scholarly journals Structural or Functional Metrics to Assess Motor Impairment in Chronic Stroke?

Stroke ◽  
2021 ◽  
Vol 52 (1) ◽  
pp. 250-252
Author(s):  
Assia Jaillard
Keyword(s):  
Motor Impairment ◽  
Chronic Stroke ◽  
Functional Metrics

scholarly journals Structural integrity of corticospinal motor fibers predicts motor impairment in chronic stroke

Neurology ◽  
2010 ◽  
Vol 74 (4) ◽  
pp. 280-287 ◽  
Author(s):  
R. Lindenberg ◽  
V. Renga ◽  
L. L. Zhu ◽  
F. Betzler ◽  
D. Alsop ◽  
...  
Keyword(s):  
Structural Integrity ◽  
Motor Impairment ◽  
Chronic Stroke

scholarly journals Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

2020 ◽  
Vol 34 (8) ◽  
pp. 733-745 ◽  
Author(s):  
Firas Mawase ◽  
Kendra Cherry-Allen ◽  
Jing Xu ◽  
Manuel Anaya ◽  
Shintaro Uehara ◽  
...  
Keyword(s):  
Hand Function ◽  
Motor Impairment ◽  
Preliminary Evidence ◽  
Chronic Stroke ◽  
Body Parts ◽  
Hand Dexterity ◽  
Function Impairment ◽  
Clinical Benefits ◽  
Clinical Measures ◽  
Hand Impairment

Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.

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 Combined Brain and Peripheral Nerve Stimulation in Chronic Stroke Patients With Moderate to Severe Motor Impairment

2017 ◽  
Vol 21 (2) ◽  
pp. 176-183 ◽  
Author(s):  
Isabella S. Menezes ◽  
Leonardo G. Cohen ◽  
Eduardo A. Mello ◽  
André G. Machado ◽  
Paul Hunter Peckham ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Motor Impairment ◽  
Chronic Stroke ◽  
Peripheral Nerve Stimulation ◽  
Stroke Patients ◽  
Severe Motor ◽  
Severe Motor Impairment

scholarly journals Self-Reported and Objective Sleep Measures in Stroke Survivors With Incomplete Motor Recovery at the Chronic Stage

2021 ◽  
pp. 154596832110298
Author(s):  
Melanie K. Fleming ◽  
Tom Smejka ◽  
David Henderson Slater ◽  
Evangeline Grace Chiu ◽  
Nele Demeyere ◽  
...  
Keyword(s):  
Sleep Onset ◽  
Motor Impairment ◽  
Depression Scale ◽  
Chronic Stroke ◽  
Sleep Diary ◽  
Poor Sleep ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Cross Sectional

Background. Stroke survivors commonly complain of difficulty sleeping. Poor sleep is associated with reduced quality of life and more understanding of long-term consequences of stroke on sleep is needed. Objective. The primary aims were to (1) compare sleep measures between chronic stroke survivors and healthy controls and (2) test for a relationship between motor impairment, time since stroke and sleep. Secondary aims were to explore mood and inactivity as potential correlates of sleep and test the correlation between self-reported and objective sleep measures. Methods. Cross-sectional sleep measures were obtained for 69 chronic stroke survivors (mean 65 months post-stroke, 63 years old, 24 female) and 63 healthy controls (mean 61 years old, 27 female). Self-reported sleep was assessed with the sleep condition indicator (SCI) and sleep diary ratings, objective sleep with 7-nights actigraphy and mood with the Hospital Anxiety and Depression Scale. Upper extremity motor impairment was assessed with the Fugl-Meyer assessment. Results. Stroke survivors had significantly poorer SCI score ( P < .001) and higher wake after sleep onset ( P = .005) than controls. Neither motor impairment, nor time since stroke, explained significant variance in sleep measures for the stroke group. For all participants together, greater depression was associated with poorer SCI score ( R2adj = .197, P < .001) and higher age with more fragmented sleep ( R2adj = .108, P < .001). There were weak correlations between nightly sleep ratings and actigraphy sleep measures ( r s = .15–.24). Conclusions. Sleep disturbance is present long-term after stroke. Depressive symptoms may present a modifiable factor which should be investigated alongside techniques to improve sleep in this population.

scholarly journals Self-efficacy and Reach Performance in Individuals With Mild Motor Impairment Due to Stroke

2019 ◽  
Vol 33 (4) ◽  
pp. 319-328 ◽  
Author(s):  
Jill Campbell Stewart ◽  
Rebecca Lewthwaite ◽  
Janelle Rocktashel ◽  
Carolee J. Winstein
Keyword(s):  
Upper Extremity ◽  
Self Efficacy ◽  
Movement Time ◽  
Motor Impairment ◽  
Arm Movements ◽  
Chronic Stroke ◽  
Motor Score ◽  
End Point ◽  
Arm Function ◽  
Reach Control

Background: Persistent deficits in arm function are common after stroke. An improved understanding of the factors that contribute to the performance of skilled arm movements is needed. One such factor may be self-efficacy (SE). Objective: To determine the level of SE for skilled, goal-directed reach actions in individuals with mild motor impairment after stroke and whether SE for reach performance correlated with actual reach performance. Methods: A total of 20 individuals with chronic stroke (months poststroke: mean 58.1 ± 38.8) and mild motor impairment (upper-extremity Fugl-Meyer [FM] motor score: mean 53.2, range 39 to 66) and 6 age-matched controls reached to targets presented in 2 directions (ipsilateral, contralateral). Prior to each block (24 reach trials), individuals rated their confidence on reaching to targets accurately and quickly on a scale that ranged from 0 ( not very confident) to 10 ( very confident). Results: Overall reach performance was slower and less accurate in the more-affected arm compared with both the less-affected arm and controls. SE for both reach speed and reach accuracy was lower for the more-affected arm compared with the less-affected arm. For reaches with the more-affected arm, SE for reach speed and age significantly predicted movement time to ipsilateral targets ( R2 = 0.352), whereas SE for reach accuracy and FM motor score significantly predicted end point error to contralateral targets ( R2 = 0.291). Conclusions: SE relates to measures of reach control and may serve as a target for interventions to improve proximal arm control after stroke.

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