Posts Tagged Motor Skill

[WEB SITE] Enhanced rehab for stroke doubles movement recovery.

Date: September 27, 2018

Source: University of Texas at Dallas

Summary: A novel therapy technique has been shown in a pilot study to double the rate of upper limb recovery in stroke patients, a leap forward in treating the nearly 800,000 Americans who suffer strokes each year.

FULL STORY

A novel therapy technique invented by researchers at The University of Texas at Dallas has been shown in a pilot study to double the rate of upper limb recovery in stroke patients, a leap forward in treating the nearly 800,000 Americans who suffer strokes each year.

The results of the study, funded by UT Dallas spinoff company MicroTransponder of Austin, Texas, were published Sept. 27 in the journal Stroke.

The findings indicate that targeted plasticity therapy — which involves stimulation of the vagus nerve — paired with traditional motor-skill rehabilitation is not only safe, but also twice as effective as rehab alone.

Dr. Jane Wigginton, the chief medical officer at UT Dallas’ Texas Biomedical Device Center (TxBDC) and an associate professor of emergency medicine at UT Southwestern Medical Center, led the Dallas site of the clinical trial, which involved 17 people across the country who had suffered a stroke.

“Stroke is too common and too debilitating for us to tolerate the status quo,” Wigginton said. “Patients need a real solution so they can get back to fully living their lives.”

Dr. Michael Kilgard, associate director and chief science officer of the TxBDC, invented targeted plasticity therapy (TPT). Kilgard, who is also the Margaret Fonde Jonsson Professor in the School of Behavioral and Brain Sciences (BBS), said the study results further validate the theories that he and his colleagues based their TPT work on beginning in 2009.

“We set out to design an approach that could transform long-term care and restore quality of life to patients for whom that has thus far been impossible,” said Kilgard, who was not involved in the clinical trial. “These results show our method has immense potential. We’re excited about what this could mean for millions of stroke patients worldwide.”

Researchers affiliated with the TxBDC and BBS developed the therapy technique, which pairs physical movements with precisely timed vagus nerve stimulation (VNS) — electrical stimulus of the nerve via a device implanted on the nerve in the neck.

The vagus nerve controls the parasympathetic nervous system, overseeing many unconscious functions such as circulation and digestion. Stimulating the nerve initiates neural plasticity — reorganization of the brain’s circuitry. The idea behind TPT is that synchronizing VNS with movement accelerates plasticity in a damaged brain, and with it, recovery.

A stroke occurs when blood flow to the brain is interrupted because of a blockage or a ruptured blood vessel. Limb mobility can be affected when nerve cells are damaged. Such forms of brain trauma are often treated with rehabilitation that includes repeated movement of the affected limb in an effort to regain motor skills. The approach is thought to work by helping the brain reorganize.

Several studies of Kilgard’s technique in animal models have previously demonstrated that it is effective in recovering limb function after stroke. A small clinical trial in Europe also provided encouraging data for its potential use in humans.

In 2009, UT Dallas licensed its VNS technique as a stroke and tinnitus treatment to MicroTransponder, which sponsored the new double-blind, placebo-controlled study. Neither the researchers nor the study subjects knew who was getting VNS stimulation and who was not.

Each study subject was a stroke patient whose stroke occurred between four months and five years prior to selection. After they had a VNS device implanted, the subjects received six weeks of in-clinic rehab followed by a home exercise program. About half were treated with active VNS while the rest received control VNS. All were assessed one, 30 and 90 days after therapy with a widely used, stroke-specific measure of performance impairment.

In addition to showing that the technique is safe, the researchers found that subjects receiving active VNS scored more than twice as high as control subjects at the 30- and 90-day intervals, opening the way for larger, more extensive clinical trials, Kilgard said. One such trial is in the recruitment phase and includes a study site in Dallas.

Story Source:

Materials provided by University of Texas at DallasNote: Content may be edited for style and length.


Journal Reference:

  1. Teresa J. Kimberley et al. Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke A Blinded Randomized Pilot StudyStroke, 2018 DOI: 10.1161/STROKEAHA.118.022279

 

via Enhanced rehab for stroke doubles movement recovery — ScienceDaily

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[Abstract] Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: a case study.

Abstract

PURPOSE:

The complexity of upper extremity (UE) behavior requires recovery of near normal neuromuscular function to minimize residual disability following a stroke. This requirement places a premium on spontaneous recovery and neuroplastic adaptation to rehabilitation by the lesioned hemisphere. Motor skill learning is frequently cited as a requirement for neuroplasticity. Studies examining the links between training, motor learning, neuroplasticity, and improvements in hand motor function are indicated.

METHODS:

This case study describes a patient with slow recovering hand and finger movement (Total Upper Extremity Fugl-Meyer examination score = 25/66, Wrist and Hand items = 2/24 on poststroke day 37) following a stroke. The patient received an intensive eight-session intervention utilizing simulated activities that focused on the recovery of finger extension, finger individuation, and pinch-grasp force modulation.

RESULTS:

Over the eight sessions, the patient demonstrated improvements on untrained transfer tasks, which suggest that motor learning had occurred, as well a dramatic increase in hand function and corresponding expansion of the cortical motor map area representing several key muscles of the paretic hand. Recovery of hand function and motor map expansion continued after discharge through the three-month retention testing.

CONCLUSION:

This case study describes a neuroplasticity based intervention for UE hemiparesis and a model for examining the relationship between training, motor skill acquisition, neuroplasticity, and motor function changes. Implications for rehabilitation Intensive hand and finger rehabilitation activities can be added to an in-patient rehabilitation program for persons with subacute stroke. Targeted training of the thumb may have an impact on activity level function in persons with upper extremity hemiparesis. Untrained transfer tasks can be utilized to confirm that training tasks have elicited motor learning. Changes in cortical motor maps can be used to document changes in brain function which can be used to evaluate changes in motor behavior persons with subacute stroke.

 

via Motor skill changes and neurophysiologic adaptation to recovery-oriented virtual rehabilitation of hand function in a person with subacute stroke: … – PubMed – NCBI

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[Abstract+References] Predicting Motor Sequence Learning in Individuals With Chronic Stroke

Background. Conventionally, change in motor performance is quantified with discrete measures of behavior taken pre- and postpractice. As a high degree of movement variability exists in motor performance after stroke, pre- and posttesting of motor skill may lack sensitivity to predict potential for motor recovery.

Objective. Evaluate the use of predictive models of motor learning based on individual performance curves and clinical characteristics of motor function in individuals with stroke.

Methods. Ten healthy and fourteen individuals with chronic stroke performed a continuous joystick-based tracking task over 6 days, and at a 24-hour delayed retention test, to assess implicit motor sequence learning.

Results. Individuals with chronic stroke demonstrated significantly slower rates of improvements in implicit sequence-specific motor performance compared with a healthy control (HC) group when root mean squared error performance data were fit to an exponential function. The HC group showed a positive relationship between a faster rate of change in implicit sequence-specific motor performance during practice and superior performance at the delayed retention test. The same relationship was shown for individuals with stroke only after accounting for overall motor function by including Wolf Motor Function Test rate in our model.

Conclusion. Nonlinear information extracted from multiple time points across practice, specifically the rate of motor skill acquisition during practice, relates strongly with changes in motor behavior at the retention test following practice and could be used to predict optimal doses of practice on an individual basis.

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Source: Predicting Motor Sequence Learning in Individuals With Chronic Stroke – Aug 10, 2016

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[Abstract] Increased functional connectivity one week after motor learning and tDCS in stroke patients

Highlights

  • Dual-tDCS enhanced motor skill learning and retention in chronic hemiparetic stroke patients (95 /125)
  • Dual-tDCS combined to training induced an increase in FC in the ipsilesional M1, PMd (and SMA) that lasted up to 1 week (120 /125)
  • Both seed and ICA-based analyses showed a FC reorganisation following dual-tDCS (between ipsilesional M1 and PMd) (114/125)
  • This study demonstrated changes of FC lasting well beyond what has been previously reported after a single session of tDCS (125 / 125)
  • tDCS, combined with motor learning, has lasting effect upon FC and could be an efficient tool in neurorehabilitation (121 /125)

Abstract

Recent studies using resting-state functional magnetic resonance imaging (rs-fMRI) demonstrated that changes in functional connectivity (FC) after stroke correlate with recovery.

The aim of this study was to explore whether combining motor learning to dual transcranial direct current stimulation (dual-tDCS, applied over both primary motor cortices (M1)) modulated FC in stroke patients. Twenty-two chronic hemiparetic stroke patients participated in a baseline rs-fMRI session. One week later, dual-tDCS/sham was applied during motor skill learning (intervention session); one week later, the retention session started with the acquisition of a run of rs-fMRI imaging.

The intervention + retention sessions were performed once with dual-tDCS and once with sham in a randomised, cross-over, placebo-controlled, double-blind design. A whole-brain independent component analysis based ANOVA demonstrated no changes between baseline and sham sessions in the somatomotor network, whereas a FC increase was observed one week after dual-tDCS compared to baseline (qFDR < 0.05, t(63) = 4.15). A seed-based analysis confirmed specific stimulation-driven changes within a network of motor and premotor regions in both hemispheres. At baseline and one week after sham, the strongest FC was observed between the M1 and dorsal premotor cortex (PMd) of the undamaged hemisphere. In contrast, one week after dual-tDCS, the strongest FC was found between the M1 and PMd of the damaged hemisphere. Thus, a single session of dual-tDCS combined with motor skill learning increases FC in the somatomotor network of chronic stroke patients for one week.

Source: Increased functional connectivity one week after motor learning and tDCS in stroke patients

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[Abstract] Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.

Abstract

Purpose: The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options.
Methods: A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly “think aloud” while they were watching their own videos.
Results: Five “operators” were identified: “act”, “know”, “observe”, “assess” and “argue”. The “act” operator consisted of 34 motor learning options, which were clustered into “instruction”, “feedback” and “organization”. The “know”, “observe”, “assess” and “argue” operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option.
Conclusions: Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists.

  • Implications for Rehabilitation

  • The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations.

  • Despite differences in patients’ abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option.

  • Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines.

  • A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.

 

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Source: Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study – Disability and Rehabilitation –

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[ARTICLE] Low Frequency Repetitive Transcranial Magnetic Stimulation to Improve Motor Function and Grip Force of Upper Limbs of Patients With Hemiplegia

…Background: Stroke is the most common and debilitating neurological disorder among adults, and is a sudden onset of neurological signs caused by brain blood vessels impairments.

Objectives: Some new therapeutic methods focus on the use of magnetic stimulation to produce therapeutic effects by inducing the currents. The aim of this study is to determine the effects of rTMS plus routine rehabilitation on hand grip and wrist motor functions in patients with hemiplegia, and compare with pure routine rehabilitation programs.

Patients and Methods: In this study, 12 patients with hemiplegia were randomly divided in two groups. Control group, received the rehabilitation program with placebo magnetic stimulation, and the experimental group, received magnetic stimulation with routine rehabilitation program for 10 sessions for three times per week. Pre and post evaluations of treatment performed using Barthel and Fugl-Meyer indices and dynamometers.

Results: In the control group, Barthel and Fugl-Meyer indices showed significant improvement (P = 0.01, P = 0.00), while in the experimental group, significant improvement in Barthel and Fugl-Meyer indices and dynamometers has been observed (P = 0.01, P = 0.00, P = 0.007).

Conclusions: rTMS can improve hand muscle force and functions of patients with chronic hemiplegia, while conventional treatment is not effective…

μέσω Low Frequency Repetitive Transcranial Magnetic Stimulation to Improve Motor Function and Grip Force of Upper Limbs of Patients With Hemiplegia – Iranian Red Crescent Medical Journal – – Kowsar.

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