Posts Tagged Motor dysfunction

[Abstract] Peripheral plus central repetitive transcranial magnetic stimulation (rTMS) for upper limb motor rehabilitation in chronic stroke – A case report

Introduction/Background

Motor dysfunction of the hand and upper limb is a major cause of physical disability for patients with chronic stroke. Our aim was to investigate the effectiveness of a peripheral plus central repetitive transcranial magnetic stimulation (rTMS) treatment for upper limb motor rehabilitation in chronic stroke patients.

Material and method

We reported the case of a patient WLX, who had one ischemic stroke more than 3 years ago, and had underwent intermittent rehabilitation since then. He still had profound right upper limb paralysis and moderate spasm, accompanied with non-fluent aphasia when came to our department; and complained that his recovery had been rather slow for about two years. In addition to the custom rehabilitation, we applied a peripheral plus central rTMS paradigm to him, which included 3 sessions of peripheral magnetic stimulation to his paralyzed right forearm, followed by a session of high frequency rTMS to the bilateral sensorimotor cortex region. The total magnetic stimulation therapy lasted about 30 min a day, and was applied 5 days/week for 4 weeks.

Results

After 4 weeks’ treatment, the patient’s Fulg–Meyer upper limb assessment (FMA) score was obviously improved (from 27 to 37 points), and the spasm was largely relieved in his right hand and arm.

Conclusion

Peripheral plus central rTMS might be an effective treatment for motor dysfunction of chronic stroke patients.

via Peripheral plus central repetitive transcranial magnetic stimulation (rTMS) for upper limb motor rehabilitation in chronic stroke – A case report – ScienceDirect

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[ARTICLE] Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis

Abstract

To conduct a meta-analysis of clinical trials that examined the effect of music-supported therapy on stroke-induced motor dysfunction, comprehensive literature searches of PubMed, Embase and the Cochrane Library from their inception to April 2016 were performed. A total of 10 studies (13 analyses, 358 subjects) were included; all had acceptable quality according to PEDro scale score. The baseline differences between the two groups were confirmed to be comparable. Compared with the control group, the standardized mean difference of 9-Hole Peg Test was 0.28 (−0.01, 0.57), 0.64 (0.31, 0.97) in Box and Block Test, 0.47 (0.08, 0.87) in Arm Paresis Score and 0.35 (−0.04, 0.75) in Action Research Arm Test for upper-limb motor function, 0.11 (−0.24, 0.46) in Berg Balance Scale score, 0.09 (−0.36, 0.54) in Fugl-Meyer Assessment score, 0.30 (−0.15, 0.74) in Wolf Motor Function Test, 0.30 (−0.15, 0.74) in Wolf Motor Function time, 0.65 (0.14, 1.16) in Stride length and 0.62 (0.01, 1.24) in Gait Velocity for total motor function, and 1.75 (0.94, 2.56) in Frontal Assessment Battery score for executive function. There was evidence of a positive effect of music-supported therapy, supporting its use for the treatment of stroke-induced motor dysfunction. This study was registered at PRESPERO (CRD42016037106).

Introduction

Stroke is a multifaceted and complicated condition. Stroke disease is one of the major causes of long-term disability and one of the leading causes of death worldwide1,2. The time frequency and functional source analysis of the signals facilitate the quantification of the functional changes occurring in the brain in association with motor tasks after stroke and the detection of damage to neuro-motor functioning3. The personal burden of being a stroke survivor is often devastating and has major consequences for the patient’s quality of life4. Rehabilitation of upper-limb motor dysfunction and total motor dysfunction have been revealed to improve the quality of life of patients after stroke5 and are safe and effective methods for restoring social and occupational functioning.

Motor dysfunction therapy relies on both pharmacological6 and non-pharmacological treatments7. Currently, pharmacological therapy is essentially symptomatic and does not have a satisfactory impact on symptoms related to the progression of neurodegenerative diseases. Therefore, several health institutions recommend the development of non-pharmacological complementary interventions as a first-line treatment. For example, intensive motor therapy can improve important motor functions. However, the effectiveness of standard physiotherapeutic approaches in stroke rehabilitation has been found to be limited8. In the human brain, one of the most powerful sources of auditory stimulation is provided by music9. As a result, more attention has been given to the effectiveness of non-pharmacological approaches in dysfunction therapy, including a growing interest in music therapy and music-based stimulation10.

The power of music and its nonverbal nature make it an effective medium of communication when language is diminished or abolished, though the curative effect of music is still uncertain. Music easily elicits movement, stimulating interactions between perception and action systems11. Thus, music-making may be an effective way to induce plastic changes in the motor system. Music-supported therapy is a prospective new series of therapy programs, and comprehensive research suggests that it could be useful because of its promotion of relaxation and of cognitive and motor improvement in post-stroke rehabilitation12. Therefore, music-supported therapy has been developed with the aim of improving motor recovery after stroke. The definition of music-supported therapy is not only hearing the music but also singing and playing rhythm and percussion instruments and is based on four principles: (i) massive repetition and exercising of simple finger and arm movements; (ii) auditory-motor coupling and integration and reinforcement of motor effects due to immediate auditory feedback; (iii) shaping and adapting the training according to individual progress; and (iv) emotion-motivation effects due to the playfulness and emotional impact of music and the acquisition of a new skill13. Music-supported therapy may involve, for example, rhythmic auditory stimulation14, the use of a MusicGlove15 or listening to CDs16. However, the differences between these music-supported techniques have not been comprehensively considered.

Music-supported therapy has been shown to be effective in post-stroke rehabilitation of motor function in some clinical trials14,15,16,17,18,19,20,21,22,23. However, little research has focused on the potential therapeutic mechanisms by which music-supported therapy improves the motor functions of post-stroke patients. Although many researchers suggest that improvement induced by music-supported therapy is due to the combined effects of intensive repetitive practice and musical stimulation21, evidence to support these propositions has been unavailable. To explore the isolated effect of music further, we designed a systematic review on the effect of music-supported therapy on the recovery of upper-limb motor function and total motor function after stroke. No previous reviews have provided a comprehensive overview with meta-analyses.

Continue —> Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis : Scientific Reports

Figure 1: Flow of studies through the review process for systematic review and meta-analysis.

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[ARTICLE] Effects of Neuromuscular Electrical Stimulation (NMES) on Hand Function in Stroke Patients

Abstract

Background

Motor dysfunction after stroke is a major reason which disables a person in performing activities of daily living (ADL). During the process of natural recovery affected upper limb and lower limb recovers but recovery of the hand function often remains incomplete and can lead to a major disability for a person. A lot of treatment options are available to solve this problem and NMES appears to be a promising and easily available among them.

Objective

To assess the effectiveness of NMES along with Conventional Physiotherapy on Hand Function rehabilitation in Stroke Patients.

Methodology

30 (thirty) patients were divided in a consecutive manner into two groups for the study; one group received conventional treatment (Control Group) and other for conventional treatment as well as NMES to wrist and finger extensors (Experimental group). An assessment was done prior to starting of treatment and after 4 weeks of treatment.

Results

At the end of 4 weeks experimental group showed significant improvement in Block to Box Test (p<0.05), Fugl Meyer Assessment Tool for Wrist and Hand (p<0.05) and Grip Strength (p0.05).

Conclusion

Conventional exercise therapy and NMES to wrist and finger extensors is more effective than Conventional exercise therapy alone in improving hand function in stroke patients.

via Indian Journals.

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