Posts Tagged proprioception

[Abstract] Effect of elastic bandage on postural control in subjects with chronic ankle instability: a randomised clinical trial

Abstract
Purpose: To report the immediate and prolonged (one week) effects of elastic bandage (EB) on balance control in subjects with chronic ankle instability.
Material and methods: Twenty-eight individuals successfully completed the study protocol, of whom 14 were randomly assigned to the EB group (7 men, 7 women) and 14 were assigned to the non-standardised tape (NST) group (9 men, 5 women). To objectively measure postural sway we used computerised dynamic posturography (CDP) with sensory organisation test (SOT) and unilateral stance (US) test. We analysed the following SOT parameters: the composite SOT score, the composite SOT strategy and the SOT condition 2 and its strategy. In addition, we studied the centre of gravity (COG) sway velocity with open eyes and close eyes during the US test.
Results: Repeated measures ANOVA showed a significant effect for time in composite SOT score (F= 34.98; p= <0.01), composite SOT strategy (F= 12.082; p= 0.02), and COG sway with open eyes (F= 3.382; p= 0.039) in EB group and NST group. Therefore, there were improvements in balance control after bandage applications (defined as better scores in SOT parameters and decreased COG sway in US test). However, no differences between groups were observed in the most relevant parameters.
Conclusions: This study did not observe differences between EB and NST during the follow-up in the majority of measurements. Several outcome measures for SOT and US tests improved in both groups immediately after bandage applications and after one week of use. EB of the ankle joint has no advantage as compared to the non-standardised tape.

Implications for rehabilitation

  • Elastic bandage (EB) of the ankle joint has no advantage as compared to the non-standardised tape.
  • The effects of the bandages could be due to a greater subjective sense of security.
  • It is important to be prudent with the use of bandage, since a greater sense of safety could also bring with it a greater risk of injury.
  • The application of the bandage on subjects with chronic ankle instability (CAI) should be prolonged and used alongside other physiotherapy treatments.

Source: Effect of elastic bandage on postural control in subjects with chronic ankle instability: a randomised clinical trial

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[ARTICLE] Strength of ~20-Hz Rebound and Motor Recovery After Stroke – Full Text

Abstract

Background. Stroke is a major cause of disability worldwide, and effective rehabilitation is crucial to regain skills for independent living. Recently, novel therapeutic approaches manipulating the excitatory-inhibitory balance of the motor cortex have been introduced to boost recovery after stroke. However, stroke-induced neurophysiological changes of the motor cortex may vary despite of similar clinical symptoms. Therefore, better understanding of excitability changes after stroke is essential when developing and targeting novel therapeutic approaches.

Objective and Methods. We identified recovery-related alterations in motor cortex excitability after stroke using magnetoencephalography. Dynamics (suppression and rebound) of the ~20-Hz motor cortex rhythm were monitored during passive movement of the index finger in 23 stroke patients with upper limb paresis at acute phase, 1 month, and 1 year after stroke.

Results. After stroke, the strength of the ~20-Hz rebound to stimulation of both impaired and healthy hand was decreased with respect to the controls in the affected (AH) and unaffected (UH) hemispheres, and increased during recovery. Importantly, the rebound strength was lower than that of the controls in the AH and UH also to healthy-hand stimulation despite of intact afferent input. In the AH, the rebound strength to impaired-hand stimulation correlated with hand motor recovery.

Conclusions. Motor cortex excitability is increased bilaterally after stroke and decreases concomitantly with recovery. Motor cortex excitability changes are related to both alterations in local excitatory-inhibitory circuits and changes in afferent input. Fluent sensorimotor integration, which is closely coupled with excitability changes, seems to be a key factor for motor recovery.

Approximately 75% of stroke survivors suffer from permanent disability; thus, stroke causes significant human suffering and poses a major economic burden on the society.1 Recovery from stroke is based on brain’s plasticity. Studies in both animals and humans have shown that a period of enhanced plasticity occurs 1-4 weeks after stroke.25 After this sensitive period, the effectiveness of poststroke rehabilitation diminishes dramatically. Recently, there have been promising attempts to prolong or enhance the sensitive period with pharmacological manipulations68 or with noninvasive brain stimulation,9,10 both aiming at changing the cortical excitation-inhibition balance. However, patients with initially similar clinical symptoms may recover differently, possibly because the underlying neurophysiological changes vary between these patients. Thus, understanding and monitoring recovery-related neurophysiological mechanisms and their temporal evolution is crucial for developing efficient, personalized rehabilitation.

Fluent upper limb motor function is important for independency in daily life. Integration of proprioceptive and tactile input with motor plans forms the basis of smooth and precise movements.11 Afferent input mediates its effect on motor functions by modulating the motor cortex excitability.12 Accordingly, our previous study in healthy subjects indicated that proprioceptive input strongly modulates the ~20-Hz motor cortex rhythm, causing an initial suppression followed by a strong and robust rebound.13 Prior studies have suggested that the ~20-Hz rebound reflects deactivation or inhibition of the motor cortex.1417 Moreover, a combined magnetiencephalography (MEG) and magnetic resonance spectroscopy study showed that the ~20-Hz rebound strength is associated with the concentration of the inhibitory neurotransmitter GABA (γ-aminobutyric acid).18

To study alterations in motor cortex excitability after stroke and its association with motor recovery, we measured the dynamics of ~20-Hz motor cortex oscillations during passive movement of the index fingers in 23 stroke patients at the acute phase and during 1-year recovery. The motivation of this study was to understand the neurophysiological mechanisms underlying stroke recovery, which is instrumental for developing novel therapeutic interventions.

Continue —> Strength of ~20-Hz Rebound and Motor Recovery After Stroke – Feb 04, 2017

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Figure 1. (A) Setup for passive movement. (B) Representative signals of 1 patient at T0 (1-7 days), T1 (1 month), and T2 (12 months) after stroke. Two upper rows: Magnetoencephalography signals from a single gradiometer channel (raw and filtered to 15-25 Hz over the primary sensorimotor cortex. The ~20-Hz modulation is observable even to a single movement. Third row: Magnitude of acceleration. Total duration of the movement highlighted in gray.

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[Abstract] Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

Abstract

Functional electrical stimulation (FES) has shown to improve motor function of the affected side in stroke patients; however, the effects of FES on proprioception, the functional recovery of the paretic upper limb, and the patient quality of life (QoL) are not clear. The aim of the current case report was to determine whether FES can improve joint position sense and the scores on measurements of upper limb function and a QoL survey. The participant was assessed before and after 10 consecutive intervention sessions; in addition, the patient performed the training tasks in the workstation assisted by the FES device. Improvements in angles and time only in the affected wrist and enhancement in the Action Research Arm Test scores for both upper limbs were found after FES intervention. In addition, the patient’s health-related QoL measurements improved. FES could ameliorate the proprioceptive deficit and the activity limitations of a stroke survivor.

Source: Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

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[Abstract] Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

Functional electrical stimulation (FES) has shown to improve motor function of theaffected side in stroke patients; however, the effects of FES on proprioception, thefunctional recovery of the paretic upper limb, and the patient quality of life (QoL)are not clear. The aim of the current case report was to determine whether FES canimprove joint position sense and the scores on measurements of upper limb functionand a QoL survey. The participant was assessed before and after 10 consecutive interventionsessions; in addition, the patient performed the training tasks in the workstationassisted by the FES device.

References

  1. Feigin, V.L., Forouzanfar, M.H., Krishnamurthi, R. et al, Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–254.
  2. Bonita, R., Mendis, S., Truelsen, T., Bogousslavsky, J., Toole, J., Yatsu, F. The global stroke initiative. Lancet Neurol. 2004;3:391–393.
  3. Lavados, P.M., Sacks, C., Prina, L., Escobar, A., Tossi, C., Araya, F. Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project). Lancet. 2005;365:2206–2215.
  4. Carey, L.M., Matyas, T.A. Frequency of discriminative sensory loss in the hand after stroke in a rehabilitation setting. J Rehabil Med. 2011;43:257–263.
  5. Borstad, A.L., Bird, T., Choi, S., Goodman, L., Schmalbrock, P., Nichols-Larsen, D.S.Sensorimotor training and neural reorganization after stroke: a case series. J Neurol Phys Ther. 2013;37:27–36.
  6. Semrau, J.A., Herter, T.M., Scott, S.H., Dukelow, S.P. Robotic identification of kinesthetic deficits after stroke. Stroke. 2013;44:3414–3421.
  7. Connell, L.A., Lincoln, N.B., Radford, K.A. Somatosensory impairment after stroke: frequency of different deficits and their recovery. Clin Rehabil. 2008;22:758–767.
  8. Tyson, S.F., Hanley, M., Chillala, J., Selley, A.B., Tallis, R.C. Sensory loss in hospital-admitted people with stroke: characteristics, associated factors, and relationship with function. Neurorehabil Neural Repair. 2008;22:166–172.
  9. Popovic, M.B., Popovic, D.B., Schwirtlich, L., Sinkjaer, T. Functional electrical therapy (FET): clinical trial in chronic hemiplegic subjects. Neuromodulation. 2004;7:133–140.
  10. Alon, G., Sunnerhagen, K.S., Geurts, A.C., Ohry, A. A home-based, self-administered stimulation program to improve selected hand functions of chronic stroke.NeuroRehabilitation. 2003;18:215–225.
  11. Kawashima, N., Popovic, M.R., Zivanovic, V. Effect of intensive functional electrical stimulation therapy on upper-limb motor recovery after stroke: case study of a patient with chronic stroke. Physiother Can. 2013;65:20–28.
  12. Thrasher, T.A., Zivanovic, V., McIlroy, W., Popovic, M.R. Rehabilitation of reaching and grasping function in severe hemiplegic patients using functional electrical stimulation therapy. Neurorehabil Neural Repair. 2008;22:706–714.
  13. Nudo, R.J., Wise, B.M., SiFuentes, F., Milliken, G.W. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science. 1996;272:1791–1794.
  14. Fu, M., Yu, X., Lu, J., Zuo, Y. Repetitive motor learning induces coordinated formation of clustered dendritic spines in vivo. Nature. 2012;483:92–95.
  15. Smith, P.S., Dinse, H.R., Kalisch, T., Johnson, M., Walker-Batson, D. Effects of repetitive electrical stimulation to treat sensory loss in persons poststroke. Arch Phys Med Rehabil. 2009;90:2108–2111.
  16. Chae, J., Bethoux, F., Bohinc, T., Dobos, L., Davis, T., Friedl, A. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke. 1998;29:975–979.
  17. Carod-Artal, J., Egido, J.A., Gonzalez, J.L., Varela de Seijas, E. Quality of life among stroke survivors 1 year after stroke: experience of a stroke unit. Stroke. 2000;31:2995–3000.
  18. Li, K.Y., Wu, Y.H. Clinical evaluation of motion and position sense in the upper extremities of the elderly using motion analysis system. Clin Interv Aging. 2014;9:1123–1131.
  19. Van der Lee, J., de Groot, V., Beckerman, H., Wagenaar, R., Lankhorst, G., Bouter, L. The intra- and interrater reliability of the action research arm test: a practical test of upper extremity function in patients with stroke. Arch Phys Med Rehabil. 2001;82:14–19.
  20. Díaz-Tapia, V., Gana, J., Sobarzo, M., Jaramillo-Muñoz, A., Illanes-Díez, S. Study on the quality of life in patients with ischaemic stroke. Rev Neurol. 2008;46:652–655.
  21. Scoggins, J.F., Patrick, D.L. The use of patient-reported outcomes instruments in registered clinical trials: evidence from ClinicalTrials.gov. Contemp Clin Trials. 2009;30:289–292.
  22. Zhan, S., Ottenbacher, K.J. Single subject research designs for disability research. Disabil Rehabil. 2001;23:1–8.
  23. Bütefisch, C., Hummelsheim, H., Denzler, P., Mauritz, K. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand.J Rehabil Med. 1995;43:257–263.
  24. Hu, X.L., Tong, K.Y., Li, R. et al, Effectiveness of functional electrical stimulation (FES)-robot assisted wrist training on persons after stroke. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:5819–5822.
  25. Bradnam, L., Stinear, C.M., Byblow, W. Ipsilateral motor pathways after stroke: implications for non-invasive brain stimulation. Front Hum Neurosci. 2013;7:184.
  26. Lin, F.M., Sabbahi, M. Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia. Arch Phys Med Rehabil. 1999;80:526–530.
  27. De Oliveira, R., Cacho, E., Borges, G. Improvements in the upper limb of hemiparetic patients after reaching movements training. Int J Rehabil Res. 2007;30:67–70.
  28. Cusmano, I., Sterpi, I., Mazzone, A. et al, Evaluation of upper limb sense of position in healthy individuals and patients after stroke. J Healthc Eng. 2014;5:145–162.
  29. Goble, D.J. Proprioceptive acuity assessment via joint position matching: from basic science to general practice. Phys Ther. 2010;90:1176–1184.
  30. Ruta, D.A., Abdalla, M.I., Garratt, A.M., Coutts, A., Russell, I.T. SF 36 health survey questionnaire: I. Reliability in two patient based studies. Qual Health Care. 1994;3:180–185.
  31. Dorman, P., Slattery, J., Farrell, B., Dennis, M., Sandercock, P. Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. Stroke. 1998;29:63–68.
  32. Anderson, C., Laubscher, S., Burns, R. Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients. Stroke. 1996;27:1812–1816.

Source: Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

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[ARTICLE] Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study – Neurocase

ABSTRACT

The purpose of this study was to determine whether a conventional robot-assisted therapy of the upper limb was able to improve proprioception and motor recovery of an individual after stroke who exhibited proprioceptive deficits.

After robotic sensorimotor training, significant changes were observed in kinematic performance variables. Two quantitative parameters evaluating position sense improved after training. Range of motion during shoulder and wrist flexion improved, but only wrist flexion remained improved at 3-month follow-up.

These preliminary results suggest that intensive robot-aided rehabilitation may play an important role in the recovery of sensory function. However, further studies are required to confirm these data.

Source: Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study – Neurocase –

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[ARTICLE] The Effect of Transcutaneous Electrical Nerve Stimulation (TENS) Applied to the Foot and Ankle on Strength, Proprioception and Balance: A Preliminary Study – Full Text PDF

Abstract

Background: Transcutaneous electrical nerve stimulation (TENS) promotes upper motor neuron excitability which has the potential to improve function. As a precursor to clinical trials, we investigated the potential efficacy of TENS on strength, proprioception and balance in healthy older adults.

Method:

  • Design: A paired-sample randomized crossover trial. No stimulation was the control.
  • Intervention: A one-off session of TENS (Modulated frequency: 70-130Hz, 5 second cycle) via a conductive sock.
  • Participants: 25 healthy older volunteers with no pre-existing balance or mobility limitations or contra-indications to TENS.
  • Outcomes: Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dynamometer and balance (postural sway and forward reach test).
  • Analysis: Paired t-tests

Results: None of the parameters showed any significant changes with TENS (p>0.05).

Conclusions: The stimulation of cutaneous sensory nerve endings of the foot with the application of TENS showed no immediate effect on the ankle proprioception, lower leg muscle strength, and postural stability. The concern that TENS would have a distracting impact on sensation and balance was not supported according to these results.

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[ARTICLE] The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance – Full Text PDF

[Purpose] This study examined the effects of ramp gait training using lower extremity patterns of proprioceptive neuromuscular facilitation (PNF) on chronic stroke patients’ dynamic balance ability.

[Subjects and Methods] In total, 30 stroke patients participated in this study, and they were assigned randomly and equally to an experimental group and a control group. The experimental group received exercise treatment for 30 min and ramp gait training with PNF for 30 min. The control group received exercise treatment for 30 min and ground gait training for 30 min. The interventions were conducted in 30 min sessions, three times per week for four week. The subjects were assessed with the Berg balance scale test, timed up and go test, and functional reach test before and after the experiment and the results were compared.

[Results] After the intervention, the BBS and FRT values had significantly increased and the TUG value had significantly decreased in the experimental group; however, the BBS, FRT, and TUG values showed no significant differences in the control group. In addition, differences between the two groups before the intervention and after the intervention were not significant.

[Conclusion] In conclusion, ramp gait training with PNF improved stroke patients’ dynamic balance ability, and a good outcome of ramp gait training with PNF is also expected for other neurological system disease patients.

Full Text PDF

via The effects of ramp gait exercise with PNF on stroke patients’ dynamic balance.

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[WEB SITE] 12 Ways to Build Ankle Strength for Top Performance

What’s in the ankle? A physically active body must achieve a stable balance around each active joint for top performance. Ligaments connect the bones to each other, and provide much of the joint’s stability. Muscles are connected to bone by tendons, allowing for movement at the joints.

Although the ligaments connecting the bones in the ankle are necessary for proper function, there are several muscles that also help support the ankle during any type of activity. Building strength and proprioception, or special awareness, in these muscles helps to prevent injury and improve performance.

Why is it important to keep the ankle strong? When an athlete performs any movement–whether running or jumping–the ankle and surrounding muscles are put under a great deal of stress. If the ankle musculature is strong, the athlete can withstand greater force before an injury is sustained. In addition to decreasing ankle injuries, strengthening lower leg muscles will help prevent chronic conditions such as shin splints and Achilles tendonitis.

Proprioception Proprioception is the body’s ability to realize its place in space. If an athlete is moving into a position that could sprain his or her ankle, increased proprioception can decrease the risk by alerting the athlete to the danger. Proprioception can also increase an athlete’s performance. An athlete with superior balance and awareness will be able to control his or her body more effectively. This is especially true in sports like basketball and soccer, but valuable in all sports or training. Proprioceptive training is done with balance exercises.

Balance Training

  1. Standing on one leg: Hold for 30 seconds, working up to one minute per leg.
  2. Balance and catch: Standing on one leg, catch and throw a ball with a partner. Make certain to throw the ball right, left, high, low. Perform three sets of 30.
  3. One leg mini squats: On one leg do a half squat with the opposite leg out front for 10 reps, out to the side for 10 reps and behind for 10 reps. Repeat three times.

more —>  12 Ways to Build Ankle Strength for Top Performance | ACTIVE.

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[ARTICLE] Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot

Abstract (provisional)

Background

Selecting and maintaining an engaging and challenging training difficulty level in robot-assisted stroke rehabilitation remains an open challenge. Despite the ability of robotic systems to provide objective and accurate measures of function and performance, the selection and adaptation of exercise difficulty levels is typically left to the experience of the supervising therapist.

Methods

We introduce a patient-tailored and adaptive robot-assisted therapy concept to optimally challenge patients from the very first session and throughout therapy progress. The concept is evaluated within a four-week pilot study in six subacute stroke patients performing robot-assisted rehabilitation of hand function. Robotic assessments of both motor and sensory impairments of hand function conducted prior to the therapy are used to adjust exercise parameters and customize difficulty levels. During therapy progression, an automated routine adapts difficulty levels from session to session to maintain patients? performance around a target level of 70%, to optimally balance motivation and challenge.

Results

Robotic assessments suggested large differences in patients? sensorimotor abilities that are not captured by clinical assessments. Exercise customization based on these assessments resulted in an average initial exercise performance around 70% (62%?20%, mean?std), which was maintained throughout the course of the therapy (64%?21%). Patients showed reduction in both motor and sensory impairments compared to baseline as measured by clinical and robotic assessments. The progress in difficulty levels correlated with improvements in a clinical impairment scale (Fugl-Meyer Assessment) (rs = 0.70), suggesting that the proposed therapy was effective at reducing sensorimotor impairment.

Conclusions

Initial robotic assessments combined with progressive difficulty adaptation have the potential to automatically tailor robot-assisted rehabilitation to the individual patient. This results in optimal challenge and engagement of the patient, may facilitate sensorimotor recovery after neurological injury, and has implications for unsupervised robot-assisted therapy in the clinic and home environment.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

via JNER | Abstract | Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot.

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[ARTICLE] Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot

Abstract (provisional)

Background

Selecting and maintaining an engaging and challenging training difficulty level in robot-assisted stroke rehabilitation remains an open challenge. Despite the ability of robotic systems to provide objective and accurate measures of function and performance, the selection and adaptation of exercise difficulty levels is typically left to the experience of the supervising therapist.

Methods

We introduce a patient-tailored and adaptive robot-assisted therapy concept to optimally challenge patients from the very first session and throughout therapy progress. The concept is evaluated within a four-week pilot study in six subacute stroke patients performing robot-assisted rehabilitation of hand function. Robotic assessments of both motor and sensory impairments of hand function conducted prior to the therapy are used to adjust exercise parameters and customize difficulty levels. During therapy progression, an automated routine adapts difficulty levels from session to session to maintain patients? performance around a target level of 70%, to optimally balance motivation and challenge.

Results

Robotic assessments suggested large differences in patients? sensorimotor abilities that are not captured by clinical assessments. Exercise customization based on these assessments resulted in an average initial exercise performance around 70% (62%?20%, mean?std), which was maintained throughout the course of the therapy (64%?21%). Patients showed reduction in both motor and sensory impairments compared to baseline as measured by clinical and robotic assessments. The progress in difficulty levels correlated with improvements in a clinical impairment scale (Fugl-Meyer Assessment) (rs = 0.70), suggesting that the proposed therapy was effective at reducing sensorimotor impairment.

Conclusions

Initial robotic assessments combined with progressive difficulty adaptation have the potential to automatically tailor robot-assisted rehabilitation to the individual patient. This results in optimal challenge and engagement of the patient, may facilitate sensorimotor recovery after neurological injury, and has implications for unsupervised robot-assisted therapy in the clinic and home environment.

The complete article is available as aprovisional PDF . The fully formatted PDF and HTML versions are in production.

via JNER | Abstract | Assessment-driven selection and adaptation of exercise difficulty in robot-assisted therapy: a pilot study with a hand rehabilitation robot.

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