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Journal of Rehabilitation Medicine Apr 2016To evaluate the evidence for, and clinical relevance of, immediate and long-term effects of trunk restraint during reach-to-grasp training poststroke on movement... (Review)
Review
OBJECTIVE
To evaluate the evidence for, and clinical relevance of, immediate and long-term effects of trunk restraint during reach-to-grasp training poststroke on movement patterns and functional abilities within the framework of the International Classification of Functioning, Disability and Health.
DATA SOURCES
PubMed, Web of Science, CINAHL, Embase, PEDro, Cochrane Library (publication dates January 1985 to March 2015).
STUDY SELECTION
Randomized controlled trials comparing training using trunk restraint with any other exercise training.
DATA EXTRACTION
Data were extracted by one researcher and checked by two other researchers. The Cochrane Collaboration's tool for assessing risk of bias and the Physiotherapy Evidence Database scale were used by two researchers to assess study quality and risk of bias.
DATA SYNTHESIS
Eight studies met the inclusion criteria. Five studies found better recovery of movement patterns (trunk displacement, elbow extension, and/or shoulder flexion - body function/structure) at post-test in the experimental compared with the control groups. Functional abilities (activity/participation) improved more in the experimental groups in 3 studies at post-test. Long-term effects were found in one study after 4 weeks.
CONCLUSION
Trunk restraint has immediate and some long-term effects in adults with chronic stroke. However, these effects are not consistently clinically relevant when referring to minimal detectable change or minimal clinically important difference values.
Topics: Elbow Joint; Exercise Therapy; Hand Strength; Humans; Paresis; Range of Motion, Articular; Recovery of Function; Restraint, Physical; Shoulder Joint; Stroke; Stroke Rehabilitation; Torso
PubMed: 27008369
DOI: 10.2340/16501977-2077 -
Journal of Neuroengineering and... Jan 2024Restorative Brain-Computer Interfaces (BCI) that combine motor imagery with visual feedback and functional electrical stimulation (FES) may offer much-needed treatment... (Randomized Controlled Trial)
Randomized Controlled Trial
Brain computer interface training with motor imagery and functional electrical stimulation for patients with severe upper limb paresis after stroke: a randomized controlled pilot trial.
BACKGROUND
Restorative Brain-Computer Interfaces (BCI) that combine motor imagery with visual feedback and functional electrical stimulation (FES) may offer much-needed treatment alternatives for patients with severely impaired upper limb (UL) function after a stroke.
OBJECTIVES
This study aimed to examine if BCI-based training, combining motor imagery with FES targeting finger/wrist extensors, is more effective in improving severely impaired UL motor function than conventional therapy in the subacute phase after stroke, and if patients with preserved cortical-spinal tract (CST) integrity benefit more from BCI training.
METHODS
Forty patients with severe UL paresis (< 13 on Action Research Arm Test (ARAT) were randomized to either a 12-session BCI training as part of their rehabilitation or conventional UL rehabilitation. BCI sessions were conducted 3-4 times weekly for 3-4 weeks. At baseline, Transcranial Magnetic Stimulation (TMS) was performed to examine CST integrity. The main endpoint was the ARAT at 3 months post-stroke. A binominal logistic regression was conducted to examine the effect of treatment group and CST integrity on achieving meaningful improvement. In the BCI group, electroencephalographic (EEG) data were analyzed to investigate changes in event-related desynchronization (ERD) during the course of therapy.
RESULTS
Data from 35 patients (15 in the BCI group and 20 in the control group) were analyzed at 3-month follow-up. Few patients (10/35) improved above the minimally clinically important difference of 6 points on ARAT, 5/15 in the BCI group, 5/20 in control. An independent-samples Mann-Whitney U test revealed no differences between the two groups, p = 0.382. In the logistic regression only CST integrity was a significant predictor for improving UL motor function, p = 0.007. The EEG analysis showed significant changes in ERD of the affected hemisphere and its lateralization only during unaffected UL motor imagery at the end of the therapy.
CONCLUSION
This is the first RCT examining BCI training in the subacute phase where only patients with severe UL paresis were included. Though more patients in the BCI group improved relative to the group size, the difference between the groups was not significant. In the present study, preserved CTS integrity was much more vital for UL improvement than which type of intervention the patients received. Larger studies including only patients with some preserved CST integrity should be attempted.
Topics: Humans; Brain-Computer Interfaces; Stroke Rehabilitation; Pilot Projects; Stroke; Upper Extremity; Paresis
PubMed: 38245782
DOI: 10.1186/s12984-024-01304-1 -
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 -
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 -
Journal of Neuroengineering and... Oct 2016Unsupported or "against-gravity" reaching and hand opening movements are greatly impaired in individuals with hemiparetic stroke. The reduction in reaching excursion and... (Review)
Review
Robotic quantification of upper extremity loss of independent joint control or flexion synergy in individuals with hemiparetic stroke: a review of paradigms addressing the effects of shoulder abduction loading.
Unsupported or "against-gravity" reaching and hand opening movements are greatly impaired in individuals with hemiparetic stroke. The reduction in reaching excursion and hand opening is thought to be primarily limited by abnormal muscle co-activation of shoulder abductors with distal limb flexors, known as flexion synergy, that results in a loss of independent joint control or joint individuation. Our laboratory employs several methods for quantifying this movement impairment, however the most documented techniques are sophisticated and laboratory-based. Here a series of robotic methods that vary in complexity from comprehensive (laboratory-based) to focused (clinically relevant) are outlined in detail in order to facilitate translation and make recommendations for utilization across the translational spectrum as part of Journal of NeuroEngineering and Rehabilitation thematic series, "Technically-advanced assessments in sensory motor rehabilitation." While these methods focus on our published work utilizing the device, ACT, these methods can be duplicated using any mechatronic device with the appropriate characteristics. The common thread and most important aspect of the methods described is addressing the deleterious effects of abduction loading. Distal upper extremity joint performance is directly and monotonically modulated by proximal (shoulder abduction) joint demands. The employment of robotic metrics is the best tool for selectively manipulating shoulder abduction task requirements spanning the individual's full range of shoulder abduction strength. From the series of methods and the concluding recommendations, scientists and clinicians can determine the ideal robotic quantification method for the measurement of the impact of loss of independent joint control on reaching and hand function.
Topics: Humans; Paresis; Robotics; Shoulder; Shoulder Joint; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 27794362
DOI: 10.1186/s12984-016-0203-0 -
Journal of Neuroengineering and... Sep 2021The cause of smoothness deficits as a proxy for quality of movement post stroke is currently unclear. Previous simulation analyses showed that spectral arc length... (Observational Study)
Observational Study
BACKGROUND
The cause of smoothness deficits as a proxy for quality of movement post stroke is currently unclear. Previous simulation analyses showed that spectral arc length (SPARC) is a valid metric for investigating smoothness during a multi-joint goal-directed reaching task. The goal of this observational study was to investigate how SPARC values change over time, and whether SPARC is longitudinally associated with the recovery from motor impairments reflected by the Fugl-Meyer motor assessment of the upper extremity (FM-UE) in the first 6 months after stroke.
METHODS
Forty patients who suffered a first-ever unilateral ischemic stroke (22 males, aged 58.6 ± 12.5 years) with upper extremity paresis underwent kinematic and clinical measurements in weeks 1, 2, 3, 4, 5, 8, 12, and 26 post stroke. Clinical measures included amongst others FM-UE. SPARC was obtained by three-dimensional kinematic measurements using an electromagnetic motion tracking system during a reach-to-grasp movement. Kinematic assessments of 12 healthy, age-matched individuals served as reference. Longitudinal linear mixed model analyses were performed to determine SPARC change over time, compare smoothness in patients with reference values of healthy individuals, and establish the longitudinal association between SPARC and FM-UE scores.
RESULTS
SPARC showed a significant positive longitudinal association with FM-UE (B: 31.73, 95%-CI: [27.27 36.20], P < 0.001), which encompassed significant within- and between-subject effects (B: 30.85, 95%-CI: [26.28 35.41], P < 0.001 and B: 50.59, 95%-CI: [29.97 71.21], P < 0.001, respectively). Until 5 weeks post stroke, progress of time contributed significantly to the increase in SPARC and FM-UE scores (P < 0.05), whereafter they levelled off. At group level, smoothness was lower in patients who suffered a stroke compared to healthy subjects at all time points (P < 0.05).
CONCLUSIONS
The present findings show that, after stroke, recovery of smoothness in a multi-joint reaching task and recovery from motor impairments are longitudinally associated and follow a similar time course. This suggests that the reduction of smoothness deficits quantified by SPARC is a proper objective reflection of recovery from motor impairment, as reflected by FM-UE, probably driven by a common underlying process of spontaneous neurological recovery early post stroke.
Topics: Humans; Male; Motor Disorders; Paresis; Recovery of Function; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 34560898
DOI: 10.1186/s12984-021-00937-w -
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 -
Journal of Neuroengineering and... Dec 2019Stroke units provide patients with a multiparametric monitoring of vital functions, while no instruments are actually available for a continuous monitoring of patients...
BACKGROUND
Stroke units provide patients with a multiparametric monitoring of vital functions, while no instruments are actually available for a continuous monitoring of patients motor performance. Our aim was to develop an actigraphic index able both to identify the paretic limb and continuously monitor the motor performance of stroke patients in the stroke unit environment.
METHODS
Twenty consecutive acute stroke patients (mean age 69.2 years SD 10.1, 8 males and 12 females) and 17 bed-restrained patients (mean age 70.5 years SD 7.3, 7 males and 10 females) hospitalized for orthopedic diseases of the lower limbs, but not experiencing neurological symptoms, were enrolled. This last group represented our control group. The motor activity of arms was recorded for 24 h using two programmable actigraphic systems showing off as wrist-worn watches. The firmware segmented the acquisition in epochs of 1 minute and for each epoch calculates two motor activity indices: MA (Epoch-related Motor Activity index) and MA (Epoch-related Motor Activity index 2). MA is defined as the standard deviation of the acceleration module and MA as the module of the standard deviation of acceleration components. To describe the 24 h motor performance of each limb, we calculated the mean value of MA and MA (respectively MA and MA). Then we obtained two Asymmetry Rate Indices: AR and AR to show the motor activity prevalence. AR refers to the asymmetry index between the values of MA of both arms and AR to MA values. The stroke patients were clinically evaluated by NIHSS at the beginning (NIHSS) and at the end (NIHSS) of the 24 h actigraphic recordings.
RESULTS
Both MA and MA indices were smaller in the paretic than in the unaffected arm (respectively p = 0.004 and p = 0.004). AR showed a better capability (95% of paretic arms correctly identified, Phi Coefficient: 0.903) to discriminate the laterality of the clinical deficit than AR (85% of paretic arms correctly identified, Phi Coefficient: 0,698). We also found that AR did not differ between the two groups of patients while AR was greater in stroke patients than in controls and positively correlated with NIHSS total scores (r: 0.714, p < 0.001 for NIHSS, IC95%: 0.42-0.90) and with the sub-score relative to the paretic upper limb (r: 0.812, p < 0.001, IC95%: 0.62-0.96).
CONCLUSIONS
Our data show that actigraphic monitoring of upper limbs can detect the laterality of the motor deficit and measure the clinical severity. These findings suggest that the above described actigraphic system could implement the existing multiparametric monitoring in stroke units.
Topics: Actigraphy; Aged; Female; Humans; Male; Middle Aged; Motor Activity; Paresis; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 31801569
DOI: 10.1186/s12984-019-0603-z -
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