scholarly journals A method of hand motor control assessment in patients with post-stroke spasticity

2017 ◽  
Vol 31 (3) ◽  
pp. 55-70
Author(s):  
Jolanta Zwolińska ◽  
Mariusz Drużbicki ◽  
Lidia Perenc ◽  
Andrzej Kwolek
Keyword(s):  
Motor Control ◽  
Therapeutic Process ◽  
Hospital Treatment ◽  
Photometric Method ◽  
Stroke Patients ◽  
Post Stroke ◽  
Numerical Indicator ◽  
Based Medicine ◽  
Ashworth Scale ◽  
Hand Motor Control

Abstract Introduction: In order to assess hand spasticity in post-stroke patients, it is necessary to apply an objective and sensitive method which allows for characterising motor control. It is significant due to the necessity to monitor the effects of the therapeutic process according to the requirements of Evidence-Based Medicine (EBM). The aim of the study was to assess the usefulness of the measurement of pressure generated during a maximal palmar grasp and after its release for evaluating the level of hand motor control in poststroke patients compared to subjective scales. Material and methods: In order to characterise motor control, a numerical indicator calculated on the basis of the measurements of pressure generated during a maximal palmar grasp and after its release was suggested. To perform the measurements, 12 poststroke patients with hemiparesis were included in the study. In the research, the level of hand paresis was assessed with Brunnström Approach, the intensity of spasticity was graded with Modified Ashworth Scale, while hand motor function was classified with Fugl-Meyer Assessment (FMA). Pressure generated during a palmar grasp and after its release as well as palm area were measured with the use of a photometric method. The assessment was made twice, i.e. on the day of admission to the in-patient rehabilitation ward and after a three-week hospital treatment. Results: In the second measurement, a slight decrease in paresis intensity according to Brunnström Approach and lower intensity of spasticity according to Ashworth Scale were noted. A higher number of points in the FMA scale was observed. The values of the suggested indicator changed; however, in no case were these changes statistically significant. Conclusions: 1. Compared to other subjective scales, the usefulness of the measurement of pressure generated during a maximal palmar grasp and after its release for assessing the level of hand motor control in post-stroke patients was not confirmed. 2. The usefulness of the recommended method of spastic hand motor control assessment needs to be verified in further research carried out according to EBM requirements.

Abstract W P140: Post-stroke Oculomotor Abnormalities evident during Objective Eye Tracking but Not under Clinical Assessment

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
John-Ross Rizzo ◽  
Todd Hudson ◽  
Briana Kowal ◽  
Michal Wiseman ◽  
Preeti Raghavan
Keyword(s):  
Motor Control ◽  
Eye Movements ◽  
Eye Movement ◽  
Oculomotor Control ◽  
Healthy Controls ◽  
Visually Guided ◽  
Stroke Patients ◽  
Movement Execution ◽  
Post Stroke ◽  
Control Post

Introduction: Visual abnormalities and manual motor control have been studied extensively after stroke, but an understanding of oculomotor control post-stroke has not. Recent studies have revealed that in visually guided reaches arm movements are planned during eye movement execution, which may contribute to increased task complexity. In fact, in healthy controls during visually guided reaches, the onset of eye movement is delayed, its velocity reduced, and endpoint errors are larger relative to isolated eye movements. Our objective in this experiment was to examine the temporal properties of eye movement execution for stroke patients with no diagnosed visual impairment. The goal is to improve understanding of oculomotor control in stroke relative to normal function, and ultimately further understand its coordination with manual motor control during joint eye and hand movements. We hypothesized that stroke patients would show abnormal initiation or onset latency for saccades made in an eye movement task, as compared to healthy controls. Methods: We measured the kinematics of eye movements during point-to-point saccades; there was an initial static, fixation point and the stimulus was a flashed target on a computer monitor. We used a video-based eye tracker for objective recording of the eye at a sampling frequency of 2000 Hz (SR Research, Eyelink). 10 stroke subjects, over 4 months from injury and with no diagnosed visual impairment, and 10 healthy controls completed 432 saccades in a serial fashion. Results: Stroke patients had significantly faster onset latencies as compared to healthy controls during saccades (99.5ms vs. 245.2ms, p=0.00058). Conclusion: A better understanding of the variations in oculomotor control post-stroke, which may go unnoticed during clinical assessment, may improve understanding of how eye control synchronizes with arm or manual motor control. This knowledge could assist in tailoring rehabilitative strategies to amplify motor recovery. For next steps, we will perform objective eye and hand recordings during visually guided reaches post-stroke to better understand the harmonization or lack thereof after neurologic insult.

scholarly journals Temporal Dynamics of Corticomuscular Coherence Reflects Alteration of the Central Mechanisms of Neural Motor Control in Post-Stroke Patients

2021 ◽  
Vol 15 ◽  
Author(s):  
Maxime Fauvet ◽  
David Gasq ◽  
Alexandre Chalard ◽  
Joseph Tisseyre ◽  
David Amarantini
Keyword(s):  
Motor Control ◽  
Healthy Subjects ◽  
Voluntary Movement ◽  
Temporal Dynamics ◽  
Elbow Extension ◽  
Stroke Patients ◽  
Post Stroke ◽  
Antagonist Muscles ◽  
Agonist And Antagonist ◽  
Agonist And Antagonist Muscles

The neural control of muscular activity during a voluntary movement implies a continuous updating of a mix of afferent and efferent information. Corticomuscular coherence (CMC) is a powerful tool to explore the interactions between the motor cortex and the muscles involved in movement realization. The comparison of the temporal dynamics of CMC between healthy subjects and post-stroke patients could provide new insights into the question of how agonist and antagonist muscles are controlled related to motor performance during active voluntary movements. We recorded scalp electroencephalography activity, electromyography signals from agonist and antagonist muscles, and upper limb kinematics in eight healthy subjects and seventeen chronic post-stroke patients during twenty repeated voluntary elbow extensions and explored whether the modulation of the temporal dynamics of CMC could contribute to motor function impairment. Concomitantly with the alteration of elbow extension kinematics in post-stroke patients, dynamic CMC analysis showed a continuous CMC in both agonist and antagonist muscles during movement and highlighted that instantaneous CMC in antagonist muscles was higher for post-stroke patients compared to controls during the acceleration phase of elbow extension movement. In relation to motor control theories, our findings suggest that CMC could be involved in the online control of voluntary movement through the continuous integration of sensorimotor information. Moreover, specific alterations of CMC in antagonist muscles could reflect central command alterations of the selectivity in post-stroke patients.

scholarly journals Assessment of test-retest reliability and internal consistency of the Wisconsin Gait Scale in hemiparetic post-stroke patients

2016 ◽  
Vol 30 (3) ◽  
pp. 41-53 ◽  
Author(s):  
Agnieszka Guzik ◽  
Mariusz Drużbicki ◽  
Grzegorz Przysada ◽  
Andrzej Kwolek ◽  
Agnieszka Brzozowska-Magoń ◽  
...  
Keyword(s):  
Motor Control ◽  
Internal Consistency ◽  
Lower Limb ◽  
Barthel Index ◽  
Gait Speed ◽  
Muscle Tone ◽  
Stroke Patients ◽  
Retest Reliability ◽  
Post Stroke ◽  
Test Retest Reliability

Abstract Introduction: A proper assessment of gait pattern is a significant aspect in planning the process of teaching gait in hemiparetic post-stroke patients. The Wisconsin Gait Scale (WGS) is an observational tool for assessing post-stroke patients’ gait. The aim of the study was to assess test-retest reliability and internal consistency of the WGS and examine correlations between gait assessment made with the WGS and gait speed, Brunnström scale, Ashworth’s scale and the Barthel Index. Material and methods: The research included 36 post-stroke patients. The patients’ gait was assessed with the use of the Wisconsin Gait Scale, gait speed with the use of walk test, the level of motor control in a paretic lower limb – according to Brunnström recovery stages, muscle tone in a paretic lower limb – according to modified Ashworth’s scale and functional independence was assessed using the Barthel Index. Gait was assessed with the use of the WGS twice, with a 7-day interval, by three experienced physiotherapists. Results: The analysis of internal consistency of the WGS revealed that the Cronbach’s α coefficient was high in the case of all the three raters and ranged from 0.85 to 0.88. It was noted that the coefficient of variation for all the comparisons was below 10%. When assessing the repeatability of the results, it was revealed that correlations between both measurements made by particular raters were very strong and highly significant. The WGS results significantly correlated with Brunnström scale, Ashworth’s scale and gait speed. Conclusions: It was concluded that the WGS has a high internal consistency and test-retest reliability. Also, significant correlations were found between gait assessment made with the use of the WGS and gait speed, level of motor control and muscle tone of a paretic lower limb. The WGS constitutes a promising tool for a qualitative, observational analysis of gait in post-stroke patients and allows for proper planning, monitoring and assessing rehabilitation results.

scholarly journals Post-Stroke Treatment with Neuromuscular Functional Electrostimulation of Antagonistic Muscles and Kinesiotherapy Evaluated with Electromyography and Clinical Studies in a Two-Month Follow-Up

2022 ◽  
Vol 19 (2) ◽  
pp. 964
Author(s):  
Juliusz Huber ◽  
Katarzyna Kaczmarek ◽  
Katarzyna Leszczyńska ◽  
Przemysław Daroszewski
Keyword(s):  
Large Population ◽  
Manual Muscle Testing ◽  
Stroke Patients ◽  
Positive Correlation ◽  
Post Stroke ◽  
Positive Effects ◽  
Muscle Testing ◽  
Neurophysiological Studies ◽  
Scale Scores ◽  
Ashworth Scale

The aim of this study was to determine the sustained influence of personalized neuromuscular functional electrical stimulation (NMFES) combined with kinesiotherapy (mainly, proprioceptive neuromuscular facilitation (PNF)) on the activity of muscle motor units acting antagonistically at the wrist and the ankle in a large population of post-stroke patients. Clinical evaluations of spasticity (Ashworth scale), manual muscle testing (Lovett scale), and surface electromyography recordings at rest (rEMG) and during attempts of maximal muscle contraction (mcEMG) were performed three times in 120 post-stroke patients (T0: up to 7 days after the incidence; T1: after 21 days of treatment; T2: after 60 days of treatment). Patients (N = 120) were divided into two subgroups—60 patients received personalized NMFES and PNF treatment (NMFES+K), and the other 60 received only PNF (K). The NMFES+K therapy resulted in a decrease in spasticity and an increase in muscle strength of mainly flexor muscles, in comparison with the K group. A positive correlation between the increase of rEMG amplitudes and high Ashworth scale scores and a positive correlation between low amplitudes of mcEMG and low Lovett scale scores were found in the wrist flexors and calf muscles on the paretic side. Negative correlations were found between the rEMG and mcEMG amplitudes in the recordings. The five-grade alternate activity score of the antagonists’ actions improved in the NMFES+K group. These improvements in the results of controlled NMFES treatment combined with PNF in patients having experienced an ischemic stroke, in comparison to the use of kinesiotherapy alone, might justify the application of conjoined rehabilitation procedures based on neurophysiological approaches. Considering the results of clinical and neurophysiological studies, we suppose that NMFES of the antagonistic muscle groups acting at the wrist and the ankle may evoke its positive effects in post-stroke patients by the modulation of the activity more in the spinal motor centers, including the level of Ia inhibitory neurons, than only at the muscular level.

scholarly journals Assessment of the correlations between gait speed in post-stroke patients and the time from stroke onset, the level of motor control in the paretic lower limb, proprioception, visual field impairment and functional independence

2016 ◽  
Vol 30 (3) ◽  
pp. 5-16
Author(s):  
Mariusz Drużbicki ◽  
Grzegorz Przysada ◽  
Justyna Podgórska-Bednarz ◽  
Andrzej Kwolek ◽  
Teresa Pop ◽  
...  
Keyword(s):  
Motor Control ◽  
Visual Field ◽  
Lower Limb ◽  
Barthel Index ◽  
Gait Speed ◽  
Functional Independence ◽  
Stroke Onset ◽  
Lower Limbs ◽  
Stroke Patients ◽  
Post Stroke

Abstract Introduction: Gait recovery is one of the main objectives in the rehabilitation of post-stroke patients. The study aim was to assess the correlations between gait speed in post-stroke hemiparetic patients and the level of motor control in the paretic lower limb, the time from stroke onset, the subjects’ age as well as the impairment of proprioception and visual field. Materials and methods: This retrospective study was performed at the Clinical Rehabilitation Ward of the Regional Hospital No. 2 in Rzeszow. The study group consisted of 600 patients after a first stroke who walked independently. The measurements focused on gait speed assessed in a 10-meter walking test, motor control in the lower limb according to Brunnström recovery stages, proprioception in lower limbs, visual field as well as functional independence according to The Barthel Index. Results: The study revealed a slight negative correlation between gait speed and the subjects’ age (r = − 0.25). No correlation was found between mean gait speed and the time from stroke onset. On the other hand, gait speed strongly correlated both with the level of motor control in the lower limb (p = 0.0008) and the incidence of impaired proprioception. Additionally, a strong statistically significant correlation between the patients’ gait speed and the level of functional independence was found with the use of The Barthel Index. Conclusions: The level of motor control in the paretic lower limb and proprioception are vital factors affecting gait speed and functional independence. Patients with a higher level of functional independence demonstrated higher gait speed.

FUNCTION AND BIOMECHANICS OF UPPER LIMB IN POST-STROKE PATIENTS — A SYSTEMATIC REVIEW

2017 ◽  
Vol 17 (06) ◽  
pp. 1750099 ◽  
Author(s):  
MUHAMMAD HANIF RAMLEE ◽  
KOK BENG GAN
Keyword(s):  
Motor Control ◽  
Upper Limb ◽  
Stroke Patient ◽  
Material Properties ◽  
Joint Torque ◽  
Stroke Patients ◽  
Geometrical Condition ◽  
Tissue Properties ◽  
Post Stroke ◽  
Biomechanical Features

Current clinical services are struggling to provide the most favorable rehabilitation treatment for patients with stroke, which inspired researchers to investigate and explore the use of rehabilitation devices suitable for the patients and rehabilitation therapy. This review paper addresses the importance of biomechanical features in patients who experienced stroke to the upper limb. First and foremost, a review was done on general biomechanical description associated with motor control, shoulder, elbow, wrist and fingers joint. This included the ability of the patients to move their affected arm and the affect on peak joint torque, range of motion, joint forces, grip strength and muscle activities during the activities of daily living. In addition, we also reviewed the material properties and geometrical condition of tissue in stroke patient. The repercussions of post-stroke patient regarding the bone density, stiffness of muscle as well as the thickness of cartilage are described in this review. Based on the findings, the movement of affected stroke hand is associated with the motor control and material properties of tissue. To strengthen the motor control and maintaining tissue properties, early physical training on patients should be conducted in two to four weeks after stroke. In conclusion, this report suggests a new approach for future biomechanical studies in order to enhance the quality of physiotherapy rehabilitation peculiarly for post-stroke patients.

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