Posts Tagged Motor function

[Abstract] Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

Highlights

• Sensory function after stroke is a prognostic factor in the achievement of functional performance.

• Sensory stimulation can be helpful technique in the chronic phase of cerebrovascular accident.

• Motor function, ADL, and spasticity can be improved through sensory stimulation.

Abstract

Introduction

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

Purpose of the Study

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

Methods

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

Results

The intervention group made improvement in motor function (P = .0001, Cohen’s d = 2.14), activities of daily living of upper limb (P = .0001, Cohen’s d = 1.32), and spasticity (P = .002, Cohen’s d = −0.94).

Discussion

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

Conclusion

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Source: https://www.sciencedirect.com/science/article/abs/pii/S0894113020300764?dgcid=rss_sd_all

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[ARTICLE] Neurobiology of Recovery of Motor Function after Stroke: The Central Nervous System Biomarker Effects of Constraint-Induced Movement Therapy – Full Text

Abstract

Recovery of motor function after stroke involves many biomarkers. This review attempts to identify the biomarker effects responsible for recovery of motor function following the use of Constraint-Induced Movement Therapy (CIMT) and discuss their implications for research and practice. From the studies reviewed, the biomarker effects identified include improved perfusion of motor areas and brain glucose metabolism; increased expression of proteins, namely, Brain-Derived Neurotrophic Factor (BDNF), Vascular Endothelial Growth Factor (VEGF), and Growth-Associated Protein 43 (GAP-43); and decreased level of Gamma-Aminobutyric Acid (GABA). Others include increased cortical activation, increased motor map size, and decreased interhemispheric inhibition of the ipsilesional hemisphere by the contralesional hemisphere. Interestingly, the biomarker effects correlated well with improved motor function. However, some of the biomarker effects have not yet been investigated in humans, and they require that CIMT starts early on poststroke. In addition, one study seems to suggest the combined use of CIMT with other rehabilitation techniques such as Transcortical Direct Stimulation (tDCs) in patients with chronic stroke to achieve the biomarker effects. Unfortunately, there are few studies in humans that implemented CIMT during early poststroke. Thus, it is important that more studies in humans are carried out to determine the biomarker effects of CIMT especially early on poststroke, when there is a greater opportunity for recovery. Furthermore, it should be noted that these effects are mainly in ischaemic stroke.

1. Introduction

Stroke is a leading cause of long-term disability. It is a neurological deficit due to impaired blood supply to the brain areas caused by ischaemia or haemorrhage or occasionally both [12]. Impaired blood supply to the brain results in a cascade of pathological processes that disrupt neurophysiological mechanisms and expression of Central Nervous System (CNS) biomarkers that eventually cause neuronal cell injury or death. When neuronal cells are injured, they discharge cytotoxic molecules that further injure or damage other apparently healthy neuronal cells [24]. This in turn creates a vicious cycle of cell injury and/or death that cause impairments in brain functions such as motor, sensory, and cognitive functions. Therefore, preventing or reducing the disruption of neurophysiological mechanisms and expression of CNS biomarkers by these pathological processes should be the target of treatment and rehabilitation following stroke. This may help prevent neuronal cell damage, improve neuronal cell homeostasis, and restore functions of the CNS.

One of the most promising rehabilitation techniques used for recovery of motor function after stroke is Constraint-Induced Movement Therapy (CIMT). The CIMT is a technique that comprises of massed task practice with the affected limb, constraint of the unaffected limb, and transfer package [57]. It has been reported to improve the use of limbs in daily activities and improve the quality, quantity, and precision of movement [89]. However, these findings relate to the system or functional level of the nervous system. According to Cohen, to effectively understand the functions of the nervous system, it needs to be studied at the molecular and functional levels, and possibly also at other sublevels between them [10]. Consequently, current evidence has shown that repetitive functional activity or modulation of afferent inputs can induce growth, modification, degradation, and death of neuronal cells which can help the CNS to recover from injury [1112].

In practice, however, understanding the precise biomarkers of the process of recovery after stroke may be difficult due to differences in patients’ presentations and the recovery processes [13]. The aim of this article is to review some of the CNS biomarkers CIMT targets after stroke and their correlations with motor function outcomes in both humans and animals (since animal studies serve as basic foundations for studies in humans). This will help us further understand the biomarkers of motor recovery following stroke, and possibly help researchers and clinicians identify the type of patients CIMT is more suitable for. A biomarker can be a gene, a naturally occurring molecule, or a particular characteristic by which a physiological or pathological process or disease can be identified [14]. It includes imaging biomarkers that are identified using computed tomography, positron emission tomography, transmagnetic stimulation, and magnetic resonance imaging; and molecular biomarkers such as a particular protein or gene expression [1517]. The search engine PubMed was used using the search term Constraint-Induced Movement Therapy. The biomarkers extracted from the CIMT studies obtained from PubMed were further searched on Google Scholar in order to obtain more information. The characteristics of some of the reviewed studies in humans are presented in Table 1.[…]

Continue —-> https://www.hindawi.com/journals/np/2020/9484298/?utm_source=researcher_app&utm_medium=referral&utm_campaign=RESR_MRKT_Researcher_inbound

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[Abstract + References] Sensory interventions on motor function, activities of daily living, and spasticity of the upper limb in people with stroke: A randomized clinical trial

Highlights

  • Sensory function after stroke is a prognostic factor in the achievement of functional performance.
  • Sensory stimulation can be helpful technique in the chronic phase of cerebrovascular accident.
  • Motor function, ADL, and spasticity can be improved through sensory stimulation.

Abstract

Introduction

Stroke is the second cause of death around the world. Motor and sensory problems are common complications of the stroke. These defects in the upper limb cause reduced use of the affected limb and consequently a decrease in the quality of life.

Purpose of the Study

The purpose of this study was to examine the effect of exteroceptive and proprioceptive stimulations on motor function, spasticity of the upper limb, and activities of daily living in people who have had stroke.

Methods

Sixty people with chronic stroke selected by convenience sampling. Before the intervention, Modified Ashworth Scale, Fugl-Meyer assessment of Motor Recovery after Stroke, and Barthel Index were measured and then the intervention phase was started. Exteroceptive and proprioceptive sensory stimulations were performed for 6 weeks. Independent t-test was used to compare groups.

Results

The intervention group made improvement in motor function ( P = .0001, Cohen’s d = 2.14), activities of daily living of upper limb ( P = .0001, Cohen’s d = 1.32), and spasticity ( P = .002, Cohen’s d = −0.94).

Discussion

Motor function and activities of daily living and spasticity of the upper limb can be improved through exteroceptive and proprioceptive stimulations. In this study, this type of intervention had the most impact on motor function compared with the rest.

Conclusion

Exteroceptive and proprioceptive stimulations in upper limb can be used in chronic phase of stroke. Improvement in motor function and activities of daily living and reducing spasticity are the results of these stimulations.

Source: https://www.jhandtherapy.org/article/S0894-1130(20)30076-4/fulltext?rss=yes

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[Abstract] Effects of two different robot-assisted arm training on upper limb motor function and kinematics in chronic stroke survivors: A randomized controlled trial

ABSTRACT

Background

Comparative studies of different robotic types are warranted to tailor robot-assisted upper limb training to patient’s functional level.

Objectives

This study aimed to directly compare the effects of high inertia robot arm (whole arm manipulator, WAM) and low inertia robot arm (Proficio) on upper limb motor function in chronic stroke patients.

Methods

In this randomized controlled trial, 40 chronic stroke survivors were randomized into robot-assisted arm training with WAM (RAT-WAM) and robot-assisted arm training with Proficio (RAT-P) groups. The RAT-WAM and RAT-P groups participated in the robot-assisted arm training with WAM and robot-assisted arm training with Proficio, respectively, for 40 min daily, three times weekly over a four week. Upper limb motor function was measured before and after the intervention using the Fugl–Meyer assessment (FMA), action research arm test, and box and block test (BBT). Curvilinearity ratio (the length ratio of a straight line from the start to the target) was also measured as an index for upper limb kinematic performance.

Results

The RAT-WAM and RAT-P groups showed significant improvements in FMA-total and -proximal (shoulder/elbow units), BBT, and ARAT after the intervention (P < .05). Also, the RAT-P group showed significantly more improvement than the RAT-WAM group in FMA-distal (hand/wrist units) (P < .05).

Conclusions

Improvements of upper limb motor function occurred during robot-assisted arm training with robotic systems. Low inertia robot arm was more effective in improving the motor function of the hand and wrist. The results may be useful for robot-assisted training for upper limb impairment.

Source: https://www.tandfonline.com/doi/full/10.1080/10749357.2020.1804699?needAccess=true

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[Abstract + References] Dynamics of post-stroke hand paresis kinematic pattern during rehabilitation

Abstract

According to the literature data, only 5–20% of post-stroke patients are able to restore the hand motor function completely. Correct goal setting and individual approach to the patient’s functional recovery are important. Our study aimed to develop an algorithm of impaired hand motor functioning assessment for post-stroke patients and to determine the principles of the rehabilitation tactics choosing based on the biomechanical analysis. Twenty five patients with hemispheric stroke and 10 healthy volunteers participated in the study. Formal clinical observation scales (Fugl-Meyer Assessment, Ashworth Scale, ARAT) and video motion analysis were used for evaluation of the hand motor function. Patients were divided into 2 groups according to the hand paresis severity (mild/moderate and pronounced/severe). Rehabilitation was carried out in both groups, including mechanotherapy, massage and physical therapy. It was revealed that in the 1st group of patients the motor function recovery in the paretic hand was due to movement performance recovery: biomechanical parameters restoration directly correlated with a decrease in the paresis degree according to the Fugl-Meyer Assessment Scale (r = 0.94; p = 0.01). In the 2nd group of patients, the motor function recovery in the paretic hand was due to motor deficit compensation: according to biomechanical analysis, the pathological motor synergies inversely correlated with a decrease in the paresis degree (r = –0.9; p = 0.03). As a result of the study, an algorithm for selecting the patient management tactics based on the baseline clinical indicators was developed.

References

via Dynamics of post-stroke hand paresis kinematic pattern during rehabilitation | Request PDF

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[Abstract] Evaluation of upper limb function with digitizing tablet-based tests: reliability and discriminative validity in healthy persons and patients with neurological disorders

Purpose

To evaluate discriminative validity, relative reliability and absolute reliability of four tablet-based tests for the evaluation of upper limb motor function in healthy persons and patients with neurological disorders.

Methods

Cross-sectional study in 54 participants: 29 patients with upper limb movement impairment due to a neurological condition recruited from an inpatient rehabilitation centre and 25 healthy persons. Accuracy, speed and path length were analysed for four tablet-based tests: “Spiral drawings,” “Tapping,” “Follow the dot” and “Trace a star.” The area under the receiver operating characteristic curve (AUC) was used to evaluate discriminative validity. Relative reliability was analysed with the intra-class correlation coefficient (ICC), and absolute reliability by limits of agreement (LoA) and minimal detectable difference (MDD).

Results

All four tests showed excellent discriminative validity for the parameter accuracy (AUC 0.93–0.98). Tapping was the best test for discriminating patients from healthy persons. Test-retest reliability was good for accuracy in all tests (ICC = 0.76–0.88), but poor to moderate for speed and path length (ICC = 0.20–0.69). The MDD varied between 14% and 38%. Performance on the four tablet-based tests was stable between sessions, indicating that there was no learning effect.

Conclusion

The parameter accuracy showed excellent discriminative validity and reliability in all four tablet-based tests. Discriminative validity was excellent for all three parameters in the Tapping test. In the other tasks speed showed good to poor reliability, while the reliability of path-length was poor in all tasks. Results were comparable for the dominant and non-dominant hand. Tablet-based tests have the advantage that patients can use them for self-monitoring of upper limb motor function.

  • Implications for rehabilitation

  • Four tablet-based tests for the assessment of upper limb motor function in patients with upper limb neurological dysfunction were evaluated: “Spiral drawings”, “Tapping”, “Follow the dot” and “Trace a star”. The parameter accuracy in these four tests had excellent discriminative validity and good reliability.

  • Patients can perform the tests independently at home for self-monitoring of progress. This may increase patients’ motivation to exercise at home.

  • The results can be sent to physicians, enabling the earlier detection of deterioration, which may require medical attention.

via Evaluation of upper limb function with digitizing tablet-based tests: reliability and discriminative validity in healthy persons and patients with neurological disorders: Disability and Rehabilitation: Vol 0, No 0

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[Abstract] Effects of Acupuncture Treatment on Lower Limb Spasticity in Patients Following Hemorrhagic Stroke: A Pilot Study

Abstract

Background and purpose: Lower limb spasticity is often a significant problem in stoke rehabilitation. The purpose of this study was to investigate the effects of acupuncture treatment on lower limb spasticity in patients following hemorrhagic stroke.

Methods: Fifty-nine patients following hemorrhagic stroke were randomized to receive acupuncture treatment combined with conventional treatment (treatment group [TG]) or conventional treatment only (control group [CG]). Acupuncture treatments were given in 24 sessions over 4 weeks. Blinded evaluation was based on Modified Ashworth Scale (MAS), short intracortical inhibition (SICI), and Hmax/Mmax ratio as the primary outcomes. In addition, Fugl-Meyer Assessment (FMA), Barthel Index (BI), motor evoked potential (MEP) and surface integrated electromyogram (IEMG) were employed as the secondary outcomes. All the evaluations were performed at 14 and 28 days after the start of the treatment.

Results: Compared with the CG, the TG showed a significantly greater over-time decrease in MAS for knee (p = 0.022) and ankle (p = 0.017), SICI (p = 0.000) and Hmax/Mmax ratio (p = 0.000). In all patients of TG, we found a greater improvement in lower-limb FMA and MEP but not in BI. IEMG show that TG obtained a greater reduction in spastic agonist muscles and a greater enhancement in spastic antagonist muscles. A significant correlation between a greater decrease in ankle MAS and a greater increase in SICI for spastic muscles was found (r = 0.390, p = 0.002).

Conclusions: Acupuncture could improve the lower limb spasticity and motor function, thus providing a safe and economical approach for treating stroke patients. The potential mechanism underpinning the greater improvement may be attributed to a reshape of corticospinal plasticity induced by acupuncture.

via Effects of Acupuncture Treatment on Lower Limb Spasticity in Patients Following Hemorrhagic Stroke: A Pilot Study – PubMed

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[Abstract] Hyperbaric Oxygen and Focused Rehabilitation Program: A Feasibility Study in Improving Upper Limb Motor Function After Stroke

ABSTRACT

Neuroplasticity and recovery after stroke can be enhanced by a rehabilitation program pertinent to upper limb motor function exercise and mental imagery (EMI) as well as hyperbaric oxygen therapy (HBOT).

We assessed the feasibility and safety of the combined approach utilizing both HBOT and EMI, and derived preliminary estimates of its efficacy. In this randomized controlled trial, twenty-seven patients with upper extremity hemiparesis 3-48 months after stroke were randomized to receive either a complementary rehabilitation program HBOT-EMI (intervention group), or EMI alone (control group).

Feasibility and safety were assessed as total session attendance, duration of sessions, attrition rates, missing data, and intervention-related adverse events. Secondary clinical outcomes were assessed with both objective tools and self-reported measures at baseline, 8 weeks (end of treatment), and 12-weeks follow-up. Session attendance, duration and attrition rate did not differ between the groups; there were no serious adverse events.

Compared to baseline, there were significant sustained improvements of objective and subjective outcomes’ measures in the intervention group, and a single improvement in an objective measure in the control group. Between-group outcome comparisons were not statistically significant.

This study demonstrated that the combination HBOT-EMI was a safe and feasible approach in patients recovering from chronic stroke. There were also trends for improved motor function of the affected upper limb after the treatments.

Registration-URL:https://www.clinicaltrials.com NCT02666469. NOVELTY: – HBOT combined with an upper limb exercise and mental imagery rehabilitation program is feasible and safe in chronic stroke patients. – This combined approach showed trends for improved functional recovery.

via Hyperbaric Oxygen and Focused Rehabilitation Program: A Feasibility Study in Improving Upper Limb Motor Function After Stroke. – Applied Physiology, Nutrition, and Metabolism

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[synopsis] Upper limb post-stroke telerehabilitation is not inferior to in-clinic rehabilitation

Question: Does home-based telerehabilitation to improve arm movements have comparable efficacy to dose-matched in-clinic rehabilitation for people with stroke?

Design: Randomised controlled non-inferiority trial with concealed allocation and blinded outcome assessment.

Setting: Eleven sites in the National Institutes of Health StrokeNet clinical trials network in the United States.

Participants: Adults within 4 to 36 weeks of ischaemic or haemorrhagic stroke who had mild-to-severe upper limb deficits without major deficits in mood or cognition. Randomisation of 124 participants allocated 62 to home-based telerehabilitation and 62 to in-clinic rehabilitation.

Interventions: Both groups received 18 supervised and 18 unsupervised 70-minute sessions over 6 to 8 weeks, comprising arm exercises (based on the principles of task-specific training and the Accelerated Skill Acquisition Program), functional training and stroke education. The in-clinic group had supervised sessions at the research centre and performed unsupervised exercise sessions at home with an individualised exercise booklet. The home-based telerehabilitation group used videoconferencing for the supervised sessions. For this group, exercises were presented on the computer screen for both supervised and unsupervised sessions, and functional games were used for functional training.

Outcome measures: The primary outcome was change in Fugl-Meyer upper extremity score from baseline to 4 weeks after intervention. Secondary outcomes were change in Box and Block Test, hand domain of the Stroke Impact Scale, stroke knowledge, and enjoyment of the rehabilitation program.

Results: A total of 114 participants completed the study but intention-to-treat analysis with multiple imputation for missing data analysed all randomised participants. Participants were adherent to more than 93% of therapy sessions in each group. The adjusted mean change in Fugl-Meyer score was 0.06 points (95% CI −2.14 to 2.26) greater in the telerehabilitation group compared with the in-clinic group. The non-inferiority margin was 2.47 points and fell outside the 95% CI, indicating that telerehabilitation is not inferior to in-clinic care. Non-inferiority was also demonstrated in the Box and Block Test but not the Stroke Impact Scale, in which the in-clinic group demonstrated a larger improvement. Both groups improved stroke knowledge after treatment. The in-clinic group reported greater enjoyment and satisfaction.

Conclusion: Upper extremity rehabilitation provided by telerehabilitation is not inferior to the same intervention provided in the clinic for improving arm motor function after stroke, but may not be satisfying or enjoyable for participants.

via Critically appraised paper: Upper limb post-stroke telerehabilitation is not inferior to in-clinic rehabilitation [synopsis] – ScienceDirect

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[WEB PAGE] MyoPro Delivers Meaningful Motor Function Improvements, Per Case Study

MyoPro Delivers Meaningful Motor Function Improvements, Per Case Study

A case report measuring the benefits of Myomo Inc’s MyoPro myoelectric orthosis, published recently in the Journal of Rehabilitation and Assistive Technologies Engineering, suggests that, “Despite long-standing traumatic brain injury, meaningful improvements in motor function were observed.”

Researchers studied a 42-year-old female, 29.5 years post-traumatic brain injury with diminished motor control/coordination and learned nonuse of the right arm. The research consisted of 9 weeks of in-clinic training followed by 9 weeks of at-home use.


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“During in-clinic training, active range of motion, tone, muscle power, Fugl-Meyer, box and blocks test, and Chedoke assessment score improved. During the home-use phase, decrease in tone was maintained and all other outcomes declined but were still better upon study completion than baseline,” the researchers write, according to a media release from Myomo Inc.

“This individual had a very limited use of her arm before intervention with the device. In addition to the therapeutic benefits we measured, the patient’s caregivers reported functional improvement in her home setting. It is very heartwarming to see these improvements in a person even this many years after injury. This research is continuing now with a larger population of patients.”

— lead author Svetlana Pundik, MD, MSc, Brain Plasticity and Neuro Recovery Laboratory, Louis Stokes Cleveland VA Medical Center

“MyoPro not only extends the limited therapy time available in the clinic to continue in the home, it may also restore a person’s ability to perform activities of daily living such as feeding one’s self and performing light household tasks. As a result, users see an improved quality of life, some may return to work, and they may reduce their overall healthcare costs.”

— Paul R. Gudonis, Myomo CEO

The study was funded by the US Department of Defense through an award to Dr Stefania Fatone at the Northwestern University Feinberg School of Medicine in Chicago and was conducted by a research team at the Louis Stokes Cleveland VA Medical Center led by Dr Svetlana Pundik.

Myomo Inc is a wearable medical robotics company that offers increased functionality for those suffering from neurological disorders and upper-limb paralysis.

[Source(s): Myomo Inc, Business Wire]

via MyoPro Delivers Meaningful Motor Function Improvements, Per Case Study – Rehab Managment

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