Action Observation Therapy for Upper Extremity Motor Recovery in an Individual With Cognitive, Sensory, and Visual–Perceptual Deficits After Stroke

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.

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Action Observation Treatment-Based Exoskeleton (AOT-EXO) for Upper Extremity After Stroke: Study Protocol for a Randomised Controlled Trial

10.21203/rs.3.rs-58170/v1 ◽

2021 ◽

Author(s):

Zejian Chen ◽

Nan Xia ◽

Chang He ◽

Minghui Gu ◽

Jiang Xu ◽

...

Keyword(s):

Upper Extremity ◽

Functional Disability ◽

Motor Evoked Potentials ◽

Action Observation ◽

Controlled Trial ◽

Measurement Unit ◽

Motor Deficit ◽

Robot Assisted ◽

Clinical Trial Registry ◽

Resting Motor Threshold

Abstract Background Stroke produces multiple symptoms, including sensory, motor, cognitive and psychological dysfunctions, among which motor deficit is the most common and is widely recognized as a major contributor to long-term functional disability. Robot-assisted training is effective in promoting upper extremity muscle strength and motor impairment recovery after stroke. Additionally, action observation treatment can enhance the effects of physical and occupational therapy by increasing neural activation. The AOT-EXO trial aims to investigate whether action observation treatment coupled with robot-assisted training could enhance motor circuit activation and improve upper extremity motor outcomes. Methods The AOT-EXO trial is a multicentre, prospective, three-group randomized controlled trial (RCT). We will screen and enrol 132 eligible patients in the trial implemented in the Department of Rehabilitation Medicine of Tongji Hospital, Optical Valley Branch of Tongji Hospital and Hubei Province Hospital of Integrated Chinese & Western Medicine in Wuhan, China. Prior to study participation, written informed consent will be obtained from eligible patients in accordance with the Declaration of Helsinki. The enrolled stroke patients will be randomised to three groups: the CT group (conventional therapy); EXO group (exoskeleton therapy) and AOT-EXO group (action observation treatment-based exoskeleton therapy). The patients will undergo blinded assessments at baseline, post-intervention (after 4 weeks) and follow-up (after 12 weeks). The primary outcome will be the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Secondary outcomes will include the Action Research Arm Test (ARAT), modified Barthel Index (MBI), kinematic metrics assessed by inertial measurement unit (IMU), resting motor threshold (rMT), motor evoked potentials (MEP), functional magnetic resonance imaging (fMRI) and safety outcomes. Discussion This trial will provide evidence regarding the feasibility and efficacy of the action observation treatment-based exoskeleton (AOT-EXO) for post-stroke upper extremity rehabilitation and elucidate the potential underlying kinematic and neurological mechanisms. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR1900026656. Registered on 17 October 2019.

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Abstract 13: Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽

10.1161/str.51.suppl_1.13 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

David J Lin ◽

Alison M Cloutier ◽

Kimberly S Erler ◽

Jessica M Cassidy ◽

Samuel B Snider ◽

...

Keyword(s):

Acute Stroke ◽

Upper Extremity ◽

Corticospinal Tract ◽

Standard Of Care ◽

Major Effect ◽

Motor Recovery ◽

Post Stroke ◽

Stroke Imaging ◽

Recovery Potential ◽

Structural Injury

Introduction: Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods: Patients (N = 48) with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer (FM) during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using four different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict delta FM. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results: 48 patients were enrolled 4.2 ± 2.7 days post-stroke and completed this study. CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with AUC values ranging from 0.75 to 0.8. In addition, CST injury explained ~20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing four different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions: Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in post-stroke upper extremity motor recovery.

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The effect of the action observation physical training on the upper extremity function in children with cerebral palsy

Journal of Exercise Rehabilitation ◽

10.12965/jer.140114 ◽

2014 ◽

Vol 10 (3) ◽

pp. 176-183 ◽

Cited By ~ 20

Author(s):

Jin-young Kim ◽

Jong-man Kim ◽

Eun-young Ko

Keyword(s):

Cerebral Palsy ◽

Upper Extremity ◽

Physical Training ◽

Action Observation ◽

Extremity Function ◽

Children With Cerebral Palsy ◽

Upper Extremity Function

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Corticospinal Tract Injury Estimated From Acute Stroke Imaging Predicts Upper Extremity Motor Recovery After Stroke

Stroke ◽

10.1161/strokeaha.119.025898 ◽

2019 ◽

Vol 50 (12) ◽

pp. 3569-3577 ◽

Cited By ~ 9

Author(s):

David J. Lin ◽

Alison M. Cloutier ◽

Kimberly S. Erler ◽

Jessica M. Cassidy ◽

Samuel B. Snider ◽

...

Keyword(s):

Acute Stroke ◽

Upper Extremity ◽

Corticospinal Tract ◽

Area Under The Curve ◽

Standard Of Care ◽

Major Effect ◽

Motor Recovery ◽

Stroke Imaging ◽

Recovery Potential

Background and Purpose— Injury to the corticospinal tract (CST) has been shown to have a major effect on upper extremity motor recovery after stroke. This study aimed to examine how well CST injury, measured from neuroimaging acquired during the acute stroke workup, predicts upper extremity motor recovery. Methods— Patients with upper extremity weakness after ischemic stroke were assessed using the upper extremity Fugl-Meyer during the acute stroke hospitalization and again at 3-month follow-up. CST injury was quantified and compared, using 4 different methods, from images obtained as part of the stroke standard-of-care workup. Logistic and linear regression were performed using CST injury to predict ΔFugl-Meyer. Injury to primary motor and premotor cortices were included as potential modifiers of the effect of CST injury on recovery. Results— N=48 patients were enrolled 4.2±2.7 days poststroke and completed 3-month follow-up (median 90-day modified Rankin Scale score, 3; interquartile range, 1.5). CST injury distinguished patients who reached their recovery potential (as predicted from initial impairment) from those who did not, with area under the curve values ranging from 0.70 to 0.8. In addition, CST injury explained ≈20% of the variance in the magnitude of upper extremity recovery, even after controlling for the severity of initial impairment. Results were consistent when comparing 4 different methods of measuring CST injury. Extent of injury to primary motor and premotor cortices did not significantly influence the predictive value that CST injury had for recovery. Conclusions— Structural injury to the CST, as estimated from standard-of-care imaging available during the acute stroke hospitalization, is a robust way to distinguish patients who achieve their predicted recovery potential and explains a significant amount of the variance in poststroke upper extremity motor recovery.

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