Chronic Stroke Subjects Research Articles

Concurrent tDCS-fMRI after stroke reveals link between attention network organization and motor improvement

Restoring motor function after stroke necessitates involvement of numerous cognitive systems. However, the impact of damage to motor and cognitive network organization on recovery is not well understood. To discover correlates of successful recovery, we explored imaging characteristics in chronic stroke subjects by combining noninvasive brain stimulation and fMRI. Twenty stroke survivors (6 months or more after stroke) were randomly assigned to a single session of transcranial direct current stimulation (tDCS) or sham during image acquisition. Twenty healthy subjects were included as controls. tDCS was limited to 10 min at 2 mA to serve as a mode of network modulation rather than therapeutic delivery. Fugl-Meyer Assessments (FMA) revealed significant motor improvement in the chronic stroke group receiving active stimulation (p = 0.0005). Motor changes in this group were correlated in a data-driven fashion with imaging features, including functional connectivity (FC), surface-based morphometry, electric field modeling and network topology, focusing on relevant regions of interest. We observed stimulation-related changes in FC in supplementary motor (p = 0.0029), inferior frontal gyrus (p = 0.0058), and temporo-occipital (p = 0.0095) areas, though these were not directly related to motor improvement. The feature most strongly associated with FMA improvement in the chronic stroke cohort was graph topology of the dorsal attention network (DAN), one of the regions surveyed and one with direct connections to each of the areas with FC changes. Chronic stroke subjects with a greater degree of motor improvement had lower signal transmission cost through the DAN (p = 0.029). While the study was limited by a small stroke cohort with moderate severity and variable lesion location, these results nevertheless suggest a top-down role for higher order areas such as attention in helping to orchestrate the stroke recovery process.

Identifying alterations in hand movement coordination from chronic stroke survivors using a wearable high-density EMG sleeve

Objective.Non-invasive, high-density electromyography (HD-EMG) has emerged as a useful tool to collect a range of neurophysiological motor information. Recent studies have demonstrated changes in EMG features that occur after stroke, which correlate with functional ability, highlighting their potential use as biomarkers. However, previous studies have largely explored these EMG features in isolation with individual electrodes to assess gross movements, limiting their potential clinical utility. This study aims to predict hand function of stroke survivors by combining interpretable features extracted from a wearable HD-EMG forearm sleeve.Approach.Here, able-bodied (N= 7) and chronic stroke subjects (N= 7) performed 12 functional hand and wrist movements while HD-EMG was recorded using a wearable sleeve. A variety of HD-EMG features, or views, were decomposed to assess alterations in motor coordination.Main Results.Stroke subjects, on average, had higher co-contraction and reduced muscle coupling when attempting to open their hand and actuate their thumb. Additionally, muscle synergies decomposed in the stroke population were relatively preserved, with a large spatial overlap in composition of matched synergies. Alterations in synergy composition demonstrated reduced coupling between digit extensors and muscles that actuate the thumb, as well as an increase in flexor activity in the stroke group. Average synergy activations during movements revealed differences in coordination, highlighting overactivation of antagonist muscles and compensatory strategies. When combining co-contraction and muscle synergy features, the first principal component was strongly correlated with upper-extremity Fugl Meyer hand sub-score of stroke participants (R2= 0.86). Principal component embeddings of individual features revealed interpretable measures of motor coordination and muscle coupling alterations.Significance.These results demonstrate the feasibility of predicting motor function through features decomposed from a wearable HD-EMG sleeve, which could be leveraged to improve stroke research and clinical care.

Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke

Background Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching. Methods We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was “gain” (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping. Results Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function. Conclusions Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement

Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke through EMG-Driven Robot Hand Training: Insights from Dynamic Causal Modeling.

EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement (β=3.56, p<0.001). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 (β=0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.

만성 뇌졸중 환자의 상지기능 향상을 위한 몰입형 가상현실과 비몰입형 가상현실 중재효과

Purpose: The purpose of this study was to investigate the effect of intervention using immersive and non-immersive virtual reality devices on the improvement of the upper limb function in 3 participants with chronic stroke. Methods: The design used a combination of an AB design and an alternating design to compare the effects of both intervention types based on a single-subject research design. The dependent variables were the upper limb functions, and BBT and FMA were applied as the evaluation tools. The study consisted of 20 sessions given during a total of 7 weeks including four sessions of a baseline period and 16 sessions of an intervention period. Results: As the results indicate, it was first confirmed that virtual reality intervention had a positive effect on improvements of the upper limb function of chronic stroke patients. All dependent variables measured during the intervention period exceeded the 2SD interval of the measured value during the baseline period. Second, there was no significant difference between non-immersive virtual reality intervention and immersive virtual reality intervention. Conclusion: The results of this study show that intervention using immersive and non-immersive virtual reality can have a positive effect on improvements of upper limb function of chronic stroke subjects.

Compound muscle action potential (CMAP) scan examination of paretic and contralateral muscles reveals motor unit alterations after stroke

This study presents a novel compound muscle action potential (CMAP) examination of motor unit changes in paretic muscle post stroke. CMAP scan of the first dorsal interosseous (FDI) muscle was performed bilaterally in 16 chronic stroke subjects. Various parameters were derived from the CMAP scan to examine paretic muscle changes, including CMAP amplitude, D50, step index (STEPIX) and amplitude index (AMPIX). A significant decrease in CMAP amplitude and STEPIX was observed in paretic muscles compared with contralateral muscles (CMAP amplitude: paretic (9.0±0.5) mV, contralateral (11.3±0.9) mV, P=0.024; STEPIX: paretic 101.2±7.6, contralateral 121.9±6.5, P=0.020). No significant difference in D50 and AMPIX was observed between the paretic and contralateral sides (P>0.05). The findings revealed complex paretic muscle changes including motor unit degeneration, muscle fiber denervation, reinnervation and atrophy, providing useful insights to help understand neuromuscular mechanisms associated with weakness and other functional deterioration post stroke. The CMAP scan experimental protocols and the applied processing methods are noninvasive, convenient, and automated, offering practical benefits for clinical application.

Data-Driven Quantitation of Movement Abnormality after Stroke.

Stroke commonly affects the ability of the upper extremities (UEs) to move normally. In clinical settings, identifying and measuring movement abnormality is challenging due to the imprecision and impracticality of available assessments. These challenges interfere with therapeutic tracking, communication, and treatment. We thus sought to develop an approach that blends precision and pragmatism, combining high-dimensional motion capture with out-of-distribution (OOD) detection. We used an array of wearable inertial measurement units to capture upper body motion in healthy and chronic stroke subjects performing a semi-structured, unconstrained 3D tabletop task. After data were labeled by human coders, we trained two deep learning models exclusively on healthy subject data to classify elemental movements (functional primitives). We tested these healthy subject-trained models on previously unseen healthy and stroke motion data. We found that model confidence, indexed by prediction probabilities, was generally high for healthy test data but significantly dropped when encountering OOD stroke data. Prediction probabilities worsened with more severe motor impairment categories and were directly correlated with individual impairment scores. Data inputs from the paretic UE, rather than trunk, most strongly influenced model confidence. We demonstrate for the first time that using OOD detection with high-dimensional motion data can reveal clinically meaningful movement abnormality in subjects with chronic stroke.

Corticomuscular and intermuscular coherence are correlated after stroke: a simplified motor control?

During movement, corticomuscular coherence is a measure of central-peripheral communication, while intermuscular coherence is a measure of the amount of common central drive to the muscles. Although these two measures are modified in stroke subjects, no author has explored a correlation between them, neither in stroke subjects nor in healthy subjects. Twenty-four chronic stroke subjects and 22 healthy control subjects were included in this cohort study, and they performed 20 active elbow extension movements. The electroencephalographic and electromyographic activity of the elbow flexors and extensors were recorded. Corticomuscular and intermuscular coherence were calculated in the time-frequency domain for each limb of stroke and control subjects. Partial rank correlations were performed to study the link between these two variables. Our results showed a positive correlation between corticomuscular and intermuscular coherence only for stroke subjects, for their paretic and non-paretic limbs (P < 0.022; Rho > 0.50). These results suggest, beyond the cortical and spinal hypotheses to explain them, that stroke subjects present a form of simplification of motor control. When central-peripheral communication increases, it is less modulated and more common to the muscles involved in the active movement. This motor control simplification suggests a new way of understanding the plasticity of the neuromuscular system after stroke.

A Novel Telerehabilitation Approach for Cognitive-Language Therapy in Chronic Stroke Subjects With Aphasia: Neurocognitive Intervention Through Neurorehabilitation Exercises and Assessments

By stating “All people, everywhere, deserve the right care, right in their community,” <xref ref-type="bibr" rid="ref21" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">[21]</xref> . the World Health Organization sets, in an exhortative way, the fundamental assumption for primary health care. Under these premises, we developed an augmented and extended approach to a home-rehabilitation system to provide intensive care to chronic stroke patients with aphasia. The system proposes neurocognitive intervention based on an information and communication technologies ecosystem through neurorehabilitation exercises and assessments. In this study, we analyzed the feasibility, satisfaction, and motivation of patients, and the clinical effect of the intervention using this complex platform which, among other functions, allows the administration of speech and language home therapy. Eight patients conducted a therapeutic plan, including speech therapy, using the remote asynchronous rehabilitation system; seven patients were included in the control group (CG) and followed a traditional speech-therapy program. The analysis of usage revealed that participants made continuous and intensive use of the platform. The results confirmed the acceptability, perceived usefulness, and ease of use of the proposed platform. Clinical assessments showed that the system administers speech and language rehabilitation as effectively as traditional therapy, allowing one to consider such an approach as a valid alternative to standard face-to-face speech therapy.

Characterization of Functional Connectivity in Chronic Stroke Subjects after Augmented Reality Training

Augmented reality (AR) tools have been investigated with promising outcomes in rehabilitation. Recently, some studies have addressed the neuroplasticity effects induced by this type of therapy using functional connectivity obtained from resting-state functional magnetic resonance imaging (rs-fMRI). This work aims to perform an initial assessment of possible changes in brain functional connectivity associated with the use of NeuroR, an AR system for upper limb motor rehabilitation of poststroke participants. An experimental study with a case series is presented. Three chronic stroke participants with left hemiparesis were enrolled in the study. They received eight sessions with NeuroR to provide shoulder rehabilitation exercises. Measurements of range of motion (ROM) were obtained at the beginning and end of each session, and rs-fMRI data were acquired at baseline (pretest) and after the last training session (post-test). Functional connectivity analyses of the rs-fMRI data were performed using a seed placed at the noninjured motor cortex. ROM increased in two patients who presented spastic hemiparesis in the left upper limb, with a change in muscle tone, and stayed the same (at zero angles) in one of the patients, who had the highest degree of impairment, showing flaccid hemiplegia. All participants had higher mean connectivity values in the ipsilesional brain regions associated with motor function at post-test than at pretest. Our findings show the potential of the NeuroR system to promote neuroplasticity related to AR-based therapy for motor rehabilitation in stroke participants.

Individual electric field predicts functional connectivity changes after anodal transcranial direct-current stimulation in chronic stroke

The neuromodulation effect of anodal tDCS is not thoroughly studied, and the heterogeneous profile of stroke individuals with brain lesions would further complicate the stimulation outcomes. This study aimed to investigate the functional changes in sensorimotor areas induced by anodal tDCS and whether individual electric field could predict the functional outcomes. Twenty-five chronic stroke survivors were recruited and divided into tDCS group (n = 12) and sham group (n = 13). Increased functional connectivity (FC) within the surrounding areas of ipsilesional primary motor cortex (M1) was only observed after anodal tDCS. Averaged FC among the ipsilesional sensorimotor regions was observed to be increased after anodal tDCS (t(11) = 2.57, p = 0.026), but not after sham tDCS (t(12) = 0.69, p = 0.50). Partial least square analysis identified positive correlations between electric field (EF) strength normal to the ipsilesional M1 surface and individual FC changes in tDCS group (r = 0.84, p < 0.001) but not in sham group (r = 0.21, p = 0.5). Our results indicated anodal tDCS facilitates the FC within the ipsilesional sensorimotor network in chronic stroke subjects, and individual electric field predicts the functional outcomes.

Changes in intermuscular connectivity during active elbow extension reveal a functional simplification of motor control after stroke.

BackgroundStroke alters muscle co-activation and notably leads to exaggerated antagonist co-contraction responsible for impaired motor function. However, the mechanisms underlying this exaggerated antagonist co-contraction remain unclear. To fill this gap, the analysis of oscillatory synchronicity in electromyographic signals from synergistic muscles, also called intermuscular coherence, was a relevant tool.ObjectiveThis study compares functional intermuscular connectivity between muscle pairs of the paretic and non-paretic upper limbs of stroke subjects and the dominant limb of control subjects, concomitantly between two muscle pairs with a different functional role, through an intermuscular coherence analysis.MethodsTwenty-four chronic stroke subjects and twenty-four healthy control subjects were included. Subjects performed twenty elbow extensions while kinematic data and electromyographic activity of both flexor and extensor elbow muscles were recorded. Intermuscular coherence was analyzed in the beta frequency band compared to the assessment of antagonist co-contraction.ResultsIntermuscular coherence was higher in the stroke subjects’ paretic limbs compared to control subjects. For stroke subjects, the intermuscular coherence of the antagonist-antagonist muscle pair (biceps brachii—brachioradialis) was higher than that of the agonist-antagonist muscle pair (triceps brachii—brachioradialis). For the paretic limb, intermuscular coherence of the antagonist-antagonist muscle pair presented a negative relationship with antagonist co-contraction.ConclusionDifferences in intermuscular coherence between the paretic limbs of stroke subjects and control subjects suggest a higher common central drive during movement. Furthermore, results highlight the association between stroke-related alteration of intermuscular functional connectivity and the alteration of motor function.

The Reaching Phase of Feeding and Self-Care Actions Optimizes Action Observation Effects in Chronic Stroke Subjects

Background The Action Observation Therapy (AOT) is a well-established post-stroke rehabilitation treatment based on the theoretical framework of the Mirror Neuron System (MNS) activation. However, AOT protocols are still heterogeneous in terms of video contents of observed actions. Objective The aim of this study was to analyze electroencephalographic (EEG) recordings in stroke patients during the observation of different videos of task-specific upper limb movements, and to define which category of actions can elicit a stronger cortical activation in the observer’s brain. Methods Signals were analyzed from 19 chronic stroke subjects observing customized videos that represented 3 different categories of upper limb actions: Finalized Actions, Non-Finalized Actions, and Control Videos. The Event-Related Desynchronization in the µ and β bands was chosen to identify the involvement of the cerebral cortex: the area of the normalized power spectral density was calculated for each category and, deepening, for the reaching and completion sub-phases of Finalized Actions. For descriptive purposes, the time course of averaged signal power was described. The Kruskal–Wallis test (P < .05) was applied. Results The analysis showed a greater desynchronization when subjects observed Finalized Actions with respect to Non-Finalized in all recorded areas; Control videos provoked a synchronization in the same areas and frequency bands. The reaching phase of feeding and self-care actions evoked a greater suppression both in µ and β bands. Conclusions The observation of finalized arm movements seems to elicit the strongest activation of the MNS in chronic stroke patients. This finding may help the clinicians to design future AOT-based stroke rehabilitation protocols. Clinical Trial Registration: Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT04047134.

Regional cerebral blood perfusion changes in chronic stroke survivors as potential brain correlates of the functional outcome following gamified home-based rehabilitation (IntelliRehab)—a pilot study

BackgroundHospital-based stroke rehabilitation for stroke survivors in developing countries may be limited by staffing ratios and length of stay that could hamper recovery potential. Thus, a home-based, gamified rehabilitation system (i.e., IntelliRehab) was tested for its ability to increase cerebral blood flow (CBF), and the secondary impact of changes on the upper limb motor function and functional outcomes.ObjectiveTo explore the effect of IntelliRehab on CBF in chronic stroke patients and its correlation with the upper limb motor function.MethodsTwo-dimensional pulsed Arterial Spin Labelling (2D-pASL) was used to obtain CBF images of stable, chronic stroke subjects (n = 8) over 3-months intervention period. CBF alterations were mapped, and the detected differences were marked as regions of interest. Motor functions represented by Fugl-Meyer Upper Extremity Assessment (FMA) and Stroke Impact Scale (SIS) were used to assess the primary and secondary outcomes, respectively.ResultsRegional CBF were significantly increased in right inferior temporal gyrus and left superior temporal white matter after 1-month (p = 0.044) and 3-months (p = 0.01) of rehabilitation, respectively. However, regional CBF in left middle fronto-orbital gyrus significantly declined after 1-month of rehabilitation (p = 0.012). Moreover, SIS-Q7 and FMA scores significantly increased after 1-month and 3-months of rehabilitation. There were no significant correlations, however, between CBF changes and upper limb motor function.ConclusionsParticipants demonstrated improved motor functions, supporting the benefit of using IntelliRehab as a tool for home-based rehabilitation. However, within-participant improvements may have limited potential that suggests the need for a timely administration of IntelliRehab to get the maximum capacity of improvement.

Motor unit distribution and recruitment in spastic and non-spastic bilateral biceps brachii muscles of chronic stroke survivors

Objective. This study aims to characterize the motor units (MUs) distribution and recruitment pattern in the spastic and non-spastic bilateral biceps brachii muscles (BBMs) of chronic stroke survivors. Approach. High-density surface electromyography (HD-sEMG) signals were collected from both spastic and non-spastic BBMs of fourteen chronic stroke subjects during isometric elbow flexion at 10%, 30%, 50% and 100% maximal voluntary contractions (MVCs). By combining HD-sEMG decomposition and bioelectrical source imaging, MU innervation zones (MUIZs) of the decomposed MUs were first localized in the 3D space of spastic and non-spastic BBMs. The MU depth defined as the distance between the localized MUIZ and its normal projection on the skin surface was then normalized to the arm radius of each subject and averaged at given contraction level. The averaged MU depth at different contraction levels on a specific arm side (intra-side) and the bilateral depths under a specific contraction level (inter-side) were compared. Main results. The average depth of decomposed MUs increased with the contraction force and significant differences observed between 10% vs 50% (p < 0.0001), 10% vs 100% (p < 0.0001) and 30% vs 100% MVC (p = 0.0017) on the non-spastic side, indicating that larger MUs with higher recruitment threshold locate in deeper muscle regions. In contrast, no force-related difference in MU depth was observed on the spastic side, suggesting a disruption of orderly recruitment of MUs with increase of force level, or the MU denervation and the subsequent collateral reinnervation secondary to upper motor neuron lesions. Inter-side comparison demonstrated significant MU depth difference at 10% (p= 0.0048) and 100% force effort (p= 0.0026). Significance. This study represents the first effort to non-invasively characterize the MU distribution inside spastic and non-spastic bilateral BBM of chronic stroke patients by combining HD-sEMG recording, EMG signal decomposition and bioelectrical source imaging. The findings of this study advances our understanding regarding the neurophysiology of human muscles and the neuromuscular alterations following stroke. It may also offer important MU depth information for botulinum toxin injection in clinical post-stroke spasticity management.

Design of Spiral-Cable Forearm Exoskeleton to Assist Supination for Hemiparetic Stroke Subjects.

We present the development of a cable-based passive forearm exoskeleton that is designed to assist supination for hemiparetic stroke survivors. Our device uniquely provides torque sufficient for counteracting spasticity within a below-elbow apparatus. The mechanism consists of a spiral single-tendon routing embedded in a rigid forearm brace and terminated at the hand and upper-forearm. A spool with an internal releasable-ratchet mechanism allows the user to manually retract the tendon and rotate the hand to counteract involuntary pronation synergies due to stroke. We characterize the mechanism with benchtop testing and five healthy subjects, and perform a preliminary assessment of the exoskeleton with a single chronic stroke subject having minimal supination ability. The mechanism can be integrated into an existing active hand-opening orthosis to enable supination support during grasping tasks, and also allows for a future actuated supination strategy.

Addressing the inconsistent electric fields of tDCS by using patient-tailored configurations in chronic stroke: Implications for treatment

Transcranial direct current stimulation (tDCS) is a promising tool to improve and speed up motor rehabilitation after stroke, but inconsistent clinical effects refrain tDCS from clinical implementation. Therefore, this study aimed to assess the need for individualized tDCS configurations in stroke, considering interindividual variability in brain anatomy and motor function representation.We simulated tDCS in individualized MRI-based finite element head models of 21 chronic stroke subjects and 10 healthy age-matched controls. An anatomy-based stimulation target, i.e. the motor hand knob, was identified with MRI, whereas a motor function-based stimulation target was identified with EEG. For each subject, we simulated conventional anodal tDCS electrode configurations and optimized electrode configurations to maximize stimulation strength within the anatomical and functional target. The normal component of the electric field was extracted and compared between subjects with stroke and healthy, age-matched controls, for both targets, during conventional and optimized tDCS.Electrical field strength was significantly lower, more variable and more frequently in opposite polarity for subjects with stroke compared to healthy age-matched subjects, both for the anatomical and functional target with conventional, i.e. non-individualized, electrode configurations. Optimized, i.e. individualized, electrode configurations increased the electrical field strength in the anatomical and functional target for subjects with stroke but did not reach the same levels as in healthy subjects.Considering individual brain structure and motor function is crucial for applying tDCS in subjects with stroke. Lack of individualized tDCS configurations in subjects with stroke results in lower electric fields in stimulation targets, which may partially explain the inconsistent clinical effects of tDCS in stroke trials.

Effect of Ankle Joint Mobilization with Movement on Range of Motion, Balance and Gait Function in Chronic Stroke Survivors: Systematic Review of Randomized Controlled Trials.

BackgroundAnkle joint mobilization with movement has been speculated to be an important intervention for enhancing range of motion, balance, and gait functions in chronic stroke survivors. Nonetheless, there is a scarcity of recent conclusive evidence that evaluates its efficacy in chronic stroke patients. The purpose of this review was to synthesize existing evidence on the efficacy of mobilization with movement therapy on range of motion, balance, and gait performance in subjects after stroke.MethodsA comprehensive systematic search of literature was performed using the following databases: PubMed/Medline, CINAHL, AMED, PEDro, Cochrane Library, and Scopus. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of included trials. The primary outcome measures of this review were dorsiflexion range of motion (DF-ROM), and Berg balance scale (BBS). This review was reported in accordance with PRISMA statement guidelines. Due to variations in relevant trials, meta-analysis was not carried out.Results and ConclusionsSeven randomized controlled trials with a total of 224 subjects were analyzed. Evidence of overall quality was graded from moderate to high. This review found that mobilization with movement therapy could be an alternative rehabilitative intervention for subjects with chronic stroke to increase range of motion, balance, and gait ability. However, the evidence remains preliminary due to the small number of participants. Large-scale RCTs in the future are warranted to investigate the efficacy of mobilization with movement in subgroups of chronic stroke subjects.

Corticoreticulospinal tract neurophysiology in an arm and hand muscle in healthy and stroke subjects.

The corticoreticulospinal tract (CReST) is a descending motor pathway that reorganizes after corticospinal tract (CST) injury in animals. In humans, the pattern of CReST innervation to upper limb muscles has not been carefully examined in healthy individuals or individuals with CST injury. In the present study, we assessed CReST projections to an arm and hand muscle on the same side of the body in healthy and chronic stoke subjects using transcranial magnetic stimulation. We show that CReST connection strength to the muscles differs between healthy and stroke subjects, with stronger connections to the hand than arm in healthy subjects, and stronger connections to the arm than hand in stroke subjects. These results help us better understand CReST innervation patterns in the upper limb, and may point to its role in normal motor function and motor recovery in humans. The corticoreticulospinal tract (CReST) is a major descending motor pathway in many animals, but little is known about its innervation patterns in proximal and distal upper extremity muscles in humans. The contralesional CReST furthermore reorganizes after corticospinal tract (CST) injury in animals, but it is less clear whether CReST innervation changes after stroke in humans. We thus examined CReST functional connectivity, connection strength, and modulation in an arm and hand muscle of healthy (n=15) and chronic stroke (n=16) subjects. We delivered transcranial magnetic stimulation to the contralesional hemisphere (assigned in healthy subjects) to elicit ipsilateral motor evoked potentials (iMEPs) from the paretic biceps (BIC) and first dorsal interosseous (FDI) muscle. We operationalized CReST functional connectivity as iMEP presence/absence, CReST projection strength as iMEP size and CReST modulation as change in iMEP size by head rotation. We found comparable CReST functional connectivity to the BICs and FDIs in both subject groups. However, the pattern of CReST connection strength to the muscles diverged between groups, with stronger connections to FDIs than BICs in healthy subjects and stronger connections to BICs than FDIs in stroke subjects. Head rotation modulated only FDI iMEPs of healthy subjects. Our findings indicate that the healthy CReST does not have a proximal innervation bias, and its strong FDI connections may have functional relevance to finger individuation. The reversed CReST innervation pattern in stroke subjects confirms its reorganization after CST injury, and its strong BIC connections may indicate upregulation for particular upper extremity muscles or their functional actions.

Upper limbs cycle ergometer increases muscle strength, trunk control and independence of acute stroke subjects: A randomized clinical trial.

Studies demonstrate the benefits of upper limbs cycle ergometer (ULCE) in subacute and chronic stroke subjects, but the literature still needs to explore the acute phase of the disease. Verify the effects of ULCE on muscular strength, trunk control and independence of post-stroke subjects in hospital acute phase. In this randomized clinical trial participants were allocated into two groups. The control group (CG) performed two daily sessions of conventional physiotherapy, while the intervention group (IG) had one daily session of conventional physiotherapy and one of ULCE. The interventions were carried out for 20 minutes for five days. Both groups were assessed before and after the treatment for upper limbs strength by manual dynamometer, trunk control by Trunk Impairment Scale and level of independence by the Modified Rankin Scale. Twenty subjects with mean ages of 63.5±4.5 were enrolled. There was a significant intra-group difference of palmar grip, shoulder abductors, elbow flexor and wrist extensor strength, trunk control and functional independence only in IG. Inter-group difference for all variables showed superiority in IG. ULCE is an effective device for increasing muscle strength, trunk control and consequently improving the independence of post-stroke subjects in the acute hospital phase.