Posts Tagged movement disorders

[ARTICLE] The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses.

Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems.

Design: A cross-sectional study was carried out.

Setting: The VICON Motion System® was used to conduct motion analysis.

Participants: Twenty-one patients with chronic stroke.

Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition.

Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass.

Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions.

Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.

Introduction

Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints compared to healthy subjects (16). The movement pattern of patients with stroke is highly related to their level of motor function impairment, which becomes modified due to the lack of inter-articular coordination (1). There is a decrease in the range of motion at the elbow joint with a tendency toward flexion, which avoids correct extension of the upper limb (UL), hampering the ability to perform appropriate reaching movements. Excessive shoulder abduction is also observed as a compensatory movement when there is a lack of appropriate shoulder flexion (7).

In the case of the trunk, greater trunk displacements have been observed in patients with stroke, forward displacements, and torsion movements, which are related to deficits in elbow extension, and shoulder flexion and adduction, as compensatory mechanisms that occur during reaching movements or other activity. Patients are able to develop new motor strategies to achieve their goal despite UL deficits (17). There is a greater involvement of the trunk and scapula during the execution of reaching movements due to the creation of new movement strategies to compensate for the deficiencies (8).

The scientific literature has shown that stroke patients need to create new movement strategies. This involves the development of pathological synergies to carry out the desired movements. An example of this is the excessive movements of the trunk and scapula to compensate the deficiencies resulting from the pathology (7). Proper activation of the interscapular muscles depends on the position of the trunk. Stroke patients, due to the deficits affecting their trunk and scapular movement patterns, are under unfavorable conditions for being able to perform appropriate and selective activation of these muscles, which has a negative impact on the movement of the UL (911).

Regarding the UL muscles involved in reaching movements, a deficit in muscle control and activation has been observed (51213). The synergistic contraction of the shoulder flexor and extensor muscles during reach becomes deteriorated due to muscle weakness and; therefore, the resulting movement is deficient (14). Furthermore, spastic muscle patterns may also prevent the correct performance of UL movements (1518).

Functional electrical stimulation (FES) is a form of treatment that seeks to activate the paretic muscles using short-duration electrical pulses applied via surface electrodes through the skin (19). The use of FES and neuroprostheses has spanned almost four decades (2021). The use of FES as a neuroprosthesis consists of self-treatment at home by means of a neuroprosthetic neuromuscular stimulation system. The objective of this modality is to assist the performance of an activity of daily living (ADL) (22). Recently, functional and clinical improvements have been reported with the therapeutic application of FES, in which stimulation was used to increase voluntary movement after stroke (2223). Therapeutic FES modalities have been used to recruit UL muscles, improving weakness, the dyscoordination of single and multiple joints movements, and spasticity (24).

Most studies employing therapeutic FES for paretic UL rehabilitation are based on stimulation of the shoulder, elbow, and wrist muscles without recruitment of the interscapular muscles (2528). The importance of an appropriate and specific contraction of the interscapular musculature during UL movement is necessary to adapt the position of the scapulothoracic joint to the degree of movement of the glenohumeral joint. This musculature has a stabilizing function upon the entire glenohumeral complex, which is necessary for a correct reaching movement (2931). In healthy subjects, the posture of the trunk has been shown to influence changes in scapular movement and interscapular muscle activity during UL elevation (2932). The motor control of shoulder movement influences the correct and proper activation and synchronization of these muscles (33).

In this study, we tested the ability of a FES system to assist the UL movement of stroke patients based on the stimulation of interscapular, shoulder, elbow, wrist, and finger muscles. To our knowledge, no empirical study to date directly addresses this question. The authors hypothesized that participants receiving FES to the UL and interscapular muscles would be able to perform the movement with less trunk anteroposterior tilt and major shoulder flexion and elbow extension. The aim of this feasibility study was to evaluate whether the application of FES to the UL and interscapular muscles of stroke patients with UL motor impairment would be able to modify their reaching patterns, measured using instrumental movement analysis systems.[…]

Continue —> Frontiers | The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study | Neurology

Figure 1. Patient with the functional electrical stimulation device.

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[BOOK] Progress in Motor Control: Theories and Translations – Google Books

ΕξώφυλλοThis single volume brings together both theoretical developments in the field of motor control and their translation into such fields as movement disorders, motor rehabilitation, robotics, prosthetics, brain-machine interface, and skill learning. Motor control has established itself as an area of scientific research characterized by a multi-disciplinary approach. Its goal is to promote cooperation and mutual understanding among researchers addressing different aspects of the complex phenomenon of motor coordination. Topics covered include recent theoretical advances from various fields, the neurophysiology of complex natural movements, the equilibrium-point hypothesis, motor learning of skilled behaviors, the effects of age, brain injury, or systemic disorders such as Parkinson’s Disease, and brain-computer interfaces.

Source: Progress in Motor Control: Theories and Translations – Google Books

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[Abstract] Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness

Highlights

 

  • A pilot study (n = 10) of motor cortex TMS as a treatment for functional (psychogenic) weakness is described.
  • Although there was a small improvement in self-reported symptom severity immediately after treatment this was not clinically significant or sustained.
  • Half of the participants reported late-onset adverse effects.
  • A single session of non-neuromodulatory TMS without additional therapy input was not an effective treatment for this cohort of stable chronic outpatients.

Abstract

Objective

There has been a recent resurgence of interest in physical treatments for functional motor disorders (FMD) including Transcranial Magnetic Stimulation (TMS). This pilot study aimed to test the effectiveness of a single session of motor cortex TMS as a treatment for functional upper limb weakness.

Methods

Ten subjects with a diagnosis of functional upper limb weakness were randomised to immediate (n = 7) or delayed (3 months) (n = 3) TMS treatment. Median age was 35 (range 23–52) and median symptom duration was 2.3 years (range 5 months – 20 years). 46–70 single pulses were applied to the motor cortex at 120–150% motor threshold. We used a verbal protocol designed to standardized the effects of suggestion. Primary outcome measures were self-reported symptom severity, grip strength and tapping frequency immediately after treatment, and symptom severity and disability (SF-12 and Modified Rankin Scale (MRS)) after 3 months.

Results

There was a small significant reduction in symptom severity immediately after treatment, but no improvement in grip strength or tapping frequency and no change in symptom severity, SF-12 or MRS 3 months after treatment. Small numbers precluded comparison of immediate treatment with delayed treatment. Four of eight subjects responding to three-month follow-up reported late-onset adverse effects.

Conclusion

This pilot study suggests limited benefits for TMS as a one-off non-neuromodulatory treatment for stable chronic outpatients. TMS may still have a role alongside more intensive multidisciplinary therapy input, or in patients with severe deficits where the possibility of normal movement can be hard to demonstrate.

Source: Transcranial magnetic stimulation as a treatment for functional (psychogenic) upper limb weakness

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[Editorial] Advances in Rehabilitation and Assistive Robots for Restoring Limb Function in Persons with Movement Disorders. 

Editorial

Advances in Rehabilitation and Assistive Robots for Restoring Limb Function in Persons with Movement Disorders

1Department of Health Care Sciences, UT Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
2Research Center for Neural Engineering, The Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Shenzhen 518055, China
3School of Energy Systems, Lappeenranta University of Technology, 53851 Lappeenranta, Finland
4The Robotics Research Group, College of Engineering, Peking University, Beijing 100871, China
5The Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL 60611, USA
6Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia

Received 3 July 2016; Accepted 3 July 2016

Copyright © 2016 Fan Gao et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


People with movement disorders are plagued with debilitating conditions, which significantly degrade their quality of life. Traditional rehabilitation typically involves intensive interaction between patients and therapists. While effective, traditional rehabilitation cannot keep abreast of the increasing patient population primarily attributed to a higher surviving rate after diseases and/or injuries. Furthermore, patients living in the rural areas have fairly limited access to rehabilitation services. In the past two decades, tremendous efforts have been put into developing rehabilitation and assistive robots to facilitate the rehabilitation training while relieving the physical involvement of therapists and/or lowering the related cost. Most notably, the rehabilitation and assistive robots have been significantly advanced with developments in actuators, sensors, microprocessors, and mobile software platforms. However, unlike traditional robotics, the intimate interaction between robot and human in rehabilitation robots indicates that the success is also closely related to a thorough understanding of the human neuromuscular aspects and human-machine interaction.

This special issue primarily aims to gather the latest achievements in rehabilitation robots, exoskeletons, and prostheses including the following topics:

(a) development of rehabilitation robots, exoskeleton, and upper/lower limb prostheses driven by bionics;
(b) functional evaluation of rehabilitation robots, exoskeleton, and upper/lower limb prostheses with an emphasis on human movement biomechanics;
(c) musculoskeletal modeling and simulation of human movements while wearing exoskeleton or prostheses;
(d) noninvasive human-machine interface based on electromyography and/or electroencephalogram;
(e) sensors for monitoring kinematics/kinetics, as well as biological signals in real time;
(f) innovative actuators and control algorithms applied to rehabilitation robots, exoskeletons, and prostheses.

In this special issue, collective studies address the aforementioned key elements via both technical and biomechanical approaches. A reconfigurable robotic hand exoskeleton was proposed to meet the fast growing need in hand rehabilitation. A novel control algorithm integrating sliding model control with cerebellar model articulation controller neural network was implemented in lower limb exoskeleton to enhance the coordination between patient and exoskeleton. An upper limb exoskeleton was enhanced with integrated optical cameras to offer more accurate estimation of joint posture than traditional motion capture system. A hybrid upper limb rehabilitation system consisting of a shoulder-elbow-forearm exoskeleton and a robotic manipulator was validated and tested in the clinic. The characteristics of muscle-tendon stimulation such as perception threshold and vibration frequency significantly influenced the muscle forces as well as the reaction time. Patellar retention was found to be superior to patellar replacement in knee arthroplasty via a comprehensive computer simulation. These collective studies, as part of the latest representative work, offered some new insights into the development and implementation of rehabilitation and assistive robots.

Fan Gao
Guanglin Li
Huapeng Wu
Qining Wang
Jie Liu
Justin Keogh

Source: Advances in Rehabilitation and Assistive Robots for Restoring Limb Function in Persons with Movement Disorders

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[ARTICLE] A survey of home based rehabilitation model performance for movement disorders caused by neurological injuries – Full Text PDF

Abstract

The aim of this study was to determine the efficacy of home based rehabilitation model performance for movement disorders caused by neurological injuries.

Method: 24 volunteers with movement disorders caused by neurological injuries were included in the study. The participants randomly assigned in one of the two groups, the interventional and the control groups. Intervention program was carried out at home. The average ages of the two groups, interventional and control, were 5.8 and 6.3 years, respectively. Two measurements were applied to determine any alteration in patient improvement: Barthel index was used for measurement of ADL, and EQ-5D (euroqol) was used for quality of life. The assessments for the two groups were carried out twice (pre-tests and posttests). Reassessments were carried out for the two groups at the end of week 5.

Results: Comparison of pre- and post-treatment assessment results of Barthel index in the interventional group indicated a difference in terms of recovery, (P < 0.05). Comparison of pre- and post-treatment assessment results of quality of life in the interventional group indicated a difference in terms of recovery (P < 0.05). The results of the two assessment methods: Barthel index and quality of life, revealed no significant differences between pre and posttests.

Conclusion: The results of this study proved that home based rehabilitation model may enhance the function of the patients and improve the family quality of life.

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[REVIEW] The therapeutic potential of cannabinoids for movement disorders – Full Text HTML/PDF

Movement DisordersABSTRACT

There is growing interest in the therapeutic potential of marijuana (cannabis) and cannabinoid-based chemicals within the medical community and, particularly, for neurological conditions. This interest is driven both by changes in the legal status of cannabis in many areas and increasing research into the roles of endocannabinoids within the central nervous system and their potential as symptomatic and/or neuroprotective therapies. We review basic science as well as preclinical and clinical studies on the therapeutic potential of cannabinoids specifically as it relates to movement disorders. The pharmacology of cannabis is complex, with over 60 neuroactive chemicals identified to date. The endocannabinoid system modulates neurotransmission involved in motor function, particularly within the basal ganglia. Preclinical research in animal models of several movement disorders have shown variable evidence for symptomatic benefits, but more consistently suggest potential neuroprotective effects in several animal models of Parkinson’s (PD) and Huntington’s disease (HD). Clinical observations and clinical trials of cannabinoid-based therapies suggests a possible benefit of cannabinoids for tics and probably no benefit for tremor in multiple sclerosis or dyskinesias or motor symptoms in PD. Data are insufficient to draw conclusions regarding HD, dystonia, or ataxia and nonexistent for myoclonus or RLS. Despite the widespread publicity about the medical benefits of cannabinoids, further preclinical and clinical research is needed to better characterize the pharmacological, physiological, and therapeutic effects of this class of drugs in movement disorders.

Continue —> The therapeutic potential of cannabinoids for movement disorders – Kluger – 2015 – Movement Disorders – Wiley Online Library

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[ARTICLE] Applications of Shape Memory Alloys for Neurology and Neuromuscular Rehabilitation – Full Text HTML

Abstract

Shape memory alloys (SMAs) are a very promising class of metallic materials that display interesting nonlinear properties, such as pseudoelasticity (PE), shape memory effect (SME) and damping capacity, due to high mechanical hysteresis and internal friction. Our group has applied SMA in the field of neuromuscular rehabilitation, designing some new devices based on the mentioned SMA properties: in particular, a new type of orthosis for spastic limb repositioning, which allows residual voluntary movement of the impaired limb and has no predetermined final target position, but follows and supports muscular elongation in a dynamic and compliant way. Considering patients in the sub-acute phase after a neurological lesion, and possibly bedridden, the paper presents a mobiliser for the ankle joint, which is designed exploiting the SME to provide passive exercise to the paretic lower limb. Two different SMA-based applications in the field of neuroscience are then presented, a guide and a limb mobiliser specially designed to be compatible with diagnostic instrumentations that impose rigid constraints in terms of electromagnetic compatibility and noise distortion. Finally, the paper discusses possible uses of these materials in the treatment of movement disorders, such as dystonia or hyperkinesia, where their dynamic characteristics can be advantageous.

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Full Text HTML —> JFB | Free Full-Text | Applications of Shape Memory Alloys for Neurology and Neuromuscular Rehabilitation | HTML.

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