Posts Tagged motor impairment
[ARTICLE] Hemispheric asymmetry in myelin after stroke is related to motor impairment and function – Full Text
The relationships between impairment, function, arm use and underlying brain structure following stroke remain unclear. Although diffusion weighted imaging is useful in broadly assessing white matter structure, it has limited utility in identifying specific underlying neurobiological components, such as myelin. The purpose of the present study was to explore relationships between myelination and impairment, function and activity in individuals with chronic stroke. Assessments of paretic upper-extremity impairment and function were administered, and 72-hour accelerometer based activity monitoring was conducted on 19 individuals with chronic stroke. Participants completed a magnetic resonance imaging protocol that included a high resolution T1 anatomical scan and a multi-component T2 relaxation imaging scan to quantify myelin water fraction (MWF). MWF was automatically parcellated from pre- and post-central subcortical regions of interest and quantified as an asymmetry ratio (contralesional/ipsilesional). Cluster analysis was used to group more and less impaired individuals based on Fugl-Meyer upper extremity scores. A significantly higher precentral MWF asymmetry ratio was found in the more impaired group compared to the less impaired group (p < 0.001). There were no relationships between MWF asymmetry ratio and upper-limb use. Stepwise multiple linear regression identified precentral MWF asymmetry as the only variable to significantly predict impairment and motor function in the upper extremity (UE). These results suggest that asymmetric myelination in a motor specific brain area is a significant predictor of upper-extremity impairment and function in individuals with chronic stroke. As such, myelination may be utilized as a more specific marker of the neurobiological changes that predict long term impairment and recovery from stroke.
Improved medical management of stroke has resulted in decreasing mortality rates (Grefkes and Ward, 2014). As a result, the number of individuals living with long-term disability as a result of stroke is rising (Krueger et al., 2015). Due to the heterogeneity of clinical presentation following stroke, it is imperative to identify biomarkers that may predict long-term impairment and function in order to appropriately individualize clinical rehabilitation goals and objectives (Bernhardt et al., 2016). With advances in diagnostic and prognostic tools, it is necessary to isolate modalities that can predict long-term outcomes for individuals with stroke, and to understand the underlying neurobiology that contributes to the predictive value of those measures.
Neuroimaging can be utilized to aid in the identification of biomarkers that may predict recovery status in individuals with stroke. White matter imaging is often used as a predictor of stroke recovery (Feng et al., 2015 and Stinear et al., 2012). Diffusion tensor imaging (DTI) can be performed within 10 days post stroke to quantify initial post stroke structural degeneration (Werring, 2000). Such indices have been found to strongly predict upper-extremity motor function at both 3- and 6-months post stroke (Puig et al., 2010 and Stinear et al., 2012). The combination of acute corticomotor function, derived from DTI and motor evoked potentials, using transcranial magnetic stimulation, has also been demonstrated to strongly predict recovery from upper-extremity impairment after stroke (Byblow et al., 2015). Although these modalities are predictive of long-term upper-extremity impairment, the underlying neurobiological bases driving the relationship between white matter microstructure and motor capacity remains unclear. Although relationships between white matter integrity, quantified with DTI, and motor impairment have been established after stroke, it is important to note that DTI measures are not a specific marker for myelination (Arshad et al., 2016). While DTI can grossly identify water movement, it is unable to differentiate between individual white matter substrates, which may produce the observed signal. Multiple structural features can be individually or collectively responsible for the observed changes in DTI measures, including: 1) axonal membrane status, 2) myelin sheath thickness, 3) number of intracellular neurofilaments and microtubules, and 4) axonal packing density (Alexander et al., 2007 and Beaulieu, 2002). To understand the neurobiological components contributing to the change in motor outcome observed there is a need to adopt neuroimaging techniques that can quantify these structural features.
Myelin formation has been identified as a specific target for therapeutic intervention following stroke, as recovery of axonal fibres is not complete without adequate myelination (Mifsud et al., 2014). Oligodendrocytes are responsible for initiating a cascade of events that result in the formation of myelin. Acute cerebral ischemia, such as that caused by a stroke, causes a rapid breakdown of oligodendrocytes and demyelination (Tekkök and Goldberg, 2001), which greatly limits overall axonal integrity in the lesioned area (Saab and Nave, 2016). Although animal work has underlined the importance of active myelination on motor recovery after stroke (Chida et al., 2011 and McKenzie et al., 2014), it is unclear how these findings transfer to humans.
Until recently, technical limitations prevented the imaging of myelin in vivo. Myelin water fraction (MWF) can be derived in humans non-invasively in vivo from multi-component T2-relaxation imaging (Alonso-Ortiz et al., 2014 and Prasloski et al., 2012b). Formalin-fixed human brains yield T2 distributions similar to those found in vivo, and histopathological studies show strong correlations between MWF and staining for myelin (Laule et al., 2004 and Moore et al., 2000). With the development of non-invasive imaging techniques, myelin can be quantified in the human brain (Prasloski et al., 2012b), both cross-sectionally and longitudinally (Lakhani et al., 2016) Work form the Human Connectome Project and others have identified that the primary motor and sensory regions are among the most densely myelinated and most easily delineated in the human brain, allowing for more reliable automatic identification and parcellation of myelinated regions (Glasser et al., 2016, Glasser and Van Essen, 2011 and Nieuwenhuys and Broere, 2016). In addition, myelination of corticospinal projections from these regions may vary based on the length of the tract and the size the axon. As such, quantification of corticospinal tract (CST) myelin using in vivo neuroimaging has not been validated to date (Glasser and Van Essen, 2011). Previous work from our group did not reveal a relationship between ipsi- and contralesional CST MWF, measured from the posterior limb of the internal capsule, and motor function or impairment (Borich et al., 2013). In order to limit variability arising from CST tract heterogeneity between individuals with stroke, the current study focused on the most well defined, myelinated regions of interest, located in precentral and postcentral areas.
Recent work has demonstrated that oligodendrocyte precursor cell proliferation and myelin structure are associated with motor learning in rodent models (Gibson et al., 2014 and Xiao et al., 2016). In particular, this work emphasized the possibility that functional motor activity may influence myelination of redundant neural pathways and improve conduction velocity via more efficient neural synchrony (Fields, 2015). The current study will extend previous lines of inquiry by exploring the relationship between real-world activity in the upper-extremity to myelination in humans. The ability to use the stroke-affected upper-limb in ‘everyday tasks’ is cited as a primary goal for individuals living with stroke (Barker and Brauer, 2005 and Barker et al., 2007). Monitoring upper-extremity usage after stroke using accelerometers is a low-cost, non-invasive way to measure functional activity and to quantify overall real-world activity (Hayward et al., 2015). Use of the stroke affected upper-limb correlates with long-term motor impairment as greater activity generally results in reduced impairment (Gebruers et al., 2014, Lang et al., 2007 and Shim et al., 2014). Identifying relationships between accelerometer based measures of activity and myelination will inform future investigations about the potential specificity of myelin as predictive biomarker for understanding what people can do, via measurement of impairment and function, versus what people actually do in the real-world.
Given the important relationships between white matter, activity and post-stroke impairment as well as the recent advances in imagining techniques, it is imperative to consider the contribution of myelination to post-stroke impairment, function and activity in humans. In order to identify potential differences in myelination based on the level of impairment after stroke, the current study identified ‘more impaired (M)’ and ‘less impaired (L)’ groups of participants. Therefore, the primary objective of the current investigation is to understand whether MWF in sensorimotor regions of interest is a biomarker of long term impairment, function or arm use in a population of individuals living with chronic stroke. Furthermore, we sought to identify if there were differences in MWF in sensorimotor regions of interest between individuals classified as ‘more impaired’ versus those who were ‘less impaired’.
Background and Objective: Stroke rehabilitation assumes motor learning contributes to motor recovery, yet motor learning in stroke has received little systematic investigation. Here we aimed to illustrate that despite matching levels of performance on a task, a trained patient should not be considered equal to an untrained patient with less impairment. Methods: We examined motor learning in healthy control participants and groups of stroke survivors with mild-to-moderate or moderate-to-severe motor impairment. Participants performed a series of isometric contractions of the elbow flexors to navigate an on-screen cursor to different targets, and trained to perform this task over a 4-day period. The speed-accuracy trade-off function (SAF) was assessed for each group, controlling for differences in self-selected movement speeds between individuals. Results: The initial SAF for each group was proportional to their impairment. All groups were able to improve their performance through skill acquisition. Interestingly, training led the moderate-to-severe group to match the untrained (baseline) performance of the mild-to-moderate group, while the trained mild-to-moderate group matched the untrained (baseline) performance of the controls. Critically, this did not make the two groups equivalent; they differed in their capacity to improve beyond this matched performance level. Specifically, the trained groups had reached a plateau, while the untrained groups had not. Conclusions: Despite matching levels of performance on a task, a trained patient is not equal to an untrained patient with less impairment. This has important implications for decisions both on the focus of rehabilitation efforts for chronic stroke, as well as for returning to work and other activities.
Stroke is a leading cause of adult disability, leaving 30% to 66% of patients with lasting motor impairment.1,2 It has long been proposed that motor recovery following stroke is a form of relearning3,4 and that there is considerable overlap between the brain regions involved in both processes.5–7 However, while acquiring skill at a task may allow a patient to perform at the same level as an individual with lesser impairment, this does not necessarily make them equal. For example, well-recovered stroke patients can match the performance of healthy controls on a motor task, but differences exist in the neural networks that underlie performance for each group.8 Furthermore, matched performance does not necessarily imply that both groups have the same ability to continue improving given the opportunity for practice. These differences can complicate judgments regarding patients’ capacity to return to work and other activities,9 and which rehabilitation activities they should focus on. In this article, we propose that acquiring skill through motor training raises a similar issue—a patient who has trained on a task may “appear better,” masking categorical differences in his or her abilities. Consider two hypothetical patients—Patient A, who has mild motor impairment, and Patient B, who is more severely impaired. Patient A performs better in a movement task than Patient B. Patient B then trains at the task, reaching the same performance level as Patient A. If Patient B is now equal to Patient A, he or she should have a similar capacity for further improvement with training. If this is not the case (eg, if Patient B has reached a performance plateau beyond which further training has a limited effect), then a categorical difference remains between these patients despite their matching task performance.
In comparison to healthy individuals, stroke patients select slower voluntary movement speeds when performing movement tasks.10 As speed and accuracy are inherently linked,11 a confound arises when comparing the accuracy of movements performed at different speeds. This limitation makes it difficult to interpret previous results, such as cases where patients improve their accuracy yet decrease their speed.12 In such cases, it is impossible to determine whether a patient improved his or her ability to perform the task (through skill acquisition) or whether he or she simply changed the aspect of performance on which they focused (eg, sacrificed speed for accuracy while remaining at the same overall level of ability). The only way to disambiguate these alternatives is to first derive the speed-accuracy trade-off function (SAF13) for a given task; participants are required to complete the task in a fixed time, allowing accuracy to be measured without the confounding effects of differences in speed. Once derived, skill represents a shift in the SAF.13–15
Here we introduce a serial voluntary isometric elbow force task, a modified version of the serial voluntary isometric pinch task (SVIPT). This task is based on an established laboratory-based model of motor learning in which participants learn to control a cursor by producing isometric forces.13–19 In the task used in the present study, participants controlled a cursor by exerting forces with their elbow flexor muscles, allowing comparisons of performance across participants with greater ranges of impairment than would be possible with the standard (hand controlled) SVIPT paradigm. To control for differences in movement speeds across groups, performance was assessed by comparing the speed-accuracy trade-off pre and post training, using measures of task-level performance (ie, binary success/failure to complete all specified aspects of the task)13–18 and trial-level measures of endpoint error and variability.20 We predicted that the severity of a participant’s motor impairment would limit his or her ability to perform the task and that training may allow him or her to achieve a similar level of performance as an individual with lesser impairment. However, we hypothesized that despite their matching performance, there would be a categorical difference between these individuals; the previously untrained participant with lesser impairment would be able to make large, rapid improvements through training, while the trained participant would not.
[Abstract] Motor Learning in Stroke. Trained Patients Are Not Equal to Untrained Patients With Less Impairment
Background and Objective: Stroke rehabilitation assumes motor learning contributes to motor recovery, yet motor learning in stroke has received little systematic investigation. Here we aimed to illustrate that despite matching levels of performance on a task, a trained patient should not be considered equal to an untrained patient with less impairment.
Methods: We examined motor learning in healthy control participants and groups of stroke survivors with mild-to-moderate or moderate-to-severe motor impairment. Participants performed a series of isometric contractions of the elbow flexors to navigate an on-screen cursor to different targets, and trained to perform this task over a 4-day period. The speed-accuracy trade-off function (SAF) was assessed for each group, controlling for differences in self-selected movement speeds between individuals.
Results: The initial SAF for each group was proportional to their impairment. All groups were able to improve their performance through skill acquisition. Interestingly, training led the moderate-to-severe group to match the untrained (baseline) performance of the mild-to-moderate group, while the trained mild-to-moderate group matched the untrained (baseline) performance of the controls. Critically, this did not make the two groups equivalent; they differed in their capacity to improve beyond this matched performance level. Specifically, the trained groups had reached a plateau, while the untrained groups had not.
Conclusions: Despite matching levels of performance on a task, a trained patient is not equal to an untrained patient with less impairment. This has important implications for decisions both on the focus of rehabilitation efforts for chronic stroke, as well as for returning to work and other activities.
Source: Motor Learning in Stroke
[Abstract] Plasticity and Reorganization in the Rehabilitation of Stroke. The Constraint-Induced Movement Therapy (CIMT) Example
Abstract. This paper outlines some actual developments in the behavioral treatment and rehabilitation of stroke and other brain injuries in post-acute and chronic conditions of brain lesion. It points to a number of processes that demonstrate the enormous plasticity and reorganization capacity of the human brain following brain lesion. It also highlights a series of behavioral and neuroscientific studies that indicate that successful behavioral rehabilitation is paralleled by plastic changes of brain structures and by cortical reorganization and that the amount of such plastic changes is obviously significantly determining the overall outcome of rehabilitation.
Lead study author Dr. Gary Steinberg, professor and chair of neurology at Stanford University School of Medicine in Palo Alto, CA, and colleagues publish their findings in the journal Stroke.
While the trial only included a small number of strokeparticipants, the results have been met with much positivity, with some health experts claiming the findings could lead to “life-changing treatments” for stroke patients.
In the United States each year, more than 795,000 people have a new or recurrent stroke.
Ischemic stroke is the most common form, accounting for around 87 percent of all strokes. It occurs when the flow of oxygen-rich blood to the brain becomes blocked, primarily due to blood clots.
Hemorrhagic stroke accounts for around 13 percent of all strokes, arising from leaking or ruptured blood vessels in the brain.
Exactly how stroke affects a person is dependent on what side of the brain it occurs and the amount of damage it causes. Some individuals may experience temporary arm or leg weakness, for example, while others may lose the ability to speak or walk.
According to the National Stroke Association, around 2 in every 3 stroke survivors will have some form of disability, and stroke is the leading cause of disability among American adults.
There are treatments available for stroke, such as tissue plasminogen activator (tPA) – considered the “gold standard” treatment for ischemic stroke. It works by dissolving the blood clot that is blocking blood flow to the brain.
However, tPA needs to be administered within hours of stroke occurrence, in order to maximize the likelihood of recovery – a time period that Dr. Steinberg and colleagues note is often exceeded by the time it takes for a patient to arrive at the hospital.
If the treatment is not received in time, the chance of a full recovery from stroke is small. But in the new study, researchers found stem cell transplantation improved patients’ recovery when administered up to 3 years after stroke.
For more Visit Site —> Stroke patients able to walk again after stem cell transplant – Medical News Today
[ARTICLE] Stroke Treatment Associated with Rehabilitation Therapy and Transcranial DC Stimulation (START-tDCS): a study protocol for a randomized controlled trial – Full Text HTML/PDF
Traditional treatment for motor impairment after stroke includes medication and physical rehabilitation. The transcranial direct current stimulation associated with a standard physical therapy program may be an effective therapeutic alternative for these patients.
This study is a sham-controlled, double-blind, randomized clinical trial aiming to evaluate the efficacy of transcranial direct current stimulation in activities of daily living and motor function post subacute stroke. In total there will be 40 patients enrolled, diagnosed with subacute, ischemic, unilateral, non-recurring stroke. Participants will be randomized to two groups, one with active stimulation and the other with a placebo current. Patients and investigators will be blinded. Everyone will receive systematic physical therapy, based on constraint-induced movement therapy. The intervention will be applied for 10 consecutive days. Patients will undergo three functional assessments: at baseline, week 2, and week 4. Neuropsychological tests will be performed at baseline and week 4. Adverse effects will be computed at each session. On completion of the baseline measures, randomization will be conducted using random permuted blocks. The randomization will be concealed until group allocation.
This study will investigate the combined effects of transcranial direct current stimulation and physical therapy on functional improvement after stroke. We tested whether the combination of these treatments is more effective than physical therapy alone when administered in the early stages after stroke.
A stroke is defined as an acute neurological dysfunction of vascular origin, with sudden development of clinical signs of brain function disorders, lasting more than 24 h .
In this sense, new therapeutic modalities have been developed for monitoring patients after a stroke . Simis et al.  conducted a placebo-controlled clinical trial and found that transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) can cause increased hand motor function compared to placebo stimulation. TMS has been used to minimize the limitations post stroke, such as functional independence and motor recovery , , but it is not portable/mobile and is expensive. In contrast, tDCS offers some advantages compared to TMS, being portable, more economical, and easy to operate. The effects are polarity-dependent, leading to an increase or a decrease in cortical excitability . Although some studies have shown that increasing the current intensity is related to more robust effects , this is also true for adverse effects such as headache and discomfort under the electrode . Therefore, the maximum current intensity used is generally 2 mA, and the cortex density varies between 0.029 and 0.08 mA/cm 2. Animal studies with a higher current density of 25 mA/cm 2 did not induce lesions in the brain tissue, meaning that limits well above those applied in humans did not result in potential adverse effects , thereby demonstrating that it is a safe technique.
There is evidence that repeated sessions of tDCS may be associated with a longer duration of the behavioral effects . Monte-Silva et al.  demonstrated that the interval between the sessions can be critical to performance. The authors found that when an extra session of tDCS is applied for 1 hour after the first session, the effects last for a longer time (120 minutes) compared to the effect of only one or two consecutive sessions, while an extra session of tDCS applied beyond that period (that is, 3 hours) did not influence the effect of the first session. These findings show that studies with the aim of achieving lasting effects should consider the timing-dependent plasticity stimulation regulation in the human motor cortex .
Regarding physical therapy, different approaches can be found for motor recovery, such as mirror therapy , repetitive task practice , and robotic training . However, the type of training that is combined with stimulation determines how generalizable the benefits would be. Improvements are specific for tasks that are strategically paired with stimulation .
In this perspective, efforts are currently being made to standardize the application of the methods that can be combined with tDCS for the treatment of stroke. Bolognini et al.  developed a placebo-controlled trial to investigate the neuropsychological and behavioral effects of bihemispheric tDCS (cathodic stimulation in the unaffected hemisphere and anode in the affected cortex) combined with a standard physical therapy program called constraint-induced movement therapy (CIMT) . The data show that CIMT applied alone only seems to be effective in modulating cortical excitability, but is not able to restore the balance of transcallosal inhibition. According to the authors, bihemispheric tDCS can already achieve this goal and promote greater functional recovery. Studies show that CIMT is associated with functional improvement in acute and subacute stages of stroke –. Although most studies in neurostimulation therapy involve post-stroke patient monitoring for short periods , , longitudinal studies would clarify the action mechanisms and the effective duration of this association (tDCS plus CIMT) from the early stages of stroke.
The effectiveness of stroke interventions is often described by measures of disability, or functional assessment. Evaluations that deal with activities of daily living (ADLs) generally include the Functional Independence Measure, the Katz index and the Barthel index (BI), the latter being a prevalent measure for the clinical evaluation of stroke patients, with substantial supporting research –. However, there are few studies involving the ADLs as the primary outcome for a marker of functional recovery after neurostimulation. For example, in a systematic review where the efficacy of tDCS in ADLs and motor function after stroke were analyzed, the authors found that the results are inaccurate and the effect was not sustained when studies of high methodological quality were included. There were 15 studies involving a total of 455 participants included, with only randomized controlled trials and randomized controlled cross-over trials evaluated. Of the total, the analysis of five studies involving 286 participants to examine the effects of tDCS on our primary outcome (ADLs evaluated by BI) has shown that no effect was observed on the performance at the end of the intervention. In three studies from this systematic review involving 99 participants to evaluate the effects of tDCS in BI scores at the end of follow-up, evidence suggested an effect on the ADL performance, but the confidence intervals were wide, and the effect was not sustained when they only included studies with low risk of bias. Thus, the authors point to the need for future research in this area to improve the generalization of the results .
Although clinical trials can be found that measure the efficacy of tDCS in ADLs pointing to positive effects ,
 among other factors, in general they only include participants in the chronic stage with brain injuries in different areas and varying levels of functional incapacity.
Therefore, central questions remain: For a daily protocol of 10 days, does the active tDCS applied under a 2 mA current and associated with CIMT have a superior response to the simulated (placebo) current applied with CIMT, and if so, what is the size of the effect? What adverse effects are associated with the therapy? Does functional improvement in the ADLs persist over time?
In light of this, a clinical trial phase II/III will be developed to evaluate the therapeutic effects of tDCS in patients in the subacute stage after stroke. The purposes are two: 1) discuss topics related to safety, adverse effects, feasibility, and effectiveness of tDCS in the treatment of stroke patients; 2) present the work protocol prior to clinical trial results, ensuring adherence to protocol. Our hypothesis is that the active stimulation in the affected hemisphere is more effective than a simulated (placebo) current in activities of daily living in subacute stroke. Secondly, we are interested in knowing whether tDCS is effective in the recovery of the following motor variables: spasticity, use of the affected limb, balance, posture, fall risk, muscle strength, and upper and lower limb function. Also, we aim to analyze if a possible functional improvement produces a change in the patients’ perception of their quality of life. We hope that the study will contribute to the discussion of the methodological procedures of clinical trials phase II/III involving neuromodulation for the treatment of patients after stroke.
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[ARTICLE] Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial
Purpose: To investigate the combined effect of transcranial direct current stimulation (tDCS) and home-based occupational therapy on activities of daily living (ADL) and grip strength, in patients with upper limb motor impairment following intracerebral hemorrhage (ICH).
Methods: A double-blind randomized controlled trial with one-week follow-up. Patients received five consecutive days of occupational therapy at home, combined with either anodal (n = 8) or sham (n = 7) tDCS. The primary outcome was ADL performance, which was assessed with the Jebsen–Taylor test (JTT).
Results: Both groups improved JTT over time (p < 0.01). The anodal group improved grip strength compared with the sham group from baseline to post-assessment (p = 0.025). However, this difference was attenuated at one-week follow-up. There was a non-significant tendency for greater improvement in JTT in the anodal group compared with the sham group, from baseline to post-assessment (p = 0.158).
Conclusions: Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone. tDCS is a promising add-on intervention regarding training of upper limb motor impairment. It is well tolerated by patients and can easily be applied for home-based training. Larger studies with long-term follow-up are needed to further explore possible effects of tDCS in patients with ICH.
Implications for Rehabilitation
- Five consecutive days of tDCS combined with occupational therapy provided greater improvements in grip strength compared with occupational therapy alone.
- tDCS is well tolerated by patients and can easily be applied for home-based rehabilitation.
via Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial, Disability and Rehabilitation, Informa Healthcare.
[ARTICLE] Is mental practice an effective adjunct therapeutic strategy for upper limb motor restoration after stroke? A systematic review and meta-analysis.
Stroke is one of the most common conditions requiring rehabilitation, and its motor impairments are a major cause of permanent disability. Hemiparesis is observed by 80% of the patients after acute stroke. Neuroimaging studies showed that real and imagined movements have similarities regarding brain activation, supplying evidence that those similarities are based on the same process. Within this context, the combination of mental practice (MP) with physical and occupational therapy appears to be a natural complement based on neurorehabilitation concepts.
Our study seeks to investigate if MP for stroke rehabilitation of upper limbs is an effective adjunct therapy. PubMed (Medline), ISI knowledge (Institute for Scientific Information) and SciELO (Scientific Electronic Library) were terminated on 20 February 2015. Data were collected on variables as follows: sample size, type of supervision, configuration of mental practice, setting the physical practice (intensity, number of sets and repetitions, duration of contractions, rest interval between sets, weekly and total duration), measures of sensorimotor deficits used in the main studies and significant results. Random effects models were used that take into account the variance within and between studies. Seven articles were selected. As there was no statistically significant difference between the two groups (MP vs control), showed a – 0.6 (95% CI: -1.27 to 0.04), for upper limb motor restoration after stroke. The present meta-analysis concluded that MP is not effective as adjunct therapeutic strategy for upper limb motor restoration after stroke.
Despite extensive rehabilitation post-stroke gait remains slow, variable and asymmetric. There is a need for simple interventions to improve lower-extremity motor control and walking ability.
Mirror therapy is a promising intervention though little attention has focused on its use on the lower-extremities post-stroke. This thesis investigates the feasibility and potential effects of a bilateral lower-extremity mirror therapy intervention (LE-MT) post-stroke.
A case series involving three participants, who performed twelve 30 minute sessions of LE-MT over four weeks, is presented. Session duration and number of repetitions completed improved over the course of the intervention indicating LE-MT poststroke is feasible.
Some cases demonstrated improved motor recovery of the leg and clinically meaningful improvements to gait velocity and step variability post-intervention indicating some potential benefits of LE-MT. Future directions will identify who may respond best to LE-MT, investigate the dose-response relationship and the underlying mechanisms of the observed improvements associated with LE-MT.
[ARTICLE] Applying Tai Chi as a rehabilitation program for stroke patients in the recovery phase Full Text PDF
Background: As the second commonest cause of death and a major cause of disability worldwide, stroke has greatly influenced patients’ quality of life and created a huge public health burden. As a special form of physical activity that has been widely practiced in China, and even throughout the world, Tai Chi may be favorable for the rehabilitation of stroke patients. Several studies have been conducted to investigate the rehabilitative effects of Tai Chi for stroke patients, but none of them have been focused on the recovery phase (2 to 24 weeks) of stroke.
Methods: This study is an assessor-blinded randomized controlled trial. A total of 50 eligible participants will be randomly assigned to either a control group or a Tai Chi group. Patients in the control group will receive standard, conventional rehabilitation therapies, and a combination of Tai Chi and conventional rehabilitation programs will be applied in the Tai Chi group. The recovery of motor impairment, functional activity and balance abilities as measured with the Fugl-Meyer Assessment, Barthel Index and Berg Balance Scale will be assessed as primary outcome measures. The secondary outcome measures to be used are the scores on the Stroke-Specific Quality of Life Scale, the National Institutes of Health Stroke Scale and the objective parameters of the RSscan footscan gait system. All assessments will be conducted at baseline, 4 weeks after the rehabilitation course and at the end of 3-month follow-up.
Discussion: The results of this study will provide preliminary evidence regarding the efficacy and feasibility of Tai Chi as an additional rehabilitative program for stroke patients in the recovery phase.
Trial registration: Chinese Clinical Trial Register ID: ChiCTR-TRC-13003661 (7 October 2013)
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.