Posts Tagged chronic stroke

[Abstract] Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients

Purpose: To assess functional status and robot-based kinematic measures four years after subacute robot-assisted rehabilitation in hemiparesis.

Material and methods: Twenty-two patients with stroke-induced hemiparesis participated in a ≥3-month upper limb combined program of robot-assisted and occupational therapy from two months post-stroke, and received community-based therapy after discharge. Four years later, nineteen (86%) participated in this long-term follow-up study. Assessments two, five and 54 months post-stroke included Fugl-Meyer (FM), Modified Frenchay Scale (MFS, at Month 54) and robot-based kinematic measures of targeting tasks in three directions, north, paretic and non-paretic: distance covered, velocity, accuracy (RMS error from straight line) and smoothness (number of velocity peaks; upward changes in accuracy and smoothness measures represent worsening). Analysis was stratified by FM score at two months: ≥17 (Group 1) or < 17 (Group 2). Correlation between impairment (FM) and function (MFS) was explored at 54 months.

Results: Fugl-Meyer scores were stable from five to 54 months (+1[-2;4], median[1st;3rd quartiles], ns). Kinematic changes in the three directions pooled were: distance covered, -1[-17;2]% (ns); velocity, -8[-32;28]% (ns); accuracy, +6[-13;98]% (ns); smoothness, +44[-6;126]% (p<0.05). Group 2 showed decline vs Group 1 (p<0.001) in FM (Group 1, +3[1;5], p<0.01; Group 2, -7[-11;-1], ns) and accuracy (Group 1, -3[-27;38]%, ns; Group 2, +29[17;140]%, p<0.001). At 54 months, FM and MFS were highly correlated (Pearson’s rho = 0.89; p<0.001).

Conclusions: While impairment appeared stable four years after robot-assisted upper limb training during subacute post-stroke phase, kinematic performance deteriorated in spite of community-based therapy, especially in patients with more severe impairment.

 

via Evolution of upper limb kinematics four years after subacute robot-assisted rehabilitation in stroke patients: International Journal of Neuroscience: Vol 0, No ja

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[Poster] Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke

Highlights

  • Participants improved on motor outcomes after engaging in high-repetition robotics arm training.
  • There were no differences between external focus or internal focus of attention on retention of motor skills after 4 weeks of arm training.
  • Individuals with moderate-to-severe arm impairment may not experience the advantages of an external focus during motor training found in healthy individuals.
  • Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment.

Abstract

Objective

To compare the long-term effects of external focus (EF) and internal focus (IF) of attention after 4 weeks of arm training.

Design

Randomized, repeated-measures, mixed analysis of variance.

Setting

Outpatient clinic.

Participants

Individuals with stroke and moderate-to-severe arm impairment living in the community (N=33; withdrawals: n=3).

Interventions

Four-week arm training protocol on a robotic device (12 sessions).

Main Outcome Measures

Joint independence, Fugl-Meyer Assessment, and Wolf Motor Function Test measured at baseline, discharge, and 4-week follow-up.

Results

There were no between-group effects for attentional focus. Participants in both groups improved significantly on all outcome measures from baseline to discharge and maintained those changes at 4-week follow-up regardless of group assignment (joint independence EF condition: F1.6,45.4=17.74; P<.0005; partial η2=.39; joint independence IF condition: F2,56=18.66; P<.0005; partial η2=.40; Fugl-Meyer Assessment: F2,56=27.83; P<.0005; partial η2=.50; Wolf Motor Function Test: F2,56=14.05; P<.0005; partial η2=.35).

Conclusions

There were no differences in retention of motor skills between EF and IF participants 4 weeks after arm training, suggesting that individuals with moderate-to-severe arm impairment may not experience the advantages of an EF found in healthy individuals. Attentional focus is most likely not an active ingredient for retention of trained motor skills for individuals with moderate-to-severe arm impairment, whereas dosage and intensity of practice appear to be pivotal. Future studies should investigate the long-term effects of attentional focus for individuals with mild arm impairment.

 

via Randomized Trial on the Effects of Attentional Focus on Motor Training of the Upper Extremity Using Robotics With Individuals After Chronic Stroke – ScienceDirect

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[Abstract] Decreased short-interval intracortical inhibition correlates with better pinch strength in patients with stroke and good motor recovery

Abstract

Background

Deeper short-interval intracortical inhibition (SICI), a marker of GABAA activity, correlates with better motor performance in patients with moderate to severe hand impairments in the chronic phase after stroke.

Objectives

We evaluated the correlation between SICI in the affected hemisphere and pinch force of the paretic hand in well-recovered patients. We also investigated the correlation between SICI and pinch force in controls.

Methods

Twenty-two subjects were included in the study. SICI was measured with a paired-pulse paradigm. The correlation between lateral pinch strength and SICI was assessed with Spearman’s rho.

Results

There was a significant correlation (rho = 0.69, p = 0.014) between SICI and pinch strength in patients, but not in controls. SICI was significantly deeper in patients with greater hand weakness.

Conclusions

These preliminary findings suggest that decreased GABAA activity in M1AH correlates with better hand motor performance in well-recovered subjects with stroke in the chronic phase.

via Decreased short-interval intracortical inhibition correlates with better pinch strength in patients with stroke and good motor recovery – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[Abstract] Pilot Study Combining Electrical Stimulation and a Dynamic Hand Orthosis for Functional Recovery in Chronic Stroke

Abstract

OBJECTIVE. We investigated the effect of a combined neuromuscular electrical stimulation (ES) and dynamic hand orthosis (DHO) regimen with a group of people with chronic stroke to improve performance on specific daily tasks.

METHOD. Four people with chronic stroke participated in an ES–DHO regimen using the affected upper extremity 5×/wk for 6 wk. Outcome measures included grip strength, range of motion (ROM), and analysis of muscle activation–deactivation during release of grasp through electromyography. Ability to perform specific daily living tasks was assessed using the Assessment of Motor and Process Skills (AMPS).

RESULTS. Results suggested that improvements in strength, ROM, and grasp deactivation are possible with the combined ES–DHO regimen. All participants’ AMPS motor scores improved.

CONCLUSIONS. An ES–DHO regimen may improve motor skills needed for functional task performance in people with chronic stroke. Results should be interpreted cautiously because of the pilot nature of the study and the small sample size.

via Pilot Study Combining Electrical Stimulation and a Dynamic Hand Orthosis for Functional Recovery in Chronic Stroke | American Journal of Occupational Therapy

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[WEB SITE] Virtual Reality for Stroke Rehabilitation

stroke rehabilitation

Researchers piloted a study to investigate the potential of using virtual reality (VR) training systems in stroke rehabilitation.

Following a stroke, survivors are often left with physical and mental disabilities. Nine out of ten stroke survivors are left with some degree of upper limb motor impairment, thus making it the most prevalent post-stroke disability suffered. Not only does stroke rehabilitation training need to be long-lasting, repetitive, task-specific and challenging, the training must also be motivating and intensive.

What is the Role of Virtual Reality?

Virtual reality (VR) is a relatively new approach to stroke rehabilitation that has shown to have moderate effectiveness in improving motor functions. VR can allow for embodied sensorimotor feedback where patients’ movements are reproduced in a virtual environment via motion capture technology. This enhanced VR experience has previously demonstrated an ability to increase patient motivation and stimulate neural circuits in the motor system to aid in functional recovery.

Can Virtual Reality Help with Stroke Rehabilitation?

In a pilot study published in the Journal of NeuroEngineering and Rehabilitation, researchers in Switzerland investigated the potential use of a VR-based stroke rehabilitation training targeted to the upper motor limbs. The study’s main goal was to assess the training intensity (the number of repetitions divided by the number of minutes of active therapy) and rehabilitation dose (number of repetitions). They also examined VR-based training improvements in functional upper limb outcomes and the safety and tolerance of this technology.

Ten stroke patients with one-sided weakness were included in the study, utilizing the Mind Motion PRO VR-based motor rehabilitation system. The intervention consisted of two one-hour sessions per week for five weeks with a physical therapist to guide the tasks according to the patient’s needs and abilities. Assessments were conducted at baseline (prior to training), post-treatment, and at a four-week follow-up. The participants engaged in VR treatment exercises that stimulated shoulder, elbow, forearm, and wrist movements at varying difficulties through game-like scenario tasks that included pointing, reaching, and grabbing objects in virtual space.

How Effective was the Virtual Reality Therapy?

All ten of the study’s participants completed the full ten training sessions in the treatment. The study found that the median duration of training increased by approximately ten minutes and the median effective training time (number of minutes that the participants actively trained, excluding breaks) per session doubled by the last session of the intervention. The intensity of the training (number of goal-directed movements per minute of effective training time) progressively increased from the first to last training session.

Secondarily, the study evaluated upper limb function, active range of motion and muscle strength, which all showed an increase from baseline. No adverse events were reported and pain and stress levels were low throughout the treatment, thus indicating that VR treatment is well tolerated. Lastly, the participants showed a high degree of concentration and comfort with the movements and expressed interest in continuing the training after the ten sessions, suggesting a high level of adherence and motivation for VR treatment – a key component to stroke rehabilitation treatment outcomes.

Overall, this pilot study demonstrated the ability of VR-based treatment to provide efficient training sessions, as the efficiency rate (relation between time of therapy session and time in active therapy) was 86.3%, which is higher than conventional therapies. The study supports the potential for VR-based intervention as stroke rehabilitation therapy to improve functional and motor outcomes. This should be further explored in future studies that incorporate control groups, a larger sample size, stratified groups and more intensive interventions with a variety of motor assessments.

Written by Maggie Leung, PharmD

Reference: Perez-Marcos, D., Chevalley, O., Schmidlin, T., Garipelli, G., Serino, A., Vuadens, P., . . . Millán, J. D. (2017). Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. Journal of NeuroEngineering and Rehabilitation,14(1). doi:10.1186/s12984-017-0328-9

via Virtual Reality for Stroke Rehabilitation – Medical News Bulletin | Health News and Medical Research

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[WEB SITE] Strategic Training May Expand the Recovery for Traumatic Brain Injuries.

June 1, 2017

Dr. Kihwan Han

Dr. Kihwan Han

A recent study from the Center for BrainHealth at The University of Texas at Dallas shows that a certain type of instructor-led, brain training protocol can stimulate structural changes in the brain and neural connections several years after a traumatic brain injury (TBI).

The findings, published in Brain and Behavior, further suggest that changes in cortical thickness and neural network connectivity may prove an effective way to quantitatively measure treatment efficacy, an ability that has not existed until now. Building upon previous research, the study challenges the widely held belief that recovery from a TBI is limited to two years after an injury.

“A TBI disrupts brain structure. These brain changes can interfere with brain network communication and the cognitive functions those networks support,” said Dr. Kihwan Han, research scientist at the Center for BrainHealth and lead author of the study.

“For people with chronic TBI, they may have trouble with daily tasks such as creating shopping lists and resolving conflicts with others for many years after the injury. These findings provide hope for people who thought, ‘This is as good as my recovery is going to get’ and for the medical community who have yet to find a way to objectively measure a patient’s recovery,” he said.

The study included 60 adults with TBI symptoms lasting an average of eight years. Participants were randomly placed into one of two cognitive training groups: strategy-based training or knowledge-based training. Over an eight-week period, the strategy-based training group learned strategies to improve attention and reasoning. The knowledge-based training group learned information about the structure and function of the brain as well as the effects of sleep and exercise on brain performance.


These findings provide hope for people who thought, ‘This is as good as my recovery is going to get’ and for the medical community who have yet to find a way to objectively measure a patient’s recovery.

Dr. Kihwan Han,
research scientist
at the Center for BrainHealth


 

Magnetic resonance imaging measured cortical thickness and resting-state functional connectivity (rsFC) before training, after training and three months post-training. Previous studies have shown that cortical thickness and rsFC can be potential markers for training-induced brain changes.

Individuals in the strategy-based reasoning training showed a greater change in cortical thickness and connectivity compared to individuals who received the knowledge-based training. Changes in cortical thickness and functional connectivity also correlated to an individual’s ability to switch between tasks quickly and consistently to achieve a specific goal.

“People who showed the greatest change in cortical thickness and connectivity, showed the greatest performance increases in our cognitive tasks,” Han said. “Perhaps future studies could investigate the added benefit of brain stimulation treatments in combination with cognitive training for individuals with chronic TBI who experience problems with attention, memory or executive functions.”

The work was supported by the Department of Defense, the Meadows Foundation and the Friends of BrainHealth Distinguished New Scientist Award.

via Strategic Training May Expand the Recovery for Traumatic Brain Injuries – News Center – The University of Texas at Dallas

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[Abstract] The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial

Abstract

Background

Stroke is the biggest cause of disability in adults. Spasticity is a primary impairment of stroke with a highly variable prevalence. In the present research, we aimed to determine the impact of functional stretching exercises on functional outcomes in stroke patients.

Methods

Thirty stroke patients were randomized into two groups-Experimental group and control group for the purposes of the study. The subjects in the experimental group participated in a functional stretching training program at the rehabilitation center thrice a week for four weeks. The subjects in both groups were evaluated in 3 intervals, once at baseline, once at the end of the program, and once at 2 months following the program. Clinical assessments, such as measuring spasticity, were conducted using the Modified Modified Ashworth Scale (MMAS). Functional outcomes were also evaluated, using the Timed Up and Go (TUG) test, as well as the Timed 10-Meter Walk Test (WTT). Friedman test in SPSS version 22.0 was used to analysis the response variables with respect to each stage of evaluation. Spearman rank correlation was also used to measure correlation among clinical assessments and functional outcomes.

Results

The comparison between two groups showed significant differences only in the Modified Modified Ashworth Scale and Visual Analogue Scale (VAS) post treatment. The experimental group showed significant differences in the MMAS (p = 0.002), WTT (p < 0.001), and TUG (p < 0.001) scores. Nevertheless, the scores of the control group were not significantly different in different stages of evaluation.

Conclusion

The findings of the study suggest that using functional stretching exercises can improve functional outcomes in chronic spastic stroke patients.

Source: The effect of functional stretching exercises on functional outcomes in spastic stroke patients: A randomized controlled clinical trial – ScienceDirect

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[Abstract] The effect of bilateral arm training on motor areas excitability in chronic stroke patients

Abstract

Objectives

Physical therapy exercises that do not enhance motor areas neuroplasticity lead to motor impairment especially at the upper extremity (UE) in the chronic stroke patients. The aim of this study was to assess the effect of using bilateral arm training on motor areas excitability (neuroplasticity) in the chronic stroke patients.

Methods

Thirty male chronic stroke patients with moderate impairment of UE were assigned into two equal groups. The changes of motor areas excitability (neuroplasticity) were assessed before and after arm training by spectral analysis of mapping electroencephalogram (EEG). Delta, theta, alpha, beta 1 and beta 2 waves were recorded. The equation which was used to detect the neural plasticity and the changing at motor areas excitability was dividing the fast wave/slow waves or detecting the ratio of mean frequency of (beta 2 + beta 1 + alpha/theta + delta).

Results

Patients in group 1 (G1) received unilateral arm training and patients in group 2 (G2) received bilateral arm training. The Results: Showed significant increase in the excitability (neuroplasticity) at (F4 + F8) and (C4) motor areas in G2 comparing to G1 (p!9 .006) and (p!9 .036 ) respectively.

Discussion

Bimanual training leads to activation of extensive networks in both hemispheres.

Conclusions

It was concluded that bilateral arm training is a recommended method to enhance the motor areas excitability (neuroplasticity) in the chronic stroke patients.

Significance

Post stroke physical therapy can make use of bimanual training for better rehabilitation.

Source: S185 The effect of bilateral arm training on motor areas excitability in chronic stroke patients – Clinical Neurophysiology

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[Abstract] Computer-aided prediction of extent of motor recovery following constraint-induced movement therapy in chronic stroke

Abstract

Constraint-induced movement therapy (CI therapy) is a well-researched intervention for treatment of upper limb function. Overall, CI therapy yields clinically meaningful improvements in speed of task completion and greatly increases use of the more affected upper extremity for daily activities. However, individual improvements vary widely. It has been suggested that intrinsic feedback from somatosensation may influence motor recovery from CI therapy. To test this hypothesis, an enhanced probabilistic neural network (EPNN) prognostic computational model was developed to identify which baseline characteristics predict extent of motor recovery, as measured by the Wolf Motor Function Test (WMFT). Individual characteristics examined were: proprioceptive function via the brief kinesthesia test, tactile sensation via the Semmes-Weinstein touch monofilaments, motor performance captured via the 15 timed items of the Wolf Motor Function Test, stroke affected side. A highly accurate predictive classification was achieved (100% accuracy of EPNN based on available data), but facets of motor functioning alone were sufficient to predict outcome. Somatosensation, as quantified here, did not play a large role in determining the effectiveness of CI therapy.

Source: Computer-aided prediction of extent of motor recovery following constraint-induced movement therapy in chronic stroke – ScienceDirect

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[Abstract] A soft robotic supernumerary finger and a wearable cutaneous finger interface to compensate the missing grasping capabilities in chronic stroke patients

Abstract:

Stroke survivors who experience severe hemipare-sis often cannot completely recover the use of their hand and arm. Many of the rehabilitation devices currently available are designed to increase the functional recovery right after the stroke when, in some cases, biological restoring and plastic reorganization of the central nervous system can take place. However, this is not always the case. Even after extensive therapeutic interventions, the probability of regaining functional use of the impaired hand is low. In this respect, we present a novel robotic system composed of a supernumerary robotic finger and a wearable cutaneous finger interface. The supernumerary finger is used to help grasping objects while the wearable interface provides information about the forces exerted by the robotic finger on the object being held. We carried out two experiments, enrolling 16 healthy subjects and 2 chronic stroke patients. Results showed that using the supernumerary finger greatly improved the grasping capabilities of the subjects. Moreover, providing cutaneous feedback significantly improved the performance of the considered task and was preferred by all subjects.

Source: A soft robotic supernumerary finger and a wearable cutaneous finger interface to compensate the missing grasping capabilities in chronic stroke patients – IEEE Xplore Document

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