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Topics in Stroke Rehabilitation Feb 2016Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Muscle weakness is the main cause of motor impairment among stroke survivors and is associated with reduced peak muscle torque.
OBJECTIVE
To systematically investigate and organize the evidence of the reliability of muscle strength evaluation measures in post-stroke survivors with chronic hemiparesis.
DATA SOURCES
Two assessors independently searched four electronic databases in January 2014 (Medline, Scielo, CINAHL, Embase).
STUDY SELECTION
Inclusion criteria comprised studies on reliability on muscle strength assessment in adult post-stroke patients with chronic hemiparesis.
DATA EXTRACTION
We extracted outcomes from included studies about reliability data, measured by intraclass correlation coefficient (ICC) and/or similar. The meta-analyses were conducted only with isokinetic data.
RESULTS
Of 450 articles, eight articles were included for this review. After quality analysis, two studies were considered of high quality. Five different joints were analyzed within the included studies (knee, hip, ankle, shoulder, and elbow). Their reliability results varying from low to very high reliability (ICCs from 0.48 to 0.99). Results of meta-analysis for knee extension varying from high to very high reliability (pooled ICCs from 0.89 to 0.97), for knee flexion varying from high to very high reliability (pooled ICCs from 0.84 to 0.91) and for ankle plantar flexion showed high reliability (pooled ICC = 0.85).
CONCLUSION
Objective muscle strength assessment can be reliably used in lower and upper extremities in post-stroke patients with chronic hemiparesis.
Topics: Exercise Test; Humans; Muscle Strength; Paresis; Reproducibility of Results; Stroke
PubMed: 26243549
DOI: 10.1179/1945511915Y.0000000008 -
Acta Neurologica Scandinavica Jul 2017To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients.
OBJECTIVES
To investigate clinical characteristics of ipsilateral hemiparesis in ischemic stroke patients.
MATERIALS AND METHODS
Patients with acute ischemic stroke were prospectively examined. Ipsilateral hemiparesis was defined as hemiparesis ipsilateral to recent stroke lesions. Patients with ipsilateral hemiparesis were examined with functional neuroimaging studies including transcranial magnetic stimulation (TMS) and functional MRI.
RESULTS
Of 8360 patients, ipsilateral hemiparesis was detected in 14 patients (0.17%, mean age 71±6 years, eight men). Lesions responsible for the recent strokes were located in the frontal cortex in three patients, corona radiata in seven, internal capsule in one, and pons in three. These lesions were located along the typical route of the corticospinal tract in all but one patient. Thirteen patients also had a past history of stroke contralateral to the recent lesions; 12 of these had motor deficits contralateral to past stroke lesions. During TMS, ipsilateral magnetic evoked potentials were evoked in two of seven patients and contralateral potentials were evoked in all seven. Functional MRI activated cerebral hemispheres ipsilaterally in eight of nine patients and contralaterally in all nine.
CONCLUSIONS
Most patients with ipsilateral hemiparesis had a past history of stroke contralateral to the recent one, resulting in motor deficits contralateral to the earlier lesions. Moreover, functional neuroimaging findings indicated an active crossed corticospinal tract in all of the examined patients. Both findings suggest the contribution of the uncrossed corticospinal tract contralateral to stroke lesions as a post-stroke compensatory motor system.
Topics: Adult; Aged; Evoked Potentials, Motor; Female; Functional Laterality; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Pyramidal Tracts; Stroke; Transcranial Magnetic Stimulation
PubMed: 27666559
DOI: 10.1111/ane.12690 -
Scientific Reports Mar 2021The aim of our study was to validate the method of head-shake static posturography (HS-posturography) in healthy individuals and to establish the value of this novel...
The aim of our study was to validate the method of head-shake static posturography (HS-posturography) in healthy individuals and to establish the value of this novel method in the diagnostics of patients with unilateral vestibular lesion (UV). The study included 202 participants divided into two groups, one consisting of 133 patients with canal paresis CP > 19% and one of 69 healthy subjects. Participant was tested according to the standard protocol of static posturography (SP), and with head movements of 0.3 Hz (HS 40), 0.6 Hz (HS 70) in random order controlled by a metronome. HS-posturography revealed a similar repeatability and internal consistency as the standard posturography. In patients with UV, 4th condition revealed higher sensitivity (74%) and specificity (71%) in HS 40 than in the standard posturography (67%, 65% respectively) and HS 70 (54%, 70% respectively). Static posturography and HS- posturography revealed a high reliability of the testing method. The head movements added to static posturography improve the sensitivity and specificity of the method in group with vestibular impairment. The most important test for that purpose seems to be the one on unstable surface with the eyes closed, with low frequency of head movements.
Topics: Adult; Aged; Case-Control Studies; Female; Head Movements; Humans; Male; Middle Aged; Paresis; Postural Balance; Posture; Sensitivity and Specificity; Vestibular Function Tests; Vestibule, Labyrinth
PubMed: 33737683
DOI: 10.1038/s41598-021-85745-x -
Revue Neurologique Oct 2023This works comprehensively analyses a modern cohort of patients with ipsilateral hemiparesis (IH) and discusses the pathophysiological theories elaborated to explain... (Review)
Review
PURPOSE
This works comprehensively analyses a modern cohort of patients with ipsilateral hemiparesis (IH) and discusses the pathophysiological theories elaborated to explain this paradoxical neurological sign according to the findings from contemporary neuroimaging and neurophysiological techniques.
METHODS
A descriptive analysis of the epidemiological, clinical, neuroradiological, neurophysiological, and outcome data in a series of 102 case reports of IH published on since the introduction of CT/MRI diagnostic methods (years 1977-2021) was performed.
RESULTS
IH mostly developed acutely (75.8%) after traumatic brain injury (50%), as a consequence of the encephalic distortions exerted by an intracranial haemorrhage eventually causing contralateral peduncle compression. Sixty-one patients developed a structural lesion involving the contralateral cerebral peduncle (SLCP) demonstrated by modern imaging tools. This SLCP showed certain variability in its morphology and topography, but it seems pathologically consistent with the lesion originally described in 1929 by Kernohan & Woltman. The study of motor evoked potentials was seldom employed for the diagnosis of IH. Most patients underwent surgical decompression, and a 69.1% experienced some improvement of the motor deficit.
CONCLUSIONS
Modern diagnostic methods support that most cases in the present series developed IH following the KWNP model. The SLCP is presumably the consequence of either compression or contusion of the cerebral peduncle against the tentorial border, although focal arterial ischemia may also play a contributing role. Some improvement of the motor deficit should be expected even in the presence of a SLCP, provided the axons of the CST were not completely severed.
Topics: Humans; Brain Diseases; Brain; Cerebral Peduncle; Magnetic Resonance Imaging; Paresis
PubMed: 36907707
DOI: 10.1016/j.neurol.2022.11.015 -
BMC Neurology May 2018Dyke-Davidoff-Masson syndrome is a rare condition of unknown frequency resulting from brain injury due to a multitude of causes; especially in early life....
BACKGROUND
Dyke-Davidoff-Masson syndrome is a rare condition of unknown frequency resulting from brain injury due to a multitude of causes; especially in early life. Characteristics include cerebral hemiatrophy/hypoplasia, contralateral hemiparesis, seizures, and compensatory osseous hypertrophy.
CASE PRESENTATION
We present a case of a 13-year-old girl who initially presented with headaches, followed by episodic complex-partial seizures; which was controlled via medication. She also had right sided hemiparesis. Computed tomography (CT) showed evidence of left parieto-temporal infarct with cerebral atrophy. Complementary magnetic resonance imaging (MRI) did not reveal additional information. Workup for young stroke was negative. Upon further evaluation by Neuroradiology, features suggesting Dyke-Davidoff-Masson syndrome were confirmed. Patient has been under Neurology follow up since.
CONCLUSIONS
Due to its rarity, Dyke-Davidoff-Masson syndrome may easily be missed by the majority of treating clinicians. Knowledge of its features on imaging enables timely and accurate diagnosis - allowing appropriate management.
Topics: Adolescent; Brain Diseases; Female; Headache; Humans; Magnetic Resonance Imaging; Paresis; Seizures; Syndrome; Tomography, X-Ray Computed
PubMed: 29843624
DOI: 10.1186/s12883-018-1079-3 -
Revue Neurologique Nov 2014Upper limb robot-assisted rehabilitation is a novel physical treatment for neurological motor impairments. During the last decade, this rehabilitation option utilizing... (Review)
Review
INTRODUCTION
Upper limb robot-assisted rehabilitation is a novel physical treatment for neurological motor impairments. During the last decade, this rehabilitation option utilizing technological tools has been evaluated in hemiparetic patients, mostly after stroke.
STATE OF ART
Studies at acute and chronic stages suggested good tolerance and a significant and persistent reduction of motor impairment; a real impact on disability has been shown in acute/sub acute patients.
PERSPECTIVES
Improved access to rehabilitation robots and an optimal use will probably be associated with higher efficiency of rehabilitative work in the paretic upper limb.
CONCLUSIONS
Even if this treatment is still confined to a narrow circle of users, the device's biomechanical properties and clinical suggestions from the literature may show promise for the future of rehabilitation.
Topics: Humans; Paresis; Recovery of Function; Robotics; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity
PubMed: 25304657
DOI: 10.1016/j.neurol.2014.07.012 -
Brain and Behavior May 2016Additionally to the forearm rolling test to detect mild unilateral upper limb dysfunction, the bed cycling test (BCT) for detection of mild to moderate lower limb... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Additionally to the forearm rolling test to detect mild unilateral upper limb dysfunction, the bed cycling test (BCT) for detection of mild to moderate lower limb dysfunction was developed, evaluated and compared to the leg holding test.
METHODS
In a prospective observer-blinded study, 60 patients with MRI/CT-proven focal cerebral hemisphere lesions and a mild to moderate unilateral paresis of the lower limb (graduated MRC 3-4/5), and 60 control persons with normal imaging were examined and filmed. Nine observers blinded to the diagnosis evaluated these videos. The sensitivity, specificity and the positive and negative predictive values of the clinical tests were analyzed.
RESULTS
The observers gave a correct evaluation of BCT in 35.5% of all patients with focal cerebral lesions compared to 26.0% for the leg holding test. On the other hand, observers had false negative results in 29.1% of cases with BCT and 44.7% with leg holding test. In 36.7% of patients, only BCT was pathological while leg holding test was unremarkable. The sensitivity of the combination of both tests was 0.68 (95% CI 0.61-0.75). The BCT is more sensitive (64.3%) than leg holding test (46.2%) while the specificity of leg holding test (85.6%) is higher than of BCT (70.1%) to detect a cerebral lesion affecting the lower limb. The inter-rater variability is high with no differences comparing different types of clinical experience.
CONCLUSIONS
The BCT is a useful additional clinical bedside test to detect subtle unilateral cerebral lesions. The BCT is easy to perform and can be added to the routine neurological examination.
Topics: Adult; Aged; Aged, 80 and over; Cerebrovascular Disorders; Exercise Test; Humans; Lower Extremity; Middle Aged; Neurologic Examination; Paresis; Young Adult
PubMed: 27096103
DOI: 10.1002/brb3.445 -
Journal of Neurophysiology Apr 2019Posture and movement planning, preparation, and execution of a goal-directed reaching movement are impaired in individuals with stroke. No studies have shown whether the...
Posture and movement planning, preparation, and execution of a goal-directed reaching movement are impaired in individuals with stroke. No studies have shown whether the deficits are generally impaired or are specific to the lesioned hemisphere/paretic arm. This study utilized StartReact (SR) responses elicited by loud acoustic stimuli (LAS) to investigate the preparation and execution of anticipatory postural adjustments (APAs) and reach movement response during both paretic and nonparetic arm reaching in individuals with stroke and in age-matched healthy controls. Subjects were asked to get ready after receiving a warning cue and to reach at a "go" cue. An LAS was delivered at -500, -200, and 0 ms relative to the go cue. Kinetic, kinematic, and electromyographic data were recorded to characterize APA-reach movement responses. Individuals with stroke demonstrated systemwide deficits in posture and in movement planning, preparation, and execution of APA-reach sequence as shown by significant reduction in the incidence of SR response and impaired APA-reach performance, with greater deficits during paretic arm reaching. Use of trunk compensation strategy as characterized by greater involvement of trunk and pelvic rotation was utilized by individuals with stroke during paretic arm reaching compared with nonparetic arm reaching and healthy controls. Our findings have implications for upper extremity and postural control, suggesting that intervention should include training not only for the paretic arm but also for the nonparetic arm with simultaneous postural control requirements to improve the coordination of the APA-reach performance and subsequently reduce instability while functional tasks are performed during standing. NEW & NOTEWORTHY Our study is the first to show that nonparetic arm reaching also demonstrates impairment in posture and movement planning, preparation, and execution when performed during standing by individuals with stroke. In addition, we found compensatory trunk and pelvic rotations were used during a standing reach task for the paretic arms. The findings have clinical implications for upper extremity and postural rehabilitation, suggesting that training should include the nonparetic arms and incorporate simultaneous postural control demands.
Topics: Aged; Anticipation, Psychological; Arm; Biomechanical Phenomena; Cues; Female; Goals; Humans; Male; Middle Aged; Movement; Paresis; Posture; Psychomotor Performance; Stroke
PubMed: 30785824
DOI: 10.1152/jn.00694.2018 -
Folia Neuropathologica 2022Spontaneous spinal epidural haematoma (SSEH) is a rare disease that requires emergency decompression or haematoma evacuation to prevent permanent neurological deficits.... (Review)
Review
Spontaneous spinal epidural haematoma (SSEH) is a rare disease that requires emergency decompression or haematoma evacuation to prevent permanent neurological deficits. Hemiparesis is an extremely rare presentation of SSEH, commonly misdiagnosed as stroke. With the help of case studies and references, this paper comprehensively discusses the effective methods to distinguish SSEH from stroke and provides theoretical support and ideas for rapid and accurate identification of SSEH. Herein, we report on the case of a 51-year-old man with SSEH who presented with acute hemiparesis and posterior neck pain. Cervical computed tomography (CT) revealed cervical degeneration. A carotid CT angiogram revealed a high-density mass in the C2-C5 right posterolateral epidural region. Cervical spine magnetic resonance imaging showed SSEH. The patient was conservatively treated and discharged following a full recovery. Rapid identification of SSEH continues to present a great challenge for neurologists. A soft tissue CT scan can be used to quickly and accurately identify SSEH; however, in the absence of cranial signs, Brown-Sequard syndrome, Lhermitte's sign and Horner syndrome should be used to differentiate SSEH from stroke.
Topics: Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Stroke; Tomography, X-Ray Computed
PubMed: 35950479
DOI: 10.5114/fn.2022.116940 -
Somatosensory & Motor Research Mar 2020Muscle tendon vibration (MTV) strongly activates muscle spindles and can evoke kinaesthetic illusions. Although potentially relevant for sensorimotor rehabilitation in...
Muscle tendon vibration (MTV) strongly activates muscle spindles and can evoke kinaesthetic illusions. Although potentially relevant for sensorimotor rehabilitation in stroke, MTV is scarcely used in clinical practice, likely because of the absence of standardised procedures to elicit and characterise movement illusions. This work developed and validated a Standardised Kinaesthetic Illusion Procedure (SKIP) to favour the use of MTV-induced illusions in clinical settings. SKIP scores were obtained in 15 individuals with chronic stroke and 18 age- and gender-matched healthy counterparts. A further 13 healthy subjects were tested to provide more data with the general population. MTV was applied over the Achilles tendon and SKIP scoring system characterised the clearness and direction of the illusions of ankle dorsiflexion movements. All healthy and stroke participants perceived movement illusions. SKIP scores on the paretic side were significantly lower compared to the non paretic and healthy. Illusions were less clear and sometimes in unexpected directions with the impaired ankle, but still possible to elicit in the presence of sensorimotor deficits. SKIP represents an ancillary and potentially useful clinical method to elicit and characterise illusions of movements induced by MTV. SKIP could be relevant to further assess the processing of proprioceptive afferents in stroke and their potential impact on motor control and recovery. It may be used to guide therapy and improve sensorimotor recovery. Future work is needed to investigate the metrological properties of our method (reliability, responsiveness, etc.), and also the neurophysiological underpinnings of MTV-induced illusions.
Topics: Achilles Tendon; Adult; Aged; Aged, 80 and over; Ankle; Chronic Disease; Female; Humans; Illusions; Kinesthesis; Male; Middle Aged; Muscle, Skeletal; Paresis; Physical Stimulation; Stroke; Vibration; Young Adult
PubMed: 31973656
DOI: 10.1080/08990220.2020.1713739