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PloS One 2019The effect of stroke topography on the recovery of hemiparetic upper limb (HUL) function is unclear due to limitations in previous studies-examination of lesion effects...
The effect of stroke topography on the recovery of hemiparetic upper limb (HUL) function is unclear due to limitations in previous studies-examination of lesion effects only in one point of time, or grouping together patients with left and right hemispheric damage (LHD, RHD), or disregard to different lesion impact on proximal and distal operations. Here we used voxel-based lesion symptom mapping (VLSM) to investigate the impact of stroke topography on HUL function taking into consideration the effects of (a) assessment time (subacute, chronic phases), (b) side of damaged hemisphere (left, right), (c) HUL part (proximal, distal). HUL function was examined in 3 groups of patients-Subacute (n = 130), Chronic (n = 66), and Delta (n = 49; patients examined both in the subacute and chronic phases)-using the proximal and distal sub-divisions of the Fugl-Meyer (FM) and the Box and Blocks (B&B) tests. HUL function following LHD tended to be affected in the subacute phase mainly by damage to white matter tracts, the putamen and the insula. In the chronic phase, a similar pattern was shown for B&B performance, whereas FM performance was affected by damage only to the white matter tracts. HUL function following RHD was affected in both phases, mainly by damage to the basal ganglia, white matter tracts and the insula, along with a restricted effect of damage to other cortical structures. In the chronic phase HUL function following RHD was affected also by damage to the thalamus. In the small Delta groups the following trends were found: In LHD patients, delayed motor recovery, captured by the B&B test, was affected by damage to the sensory-motor cortex, white matter association fibers and parts of the perisilvian cortex. In the RHD patients of the Delta group, delayed motor recovery was affected by damage to white matter projection fibers. Proximal and distal HUL functions examined in LHD patients (both in the subacute and chronic phases) tended to be affected by similar structures-mainly white matter projection tracts. In RHD patients, a distinction between proximal and distal HUL functions was found in the subacute but not in the chronic phase, with proximal and distal HUL functions affected by similar subcortical and cortical structures, except for an additional impact of damage to the superior temporal cortex and the retro-lenticular internal capsule only on proximal HUL function. The current study suggests the existence of important differences between the functional neuroanatomy underlying motor recovery following left and right hemisphere damage. A trend for different lesion effects was shown for residual proximal and distal HUL motor control. The study corroborates earlier findings showing an effect of the time after stroke onset (subacute, chronic) on the results of VLSM analyses. Further studies with larger sample size are required for the validation of these results.
Topics: Aged; Basal Ganglia; Brain; Female; Functional Laterality; Humans; Male; Middle Aged; Paresis; Prevalence; Recovery of Function; Stroke; Temporal Lobe; Tomography, X-Ray Computed; Upper Extremity; White Matter
PubMed: 31323056
DOI: 10.1371/journal.pone.0219738 -
PloS One 2015The Timed Up and Go (TUG) test is often used to estimate risk of falls. Foot clearance and displacement of the center of mass (COM), which are related to risk of...
BACKGROUND
The Timed Up and Go (TUG) test is often used to estimate risk of falls. Foot clearance and displacement of the center of mass (COM), which are related to risk of tripping and dynamic stability have never been evaluated during the TUG. Accurate assessment of these parameters using instrumented measurements would provide a comprehensive assessment of risk of falls in hemiparetic patients. The aims of this study were to analyze correlations between TUG performance time and displacement of the COM and foot clearance in patients with stroke-related hemiparesis and healthy subjects during the walking and turning sub-tasks of the TUG and to compare these parameters between fallers and non-fallers.
METHODS
29 hemiparetic patients and 25 healthy subjects underwent three-dimensional gait analysis during the TUG test. COM and foot clearance were analyzed during the walking and turning sub-tasks of the TUG.
RESULTS
Lateral displacement of the COM was greater and faster during the walking sub-tasks and vertical displacement of the COM was greater during the turn in the patients compared to the healthy subjects (respectively p<0.01 and p<0.05). Paretic foot clearance was greater during walking and displacement of the COM was slower during the turn in the patients (p<0.01). COM displacement and velocity during the turn were correlated with TUG performance in the patients, however, vertical COM displacement was not. These correlations were significant in the healthy subjects. There were no differences between COM parameters or foot clearance in fallers and non-fallers.
DISCUSSION AND CONCLUSION
Hemiparetic patients are less stable than healthy subjects, but compensate with a cautious gait to avoid tripping. Instrumented analysis of the TUG test appears relevant for the assessment of dynamic stability in hemiparetic patients, providing more information than straight-line gait.
Topics: Accidental Falls; Adult; Aged; Biomechanical Phenomena; Exercise Test; Female; Gait; Healthy Volunteers; Humans; Male; Middle Aged; Paresis; Risk Assessment; Stroke
PubMed: 26469345
DOI: 10.1371/journal.pone.0140317 -
Gait & Posture Jul 2022In individuals with post-stroke hemiparesis, reduced paretic leg propulsion, measured through anterior ground reaction forces (AGRF), is a common and...
BACKGROUND
In individuals with post-stroke hemiparesis, reduced paretic leg propulsion, measured through anterior ground reaction forces (AGRF), is a common and functionally-relevant gait impairment. Deficits in other biomechanical variables such as plantarflexor moment, ankle power, and ankle excursion contribute to reduced propulsion. While reduction in the magnitude of propulsion post-stroke is well studied, here, our objective was to compare the timing of propulsion-related biomechanical variables.
RESEARCH QUESTION
Are there differences in the timing of propulsion and propulsion-related biomechanical variables between able-bodied individuals, the paretic leg, and non-paretic leg of post-stroke individuals?
METHODS
Nine able-bodied and 13 post-stroke individuals completed a gait analysis session comprising treadmill walking trials at each participant's self-selected speed. Two planned independent sample t-tests were conducted to detect differences in the timing of dependent variables between the paretic versus non-paretic leg post-stroke and paretic leg versus the dominant leg of able-bodied individuals.
RESULTS
Post-stroke individuals demonstrated significantly earlier timing of peak AGRF of their paretic leg versus their non-paretic leg and able-bodied individuals. Post-stroke participants displayed earlier timing of peak power of their paretic leg versus their non-paretic leg and able-bodied individuals, and earlier timing of peak ankle moment of the paretic leg versus able-bodied. No significant differences were detected in the timing of peak ankle angle.
SIGNIFICANCE
The earlier onset of peak AGRF, peak ankle power, and peak ankle moment may be an important, under-studied biomechanical factor underlying stroke gait impairments, and a potential therapeutic target for stroke gait retraining. Future investigations can explore the use of interventions such as gait biofeedback to normalize the timing of these peaks, thereby improving propulsion and walking function post-stroke.
Topics: Biomechanical Phenomena; Gait; Humans; Paresis; Stroke; Stroke Rehabilitation; Walking
PubMed: 35716486
DOI: 10.1016/j.gaitpost.2022.05.022 -
Journal of Neuroengineering and... May 2022Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are...
BACKGROUND
Individuals with hemiparesis post-stroke often have difficulty with tasks requiring upper extremity (UE) intra- and interlimb use, yet methods to quantify both are limited.
OBJECTIVE
To develop a quantitative yet sensitive method to identify distinct features of UE intra- and interlimb use during task performance.
METHODS
Twenty adults post-stroke and 20 controls wore five inertial sensors (wrists, upper arms, sternum) during 12 seated UE tasks. Three sensor modalities (acceleration, angular rate of change, orientation) were examined for three metrics (peak to peak amplitude, time, and frequency). To allow for comparison between sensor data, the resultant values were combined into one motion parameter, per sensor pair, using a novel algorithm. This motion parameter was compared in a group-by-task analysis of variance as a similarity score (0-1) between key sensor pairs: sternum to wrist, wrist to wrist, and wrist to upper arm. A use ratio (paretic/non-paretic arm) was calculated in persons post-stroke from wrist sensor data for each modality and compared to scores from the Adult Assisting Hand Assessment (Ad-AHA Stroke) and UE Fugl-Meyer (UEFM).
RESULTS
A significant group × task interaction in the similarity score was found for all key sensor pairs. Post-hoc tests between task type revealed significant differences in similarity for sensor pairs in 8/9 comparisons for controls and 3/9 comparisons for persons post stroke. The use ratio was significantly predictive of the Ad-AHA Stroke and UEFM scores for each modality.
CONCLUSIONS
Our algorithm and sensor data analyses distinguished task type within and between groups and were predictive of clinical scores. Future work will assess reliability and validity of this novel metric to allow development of an easy-to-use app for clinicians.
Topics: Adult; Humans; Paresis; Reproducibility of Results; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 35525970
DOI: 10.1186/s12984-022-01020-8 -
European Journal of Physical and... Jun 2022Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on...
BACKGROUND
Ankle-foot orthoses are used to improve gait stability in patients with post-stroke gait; however, there is not enough evidence to support their beneficial impact on gait stability.
AIM
To investigate the effects of ankle-foot orthoses on post-stroke gait stability.
DESIGN
An experimental study with repeated measurements of gait parameters with and without orthosis.
SETTING
Inpatients and outpatients in the Fujita Health University Hospital, Toyoake, Japan.
POPULATION
Thirty-two patients (22 males; mean age 48.3±20.0 years) with post-stroke hemiparesis participated in the study.
METHODS
Three-dimensional treadmill gait analysis was performed with and without ankle-foot orthosis for each participant. Spatiotemporal parameters, their coefficient of variation, and margin of stability were evaluated. Toe clearance, another major target of orthosis, was also examined. The effect of orthosis in the patients with severe (not able to move within the full range of motion, defying gravity) and mild ankle impairment (able to move within the full range but have problem with speed and/or smoothness of the ankle movement) was compared.
RESULTS
In the total group comparison, the decrease in the coefficient of variation of step width (P=0.012), and margin of stability on the paretic side (P=0.023) were observed. In the severe ankle impairment groups, the decreased in the coefficient of variation of the non-paretic step length (P=0.007), stride length (P=0.037), and step width (P=0.033) and margin of stability on the paretic side (P=0.006) were observed. No significant effects were observed in the mild ankle impairment group; rather, the coefficient of variation of non-paretic step length increased with the use of orthosis in this group (P=0.043); however, toe clearance increased with the use of ankle-foot orthosis (P=0.041).
CONCLUSIONS
Ankle-foot orthoses improved gait stability indices; however, the effect was either not significant or showed possible worsening in the patients with mild ankle impairment, while the effect on toe clearance was significant. These results suggest that the effects of using orthoses in patients with mild impairment should be carefully evaluated.
CLINICAL REHABILITATION IMPACT
Understanding the effects of ankle-foot orthoses on the stability of post-stroke gait and their relationship with ankle impairment severity may support clinical decision-making while prescribing orthosis for post-stroke hemiparesis.
Topics: Adult; Aged; Ankle; Ankle Joint; Biomechanical Phenomena; Foot Orthoses; Gait; Gait Disorders, Neurologic; Humans; Male; Middle Aged; Paresis; Stroke; Stroke Rehabilitation
PubMed: 34498833
DOI: 10.23736/S1973-9087.21.07048-9 -
Acta Neurologica Belgica Sep 2019Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from...
Skull base osteomyelitis is a serious disease with a high risk of complications including neuroinfection. Typically, the inflammation of the skull base results from infection from neighboring tissues. In case of malignant otitis externa, inflammation disseminates from the external auditory canal. In this study, we present our experience with seven patients diagnosed with skull base osteomyelitis that began with otitis externa and have been treated in our department for the last 10 years. Department Patient Database was searched for the diagnosis skull base osteomyelitis. The search covered the last 10 years. The search revealed seven patients who met the above-described criteria. Medical records of those patients were carefully analyzed including age, gender, symptoms and signs, diagnostics details, treatment, performed procedures, number of hospitalization days, comorbid diseases, and complications including any cranial nerve palsy. Detailed analysis of medical records of patients included in this study showed that skull base osteomyelitis presents a challenge for diagnosis and treatment. Treatment strategy requires prolonged aggressive intravenous antibiotic therapy, and in some cases combined with surgical intervention. Cranial nerve paresis indicates progression of the disease and is associated with longer hospital stay. Similar relationship is observed in patients with skull base osteomyelitis that required surgery. Diabetes in patient's medical history may complicate the healing process. Diabetes, neural involvement, and surgery may overlap each other resulting in longer hospital stay. Cranial nerve paresis may not resolve completely and some neural deficits become persistent.
Topics: Adult; Aged; Aged, 80 and over; Cranial Nerve Diseases; Female; Humans; Length of Stay; Male; Middle Aged; Osteomyelitis; Otitis Externa; Outcome Assessment, Health Care; Paresis; Prognosis; Retrospective Studies; Skull Base
PubMed: 30840222
DOI: 10.1007/s13760-019-01110-w -
Medicine Jul 2020Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome... (Review)
Review
RATIONALE
Segmental zoster paresis (SZP) is a relatively rare neurologic complication of herpes zoster (HZ), and is characterized by focal asymmetric motor weakness in the myotome that corresponds to skin lesions of the dermatome. The upper extremities are the second most commonly involved regions after the face, and predominantly involve proximal muscles. The pathogenesis of SZP remains unclear; however, most of the reports indicate that it is the inflammation because of the spread of the herpes virus.
PATIENT CONCERNS
A 72-year-old man without trauma history of the left shoulder joint developed weakness of the left proximal upper extremity 10 days after vesicular eruption of HZ.
DIAGNOSES
His left shoulder girdle paresis was diagnosed with the upper truncus of the brachial plexus as a HZ complication according to a series of tests, including cervical magnetic resonance imaging (MRI), cerebral fluid analysis, sonography, and electrophysiological studies.
INTERVENTIONS
Acyclovir and prednisolone were administered during hospitalization to treat SZP. Meanwhile, analgesics and gabapentin were administered to control the patient's neuralgic pain. He also received inpatient (daily) and outpatient (3 times per week) physical therapy along with range of motion and strengthening exercises.
OUTCOMES
Partial improvement of the strength of the left shoulder girdle, and no improvement of the left deltoid muscle was observed 2 months after the interventions.
LESSONS
This case emphasizes that HZ infections may be complicated by segmental paresis and they should be considered in the differential diagnosis of acute paresis in the upper limb. Awareness of this disorder is important because it avoids unnecessary invasive investigations and interventions, leading to suitable treatments with favorable prognosis.
Topics: Aged; Herpes Zoster; Humans; Male; Paresis; Upper Extremity
PubMed: 32664058
DOI: 10.1097/MD.0000000000020466 -
Journal of the American Veterinary... May 2017
Topics: Animals; Diagnosis, Differential; Dog Diseases; Dogs; Female; Magnetic Resonance Imaging; Meningeal Neoplasms; Meningioma; Neurologic Examination; Paresis
PubMed: 28467743
DOI: 10.2460/javma.250.10.1097 -
Clinical Rehabilitation Jun 2020The aim of this study is to evaluate a novel composite measure of active range of motion (X) and determine whether this measure correlates with active function. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of this study is to evaluate a novel composite measure of active range of motion (X) and determine whether this measure correlates with active function.
DESIGN
Post hoc analysis of two randomized, placebo-controlled, double-blind studies with open-label extensions exploring changes in active function with abobotulinumtoxinA.
SETTING
Tertiary rehabilitation centers in Australia, Europe, and the United States.
SUBJECTS
Adults with upper ( = 254) or lower ( = 345) limb spastic paresis following stroke or brain trauma.
INTERVENTIONS
AbobotulinumtoxinA (⩽5 treatment cycles) in the upper or lower limb.
MAIN MEASURES
X was used to calculate a novel composite measure (CX), defined as the sum of X against elbow, wrist, and extrinsic finger flexors (upper limb) or soleus and gastrocnemius muscles (lower limb). Active function was assessed by the Modified Frenchay Scale and 10-m comfortable barefoot walking speed in the upper limb and lower limb, respectively. Correlations between CX and active function at Weeks 4 and 12 of open-label cycles were explored.
RESULTS
CX and active function were moderately correlated in the upper limb ( < 0.0001-0.0004, = 0.476-0.636) and weakly correlated in the lower limb ( < 0.0001-0.0284, = 0.186-0.285) at Weeks 4 and 12 of each open-label cycle. Changes in CX and active function were weakly correlated only in the upper limb (Cycle 2 Week 12, = 0.0160, = 0.213; Cycle 3 Week 4, = 0.0031, = 0.296). Across cycles, CX improvements peaked at Week 4, while functional improvements peaked at Week 12.
CONCLUSION
CX is a valid measure for functional impairments in spastic paresis. CX improvements following abobotulinumtoxinA injection correlated with and preceded active functional improvements.
Topics: Acetylcholine Release Inhibitors; Adult; Aged; Australia; Botulinum Toxins, Type A; Brain Injuries; Double-Blind Method; Female; Humans; Lower Extremity; Male; Middle Aged; Muscle Spasticity; Muscle, Skeletal; Outcome Assessment, Health Care; Paresis; Range of Motion, Articular; Recovery of Function; Stroke; Treatment Outcome; Upper Extremity; Walking Speed
PubMed: 32336148
DOI: 10.1177/0269215520911970 -
Journal of Applied Physiology... Sep 2021Upper limb motor impairments, such as muscle weakness, loss of dexterous movement, and reduced sensation, are common after a stroke. The extent and severity of these...
Upper limb motor impairments, such as muscle weakness, loss of dexterous movement, and reduced sensation, are common after a stroke. The extent and severity of these impairments differ among individuals, depending on the anatomical location and size of lesions. Identifying impairments specific to the individual is critical to optimize their functional recovery. The upper limb Physiological Profile Assessment (PPA) provides quantitative measures of key physiological domains required for adequate function in the upper limbs. The present study investigates the use of the upper limb PPA in a chronic stroke population. Fifty participants with chronic stroke completed all tests of the upper limb PPA with both their affected and less affected upper limbs. Performance in each test was compared to that of 50 age- and sex-matched control subjects with no history of a stroke. Correlations between test performance and validated measures of stroke, sensorimotor function, and disability were examined. Compared with control subjects, people with stroke demonstrated substantially impaired upper limb PPA performance for both their affected and less affected limbs. Performance in the upper limb PPA was associated with validated measures of sensorimotor function specific to the stroke population (Fugl-Meyer Assessment) and stroke-related disability (Stroke Impact Scale). The upper limb PPA shows good concurrent validity as a means to quantify upper limb function in a chronic stroke population. These tests identify domain-specific deficits and could be further tailored to an individual patient by the clinician to inform rehabilitation and track recovery. Upper limb motor impairment is a common manifestation after stroke, compromising independence in fundamental daily activities involving the ability to reach, grasp, and manipulate objects. The upper limb Physiological Profile Assessment (PPA) offers a means of quantifying performance of the individual sensorimotor domains that are essential for upper limb function. Establishing individual performance profiles based on age- and sex-based normative scores may facilitate individualized treatment decisions by identifying the stroke patient's specific strengths and limitations.
Topics: Humans; Motor Disorders; Paresis; Recovery of Function; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 34264125
DOI: 10.1152/japplphysiol.00078.2021