extremity motor function following therapy in chronic stroke patients is a difficult task for clinicians but is key in prescribing appropriate therapeutic strategies. Machine learning is a highly promising avenue with which to improve prediction accuracy in clinical practice. Objectives. The objective was to evaluate the performance of 5 machine learning methods in predicting postintervention upper-extremity motor impairment in chronic stroke patients using demographic, clinical, neurophysiological, and imaging input variables. Methods. A total of 102 patients (female: 31%, age 61 ± 11 years) were included. The upper-extremity Fugl-Meyer Assessment (UE-FMA) was used to assess motor impairment of the upper limb before and after intervention. Elastic net (EN), support vector machines, artificial neural networks, classification and regression trees, and random forest were used to predict postintervention UE-FMA. The performances of methods were compared using cross-validated R2. Results. EN performed significantly better than other methods in predicting postintervention UE-FMA using demographic and baseline clinical data (median [Formula: see text] P < .05). Preintervention UE-FMA and the difference in motor threshold (MT) between the affected and unaffected hemispheres were the strongest predictors. The difference in MT had greater importance than the absence or presence of a motor-evoked potential (MEP) in the affected hemisphere. Conclusion. Machine learning methods may enable clinicians to accurately predict a chronic stroke patient’s postintervention UE-FMA. Interhemispheric difference in the MT is an important predictor of chronic stroke patients’ response to therapy and, therefore, could be included in prospective studies.

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).

scholarly journals Effect of Scapular Kinesiotaping as an Adjunct to Dynamic Neuromuscular Stabilization Exercises on Upper Extremity Functions in Stroke Patients

2022 ◽  
Vol 12 (1) ◽  
pp. 13-22
Author(s):  
Rutuja Jadhav ◽  
Shamla Pazare
Keyword(s):  
Grip Strength ◽  
Upper Extremity ◽  
Control Group ◽  
Stroke Patients ◽  
Extremity Function ◽  
Function Index ◽  
Intergroup Comparison ◽  
Significant Difference ◽  
Upper Extremity Function ◽  
And Control

Background and Purpose: Stroke is one of the leading causes of death and disability in India. Upper extremities get more affected in Middle cerebral artery syndrome. Stroke patients have lack of functional ability of upper extremity due to scapular malalignment resulting from paralysis of the scapular muscles. Kinesiotape helps to realign the muscles and thus it becomes easy to activate or inhibit them. We hypothesised that Dynamic Neuromuscular Stabilisation exercises along with kinesiotape could improve upper extremity function. Methodology: Ethical clearance was obtained. Informed consent was taken. 30 patients were selected according to inclusion and exclusion criteria. 15 subjects were randomly divided into experimental and control group. Subjects were given Dynamic neuromuscular stabilisation exercises for scapular strengthening. The experimental group was given Kinesiotaping to the scapula using muscle technique. Pre and post treatment assessment was done using Upper Extremity Function Index, grip strength and scapular abduction position with MB ruler. Result: The intergroup comparison revealed a highly significant difference for upper extremity function index and grip strength whereas scapular abduction was not significant. Conclusion: The Scapular Kinesiotaping as an adjunct to Dynamic Neuromuscular Stabilization Exercises is significantly effective to improve upper extremity functions and grip strength in post stroke patients. Key words: Stroke, Upper Extremity Functions, Dynamic Neuromuscular Stabilization Exercises, Scapular Kinesiotaping.

Abstract 102: NIHSS Lacks Validity and Sensitivity in Postacute Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Brittani Basobas ◽  
Brittany Hand ◽  
Heather Peters ◽  
Stephen Page
Keyword(s):  
Health Status ◽  
Upper Extremity ◽  
Functional Limitation ◽  
Motor Impairment ◽  
Neurological Status ◽  
Multicenter Trial ◽  
Chronic Stroke ◽  
Motor Deficits ◽  
Ability Test ◽  
Stroke Impact Scale

Stroke remains a leading cause of disability, with those affected usually experiencing long-term motor deficits. The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure acute neurological status, but recently is being deployed in at least 29 chronic stroke trials as a secondary UE motor outcome despite a lack of evidence surrounding its validity in chronic stroke. The purpose of this secondary, retrospective analysis of randomized controlled, multicenter, trial data was to (a) determine the NIHSS’s association with the Stroke Impact Scale (SIS), a poststroke health status measurement, the upper extremity Fugl Meyer (UEFM) and the Arm Motor Ability Test (AMAT), measures of upper extremity (UE) impairment and functional limitation and (b) determine the NIHSS’s sensitivity to UE motor change over time . There was no association between total NIHSS scores and SIS physical dimension, overall perception of recovery, activity of daily living scores ( P = -.036, P = .782; P = -.039, P = .640; P = -.054, P 5.520, respectively) or functional limitation ( P; = –0.141; P; = 0.089 ). NIHSS and UE impairment associations were significant ( P; = –0.204; P; = 0.014 ) but explained less than 4% of the variance among UEFM scores. Subjects scoring a “zero” on the NIHSS exhibited discernible UE motor deficits and varied scores on the UEFM, AMAT, and SIS. A statistically significant sensitivity to change was found for the UEFM ( χ 2 (3) = 10.783, p = 0.013 ), but not for NIHSS ( X 2 (3) = 1.250, p = 0.741 ) or either AMAT functional ability or quality of movement scores ( χ 2 (3) = 3.953, p = 0.267; χ 2 (3) = 4.199, p = 0.241, respectively ). There was a significant weak, negative correlation between the NIHSS and UEFM ( r s (47) = -.325, p = .026 ), but nonsignificant weak, negative correlations between the NIHSS and either AMAT scores ( r s (47) = -.051, p = .740; r s (47) = -.103, p = .489, respectively ). While being increasingly used in postacute trials, the NIHSS’s weak correlation with measures of motor impairment, functional limitation, and health status measurements as well as its insensitivity to change suggest that its use be reserved to acute bedside status. Its utility as a predictor of real world UE motor outcomes has been purported and is currently under investigation as a next step.

scholarly journals Kinematic parameters obtained with the ArmeoSpring for upper-limb assessment after stroke: a reliability and learning effect study for guiding parameter use

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Nabila Brihmat ◽  
Isabelle Loubinoux ◽  
Evelyne Castel-Lacanal ◽  
Philippe Marque ◽  
David Gasq
Keyword(s):  
Upper Extremity ◽  
Repeated Measures ◽  
Learning Effect ◽  
Assessment Tool ◽  
Peak Velocity ◽  
Minimal Detectable Change ◽  
Kinematic Parameters ◽  
Stroke Patients ◽  
Post Stroke ◽  
Significant Difference

Abstract Background After stroke, kinematic measures obtained with non-robotic and robotic devices are highly recommended to precisely quantify the sensorimotor impairments of the upper-extremity and select the most relevant therapeutic strategies. Although the ArmeoSpring exoskeleton has demonstrated its effectiveness in stroke motor rehabilitation, its interest as an assessment tool has not been sufficiently documented. The aim of this study was to investigate the psychometric properties of selected kinematic parameters obtained with the ArmeoSpring in post-stroke patients. Methods This study involved 30 post-stroke patients (mean age = 54.5 ± 16.4 years; time post-stroke = 14.7 ± 26.7 weeks; Upper-Extremity Fugl-Meyer Score (UE-FMS) = 40.7 ± 14.5/66) who participated in 3 assessment sessions, each consisting of 10 repetitions of the ‘horizontal catch’ exercise. Five kinematic parameters (task and movement time, hand path ratio, peak velocity, number of peak velocity) and a global Score were computed from raw ArmeoSpring’ data. Learning effect and retention were analyzed using a 2-way repeated-measures ANOVA, and reliability was investigated using the intra-class correlation coefficient (ICC) and minimal detectable change (MDC). Results We observed significant inter- and intra-session learning effects for most parameters except peak velocity. The measures performed in sessions 2 and 3 were significantly different from those of session 1. No additional significant difference was observed after the first 6 trials of each session and successful retention was also highlighted for all the parameters. Relative reliability was moderate to excellent for all the parameters, and MDC values expressed in percentage ranged from 42.6 to 102.8%. Conclusions After a familiarization session, the ArmeoSpring can be used to reliably and sensitively assess motor impairment and intervention effects on motor learning processes after a stroke. Trial registration The study was approved by the local hospital ethics committee in September 2016 and was registered under number 05-0916.

scholarly journals Application Of Mirror Therapy On Upper Extremity Motor Recovery In Post-Stroke Patients

2021 ◽  
pp. 136-144
Author(s):  
Roh Hastuti Prasetyaningsih ◽  
Hendri Kurniawan
Keyword(s):  
Upper Extremity ◽  
Motor Recovery ◽  
The Body ◽  
P Value ◽  
Mirror Therapy ◽  
Research Subjects ◽  
Hand Rehabilitation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Significant Difference

Background: Stroke is a health problem for both developed and developing countries, including Indonesia. Paralysis in stroke is mainly due to damage to the internal capsule. This damage requires neuroplasticity involving a number of parts of the brain to restore. One therapy that is beneficial for neuroplasticity is Mirror Therapy (MT). MT is a rehabilitation tool that aims to restore some of the pathological conditions in which the body representation is affected, including post-stroke motor impairment. Methods: This research is a quantitative pre-experimental design with the type one group pretest-postest. The research subjects were 15 post-stroke patients in residency of Semarang. Research data were collected in August-September 2020. Sample selection with  purposive sampling technique who conform inclusion criteria. The Fulg-Meyer Upper Extremity Assessment (FMA-UE) as an aoutcame measure that be avowed valid and reliabel. Data analysis using Paired Sample T-Test because of normally distributed. Results: Statistically the results represent a significant difference in the UE  motor ability of post-stroke patients between baseline and after mirror therapy intervention, with a mean difference (5,14) and p value =  0.000  (ρ < 0,05). Application  of MT effect on upper extremity motor recovery in post-stroke patients. Conclusions: MT program is an effective intervention for UE motor recovery and motor function improvement in post- stroke patients. MT program can be used as a standardized of hand rehabilitation intervention in hospital, clinics and homes.

Sign in / Sign up

Export Citation Format

Share Document