Daily Life Upper Limb Activity for Patients with Match and Mismatch between Observed Function and Perceived Activity in the Chronic Phase Post Stroke

We investigated actual daily life upper limb (UL) activity in relation to observed UL motor function and perceived UL activity in chronic stroke in order to better understand and improve UL activity in daily life. In 60 patients, we collected (1) observed UL motor function (Fugl-Meyer Assessment (FMA-UE)), (2) perceived UL activity (hand subscale of the Stroke Impact Scale (SIS-Hand)), and (3) daily life UL activity (bilateral wrist-worn accelerometers for 72 h) data. Data were compared between two groups of interest, namely (1) good observed (FMA-UE >50) function and good perceived (SIS-Hand >75) activity (good match, n = 16) and (2) good observed function but low perceived (SIS-Hand ≤75) activity (mismatch, n = 15) with Mann–Whitney U analysis. The mismatch group only differed from the good match group in perceived UL activity (median (Q1–Q3) = 50 (30–70) versus 93 (85–100); p < 0.001). Despite similar observed UL motor function and other clinical characteristics, the affected UL in the mismatch group was less active in daily life compared to the good match group (p = 0.013), and the contribution of the affected UL compared to the unaffected UL for each second of activity (magnitude ratio) was lower (p = 0.022). We conclude that people with chronic stroke with low perceived UL activity indeed tend to use their affected UL less in daily life despite good observed UL motor function.

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Evolution and prediction of mismatch between observed and perceived upper limb function after stroke: a prospective, longitudinal, observational cohort study

BMC Neurology ◽

10.1186/s12883-021-02493-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bea Essers ◽

Annick Van Gils ◽

Christophe Lafosse ◽

Marc Michielsen ◽

Hilde Beyens ◽

...

Keyword(s):

Upper Limb ◽

Inpatient Rehabilitation ◽

Stroke Severity ◽

Good Match ◽

Post Stroke ◽

Upper Limb Function ◽

Stroke Impact Scale ◽

Impact Scale ◽

The Individual ◽

Prospective Longitudinal

Abstract Background A previously shown ‘mismatch’ group of patients with good observed upper limb (UL) motor function but low perceived UL activity at six months post stroke tends to use the affected UL less in daily life than would be expected based on clinical tests, and this mismatch may also be present at 12 months. We aimed to confirm this group in another cohort, to investigate the evolution of this group from six to 12 months, and to determine factors on admission to inpatient rehabilitation and at 6 months that can discriminate between mismatch and good match groups at 12 months. Methods Persons after stroke were recruited on rehabilitation admission and re-assessed at six and 12 months. Observed UL function was measured with the upper extremity subscale of the Fugl-Meyer Assessment (FMA-UE) and perceived UL activity by the hand subscale of the Stroke Impact Scale 3.0 (SIS-Hand). We defined mismatch as good observed UL function (FMA-UE > 50/66) but low perceived activity (SIS-Hand≤75/100). Potential discriminators at admission and 6 months (demographic characteristics, stroke characteristics, UL somatosensory function, cognitive deficits, mental function and activity) were statistically compared for match and mismatch groups at 12 months. Results We included 60 participants (female: 42%) with mean (SD) age of 65 (12) years. We confirmed a mismatch group of 11 (18%) patients at 6 months, which increased to 14 (23%) patients at 12 months. In the mismatch group compared to the good match group at 12 months, patients had a higher stroke severity and more somatosensory impairments on admission and at 6 months. Conclusions We confirmed a group of patients with good observed UL function but low perceived activity both at six and at 12 months post stroke. Assessment of stroke severity and somatosensory impairments on admission into rehabilitation could determine mismatch at 12 months and might warrant intervention. However, large differences in clinical outcomes between patients in the mismatch group indicate the importance of tailoring training to the individual needs.

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

Neurological Research ◽

10.1179/1743132815y.0000000034 ◽

2015 ◽

Vol 37 (5) ◽

pp. 434-440 ◽

Cited By ~ 17

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

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Early post-stroke rehabilitation for upper limb motor function using virtual reality and exoskeleton: equally efficient in older patients

Neurologia i Neurochirurgia Polska ◽

10.5603/pjnns.a2020.0096 ◽

2020 ◽

Author(s):

Tereza Gueye ◽

Miriama Dedkova ◽

Vladimir Rogalewicz ◽

Marcela Grunerova-Lippertova ◽

Yvona Angerova

Keyword(s):

Virtual Reality ◽

Motor Function ◽

Upper Limb ◽

Older Patients ◽

Stroke Rehabilitation ◽

Post Stroke

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Abstract TP150: Two Weeks of Ischemic Preconditioning Training on the Paretic Leg Improves Leg Strength and Delays Muscle Fatigue in Chronic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp150 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Matthew J Durand ◽

Spencer A Murphy ◽

Brian D Schmit ◽

David D Gutterman ◽

Allison S Hyngstrom

Keyword(s):

Motor Function ◽

Ischemic Preconditioning ◽

Vascular Function ◽

Knee Extensor ◽

Chronic Stroke ◽

Muscle Performance ◽

Walking Ability ◽

Post Stroke ◽

Leg Strength ◽

Improve Motor Function

Introduction: Individuals living with chronic stroke have weakness and increased neuromuscular fatigue in the paretic leg, which can limit walking ability and endurance. In cardiac and healthy populations, ischemic preconditioning (IPC) is a widely studied, effective, non-invasive stimulus which not only improves vascular function, but also motor performance. IPC occurs when the tissue of interest is exposed to repeated, short bouts of ischemia, which can improve motor function by enhancing vascular, neural and muscle function. IPC has not been tested as a method to improve motor function in individuals post-stroke. Hypothesis: Two weeks of IPC training on the paretic leg will improve leg strength and time-to-task failure (TTF) during a fatiguing muscle contraction. Methods: A feasibility study of 4 individuals (3 female, 1 male) with chronic stroke (20 ± 4 years) was conducted. A Biodex dynamometer was used to assess paretic leg knee extensor maximal voluntary contraction (MVC). To assess muscle fatigability, subjects maintained a sustained contraction equal to 30% of their MVC until failure using visual feedback. After baseline testing, subjects made six visits to the laboratory over a two week period to have IPC performed on their paretic leg. A blood pressure cuff was inflated on the thigh to 225 mmHg for five, five-minute bouts per session. Five minutes of rest was given between inflation cycles. After the last session, subjects returned within 48 hours to have MVC and TTF reassessed. Results: Three subjects completed all study procedures. One subject withdrew for medical reasons unrelated to the study. The IPC procedure was well tolerated by all subjects. After two-week IPC training, knee extensor MVC increased in the paretic leg (45.0 ± 2.7 Nm vs. 52.6 ± 5.7 Nm). Fatigability of the muscles was dramatically reduced after IPC training as TTF tripled (359 ± 180 seconds vs. 1097 ± 343 seconds). Conclusions: We are the first group to show that IPC is a well-tolerated and effective stimulus to improve paretic leg strength and reduce muscle fatigability in subjects with chronic stroke. The results of this pilot study warrant a larger study to determine whether IPC improves muscle performance post-stroke through neural, vascular, or muscle-related mechanisms.

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Virtual Reality effect on upper limb Motor function paretic in post stroke

Revista Neurociências ◽

10.4181/rnc.2015.23.04.1038.06p ◽

2015 ◽

Vol 23 (04) ◽

pp. 493-498 ◽

Cited By ~ 3

Author(s):

Maria Luiza Galvão ◽

Príscila Gouvêa ◽

Gabriela Ocamoto ◽

Adriana Silva ◽

Luciana Reis ◽

...

Keyword(s):

Virtual Reality ◽

Motor Function ◽

Upper Limb ◽

Post Stroke ◽

Reality Effect

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Efficacy of motor imagery additional to motor-based therapy in the recovery of motor function of the upper limb in post-stroke individuals: a systematic review

Topics in Stroke Rehabilitation ◽

10.1080/10749357.2019.1627716 ◽

2019 ◽

Vol 26 (7) ◽

pp. 548-553 ◽

Cited By ~ 6

Author(s):

Tácia Cotinguiba Machado ◽

Adriani Andrade Carregosa ◽

Matheus S. Santos ◽

Nildo Manoel da Silva Ribeiro ◽

Ailton Melo

Keyword(s):

Systematic Review ◽

Motor Function ◽

Motor Imagery ◽

Upper Limb ◽

Post Stroke ◽

Recovery Of Motor Function

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β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320913502 ◽

2020 ◽

Vol 34 (5) ◽

pp. 450-462 ◽

Cited By ~ 2

Author(s):

Chih-Wei Tang ◽

Fu-Jung Hsiao ◽

Po-Lei Lee ◽

Yun-An Tsai ◽

Ya-Fang Hsu ◽

...

Keyword(s):

Motor Function ◽

Upper Limb ◽

Primary Motor Cortex ◽

Hand Movement ◽

Stroke Recovery ◽

Stroke Survivors ◽

Healthy Controls ◽

Functional Changes ◽

Post Stroke ◽

Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

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