Posts Tagged Fugl-Meyer

[ARTICLE] Using Brain Oscillations and Corticospinal Excitability to Understand and Predict Post-Stroke Motor Function – Full Text

What determines motor recovery in stroke is still unknown and finding markers that could predict and improve stroke recovery is a challenge. In this study, we aimed at understanding the neural mechanisms of motor function recovery after stroke using neurophysiological markers by means of cortical excitability (Transcranial Magnetic Stimulation – TMS) and brain oscillations (electroencephalography – EEG). In this cross-sectional study, fifty-five subjects with chronic stroke (62±14 yo, 17 women, 32±42 months post-stroke) were recruited in two sites. We analyzed TMS measures (i.e. motor threshold – MT – of the affected and unaffected sides) and EEG variables (i.e. power spectrum in different frequency bands and different brain regions of the affected and unaffected hemispheres) and their correlation with motor impairment as measured by Fugl-Meyer. Multiple univariate and multivariate linear regression analyses were performed to identify the predictors of good motor function. A significant interaction effect of MT in the affected hemisphere and power in beta bandwidth over the central region for both affected and unaffected hemispheres was found. We identified that motor function positively correlates with beta rhythm over the central region of the unaffected hemisphere, while it negatively correlates with beta rhythm in the affected hemisphere. Our results suggest that cortical activity in the affected and unaffected hemisphere measured by EEG provides new insights on the association between high frequency rhythms and motor impairment, highlighting the role of excess of beta in the affected central cortical region in poor motor function in stroke recovery.


Stroke is a leading cause of morbidity, mortality, and disability worldwide (12). Among the sequels of stroke, motor impairment is one of the most relevant, since it conditions the quality of life of patients, it reduces their capability to perform their daily activities and it impairs their autonomy (3). Despite the advancements of the acute stroke therapy, patients require an intensive rehabilitation program that will partially determine the extent of their recovery (4). These rehabilitation programs aim at stimulating cortical plasticity to improve motor performance and functional recovery (5). However, what determines motor improvement is still unknown. Indeed, finding markers that could predict and enhance stroke recovery is still a challenge (6). Different types of biomarkers exist: diagnostic, prognostic, surrogate outcome, and predictive biomarkers (7). The identification of these biomarkers is critical in the management of stroke patients. In the field of stroke research, great attention has been put to biomarkers found in the serum, especially in acute care. However, research on biomarkers of stroke recovery is still limited, especially using neurophysiological tools.

A critical research area in stroke is to understand the neural mechanisms underlying motor recovery. In this context, neurophysiological techniques such as transcranial magnetic stimulation (TMS) and electroencephalography (EEG) are useful tools that could be used to identify potential biomarkers of stroke recovery. However, there is still limited data to draw further conclusions on neural reorganization in human trials using these techniques. A few studies have shown that, in acute and sub-acute stage, stroke patients present increased power in low frequency bands (i.e., delta and theta bandwidths) in both affected and unaffected sides, as well as increased delta/alpha ratio in the affected brain area; these patterns being also correlated to functional outcome (811). Recently, we have identified that, besides TMS-indexed motor threshold (MT), an increased excitability in the unaffected hemisphere, coupled with a decreased excitability in the affected hemisphere, was associated with poor motor function (12), as measured by Fugl-Meyer (FM) [assessing symptoms severity and motor recovery in post-stroke patients with hemiplegia—Fugl-Meyer et al. (13); Gladstone et al. (14)]. However, MT measurement is associated with a poor resolution as it indexes global corticospinal excitability. Therefore, combining this information with direct cortical measures such as cortical oscillations, as measured by EEG, can help us to understand further neural mechanisms of stroke recovery.

To date, there are very few studies looking into EEG and motor recovery. For that reason, we aimed, in the present study, to investigate the relationship between motor impairment, EEG, and TMS variables. To do so, we conducted a prospective multicenter study of patients who had suffered from a stroke, in which we measured functional outcome using FM and performed TMS and EEG recordings. Based on our preliminary work, we expected to identify changes in interhemispheric imbalances on EEG power, especially in frequency bands associated with learning, such as alpha and beta bandwidths. […]

Continue —> Frontiers | Using Brain Oscillations and Corticospinal Excitability to Understand and Predict Post-Stroke Motor Function | Neurology

Figure 1. Topoplots showing the topographic distribution of high-beta bandwidth (25 Hz) for every individual. Red areas represent higher high-beta activity, while blue areas represent lower high-beta activity. Central region (C3 or C4) in red stands for the affected side. For patients with poor motor function, a higher beta activity of the affected central region as compared to the affected side is observed in 16 out of 28 individuals. For patients with good motor function, a similar activity over central regions bilaterally, or higher activity over the unaffected central area can be identified in 21 out of 27 individuals. FM = Fugl-Meyer.

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[ARTICLE] The Fugl-Meyer Upper Extremity Scale – Journal of Physiotherapy – Full Text


The Fugl-Meyer Upper Extremity (FMUE) Scale1 is a widely used and highly recommended stroke-specific, performance-based measure of impairment.2,3 It is designed to assess reflex activity, movement control and muscle strength in the upper extremity of people with post-stroke hemiplegia. It has been extensively used as an outcome measure in rehabilitation trials and to record post-stroke recovery, particularly in the USA

The Fugl-Meyer Upper Extremity (FMUE) Scale1 is a widely used and highly recommended stroke-specific, performance-based measure of impairment.2, 3 It is designed to assess reflex activity, movement control and muscle strength in the upper extremity of people with post-stroke hemiplegia. It has been extensively used as an outcome measure in rehabilitation trials and to record post-stroke recovery, particularly in the USA.4

The FMUE Scale comprises 33 items, each scored on a scale of 0 to 2, where 0 = cannot perform, 1 = performs partially and 2 = performs fully. It is free, requires only household items for testing, and takes up to 30 minutes to administer. Two illustrated manuals outlining the assessed components of the scale and scoring criteria have been published to address shortcomings of the original description.5, 6

The time taken to complete the full FMUE Scale has led researchers to develop variants, including a distal upper extremity sub-scale comprising 12 wrist/hand items7 and a ‘short form’ six-item scale of the whole FMUE Scale, which was developed using Rasch analysis to determine the easiest and most difficult items.8 In the development of the short form of the scale, care was taken to preserve the original content representativeness, which is based on sequential stages of post-stroke motor recovery, first documented by Brunnstrom in 1966.9 However, the short form version has been shown to be less sensitive to change at an individual level, which limits its clinical utility.10

Extensive assessment of the psychometric properties of the FMUE Scale has been undertaken.3 The longitudinal stability of assessment items (apart from reflex evaluation) over 6 months has been established, supporting the validity of the measure over time.4 Excellent internal consistency (alpha = 0.94 to 0.98 across four administrations over 6 months) has been demonstrated.11 Satisfactory concurrent validity has been shown in comparison with three other commonly used measures of upper extremity motor recovery.11 In this study, the FMUE Scale was the only tool that did not have significant floor and ceiling effects, and intra-rater (ICC 0.99, 95% CI 0.99 to 1.00) and inter-rater (ICC 0.96, 95% CI 0.92 to 0.98) agreement were shown to be excellent. These authors reported a minimal detectable change for intra-rater assessments of 5.2 on the 66-point scale (8% of the total measure) and 12.9 (20% of the total measure) for inter-rater assessments.

A range of data exists for minimal clinically important differences for the FMUE Scale. A change of between 4 and 7 points in chronic stroke,7 and 9 to 10 points in subacute stroke12 is considered to be clinically significant. A recent study by Hoonhorst et al13 aimed to determine the optimal cut-off scores for the FMUE Scale regarding predictions of upper limb capacity at 6 months post stroke. These authors reported that FMUE Scale scores < 31 corresponded with ‘no to poor’ upper extremity capacity, while 32 to 47 represented ‘limited capacity’, 48 to 52 represented ‘notable capacity’ and 53 to 66 represented ‘full’ upper extremity capacity. Shelton et al14 reported that a 10-point increase from admission to discharge on the FMUE Scale corresponded to a 1.5-point change on the Functional Independence Measure.

Continue —> The Fugl-Meyer Upper Extremity Scale – Journal of Physiotherapy

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[ARTICLE] Functional versus non-functional rehabilitation in chronic ischemic stroke: evidences from a randomized functional MRI study – Full Text PDF


Motor rehabilitation of stroke survivors is often based on different rehabilitation strategies that may include functional and/or non-functional exercises. Although functional strategies are largely used, there are still not enough evidences of its clinical efficacy, neither of its impact on functional neuroplasticity following rehabilitation, when compared with non-functional exercises.

The present study aimed to compare the effect of these strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI). Twelve hemiparetic patients with a chronic stroke were selected. Patients were randomly assigned a non-functional (NFS) or functional (FS) rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA Test and modified Barthel) and fMRI were applied at four moments: before rehabilitation (P1), immediately after (P2), 1 month (P3) and three months (P4) after the end of rehabilitation. The NFS group improved significantly their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in ARA and Barthel.

fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to: decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by lateralization indexes. Nevertheless, no clear fMRI differences were found between groups.

Our analysis revealed similar clinical effects between FS and NFS, indicating that the strategy of choice may ultimately depend on the main goal of the individual rehabilitation program.

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