scholarly journals Interhemispheric Pathways Are Important for Motor Outcome in Individuals with Chronic and Severe Upper Limb Impairment Post Stroke

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Kathryn S. Hayward ◽  
Jason L. Neva ◽  
Cameron S. Mang ◽  
Sue Peters ◽  
Katie P. Wadden ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Upper Limb ◽  
Motor Impairment ◽  
Post Stroke ◽  
Significant Difference ◽  
Motor Outcome ◽  
Wolf Motor Function Test ◽  
Severe Group ◽  
And Function ◽  
Motor Outcomes

Background. Severity of arm impairment alone does not explain motor outcomes in people with severe impairment post stroke.Objective. Define the contribution of brain biomarkers to upper limb motor outcomes in people with severe arm impairment post stroke.Methods. Paretic arm impairment (Fugl-Meyer upper limb, FM-UL) and function (Wolf Motor Function Test rate, WMFT-rate) were measured in 15 individuals with severe (FM-UL ≤ 30/66) and 14 with mild–moderate (FM-UL > 40/66) impairment. Transcranial magnetic stimulation and diffusion weight imaging indexed structure and function of the corticospinal tract and corpus callosum. Separate models of the relationship between possible biomarkers and motor outcomes at a single chronic (≥6 months) time point post stroke were performed.Results. Age (ΔR20.365,p=0.017) and ipsilesional-transcallosal inhibition (ΔR20.182,p=0.048) explained a 54.7% (p=0.009) variance in paretic WMFT-rate. Prefrontal corpus callous fractional anisotropy (PF-CC FA) alone explained 49.3% (p=0.007) variance in FM-UL outcome. The same models did not explain significant variance in mild–moderate stroke. In the severe group, k-means cluster analysis of PF-CC FA distinguished two subgroups, separated by a clinically meaningful and significant difference in motor impairment (p=0.049) and function (p=0.006) outcomes.Conclusion. Corpus callosum function and structure were identified as possible biomarkers of motor outcome in people with chronic and severe arm impairment.

scholarly journals Effect of post-stroke spasticity on voluntary movement of the upper limb

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Hadar Lackritz ◽  
Yisrael Parmet ◽  
Silvi Frenkel-Toledo ◽  
Melanie C. Baniña ◽  
Nachum Soroker ◽  
...  
Keyword(s):  
Upper Limb ◽  
Target Location ◽  
Distance Measure ◽  
Movement Time ◽  
Motor Impairment ◽  
Reach To Grasp ◽  
Motion Patterns ◽  
Post Stroke ◽  
The Impact ◽  
Elbow Motion

Abstract Background Hemiparesis following stroke is often accompanied by spasticity. Spasticity is one factor among the multiple components of the upper motor neuron syndrome that contributes to movement impairment. However, the specific contribution of spasticity is difficult to isolate and quantify. We propose a new method of quantification and evaluation of the impact of spasticity on the quality of movement following stroke. Methods Spasticity was assessed using the Tonic Stretch Reflex Threshold (TSRT). TSRT was analyzed in relation to stochastic models of motion to quantify the deviation of the hemiparetic upper limb motion from the normal motion patterns during a reaching task. Specifically, we assessed the impact of spasticity in the elbow flexors on reaching motion patterns using two distinct measures of the ‘distance’ between pathological and normal movement, (a) the bidirectional Kullback–Liebler divergence (BKLD) and (b) Hellinger’s distance (HD). These measures differ in their sensitivity to different confounding variables. Motor impairment was assessed clinically by the Fugl-Meyer assessment scale for the upper extremity (FMA-UE). Forty-two first-event stroke patients in the subacute phase and 13 healthy controls of similar age participated in the study. Elbow motion was analyzed in the context of repeated reach-to-grasp movements towards four differently located targets. Log-BKLD and HD along with movement time, final elbow extension angle, mean elbow velocity, peak elbow velocity, and the number of velocity peaks of the elbow motion were computed. Results Upper limb kinematics in patients with lower FMA-UE scores (greater impairment) showed greater deviation from normality when the distance between impaired and normal elbow motion was analyzed either with the BKLD or HD measures. The severity of spasticity, reflected by the TSRT, was related to the distance between impaired and normal elbow motion analyzed with either distance measure. Mean elbow velocity differed between targets, however HD was not sensitive to target location. This may point at effects of spasticity on motion quality that go beyond effects on velocity. Conclusions The two methods for analyzing pathological movement post-stroke provide new options for studying the relationship between spasticity and movement quality under different spatiotemporal constraints.

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.

scholarly journals Upper Limb Motor Improvement after TBI: Systematic Review of Interventions

2020 ◽  
Author(s):  
Sandeep K. Subramanian ◽  
Melinda A. Fountain ◽  
Ashley F. Hood ◽  
Monica Verduzco-Gutierrez
Keyword(s):  
Upper Limb ◽  
Motor Impairment ◽  
Effect Sizes ◽  
Cell Transplant ◽  
Study Quality ◽  
Serial Casting ◽  
Wolf Motor Function Test ◽  
Activity Performance ◽  
Motor Improvement ◽  
Task Oriented

AbstractTraumatic Brain Injury (TBI) is a leading cause of adult morbidity and mortality. Individuals sustaining a TBI have impairments in both cognitive and motor domains. Motor improvements post-TBI are attributable to adaptive neuroplasticity and motor learning. Majority of the studies focus on remediation of balance and mobility impairments. There is limited understanding on the use of interventions for upper limb (UL) motor improvements in this population. We examined the evidence regarding the effectiveness of different interventions to augment UL motor improvement after a TBI. We systematically reviewed the literature published in English from 1990-2020. The modified Down’s and Black checklist helped assess study quality (total score:28). Studies were classified as excellent:24-28, good:19-23, fair:14-18 and poor:≤13 in quality. Effect sizes helped quantify intervention effectiveness. Twenty-three studies were retrieved. Study quality was excellent (n=1), good (n=4) or fair (n=19). Interventions used included strategies to decrease spasticity [Botulinum toxin provision (n=2), serial casting, soft splinting, tizanidine and acupuncture (n=1 each)], constraint induced movement therapy (n=4), virtual reality gaming (n=5), noninvasive stimulation (n=3), arm motor ability training (n=1), stem-cell transplant (n=1); task-oriented training (n=2) and augmented feedback (n=1). Motor impairment outcomes included Fugl-Meyer Assessment, Modified Ashworth Scale and kinematic outcomes (error and movement straightness). Activity limitation outcomes included Wolf Motor Function Test and Motor Activity Log. Effect sizes for majority of the interventions ranged from medium (0.5-0.79) to large (≥0.8). Only ten studies included retention testing. Results suggest that using these interventions can reduce UL motor impairment and improve activity performance after a TBI.

scholarly journals Efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients

Biomedicine ◽  
2021 ◽  
Vol 41 (1) ◽  
pp. 120-124
Author(s):  
V. Rajalaxmi ◽  
M. Tharunya ◽  
S.S. Subramanian ◽  
G. Vaishnavi ◽  
Chandra Kumar K ◽  
...  
Keyword(s):  
Upper Limb ◽  
Fine Motor ◽  
Stroke Patients ◽  
Mean Values ◽  
Post Stroke ◽  
Medical College ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Nine Hole Peg Test

Introduction and Aim:Strokeis one of the leading causes of death and disability in India. The incidence of stroke rapidly increases with age, doubling for each decade after 55.In the majority of patients the upper limb is severely impaired than lower limb. The aim of this study was to analyze the efficacy of motor therapy over sensorimotor therapy in upper limb functions of post stroke patients.   Materials and Methods: This was an experimental study, of pre-post type, that was conducted in the outpatient department of Physiotherapy at ACS Medical College and Hospital,chennai.30 samples were selected from 45 volunteers according to inclusion criteria and the study was conducted for Group A received sensorimotor therapy for one session/day for 6 days a week for 12 weeks. Group B received motor therapy for one session/day for 6 days a week for 12 weeks. Pre and post measurement were done using motor assessment scale, stroke upper limb capacity scale, action research arm test and nine-hole peg test.   Results: There was a significant difference in mean values of group A and B on comparison. Group A seems to be more effective than group B.   Conclusion: The study concludes that both motor therapy and sensorimotor therapy are beneficial in stroke rehabilitation, but sensorimotor therapy is more effective in improving the gross and fine motor skills of the upper limb of stroke patients.

scholarly journals Comparing a novel neuroanimation experience to conventional therapy for high-dose, intensive upper-limb training in subacute stroke: The SMARTS2 randomized trial

2020 ◽  
Author(s):  
John W Krakauer ◽  
Tomoko Kitago ◽  
Jeff Goldsmith ◽  
Omar Ahmad ◽  
Promit Roy ◽  
...  
Keyword(s):  
Upper Limb ◽  
High Intensity ◽  
Animal Studies ◽  
Motor Impairment ◽  
High Dose ◽  
Time On Task ◽  
Historical Cohort ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Secondary Outcomes

Background: Evidence from animal studies suggests that greater reductions in post-stroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, post-stroke period. Objective: To compare two approaches of delivering high-intensity, high-dose upper limb therapy in patients with subacute stroke: a novel exploratory neuro-animation therapy (NAT), and modified conventional occupational therapy (COT). Methods: Twenty-four patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included: Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale (SIS) hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 post-training. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper limb therapy per day. Results: There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ±2.9 pts, p=0.011), but not the FM-UE (1.4 ±2.6 pts, p =0.564) when compared to the HC. Conclusions: Two forms of high-dose intensive upper limb therapy produced greater activity but not impairment improvements compared with regular care. Neuroanimation may offer a new enjoyable, efficient and scalable way to deliver increased upper limb therapy.

Electroencephalogram phase synchrony correlates with post-stroke upper limb motor impairment

2017 ◽  
Vol 381 ◽  
pp. 600-601
Author(s):  
T. Kawano ◽  
N. Hattori ◽  
Y. Uno ◽  
M. Hatakenaka ◽  
H. Yagura ◽  
...  
Keyword(s):  
Upper Limb ◽  
Motor Impairment ◽  
Phase Synchrony ◽  
Post Stroke

scholarly journals Movement kinematics and proprioception in post-stroke spasticity: assessment using the Kinarm robotic exoskeleton

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
George Mochizuki ◽  
Andrew Centen ◽  
Myles Resnick ◽  
Catherine Lowrey ◽  
Sean P. Dukelow ◽  
...  
Keyword(s):  
Upper Limb ◽  
Motor Impairment ◽  
Movement Patterns ◽  
Visually Guided ◽  
Central Target ◽  
Robotic Exoskeleton ◽  
Visually Guided Reaching ◽  
Post Stroke ◽  
Temporal Features ◽  
Limb Spasticity

Abstract Background Motor impairment after stroke interferes with performance of everyday activities. Upper limb spasticity may further disrupt the movement patterns that enable optimal function; however, the specific features of these altered movement patterns, which differentiate individuals with and without spasticity, have not been fully identified. This study aimed to characterize the kinematic and proprioceptive deficits of individuals with upper limb spasticity after stroke using the Kinarm robotic exoskeleton. Methods Upper limb function was characterized using two tasks: Visually Guided Reaching, in which participants moved the limb from a central target to 1 of 4 or 1 of 8 outer targets when cued (measuring reaching function) and Arm Position Matching, in which participants moved the less-affected arm to mirror match the position of the affected arm (measuring proprioception), which was passively moved to 1 of 4 or 1 of 9 different positions. Comparisons were made between individuals with (n = 35) and without (n = 35) upper limb post-stroke spasticity. Results Statistically significant differences in affected limb performance between groups were observed in reaching-specific measures characterizing movement time and movement speed, as well as an overall metric for the Visually Guided Reaching task. While both groups demonstrated deficits in proprioception compared to normative values, no differences were observed between groups. Modified Ashworth Scale score was significantly correlated with these same measures. Conclusions The findings indicate that individuals with spasticity experience greater deficits in temporal features of movement while reaching, but not in proprioception in comparison to individuals with post-stroke motor impairment without spasticity. Temporal features of movement can be potential targets for rehabilitation in individuals with upper limb spasticity after stroke.

scholarly journals Validity, reliability, and sensitivity to motor impairment severity of a multi-touch app designed to assess hand mobility, coordination, and function after stroke

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sara Mollà-Casanova ◽  
Roberto Llorens ◽  
Adrián Borrego ◽  
Bárbara Salinas-Martínez ◽  
Pilar Serra-Añó
Keyword(s):  
Upper Limb ◽  
Convergent Validity ◽  
Hand Function ◽  
Motor Impairment ◽  
Minimal Detectable Change ◽  
Motor Impairments ◽  
Clinical Scales ◽  
Clinical Assessments ◽  
And Function ◽  
Impairment Severity

Abstract Background The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test. Methods The hand mobility, coordination, and function of 88 individuals with stroke were assessed using the app, and their upper-limb functions were assessed using the Fugl-Meyer Assessment for Upper Extremity, the Jebsen-Taylor Hand Function Test, the Box and Block Test, and the Nine Hole Peg Test. Twenty-three participants were further considered to investigate inter- and intra-rater reliability, standard error of measurement, and the minimal detectable change threshold of the app. Finally, participants were categorized according to motor impairment severity and the sensitivity of the app relative to these classifications was investigated. Results Significant correlations, of variable strengths, were found between the measurements performed by the app and the clinical scales and tests. Variable reliability, ranging from moderate to excellent, was found for all app measurements. Exercises that involved tapping and maximum finger-pincer grasp were sensitive to motor impairment severity. Conclusions The convergent validity, reliability, and sensitivity to motor impairment severity of the app, especially of those exercises that involved tapping and the maximum extension of the fingers, together with the widespread availability of the app, could support the use of this and similar apps to complement conventional clinical assessments of hand function after stroke.

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