Posts Tagged Hand dexterity

[ARTICLE] Does non-invasive brain stimulation modify hand dexterity? Protocol for a systematic review and meta-analysis – Full Text

 

Abstract

Introduction Dexterity is described as coordinated hand and finger movement for precision tasks. It is essential for day-to-day activities like computer use, writing or buttoning a shirt. Integrity of brain motor networks is crucial to properly execute these fine hand tasks. When these networks are damaged, interventions to enhance recovery are frequently accompanied by unwanted side effects or limited in their effect. Non-invasive brain stimulation (NIBS) are postulated to target affected motor areas and improve hand motor function with few side effects. However, the results across studies vary, and the current literature does not allow us to draw clear conclusions on the use of NIBS to promote hand function recovery. Therefore, we developed a protocol for a systematic review and meta-analysis on the effects of different NIBS technologies on dexterity in diverse populations. This study will potentially help future evidence-based research and guidelines that use these NIBS technologies for recovering hand dexterity.

Methods and analysis This protocol will compare the effects of active versus sham NIBS on precise hand activity. Records will be obtained by searching relevant databases. Included articles will be randomised clinical trials in adults, testing the therapeutic effects of NIBS on continuous dexterity data. Records will be studied for risk of bias. Narrative and quantitative synthesis will be done.

Strengths and limitations of this study

  • This is a novel systematic review and meta-analysis focusing specifically on dexterity.

  • We use continuous data not dependent on the evaluator or participant.

  • This work will potentially help future evidence-based research and guidelines to refine non-invasive brain stimulation.

Introduction

The hand’s somatotopy is extensively represented in the human motor cortex.1 2 Phylogenetically, this relates to the development of corticomotoneuronal cells that specialise in creating patterns of muscle activity that synergises into highly skilled movements.3 This organised hand-and-finger movement to use objects during a specific task is known as dexterity.4 Evolutionary, dexterity played a pivotal role in human survival and is fundamental to actives of daily living, and hence quality of life.5 6

This precision motor movement relies on integration of information from the cerebral cortex, the spinal cord, several neuromusculoskeletal systems and the external world to coordinate finger force control, finger independence, timing and sequence performance.7 During these tasks, multivoxel pattern decoding shows bilateral primary motor cortex activation (M1), which was responsible for muscle recruitment timing and hand movement coordination.8 9 This is related to motor cortex connectivity through the corpus callosum, to motor regions of the cerebellum and white matter integrity.10–15 Adequate motor output translates into successfully executed tasks, like picking up objects, turning over cards, manipulating cutlery, writing, using computer–hand interfaces like smartphones, playing an instrument and performing many other similarly precise skills.16

These motor tasks are negatively impacted when motor output networks are affected, as seen in stroke or Parkinson’s disease.17 18 Therapeutic interventions that restore these damaged motor networks can be vital to restore fine motor movement after injury occurs. Pharmaceutical approaches often lead to adverse effects such as dyskinesias in Parkinson’s disease. Moreover, even after intensive rehabilitation programmes, only about 5%–20% of patients with stroke fully recover their motor function.19–21 Non-invasive brain stimulation (NIBS) techniques, like transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), are proposed adjuvant or stand-alone interventions to target these affected areas and improve fine motor function.22 23 Briefly, these NIBS interventions are shown to influence the nervous system’s excitability and modulate long-term plasticity, which may be beneficial to the brain’s recovery of functions after injury.24–27

Fine hand motor ability is not studied as much in previous reviews of NIBS. Specifically, one narrative review focuses on rTMS in affected hand recovery poststroke; however, it does not consider the implications of varying International Classification of Functioning, Disability and Health (ICF) domains, data types and rater dependent outcomes, and its interpretability is limited without quantitative synthesis.28–31 The overarching conclusion was supportive of rTMS for paretic hand recovery, though with limited data to support its regular use, and a pressing need to study individualised patient parameters.28 One meta-analysis had positive and significant results when specifically studying the effects of rTMS on finger coordination and hand function after stroke.32 However, while various meta-analysis, and another systematic review, studied upper-limb movement after NIBS in distinct populations, they did not focus on precise hand function, pooled upper-limb outcomes with hand outcomes and presented mixed results.33–38

Motivated by this gap in the evidence for NIBS in dexterity, we will do a systematic review and meta-analysis of the literature on these brain stimulation technologies using outcomes that focus exactly on manual dexterity. These outcomes will be continuous and not dependent on the participant’s or rater’s observation (ie, they will be measured in seconds, or number of blocks/pegs placed, and not by an individual’s interpretation). They will be comprised of multiple domains as defined by the ICF, providing an appreciation of function rather than only condition or disease.29–31 By focusing on the ICF model, we will be able to study dexterity across a larger sample of studies, NIBS techniques and conditions in order to provide a better understanding of brain stimulation efficacy on hand function in various populations.[…]

Continue —. Does non-invasive brain stimulation modify hand dexterity? Protocol for a systematic review and meta-analysis | BMJ Open

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[ARTICLE] Effects of repeated vibratory stimulation of wrist and elbow flexors on hand dexterity, strength, and sensory function in patients with chronic stroke: a pilot study – Full Text PDF

Abstract.

[Purpose] The aim of this study was to investigate the effects of repeated vibratory stimulation to muscles related to hand functions on dexterity, strength, and sensory function in patients with chronic stroke.

[Subjects and Methods] A total of 10 stroke patients with hemiplegia participated in this study. They were divided into two groups: a) Experimental and b) Control, with five randomly selected subjects for each group. The experimental group received vibratory stimulation, while the control group received the traditional physical therapy. Both interventions were performed for 30 minutes each session, three times a week for four weeks.

[Results] There was a significant within-group improvement in the box and block test results in both groups for dexterity. Grip strength improved in both groups but the improvement was not statistically significant.

[Conclusion] The vibratory stimulation activated the biceps brachii and flexor carpi radialis, which increased dexterity to grasp and lift the box and block from the surface. Therefore, repeated vibratory stimulation to muscles related to hand functions improved hand dexterity equality to the traditional physical therapy in patients with chronic stroke.

Full Text PDF

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[WEB SITE] New electrical stimulation therapy improves hand function for stroke survivors

A new electrical stimulation therapy improved hand dexterity for stroke survivors more than an existing technique, in a study released today.

Strokes, which strike about in 800,000 people in the United States each year, usually result in some degree of paralysis on one side of the body that can make it hard for survivors to open a hand.

A common therapy in stroke rehabilitation uses low levels of electric current to stimulate paralyzed muscles to open the hand, improve muscle strength and possibly restore hand function. A therapist sets stimulation intensity, cycle timing and repetitions.

In the new experimental therapy developed by researchers at the MetroHealth System, Case Western Reserve University and the Cleveland Functional Electrical Stimulation Center, patients control the stimulation to their weak hand by wearing a glove with sensors on the opposite, unaffected hand. When patients open their unaffected hand, they receive a corresponding amount of stimulation that opens their weak stroke-affected hand. This puts patients back in control of their hand and enables them to participate in therapy with the assistance of electrical stimulation.

For the study, 40 stroke survivors received therapy using the new glove for 12 weeks and 40 received the common therapy. Both groups used an electrical stimulator on their own at home for 10 hours a week, plus 3 hours per week practicing hand tasks with an occupational therapist in the lab.

Hand function was measured before and after therapy with a standard dexterity test that determined the number of blocks participants can pick up, lift over a barrier and release in another area on a table within 60 seconds.

Researchers found:

  • Patients who received the new therapy had greater improvement on the dexterity test (4.6 blocks) than the common group (1.8 blocks).
  • Patients who had the greatest improvements in hand dexterity following the new therapy were less than two years post-stroke and had at least some finger movement when they started the study. These patients saw an improvement of 9.6 blocks on the dexterity test, compared to 4.1 blocks in the common group.
  • Patients with no finger movement also saw improvements in arm movement after the new therapy.
  • At treatment end, 97 percent of the participants who received the new therapy agreed that they could use their hand better than at the start of the study.

Researchers plan to perform a multi-site study to confirm their results, as well as measure quality of life improvements for patients.

While the researchers speculate that the new therapy may be changing neural connections in the brain that control hand dexterity, additional studies are needed to determine what effects it may have on the central nervous system.

The study also demonstrates that stroke patients can effectively use technology for self-administered therapy at home, said Jayme S. Knutson, Ph.D., an assistant professor of physical medicine and rehabilitation at Case Western Reserve University School of Medicine in Cleveland, Ohio.

“Home-based therapy is becoming increasingly important to offset increasing healthcare costs and to meet the need for high doses of therapy that are critical for attaining the best outcomes,” he said. “The more therapy a patient can get, the better potential outcome they will get.”

The study is published in in the American Heart Association journal Stroke.

September 8th, 2016

Source: New electrical stimulation therapy improves hand function for stroke survivors – News on Heart.org

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[WEB SITE] Scientists Test Electrical Stimulation Glove As Poststroke Hand Therapy – Rehab Managment

http://www.dreamstime.com/stock-photos-beautiful-woman-hands-nails-perfect-french-manicure-close-up-image41312553

An experimental stroke therapy involving the wearing of a glove using electrical sensors could help poststroke patients with hand weakness improve their hand dexterity more than an existing stimulation technique, according to a recent study.

In the therapy, developed by researchers at the MetroHealth System, Case Western Reserve University and the Cleveland Functional Electrical Stimulation Center, patients control the stimulation to their weak hand by wearing a glove with sensors on the opposite, unaffected hand.

When the patient opens their unaffected hand, they receive a corresponding amount of stimulation that opens their weak stroke-affected hand. This puts the patient back in control of their hand and enables them to participate in therapy with the assistance of electrical stimulation, notes a media release from the American Heart Association.

The study involved 80 poststroke patients. Half of them used the experimental stroke therapy using the glove, and the other half used a common therapy that uses low levels of electric current to stimulate the paralyzed muscles to open the hand, improve muscle strength, and possibly restore hand function.

Both groups used an electrical stimulator on their own at home for 10 hours a week, plus 3 hours per week practicing hand tasks with an occupational therapist in the lab. Hand function was measured before and after therapy with a standard dexterity test that measured the number of blocks participants can pick up, lift over a barrier, and release in another area on a table within a 60-second period, the release continues.

After reviewing the data, the scientists conclude, per the release, that: Patients who received the new therapy had greater improvement on the dexterity test (4.6 blocks) than the common group (1.8 blocks); and Patients who had the greatest improvements in hand dexterity following the new therapy were less than 2 years poststroke and had at least some finger movement when they started the study. These patients saw an improvement of 9.6 blocks on the dexterity test, compared to 4.1 blocks in the common group.

Further findings include: Patients with no finger movement also saw improvements in arm movement after the new therapy; and At treatment end, 97% of the participants who received the new therapy agreed that they could use their hand better than at the start of the study.

Researchers plan to perform a multi-site study to confirm these findings, as well as to measure quality of life improvements for patients.

They also suggest that the study demonstrates that stroke patients can effectively use technology for self-administered therapy at home.

“Home-based therapy is becoming increasingly important to offset increasing healthcare costs and to meet the need for high doses of therapy that are critical for attaining the best outcomes,” says senior author Jayme S. Knutson, PhD, assistant professor of Physical Medicine and Rehabilitation at Case Western Reserve University School of Medicine in Cleveland, in the release. “The more therapy a patient can get the better potential outcome they will get.”

The study was published recently in Stroke.

Source: Scientists Test Electrical Stimulation Glove As Poststroke Hand Therapy – Rehab Managment

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[Google News] New electrical stimulation therapy…

THURSDAY, Sept. 8, 2016

Comprehensive up-to-date news coverage, aggregated from sources all over the world by Google News.

New electrical stimulation therapy can help stroke patients move paralyzed hand

UPI.com – ‎10 hours ago‎
THURSDAY, Sept. 8, 2016 — A new form of electrical stimulation therapy can help rewire the brain and restore some dexterity to a hand that’s been paralyzed by stroke, a new clinical trial shows. In the experimental therapy, patients use their good

New Electrical Stimulation Therapy Shows Promise Improving Hand Function In Stroke Patients

Tech Times – ‎3 hours ago‎
Stroke survivors typically experience weakness in one hand. Now, researchers are saying that a new electrical stimulation therapy can improve hand function for survivors at a rate better than what current stimulation techniques have to offer

Stroke: Innovative electrical stimulation glove improves hand function

Medical News Today – ‎7 hours ago‎
A novel therapy has been devised for survivors of stroke with hand weakness to help improve hand function through the use of a glove that delivers electrical stimulation. [Closed hand] Hand functionality was significantly more improved in participants

New electrical stimulation therapy may improve hand function after stroke

Science Codex – ‎13 hours ago‎
DALLAS, Sept. 8, 2016 — A new electrical stimulation therapy helped stroke survivors with hand weakness improve hand dexterity more than an existing stimulation technique, according to new research in the American Heart Association’s journal Stroke.

New electrical therapy could help patients move paralyzed hand

Capital Wired – ‎1 hour ago‎
A new electrical therapy could help patients who suffered a stroke to more their paralyzed hand. According to the American Heart Association, this new stimulation helped patients to improve their hand dexterity more than other treatment they have used.

Source: New electrical stimulation therapy…

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[Abstract] Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis.

Abstract

Background: Previous reports have suggested that action observation training (AOT) is beneficial in enhancing the early learning of new motor tasks; however, EEG-based investigation has received little attention for AOT.
Objective: The purpose of this study was to illustrate the effects of AOT on hand dexterity and cortical activation in patients with post-stroke hemiparesis.
Method: Twenty patients with post-stroke hemiparesis were randomly divided into either the experimental group (EG) or control group (CG), with 10 patients in each group. Prior to the execution of motor tasks (carrying wooden blocks from one box to another), subjects in the EG and CG observed a video clip displaying the execution of the same motor task and pictures showing landscapes, respectively. Outcome measures included the box and block test (BBT) to evaluate hand dexterity and EEG-based brain mapping to detect changes in cortical activation.
Results: The BBT scores (EG: 20.50 ± 6.62 at pre-test and 24.40 ± 5.42 at post-test; CG: 20.20 ± 6.12 at pre-test and 20.60 ± 7.17 at post-test) revealed significant main effects for the time and group and significant time-by-group interactions (p < 0.05). For the subjects in the EG, topographical representations obtained with the EEG-based brain mapping system were different in each session of the AOT and remarkable changes occurred from the 2nd session of AOT. Furthermore, the middle frontal gyrus was less active at post-test than at pre-test.
Conclusions: These findings support that AOT may be beneficial in altering cortical activation patterns and hand dexterity.

 

Source: Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis – Topics in Stroke Rehabilitation –

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[ARTICLE] Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial

Abstract

Objective: To assess the effects of additional electrical stimulation to hand muscles combined with repetitive task practice therapy on skilled hand performance in stroke patients.

Design: A randomized controlled study.

Setting: Neurological physical therapy outpatient clinic.

Subjects: Forty stroke patients of both sexes (45-65 years – 16 females and 24 males).

Methods: Participants were randomly assigned into two equal groups: experimental and control groups. All patients received repetitive task practice. Those in the experimental group received additional electrical stimulation for specific hand muscles and patients in the control group received sham electrical stimulation. Treatment was provided three times/week for two months.

Main outcome measures: Patients received baseline and post-treatment assessments using three-dimensional motion analysis (to evaluate range of motion of fingers abduction and extension), motor assessment scale (to assess hand motor function) and time to complete Jebsen Taylor Test (to assess hand skills).

Results: Patients in the experimental group showed a significant improvement as compared with those in the control group. Motor assessment scale score was 4.25±0.63 for the experimental group and 3.35±0.74 for the control group (t=-3.50 and p= 0.0001). Time to complete Jebsen Taylor Test was 180.90±7.04 for the experimental group and 192.80±6.87 for the control group (t=4.50 and p= 0.0001). There was a significant improvement in fingers abduction and extension in both groups (in favor to the experimental group).

Conclusion: Repetitive task practice therapy combined with electrical stimulation can improve skilled hand performance in terms of hand motor function, skills and range of motion in stroke patients.

Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial.

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[ARTICLE] Transcranial Direct Current Stimulation to Primary Motor Area Improves Hand Dexterity and Selective Attention in Chronic Stroke

Abstract

Objective: The aim of this study was to determine whether transcranial direct current stimulation (tDCS) applied to the primary motor hand area modulates hand dexterity and selective attention after stroke.

Design: This study was a double-blind, placebo-controlled, randomized crossover trial involving subjects with chronic stroke. Ten stroke survivors with some pinch strength in the paretic hand received three different tDCS interventions assigned in random order in separate sessions—anodal tDCS targeting the primary motor area of the lesioned hemisphere (M1lesioned), cathodal tDCS applied to the contralateral hemisphere (M1nonlesioned), and sham tDCS—each for 20 mins. The primary outcome measures were Purdue pegboard test scores for hand dexterity and response time in the color-word Stroop test for selective attention. Pinch strength of the paretic hand was the secondary outcome.

Results: Cathodal tDCS to M1nonlesioned significantly improved affected hand dexterity (by 1.1 points on the Purdue pegboard unimanual test, P = 0.014) and selective attention (0.6 secs faster response time on the level 3 Stroop interference test for response inhibition, P = 0.017), but not pinch strength. The outcomes were not improved with anodal tDCS to M1lesioned or sham tDCS.

Conclusions: Twenty minutes of cathodal tDCS to M1nonlesioned can promote both paretic hand dexterity and selective attention in people with chronic stroke.

μέσω Transcranial Direct Current Stimulation to Primary Motor Are… : American Journal of Physical Medicine & Rehabilitation.

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