scholarly journals Finger recruitment patterns during mirror movements suggest two systems for hand recovery after stroke

2017 ◽  
Author(s):  
Naveed Ejaz ◽  
Jing Xu ◽  
Meret Branscheidt ◽  
Benjamin Hertler ◽  
Heidi Schambra ◽  
...  
Keyword(s):  
Time Course ◽  
Recovery Of Function ◽  
Hand Function ◽  
Stroke Recovery ◽  
Stroke Patients ◽  
Mirror Movements ◽  
Non Invasive ◽  
Motor Circuits ◽  
Recovery Study ◽  
Cortical Inputs

AbstractAccumulating behavioural and neurophysiological evidence suggests that upper-limb control relies on contributions from both cortical and subcortical motor circuits, with cortical inputs providing fine-finger function and subcortical inputs providing the ability for gross movements, respectively. During recovery of function after stroke, the relative contributions from these pathways may shift. Here we propose that mirror movements that appear after stroke provide a non-invasive assay through which relative contributions from cortical and subcortical pathways towards hand recovery can be studied. We hypothesized that mirror movements, like hand function, are generated by summed contributions from cortical and subcortical pathways, and suggest that subcortical contributions should be characterized by a broad recruitment of fingers, while cortical contributions primarily recruit the homologous finger in the passive hand. In a longitudinal stroke recovery study (Xu et al., 2016), we quantified mirror movements and paretic hand function in 53 stroke patients in the year following unilateral stroke. Mirror movements in the non-paretic hand were exaggerated early after damage (week 2), with paretic finger presses broadly recruiting multiple fingers in the non-paretic hand. On average, however, mirroring in homologous fingers was 1.76 times larger than in non-homologous fingers. Over the year, mirroring in the non-paretic hand progressively normalized with a time-course that mimicked that for the fine-finger deficits in the paretic hand. In comparison, during non-paretic finger presses, the homologous component of mirroring in the paretic hand was reduced early after stroke (week 2) but progressively normalized. Altogether, we conclude that the pattern of mirror movements across homologous and non-homologous fingers reflect the summed contributions of both cortical and subcortical systems, and we discuss the implications of our results towards hand recovery after stroke.

Effects of bilateral arm training on upper extremity function in right and left hemispheric stroke

2020 ◽  
pp. 1-9
Author(s):  
Humera Ambreen ◽  
Hina Tariq ◽  
Imran Amjad
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Recovery Of Function ◽  
Hand Function ◽  
Group Analysis ◽  
Stroke Patients ◽  
Hemispheric Stroke ◽  
Beneficial Effects ◽  
Significant Difference ◽  
Bilateral Arm Training

Abstract Objective: This experimental study on 24 stroke patients aimed at evaluating and comparing the effects of bilateral arm training on upper extremity (UE) motor function between right and left hemispheric chronic stroke patients. Methods: Both groups received the same intervention involving 5 functional tasks for 1 hour, 3 days per week, for a total of 6 weeks. Fugl-Meyer Assessment-Upper Extremity and Wolf-Motor Function Test were applied as outcome measures at baseline and after 6 weeks of training to assess the recovery of function in the affected area. Results: Intra-group analysis showed no significant improvement in the wrist and hand function in the left hemispheric stroke (LHS) (p>0.05), while right hemispheric stroke (RHS) patients did not improve significantly in the coordination/speed domain (p>0.05). Inter-group analysis showed no significant difference between right and left hemispheric stroke patients (p>0.05). Conclusion: Bilateral arm training showed beneficial effects in improving UE function in both RHS and LHS patients. Distal UE function in LHS and coordination and speed of movement in RHS patients did not show any significant improvement. Key Words: Stroke, Upper extremity, Recovery of function, Bilateral arm training. Continuous...

scholarly journals Functional outcome of joint mobilization added to task-oriented training on hand function in chronic stroke patients

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Asmaa Sabbah ◽  
Sherine El Mously ◽  
Hanan Helmy Mohamed Elgendy ◽  
Mona Adel Abd Eltawab Farag ◽  
Abeer Abo Bakr Elwishy
Keyword(s):  
Functional Outcome ◽  
Hand Function ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Joint Mobilization ◽  
Task Oriented

Interhemispheric Competition After Stroke: Brain Stimulation to Enhance Recovery of Function of the Affected Hand

2009 ◽  
Vol 23 (7) ◽  
pp. 641-656 ◽  
Author(s):  
Dennis A. Nowak ◽  
Christian Grefkes ◽  
Mitra Ameli ◽  
Gereon R. Fink
Keyword(s):  
Brain Stimulation ◽  
Motor Behavior ◽  
Cortical Excitability ◽  
Recovery Of Function ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Hand Function ◽  
Clinical Effects ◽  
Sensorimotor Network ◽  
Interhemispheric Competition ◽  
Plastic Changes

Background and purpose. Within the concept of interhemispheric competition, technical modulation of the excitability of motor areas in the contralesional and ipsilesional hemisphere has been applied in an attempt to enhance recovery of hand function following stroke. This review critically summarizes the data supporting the use of novel electrophysiological concepts in the rehabilitation of hand function after stroke. Summary of review. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are powerful tools to inhibit or facilitate cortical excitability. Modulation of cortical excitability may instantaneously induce plastic changes within the cortical network of sensorimotor areas, thereby improving motor function of the affected hand after stroke. No significant adverse effects have been noted when applying brain stimulation in stroke patients. To date, however, the clinical effects are small to moderate and short lived. Future work should elucidate whether repetitive administration of rTMS or tDCS over several days and the combination of these techniques with behavioral training (ie, physiotherapy) could result in an enhanced effectiveness. Conclusion. Brain stimulation is a safe and promising tool to induce plastic changes in the cortical sensorimotor network to improve motor behavior after stroke. However, several methodological issues remain to be answered to further improve the effectiveness of these new approaches.

scholarly journals Cognitive and Neurophysiological Effects of Non-invasive Brain Stimulation in Stroke Patients after Motor Rehabilitation

2016 ◽  
Vol 10 ◽  
Author(s):  
Federico D'Agata ◽  
Elena Peila ◽  
Alessandro Cicerale ◽  
Marcella M. Caglio ◽  
Paola Caroppo ◽  
...  
Keyword(s):  
Brain Stimulation ◽  
Motor Rehabilitation ◽  
Stroke Patients ◽  
Non Invasive

scholarly journals Non-invasive mapping of corticofugal fibres from multiple motor areas—relevance to stroke recovery

Brain ◽  
2006 ◽  
Vol 129 (7) ◽  
pp. 1844-1858 ◽  
Author(s):  
Jennifer M. Newton ◽  
Nick S. Ward ◽  
Geoffrey J. M. Parker ◽  
Ralf Deichmann ◽  
Daniel C. Alexander ◽  
...  
Keyword(s):  
Stroke Recovery ◽  
Non Invasive ◽  
Motor Areas

Abstract W P386: Matrix Metalloproteinase Levels May Mediate Ischemic Stroke Incidence and Recovery in Stroke Patients with Metabolic Syndrome

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ashley B Petrone ◽  
Taura L Barr ◽  
Kelly Devlin ◽  
Sara B Fournier ◽  
Evan D Devallance ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Stroke Risk ◽  
Plasma Concentrations ◽  
Stroke Recovery ◽  
Ultrasound Images ◽  
Stroke Patients ◽  
Stroke Incidence ◽  
The Metabolic Syndrome ◽  
Diabetes Status ◽  
Increased Risk

Intro: The metabolic syndrome (MetS) is highly prevalent in the US characterized by a combination of risk factors that can lead to cardiovascular disease (CVD). While the association between CVD, inflammation, and stroke risk has been characterized, the immune mechanisms underlying increased risk of stroke in MetS is unclear. While stroke risk is higher among MetS, MetS individuals tend to have better stroke recovery than controls. The immune response may mediate these paradoxical observations in stroke. In particular, matrix metalloproteinases (MMP) enzymes play a role in stroke incidence and recovery. Similar to MetS, MMPs have a dual role in stroke, as they are harmful immediately after stroke, but play a vital role in brain repair and recovery following stroke. We hypothesize that elevated levels of MMPs in MetS may account for the paradoxical increased stroke risk, yet better recovery seen in stroke patients with MetS. Methods: MMP protein concentrations were obtained from fasting venous samples and quantified using a Multi-Analyte Profiling Kit (Millipore) on the Luminex®. Each subject was assigned a metabolic risk score (MRS) based on sex, age, SBP, treatment for hypertension, smoking and diabetes status, HDL, and total cholesterol. B-mode ultrasound images of the right common carotid artery were obtained to measure intima-medial thickness (cIMT). Spearman correlations were used to measure the relationship between MRS, cIMT, and MMP levels. Results: In n=68 subjects (60% female) with a mean age of 48+14 yrs, MRS of 25+12, and cIMT of 0.57+0.12 mm. MRS was significantly correlated with cIMT (r=0.39, p< .001). Further, cIMT was positively correlated with MMP1 (r=0.025, p=0.04), MMP7 (r=0.5, p=0.01), and MMP9 (r=0.31, p=0.01). Conclusion: Plasma concentrations of MMP1, 7, and 9 were significantly correlated with cIMT, indicating that increased severity of MetS is associated with increased inflammation. Elevated MMP protein levels may account for the increased stroke risk, yet better recovery seen in stroke patients with MetS.

Abstract 2580: How Frequent Is Impaired Arm And Hand Function After First Occasion Of Stroke? An Unselected Population From A Stroke Unit With A Geographical Catchment.

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Katharina Stibrant Sunnerhagen ◽  
Hanna C Persson
Keyword(s):  
Upper Extremity ◽  
Stroke Unit ◽  
Catchment Area ◽  
Hand Function ◽  
Stroke Onset ◽  
Stroke Patients ◽  
Extremity Function ◽  
Unselected Population ◽  
Upper Extremity Function ◽  
Impaired Motor Function

Introduction Reduced upper extremity function after stroke has previously been reported in 70-80% of patients with stroke in the acute stage and is one of the most common impairments after acute stroke impaired motor function, both in upper and lower extremity, influence the stroke unit care and planning of the rehabilitation, partly due to the economic costs. There is limited information in upper extremity function within the first days after a stroke. Prior studies include either both first and recurrent stroke or only one type of stroke. Objectives To investigate the frequency impaired arm and hand function in an unselected group of patients with first occasion of stroke. Method All patients at a stroke unit at Sahlgrenska University Hospital were assessed during 18 months. From the hospital records, the patients were identified, the patient charts were read and first stroke diagnosis was confirmed (by either imaging or clinical assessment). Impaired upper extremity function was defined in the following manner: assessed with the Modified Motor Assessment Scale (M-MAS UAS -95) by physiotherapist working at the stroke unit within 72 hours after stroke onset or if this was found in the patients chart, other standardized assessments of upper extremity function performed by the physical therapist, the occupational therapist or the physicians on the ward. Results During the study period 984 patients with first ever stroke (438 women 44.5%) were admitted to the stroke unit. A total of 213 patients were not at the stroke unit within 72 hours after onset and therefore excluded; 90 patients had unclear stroke onset time, 49 patients were located at another ward, 36 patients were in the intensive care unit, 25 in other hospitals in Sweden and 12 patients were hospitalized in another country. There were 771 patients over 18 years old at the stroke unit within 72 hours after stroke onset. Of these 56 patients (7.3%), were not living in the catchment area and therefore excluded. Of the 715 patients living in the geographical catchment area, 58, (8.1%) hade other upper extremity injury prior the stroke onset. Of the remaining first ever stroke patients (n=657), 311 patients (47.3%) hade impaired arm and hand function within 72 hours after stroke onset. Conclusion The frequency of impaired upper extremity function in this unselected population of first occasion of stroke is lower than previously reported. The Copenhagen stroke study noted 69 % impaired at admission and 43 % at one week. This indicates that today’s stroke patients present less frequent with impaired motor function in the upper extremity. However, they may have difficulties in functional activities which may influence content of rehabilitation process.

Movement-Related EEG Oscillations of Contralesional Hemisphere Discloses Compensation Mechanisms of Severely Affected Motor Chronic Stroke Patients

2021 ◽  
Author(s):  
Juan A. Barios ◽  
Santiago Ezquerro ◽  
Arturo Bertomeu-Motos ◽  
Jose M. Catalan ◽  
Jose M. Sanchez-Aparicio ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Time Course ◽  
Chronic Stroke ◽  
Cortical Activation ◽  
Motor Deficit ◽  
Control Group ◽  
Detailed Knowledge ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Compensation Mechanisms

Conventional rehabilitation strategies for stroke survivors become difficult when voluntary movements are severely disturbed. Combining passive limb mobilization, robotic devices and EEG-based brain-computer interfaces (BCI) systems might improve treatment and clinical follow-up of these patients, but detailed knowledge of neurophysiological mechanisms involved in functional recovery, which might help for tailoring stroke treatment strategies, is lacking. Movement-related EEG changes (EEG event-related desynchronization (ERD) in [Formula: see text] and [Formula: see text] bands, an indicator of motor cortex activation traditionally used for BCI systems), were evaluated in a group of 23 paralyzed chronic stroke patients in two unilateral motor tasks alternating paretic and healthy hands ((i) passive movement, using a hand exoskeleton, and (ii) voluntary movement), and compared to nine healthy subjects. In tasks using unaffected hand, we observed an increase of contralesional hemisphere activation for stroke patients group. Unexpectedly, when using paralyzed hand, motor cortex activation was reduced or absent in severely affected group of patients, while patients with moderate motor deficit showed an activation greater than control group. Cortical activation was reduced or absent in damaged hemisphere of all the patients in both tasks. Significant differences related to severity of motor deficit were found in the time course of [Formula: see text] bands power ratio in EEG of contralesional hemisphere while moving affected hand. These findings suggest the presence of different compensation mechanisms in contralesional hemisphere of stroke patients related to the grade of motor disability, that might turn quantitative EEG during a movement task, obtained from a BCI system controlling a robotic device included in a rehabilitation task, into a valuable tool for monitoring clinical progression, evaluating recovery, and tailoring treatment of stroke patients.

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