scholarly journals Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Monika Zbytniewska ◽  
Christoph M. Kanzler ◽  
Lisa Jordan ◽  
Christian Salzmann ◽  
Joachim Liepert ◽  
...  
Keyword(s):  
Motor Function ◽  
Discriminant Validity ◽  
Metacarpophalangeal Joint ◽  
Stroke Recovery ◽  
Sensorimotor Function ◽  
Motor Impairments ◽  
Robot Assisted ◽  
Stroke Population ◽  
Neurological Injuries ◽  
Robotic Tasks

Abstract Background Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations $$\rho$$ ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations ($$\rho$$ ρ =0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other ($$\rho \le$$ ρ ≤ 0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile. Conclusions The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies.

scholarly journals Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

2020 ◽  
Author(s):  
Monika Zbytniewska ◽  
Christoph M. Kanzler ◽  
Lisa Jordan ◽  
Christian Salzmann ◽  
Joachim Liepert ◽  
...  
Keyword(s):  
Motor Function ◽  
Discriminant Validity ◽  
Metacarpophalangeal Joint ◽  
Stroke Recovery ◽  
P Value ◽  
Sensorimotor Function ◽  
Motor Impairments ◽  
Robot Assisted ◽  
Neurological Injuries ◽  
Robotic Tasks

Abstract Background: Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments). Methods: For this purpose, a battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations rho) of these tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls. Results: Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects on all metrics extracted from the robotic tasks. Concurrent validity was shown through moderate to strong correlations (rho=0.4-0.8) between the robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits were not strongly correlated, thereby presenting complementary information about a patient’s impairment profile. Conclusions: The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies.

Quantifying upper limb motor impairment in chronic stroke: a physiological profiling approach

2021 ◽  
Author(s):  
Lewis Anthony Ingram ◽  
Annie A. Butler ◽  
Matthew Andrew Dalhousie Brodie ◽  
Stephen Ronald Lord ◽  
Simon C. Gandevia
Keyword(s):  
Upper Limb ◽  
Test Performance ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Anatomical Location ◽  
Sensorimotor Function ◽  
Upper Limbs ◽  
Motor Impairments ◽  
Upper Limb Function ◽  
Stroke Population

Upper limb motor impairments, such as muscle weakness, loss of dexterous movement and reduced sensation are common following a stroke. The extent and severity of these impairments differs among individuals, depending on the anatomical location and size of lesions. Identifying impairments specific to the individual is critical to optimize their functional recovery. The upper limb Physiological Profile Assessment (PPA) provides quantitative measures of key physiological domains required for adequate function in the upper limbs. The current study investigates the use of the upper limb PPA in a chronic stroke population. 50 participants with chronic stroke completed all tests of the upper limb PPA; both with their affected and less affected upper limbs. Performance in each test was compared to 50 age- and sex matched controls with no history of a stroke. Correlations between test performance and validated measures of stroke, sensorimotor function and disability were examined. Compared to controls, people with stroke demonstrated substantially impaired upper limb PPA performance for both their affected and less affected limbs. Performance in the upper limb PPA was associated with validated measures of sensorimotor function specific to the stroke population (Fugl-Meyer Assessment), and stroke-related disability (Stroke Impact Scale). The upper limb PPA shows good concurrent validity as a means of to quantify upper limb function in a chronic stroke population. These tests identify domain-specific deficits and could be further tailored to an individual patient by the clinician to inform rehabilitation and track recovery.

scholarly journals Neglected femoral neck fractures in cerebral palsy: a narrative review

2020 ◽  
Vol 5 (1) ◽  
pp. 58-64
Author(s):  
Giuseppe Toro ◽  
Antimo Moretti ◽  
Marco Paoletta ◽  
Annalisa De Cicco ◽  
Adriano Braile ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Femoral Neck ◽  
Motor Function ◽  
Treatment Options ◽  
High Morbidity ◽  
Fibular Graft ◽  
Motor Impairments ◽  
High Prevalence ◽  
Neck Fracture

Hip fractures are severe conditions with a high morbidity and mortality, especially when the diagnosis is delayed, and if formulated over 30 days after the injury, is termed a ‘neglected femoral neck fracture’ (NFNF). Cerebral palsy (CP) is probably one of the major risk factors for NFNF in Western countries, mainly because of both cognitive and motor impairments. However, considering the high prevalence of fractures in these patients, the incidence of NFNF in this population is probably underestimated, and this condition might result in persistent hip or abdominal pain. Several techniques are available for the treatment of NFNF (i.e. muscle pedicle bone graft, fixation with fibular graft, valgisation osteotomy), but most of them could affect motor function. Motor function must be preserved for as long as possible, in order to enhance the quality of life of CP patients. After discussing published NFNF cases in CP patients and available treatment options, a practical approach is proposed to facilitate the orthopaedic surgeon to both early identify and appropriately manage these challenging fractures. Cite this article: EFORT Open Rev 2020;5:58-64. DOI: 10.1302/2058-5241.5.190019

Complementary and alternative interventions for stroke recovery – a narrative overview of the published evidence

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Narayanaswamy Venketasubramanian
Keyword(s):  
Motor Function ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Sham Acupuncture ◽  
Stroke Recovery ◽  
Cochrane Library ◽  
Walking Ability ◽  
Alternative Interventions ◽  
Published Evidence ◽  
Complementary And Alternative

Abstract Objectives Stroke survivors dissatisfied with their progress often seek complementary and alternative interventions (CAI). This paper reviews the evidence for CAIs in stroke recovery. Methods A literature search was performed for publications until December 2019 of CAI for stroke in Pubmed, Cochrane Library, EMBASE, CINAHL, AMED. Evidence was assessed according to Oxford Centre for Evidence-based Medicine criteria. Results In a meta-analysis, acupuncture reduced death or dependency compared to control at the end of follow-up and over the long term (≥3 months), OR 0.61(95%CI 0.46–0.79) and OR 0.67(95%CI 0.53–0.85) respectively, but was neutral against sham acupuncture. A Cochrane review of acupuncture vs. sham acupuncture in subacute or chronic stroke vs. showed no differences in motor function and quality of life. Three trials found favourable effects of moxibustion on motor function (SMD=0.72, 95%CI 0.37–1.08, p<0.0001). Two trials showed cupping compared to acupuncture reduced hemiplegic shoulder pain and upper-limb ‘myodynamia’. A meta-analysis of traditional Chinese medicines for ischaemic stroke showed marked improvement in neurological deficit on stroke scales. There was no evidence for Ayurveda, homoeopathy or reiki. Tui-na reduced the Modified Ashworth Scale in some muscle groups. Marma massage improved Motricity Index and trunk control. Thai massage and herbal treatments improved the Barthel Index. On meta-analysis, Yoga improved memory and anxiety, while tai-chi improved activities of daily living, balance and walking ability. Studies were generally of poor quality. Conclusions The evidence for benefit of CAIs for stroke recovery is weak. More research is needed to justify these treatments for stroke, by well-conducted, adequately-sized, double-blinded, randomized controlled trials.

The Relationship between Aquatic Independence and Gross Motor Function in Children with Neuro-Motor Impairments

2006 ◽  
Vol 23 (4) ◽  
pp. 339-355 ◽  
Author(s):  
Miriam Getz ◽  
Yeshayahu Hutzler ◽  
Adri Vermeer
Keyword(s):  
Motor Function ◽  
Motor Performance ◽  
Motor Impairments ◽  
Gross Motor ◽  
Gross Motor Function ◽  
Gross Motor Function Measure ◽  
Scale Scores ◽  
The Relationship ◽  
Pearson Correlations ◽  
Function Measure

The purpose of this study was to investigate the relationship between motor performance in the aquatic setting as measured by the Aquatic Independence Measure (AIM) to motor performance on land as measured by the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI). Fourty- nine children with neuro-motor impairments ages 3 to 7 participated in the study. Pearson correlations were applied to determine the relationships between the AIM and the GMFM, PEDI, and Gross Motor Function Classification System (GMFCS). Significant correlations were found between the total AIM and GMFM scores (r = 69, p < .01) and PEDI self-care sub-scale (r = .79, p < .01) as well as the PEDI mobility sub-scale scores (r = .35, p < .05). The water adjustment sub-scale as measured by the AIM showed the strongest relationship to motor performance on land as measured by the GMFM and PEDI in our sample of 49 children.

Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery

2013 ◽  
Vol 33 (1) ◽  
pp. 33-39 ◽  
Author(s):  
Stefano Mazzoleni ◽  
Patrizio Sale ◽  
Marco Franceschini ◽  
Samuele Bigazzi ◽  
Maria Chiara Carrozza ◽  
...  
Keyword(s):  
Upper Limb ◽  
Chronic Stroke ◽  
Stroke Recovery ◽  
Robot Assisted ◽  
Upper Limb Rehabilitation ◽  
Limb Rehabilitation

Abstract TMP33: Repair of Ischemic Intestinal Epithelial Stem Cells: Potential Therapy to Improve Stroke Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kathiresh Kumar Mani ◽  
Farida Sohrabji
Keyword(s):  
Stem Cells ◽  
Motor Function ◽  
Stroke Recovery ◽  
Female Rats ◽  
Stem Cell Marker ◽  
Left Middle Cerebral Artery ◽  
Intestinal Epithelial ◽  
Epithelial Stem Cells ◽  
Stroke Outcomes ◽  
Sensory Motor

Background: Nearly 50% of all stroke patients experience “leaky” gut, gut hemorrhage and gut epithelium damage. Gut leakiness may increase circulating inflammatory cytokines and other gut products such as endotoxins, which can impair stroke recovery. Here we tested the hypothesis that normalizing gut function via transplantation of intestinal epithelial stem cells (IESC) after stroke may stimulate repair of gut structures and improve stroke outcomes. Methods: Reproductive senescent female Sprague-Dawley rats used for this study and assigned to the following groups: Control (no stroke); stroke with sham transplant (vehicle); stroke with IESC transplantation. Rats were subjected to stereotaxic surgery to occlude the left middle cerebral artery by using Endothelin-1. Primary IECs were isolated from young female rats to prepare organoids cultures. Dissociated organoids were labeled with PKH26 and injected iv either once (48h after stroke) or 3 times (4h/24h/48h after stroke). Behavioral assays and saphenous blood draws were performed pre-stroke, 2d and 5d after stroke. Trunk blood, brain tissue and a segment of small intestine was collected at termination and processed for the expression of the stem cell marker Lgr5+, Na/K ATPase-α, and tight junction proteins. Results: Significant deterioration of the gut architecture was observed after stroke, including blunted or absent villi and irregular crypts. In animals that received PKH26-labeled organoid tranplants at 48h post stroke, labeled cells were seen in the center of the villus and a few organoid cells were immunositve for Lgr5+. Animals that received 3 organoid injections showed PKH26-labeled cells incorporated in both the villus and crypts. In these animals, villus were well formed and appeared no different from non-stroke controls. Sensory motor function assessed by adhesive removal test on the side contralateral to the infarction was severely impaired in the stroke/no transplant animals (120+secs/timed out), while this impairment was attenuated in the group that received 3 organoid injections (31±11 secs). Conclusion: These data suggest that transplantation of IESC after stroke may promote repair of gut villus and crypts, with a concomitant improvement in sensory motor function.

scholarly journals Prediction of motor recovery using indirect connectivity in a lesion network after ischemic stroke

2020 ◽  
Vol 13 ◽  
pp. 175628642092567
Author(s):  
Jungsoo Lee ◽  
Eunhee Park ◽  
Ahee Lee ◽  
Won Hyuk Chang ◽  
Dae-Shik Kim ◽  
...  
Keyword(s):  
Prediction Model ◽  
Motor Function ◽  
Brain Network ◽  
Reference Network ◽  
Lesion Volume ◽  
Motor Impairments ◽  
Rehabilitation Programs ◽  
Time Courses ◽  
The Impact ◽  
The Brain

Background: Recovery prediction can assist in the planning for impairment-focused rehabilitation after a stroke. This study investigated a new prediction model based on a lesion network analysis. To predict the potential for recovery, we focused on the next link-step connectivity of the direct neighbors of a lesion. Methods: We hypothesized that this connectivity would contribute to recovery after stroke onset. Each lesion in a patient who had suffered a stroke was transferred to a healthy subject. First link-step connectivity was identified by observing voxels functionally connected to each lesion. Next (second) link-step connectivity of the first link-step connectivity was extracted by calculating statistical dependencies between time courses of regions not directly connected to a lesion and regions identified as first link-step connectivity. Lesion impact on second link-step connectivity was quantified by comparing the lesion network and reference network. Results: The lower the impact of a lesion was on second link-step connectivity in the brain network, the better the improvement in motor function during recovery. A prediction model containing a proposed predictor, initial motor function, age, and lesion volume was established. A multivariate analysis revealed that this model accurately predicted recovery at 3 months poststroke ( R 2 = 0.788; cross-validation, R 2 = 0.746, RMSE = 13.15). Conclusion: This model can potentially be used in clinical practice to develop individually tailored rehabilitation programs for patients suffering from motor impairments after stroke.

The effect and optimal parameters of repetitive transcranial magnetic stimulation on motor recovery in stroke patients: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Vol 33 (5) ◽  
pp. 847-864 ◽  
Author(s):  
Huifang Xiang ◽  
Jing Sun ◽  
Xiang Tang ◽  
Kebin Zeng ◽  
Xiushu Wu
Keyword(s):  
Motor Function ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Motor Recovery ◽  
Controlled Trials ◽  
Optimal Parameters ◽  
Stroke Patients ◽  
Randomized Controlled ◽  
Stimulation Parameters ◽  
Stroke Population

Objective: The primary aim of this meta-analysis was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on limb movement recovery post-stroke and cortex excitability, to explore the optimal parameters of rTMS and suitable stroke population. Second, adverse events were also included. Data sources: The databases of PubMed, EBSCO, MEDLINE, the Cochrane Central Register of Controlled Trials, EBM Reviews-Cochrane Database, the Chinese National Knowledge Infrastructure, and the Chinese Science and Technology Journals Database were searched for randomized controlled trials exploring the effects of rTMS on limb motor function recovery post-stroke before December 2018. Review methods: The effect sizes of rTMS on limb motor recovery, the effect size of rTMS stimulation parameters, and different stroke population were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate. Results: For the motor function assessment, 42 eligible studies involving 1168 stroke patients were identified. The summary effect size indicated that rTMS had positive effects on limb motor recovery (SMD = 0.50, P < 0.00001) and activities of daily living (SMD = 0.82, P < 0.00001), and motor-evoked potentials of the stimulated hemisphere differed according to the stimulation frequency, that is, the high-frequency group (SMD = 0.57, P = 0.0006), except the low-frequency group (SMD = –0.27, P = 0.05). No significant differences were observed among the stimulation parameter subgroups except for the sessions subgroup ( P = 0.02). Only 10 included articles reported transient mild discomfort after rTMS. Conclusions: rTMS promoted the recovery of limb motor function and changed the cortex excitability. rTMS may be better for early and pure subcortical stroke patients. Regarding different stimulation parameters, the number of stimulation sessions has an impact on the effect of rTMS.

scholarly journals Motor Function Predicts Parent-Reported Musculoskeletal Pain in Children with Cerebral Palsy

2013 ◽  
Vol 18 (6) ◽  
pp. 323-327 ◽  
Author(s):  
Chantel C Barney ◽  
Linda E Krach ◽  
Patrick F Rivard ◽  
John L Belew ◽  
Frank J Symons
Keyword(s):  
Cerebral Palsy ◽  
Activities Of Daily Living ◽  
Musculoskeletal Pain ◽  
Motor Function ◽  
Daily Living ◽  
Brief Pain Inventory ◽  
Self Report ◽  
General Description ◽  
Motor Impairments ◽  
Gmfcs Level

BACKGROUND: The relationship between pain and motor function is not well understood, especially for children and adolescents with communication and motor impairments associated with cerebral palsy (CP).OBJECTIVES: To determine whether a predictive relationship between motor function and musculoskeletal pain exists in children with CP.METHODS: Following informed consent, caregivers of 34 pediatric patients with CP (mean [± SD] age 9.37±4.49 years; 80.0% male) completed pain- and function-related measures. Parents completed the Dalhousie Pain Interview and the Brief Pain Inventory based on a one-week recall to determine whether pain had been experienced in the past week, its general description, possible cause, duration, frequency, intensity and interference with daily function. The Gross Motor Function Classification System (GMFCS) was used to classify the motor involvement of the child based on their functional ability and their need for assistive devices for mobility.RESULTS: GMFCS level significantly predicted parent-reported musculoskeletal pain frequency (P<0.02), duration (P=0.05) and intensity (P<0.01). Duration of pain was significantly related to interference with activities of daily living (P<0.05).CONCLUSIONS: Children with CP with greater motor involvement, as indexed by GMFCS level, may be at risk for increased pain (intensity, frequency and duration) that interfers with activities of daily living. The clinical index of suspicion should be raised accordingly when evaluating children with developmental disability who cannot self-report reliably.

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