scholarly journals Impact of Shoulder Subluxation on Peripheral Nerve Conduction and Function of Hemiplegic Upper Extremity in Stroke Patients: A Retrospective, Matched-Pair Study

2020 ◽  
Author(s):  
Xiangzhe Li ◽  
Zhiwei Yang ◽  
Sheng Wang ◽  
Panpan Xu ◽  
Tianqi Wei ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Nerve Conduction ◽  
Peripheral Nerves ◽  
Matched Pair ◽  
Motor Conduction Velocity ◽  
Stroke Patients ◽  
Post Stroke ◽  
Healthy Side ◽  
And Function

Abstract Background: After stroke, the peripheral nerves of the hemiplegic upper extremity (HUE) could exist impairments which seriously delay the function recovery of the HUE. However, the impacts of shoulder subluxation (SS) on the HUE electromyography characteristics in post-stroke are rarely reported. Therefore, this study was to investigate the impact of SS on peripheral nerve conduction and function of the HUE in post-stroke patients.Methods: A retrospective, matched-pair study was conducted. 30 post-stroke in-patients (15 patients for each group) were selected and their peripheral nerves of bilateral upper limbs were used to be underdone by the electroneurographic examination. The characteristics of patients, such as age and type of stroke, were recorded and paired. The electroneurographic parameters of upper limb motor/sensory nerves contained: the compound muscle action potential (CMAP) amplitude and latency of suprascapular, axillary, musculocutaneous, radial, median and ulnar nerves; the motor conduction velocity/ the sensory nerve action potential (SNAP) amplitude and latency of median, ulnar and radial nerves. The Brunnstrom stage scale was used to evaluate the motor function of the HUE.Results: The CMAP amplitude of each nerve in the HUE of both groups was lower than that in the healthy side (P < 0.05). CMAP amplitude of peripheral nerves (except ulnar) in the HUE of SS group was decreased (P < 0.05). The CMAP latency of the suprascapular, axillary and musculocutaneous nerves was longer than that of the healthy side in the SS group (P < 0.05). The axillary nerve CMAP latency in the SS group was prolonged more (P < 0.05). The motor conduction velocity of the median nerve on the HUE in the SS group was lower than that of the HUE in the N-SS group (P < 0.05). The SNAP amplitudes of the nerves in the HUE in both groups were lower than those in the healthy side (P < 0.05). The Brunnstrom stage of HUE in the SS group was lower (P < 0.05).Conclusions: Stroke may lead to extensive damage of the HUE nerves, and SS may aggravate the damage of these nerves, delaying the recovery of upper limb function.

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.

Compression neuropathies of the forearm: anatomy, clinical features and management

2021 ◽  
pp. 1-10
Author(s):  
Alexander Scarborough ◽  
Robert J MacFarlane ◽  
Michail Klontzas ◽  
Rui Zhou ◽  
Mohammad Waseem
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Upper Limb ◽  
Peripheral Nerves ◽  
Clinical Presentation ◽  
Permanent Damage ◽  
Peripheral Nerve Lesions ◽  
Clinical Presentations ◽  
Wide Range ◽  
Prompt Diagnosis

The upper limb consists of four major parts: a girdle formed by the clavicle and scapula, the arm, the forearm and the hand. Peripheral nerve lesions of the upper limb are divided into lesions of the brachial plexus or the nerves arising from it. Lesions of the nerves arising from the brachial plexus are further divided into upper (proximal) or lower (distal) lesions based on their location. Peripheral nerves in the forearm can be compressed in various locations and by a wide range of pathologies. A thorough understanding of the anatomy and clinical presentations of these compression neuropathies can lead to prompt diagnosis and management, preventing possible permanent damage. This article discusses the aetiology, anatomy, clinical presentation and surgical management of compressive neuropathies of the upper limb.

Music-supported therapy (MST) in improving post-stroke patients' upper-limb motor function: a randomised controlled pilot study

2015 ◽  
Vol 37 (5) ◽  
pp. 434-440 ◽  
Author(s):  
Yanna Tong ◽  
Brian Forreider ◽  
Xinting Sun ◽  
Xiaokun Geng ◽  
Weidong Zhang ◽  
...  
Keyword(s):  
Pilot Study ◽  
Motor Function ◽  
Upper Limb ◽  
Stroke Patients ◽  
Post Stroke ◽  
Randomised Controlled

scholarly journals Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016566
Author(s):  
Eline C C van Lieshout ◽  
Johanna M A Visser-Meily ◽  
Sebastiaan F W Neggers ◽  
H Bart van der Worp ◽  
Rick M Dijkhuizen
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Primary Outcome ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

Anti-spastic effect of low-frequency rTMS applied with occupational therapy in post-stroke patients with upper limb hemiparesis

Brain Injury ◽  
2011 ◽  
Vol 25 (5) ◽  
pp. 496-502 ◽  
Author(s):  
Wataru Kakuda ◽  
Masahiro Abo ◽  
Kazushige Kobayashi ◽  
Ryo Momosaki ◽  
Aki Yokoi ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Upper Limb ◽  
Low Frequency ◽  
Stroke Patients ◽  
Post Stroke ◽  
Upper Limb Hemiparesis ◽  
Low Frequency Rtms

scholarly journals Motor‐imagery ability and function of hemiplegic upper limb in stroke patients

2019 ◽  
Vol 6 (3) ◽  
pp. 596-604 ◽  
Author(s):  
Shu Morioka ◽  
Michihiro Osumi ◽  
Yuki Nishi ◽  
Tomoya Ishigaki ◽  
Rintaro Ishibashi ◽  
...  
Keyword(s):  
Motor Imagery ◽  
Upper Limb ◽  
Imagery Ability ◽  
Stroke Patients ◽  
And Function

scholarly journals The Influence of Primary Motor Cortex Inhibition on Upper Limb Impairment and Function in Chronic Stroke: A Multimodal Study

2019 ◽  
Vol 33 (2) ◽  
pp. 130-140 ◽  
Author(s):  
Ronan A. Mooney ◽  
Suzanne J. Ackerley ◽  
Deshan K. Rajeswaran ◽  
John Cirillo ◽  
P. Alan Barber ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Motor Impairment ◽  
Intracortical Inhibition ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Gaba Concentration ◽  
Chronic Stage ◽  
And Function

Background. Stroke is a leading cause of adult disability owing largely to motor impairment and loss of function. After stroke, there may be abnormalities in γ-aminobutyric acid (GABA)-mediated inhibitory function within primary motor cortex (M1), which may have implications for residual motor impairment and the potential for functional improvements at the chronic stage. Objective. To quantify GABA neurotransmission and concentration within ipsilesional and contralesional M1 and determine if they relate to upper limb impairment and function at the chronic stage of stroke. Methods. Twelve chronic stroke patients and 16 age-similar controls were recruited for the study. Upper limb impairment and function were assessed with the Fugl-Meyer Upper Extremity Scale and Action Research Arm Test. Threshold tracking paired-pulse transcranial magnetic stimulation protocols were used to examine short- and long-interval intracortical inhibition and late cortical disinhibition. Magnetic resonance spectroscopy was used to evaluate GABA concentration. Results. Short-interval intracortical inhibition was similar between patients and controls ( P = .10). Long-interval intracortical inhibition was greater in ipsilesional M1 compared with controls ( P < .001). Patients who did not exhibit late cortical disinhibition in ipsilesional M1 were those with greater upper limb impairment and worse function ( P = .002 and P = .017). GABA concentration was lower within ipsilesional ( P = .009) and contralesional ( P = .021) M1 compared with controls, resulting in an elevated excitation-inhibition ratio for patients. Conclusion. These findings indicate that ipsilesional and contralesional M1 GABAergic inhibition are altered in this small cohort of chronic stroke patients. Further study is warranted to determine how M1 inhibitory networks might be targeted to improve motor function.

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