Hand Motor Recovery Research Articles

Functional MRI evaluation of hyperbaric oxygen therapy’s effect on hand motor recovery in a chronic post-stroke patient: a case report and physiological discussion

The objective of the case report was to evaluate a specific HBOT protocol as an effective treatment for stroke rehabilitation, specifically improving hand motor function in chronic post-stroke patients. Stroke is the second leading cause of long-term disability worldwide. About 80% of individuals with acute stroke present upper-limb motor impairment, and 50–60% will have persistent disability or weakness at the chronic phase. Impaired upper-limb motor function is highly associated with low self-care ability, limited mobility and poor quality of life. In recent years, there has been evidence of the neuroplasticity effects of HBOT, and HBOT was found to induce neuroplasticity in chronic stages, even years after brain injury. While the healthcare system is primarily focused on teaching patients to live with their impairments, this case report evaluates the effect of a specific hyperbaric oxygen therapy (HBOT) protocol on true stroke rehabilitation, specifically, improving upper-limb function. This case report studied motor task functional MRI (fMRI) activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb two years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and after the treatment using the Fugl–Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC). Following the HBOT protocol, the patient’s FMA score improved from 17 (severe impairment) to 31 (moderate impairment), and there was an increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally during trials involving the right hand. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex and the premotor cortex. This case report provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients, and shows HBOT’s potential as an effective, valuable treatment option for those suffering with lingering symptoms after a stroke. This work was conducted by a research team at the Sagol Center for Hyperbaric Medicine and Research at Shamir Medical Center and Tel Aviv University, and published in Frontiers in Neurology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Three-Dimensional Magnetic Rehabilitation, Robot-Enhanced Hand-Motor Recovery after Subacute Stroke: A Randomized Controlled Trial.

We developed an end-effector-type rehabilitation robot that can uses electro- and permanent magnets to generate a three-way magnetic field to assist hand movements and perform rehabilitation therapy. This study aimed to investigate the therapeutic effect of a rehabilitation program using a three-dimensional (3D) magnetic force-based hand rehabilitation robot on the motor function recovery of the paralyzed hands of patients with stroke. This was a double-blind randomized controlled trial in which 36 patients with subacute stroke were assigned to intervention and control groups of 18 patients each. The intervention group received 30 min of rehabilitation therapy per day for a month using a 3D magnetic force-driven hand rehabilitation robot, whereas the control group received 30 min of conventional occupational therapy to restore upper-limb function. The patients underwent three behavioral assessments at three time points: before starting treatment (T0), after 1 month of treatment (T1), and at the follow-up 1-month after treatment completion (T2). The primary outcome measure was the Wolf Motor Function Test (WMFT), and secondary outcome measures included the Fugl-Meyer Assessment of the Upper Limb (FMA_U), Modified Barthel Index (MBI), and European Quality of Life Five Dimensions (EQ-5D) questionnaire. No participant safety issues were reported during the intervention. Analysis using repeated measures analysis of variance showed significant interaction effects between time and group for both the WMFT score (p = 0.012) and time (p = 0.010). In post hoc analysis, the WMFT scores and time improved significantly more in the patients who received robotic rehabilitation at T1 than in the controls (p = 0.018 and p = 0.012). At T2, we also consistently found improvements in both the WMFT scores and times for the intervention group that were superior to those in the control group (p = 0.024 and p = 0.018, respectively). Similar results were observed for FMA_U, MBI, and EQ-5D. Rehabilitation using the 3D hand-rehabilitation robot effectively restored hand function in the patients with subacute stroke, contributing to improvement in daily independence and quality of life.

Effects of repetitive transcranial magnetic stimulation over the contralesional dorsal premotor cortex on upper limb function in severe ischaemic stroke: study protocol for a randomised controlled trial

IntroductionRepetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment widely recommended to promote hand motor recovery after ischaemic stroke. However, the therapeutic efficacy of rTMS over the motor cortex in...

Neuromodulation for Post-Stroke Motor Recovery: a Narrative Review of Invasive and Non‑Invasive Tools.

Stroke remains a leading disabling condition, and many survivors have permanent disability despite acute stroke treatment and subsequent standard-of-care rehabilitation therapies. Adjunctive neuromodulation is an emerging frontier in the field of stroke recovery. In this narrative review, we aim to highlight and summarize various neuromodulation techniques currently being investigated to enhance recovery and reduce impairment in patients with stroke. For motor recovery, repetitive transcranial magnetic simulation (rTMS) and direct current stimulation (tDCS) have shown promising results in many smaller-scale trials. Still, their efficacy has yet to be proven in large-scale pivotal trials. A promising large-scale study investigating higher dose tDCS combined with constraint movement therapy to enhance motor recovery is currently underway. MRI-guided tDCS studies in subacute and chronic post-stroke aphasia showed promising benefits for picture-naming recovery. rTMS, particularly inhibitory stimulation over the contralesional homolog, could represent a pathway forward in post-stroke motor recovery in the setting of a well-designed and adequately powered clinical trial. Recently evidenced-based guideline actually supported Level A (definite efficacy) for the use of low-frequency rTMS of the primary motor cortex for hand motor recovery in the post-acute stage of stroke based on the meta-analysis result. Adjunctive vagal nerve stimulation has recently received FDA approval to enhance upper limb motor recovery in chronic ischemic stroke with moderate impairment, and progress has been made to implement it in real-world practice. Despite a few small and large-scale studies in epidural stimulation (EDS), further research on the utilization of EDS in post-stroke recovery is needed. Deep brain stimulation or stent-based neuromodulation has yet to be further tested regarding safety and efficacy. Adjunctive neuromodulation to rehabilitation therapy is a promising avenue for promoting post-stroke recovery and decreasing the overall burden of disability. The pipeline for neuromodulation technology remains strong as they span from the preclinical stage to the post-market stage. We are optimistic to see that more neuromodulation tools will be available to stroke survivors in the not-to-distant future.

The Promotoer, a brain-computer interface-assisted intervention to promote upper limb functional motor recovery after stroke: a statistical analysis plan for a randomized controlled trial

BackgroundElectroencephalography (EEG)-based brain-computer interfaces (BCIs) allow to modulate the sensorimotor rhythms and are emerging technologies for promoting post-stroke motor function recovery. The Promotoer study aims to assess the short and long-term efficacy of the Promotoer system, an EEG-based BCI assisting motor imagery (MI) practice, in enhancing post-stroke functional hand motor recovery. This paper details the statistical analysis plan of the Promotoer study.MethodsThe Promotoer study is a randomized, controlled, assessor-blinded, single-centre, superiority trial, with two parallel groups and a 1:1 allocation ratio. Subacute stroke patients are randomized to EEG-based BCI-assisted MI training or to MI training alone (i.e. no BCI). An internal pilot study for sample size re-assessment is planned. The primary outcome is the effectiveness of the Upper Extremity Fugl-Meyer Assessment (UE-FMA) score. Secondary outcomes include clinical, functional, and user experience scores assessed at the end of intervention and at follow-up. Neurophysiological assessments are also planned. Effectiveness formulas have been specified, and intention-to-treat and per-protocol populations have been defined. Statistical methods for comparisons of groups and for development of a predictive score of significant improvement are described. Explorative subgroup analyses and methodology to handle missing data are considered.DiscussionThe Promotoer study will provide robust evidence for the short/long-term efficacy of the Promotoer system in subacute stroke patients undergoing a rehabilitation program. Moreover, the development of a predictive score of response will allow transferring of the Promotoer system to optimal clinical practice. By carefully describing the statistical principles and procedures, the statistical analysis plan provides transparency in the analysis of data.Trial registrationClinicalTrials.gov NCT04353297. Registered on April 15, 2020.

Enhancing Upper Limb Performance in Sub-acute Stroke Patients: A Systematic Review of Combined Modified Constraint-Induced Movement Therapy and Mirror Therapy Interventions

Objective: Sub-acute stroke is a common condition that often results in upper limb impairments. This systematic review aims to evaluate the effectiveness of combined modified constraint-induced movement therapy (mCIMT) and mirror therapy on upper limb performance in patients with sub-acute stroke. The review also aimed to identify gaps in the existing literature and provide recommendations for future research.
 Methods: A comprehensive search was conducted on electronic databases, including PubMed, Google Scholar, ResearchGate, and AJOT. Studies published between 2010 and 2022 were included in the review. Qualitative studies that investigated the effects of combined mCIMT and mirror therapy in patients with sub-acute stroke were included. The PRISMA flow diagram was utilized to track the study selection process. Two independent reviewers assessed the eligibility of the studies and extracted relevant data using predefined criteria.
 Results: Out of the initial 250 articles, 10 studies met the inclusion criteria and were included in the review. Published between 2010 and 2022, these studies utilized various research designs, including quasi-experimental studies, randomized controlled trials, and pilot studies. The majority of the studies were conducted in hospital settings and involved patients with sub-acute stroke. The findings of the included studies suggest that combined mCIMT and mirror therapy have positive effects on hand functions, motor recovery, functional outcomes, and activities of daily living in patients with sub-acute stroke.
 Conclusion: This systematic review provides evidence supporting the effectiveness of combined mCIMT and mirror therapy in improving upper limb performance in patients with sub-acute stroke. These interventions have the potential to enhance motor recovery and functional outcomes in this population. However, further research is needed to determine the optimal duration, intensity, and timing of these interventions. Standardized outcome measures and larger sample sizes should be considered in future studies to strengthen the evidence base.

Functional-oriented, portable brain-computer interface training for hand motor recovery after stroke: a randomized controlled study.

Brain-computer interfaces (BCIs) have been proven to be effective for hand motor recovery after stroke. Facing kinds of dysfunction of the paretic hand, the motor task of BCIs for hand rehabilitation is relatively single, and the operation of many BCI devices is complex for clinical use. Therefore, we proposed a functional-oriented, portable BCI equipment and explored the efficiency of hand motor recovery after a stroke. Stroke patients were randomly assigned to the BCI group and the control group. The BCI group received BCI-based grasp/open motor training, while the control group received task-oriented guidance training. Both groups received 20 sessions of motor training in 4 weeks, and each session lasted for 30 min. The Fugl-Meyer assessment of the upper limb (FMA-UE) was applied for the assessment of rehabilitation outcomes, and the EEG signals were obtained for processing. The progress of FMA-UE between the BCI group [10.50 (5.75, 16.50)] and the control group [5.00 (4.00, 8.00)] was significantly different (Z = -2.834, P = 0.005). Meanwhile, the FMA-UE of both groups improved significantly (P < 0.001). A total of 24 patients in the BCI group achieved the minimal clinically important difference (MCID) of FMA-UE with an effective rate of 80%, and 16 in the control group achieved the MCID, with an effective rate of 51.6%. The lateral index of the open task in the BCI group was significantly decreased (Z = -2.704, P = 0.007). The average BCI accuracy for 24 stroke patients in 20 sessions was 70.7%, which was improved by 5.0% in the final session compared with the first session. Targeted hand movement and two motor task modes, namely grasp and open, to be applied in a BCI design may be suitable in stroke patients with hand dysfunction. The functional-oriented, portable BCI training can promote hand recovery after a stroke, and it is expected to be widely used in clinical practice. The lateral index change of inter-hemispheric balance may be the mechanism of motor recovery. ChiCTR2100044492.

Clinical Features to Predict the Use of a sEMG Wearable Device (REMO®) for Hand Motor Training of Stroke Patients: A Cross-Sectional Cohort Study

After stroke, upper limb motor impairment is one of the most common consequences that compromises the level of the autonomy of patients. In a neurorehabilitation setting, the implementation of wearable sensors provides new possibilities for enhancing hand motor recovery. In our study, we tested an innovative wearable (REMO®) that detected the residual surface-electromyography of forearm muscles to control a rehabilitative PC interface. The aim of this study was to define the clinical features of stroke survivors able to perform ten, five, or no hand movements for rehabilitation training. 117 stroke patients were tested: 65% of patients were able to control ten movements, 19% of patients could control nine to one movement, and 16% could control no movements. Results indicated that mild upper limb motor impairment (Fugl-Meyer Upper Extremity ≥ 18 points) predicted the control of ten movements and no flexor carpi muscle spasticity predicted the control of five movements. Finally, severe impairment of upper limb motor function (Fugl-Meyer Upper Extremity > 10 points) combined with no pain and no restrictions of upper limb joints predicted the control of at least one movement. In conclusion, the residual motor function, pain and joints restriction, and spasticity at the upper limb are the most important clinical features to use for a wearable REMO® for hand rehabilitation training.

Effect Of Thermal Stimulation And Mirror Therapy On Hand Functions In Patients With Stroke: An Interventional Study

&#x0D; Background: Thermal stimulation can be used as an intervention to enhance sensory function. Activated areas by thermal stimulation are greater than those by tactile or mechanical stimulation. Mirror therapy creates the illusion of normal movement with the mirror image of the unaffected upper extremity. Thermal stimulation provides somatosensory stimulation that causes the forced use of the involved extremity as a protective response to heat which provokes volitional/reflexive motor activity. Somatosensory stimulation may induce brain plasticity.&#x0D; Purpose: This study was carried out to determine the effect of thermal stimulation and mirror therapy in the sensorimotor and functional recovery of hand in stroke patients with hand impairment.&#x0D; Methods: 18 stroke survivors were randomly assigned to Thermal Stimulation rehabilitation treatment and Mirror Therapy rehabilitation group (30 minutes daily for 3 weeks). Three measures, including Brunnstorm stage, Wolf motor Function Test, and Revised Nottingham Sensory Assessment scale was used as an outcome measure to assess the motor and sensory recovery.&#x0D; &#x0D; &#x0D; &#x0D; Results: The Thermal Stimulation group showed a potential trend for improved recovery stage as measured by Brunnstorm staging for motor recovery of hand as compared to the Mirror therapy group. The Thermal Stimulation group also showed a statistically significant and large improvement in tactile, proprioception and stereognosis score as measured by Revised Nottingham sensory assessment scale whereas Mirror Therapy group showed significant improvement in stereognosis score alone.&#x0D; &#x0D; &#x0D; &#x0D; Conclusion: Thermal stimulation has more positive effect in the sensorimotor and functional recovery of hand in acute stroke patients with hand impairment within 3 weeks in comparison to Mirror Therapy. Thermal stimulation protocol should be added in the clinical setting of rehabilitation in stroke patients with hand impairment on the basis of the result of this study.&#x0D;

Development of soft actuators for stroke rehabilitation using deep learning

Automation has created a mind-blowing impact in diversified fields all over the world. Not only in business but also in various domains like health care sectors, manufacturing, etc. a faultless execution is a prime concern. Robotic Process Automation has paved the way for research in the mechanical and mechatronics field. Software robots are trained well to complete repetitive tasks in an efficient manner. A design of such a soft robot can be greatly helpful in the arena of healing. Automation of Rehabilitation therapy has gained attention in recent years. The main aspiration towards the conduct of this research work is to accomplish a soft exoskeleton robot using a thin McKibben actuator applying Deep Learning approaches to aid automatic therapy to the paralyzed patients and help them carry out the hand movement-based exercises. Convolutional Neural Network (CNN) algorithm will be used to support the training of the AI-enabled automated device. The proposed methodology will support stroke survivors to perform exercises independently to enhance their hand motor recovery. For this purpose, it involves pneumatic soft actuator technology using thin McKibben artificial muscles to create a cognitive potential to induce rehabilitation. A soft actuator is proposed so as to confirm the safety purposes of stroke patients.

A randomised clinical trial comparing 35\xa0Hz versus 50\xa0Hz frequency stimulation effects on hand motor recovery in older adults after stroke

More solid data are needed regarding the application of neuromuscular electrical stimulation (NMES) in the paretic hand following a stroke. A randomised clinical trial was conducted to compare the effects of two NMES protocols with different stimulation frequencies on upper limb motor impairment and function in older adults with spastic hemiparesis after stroke. Sixty nine outpatients were randomly assigned to the control group or the experimental groups (NMES with 50 Hz or 35 Hz). Outcome measures included motor impairment tests and functional assessment. They were collected at baseline, after 4 and 8 weeks of treatment, and after a follow-up period. NMES groups showed significant changes (p < 0.05) with different effect sizes in range of motion, grip and pinch strength, the Modified Ashworth Scale, and the muscle electrical activity in the extensors of the wrist. The 35 Hz NMES intervention showed a significant effect on Barthel Index. Additionally, there were no significant differences between the groups in the Box and Block Test. Both NMES protocols proved evidence of improvements in measurements related to hand motor recovery in older adults following a stroke, nevertheless, these findings showed that the specific stimulation frequency had different effects depending on the clinical measures under study.

Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke.

Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS.Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months.Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery.Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.

Interhemispheric Functional Connectivity in the Primary Motor Cortex Assessed by Resting-State Functional Magnetic Resonance Imaging Aids Long-Term Recovery Prediction among Subacute Stroke Patients with Severe Hand Weakness.

This study aimed to evaluate the usefulness of interhemispheric functional connectivity (FC) as a predictor of motor recovery in severe hand impairment and to determine the cutoff FC level as a clinically useful parameter. Patients with stroke (n = 22; age, 59.9 ± 13.7 years) who presented with unilateral severe upper-limb paresis and were confirmed to elicit no motor-evoked potential responses were selected. FC was measured using resting-state functional magnetic resonance imaging (rsfMRI) scans at 1 month from stroke onset. The good recovery group showed a higher FC value than the poor recovery group (p = 0.034). In contrast, there was no statistical difference in FC value between the good recovery and healthy control groups (p = 0.182). Additionally, the healthy control group showed a higher FC value than that shown by the poor recovery group (p = 0.0002). Good and poor recovery were determined based on Brunnstrom stage of upper-limb function at 6 months as the standard, and receiver operating characteristic curve indicated that a cutoff score of 0.013 had the greatest prognostic ability. In conclusion, interhemispheric FC measurement using rsfMRI scans may provide useful clinical information for predicting hand motor recovery during stroke rehabilitation.

Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery.

Objective: This longitudinal observational study investigated how neural stretch-resistance in wrist and finger flexors develops after stroke and relates to motor recovery, secondary complications, and lesion location.Methods: Sixty-one patients were assessed at 3 weeks (T1), three (T2), and 6 months (T3) after stroke using the NeuroFlexor method and clinical tests. Magnetic Resonance Imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL) and to perform voxel-based lesion symptom mapping.Results: NeuroFlexor assessment demonstrated spasticity (neural component [NC] >3.4N normative cut-off) in 33% of patients at T1 and in 51% at T3. Four subgroups were identified: early Severe spasticity (n = 10), early Moderate spasticity (n = 10), Late developing spasticity (n = 17) and No spasticity (n = 24). All except the Severe spasticity group improved significantly in Fugl-Meyer Assessment (FMA-HAND) to T3. The Severe and Late spasticity groups did not improve in Box and Blocks Test. The Severe spasticity group showed a 25° reduction in passive range of movement and more frequent arm pain at T3. wCST-LL correlated positively with NC at T1 and T3, even after controlling for FMA-HAND and lesion volume. Voxel-based lesion symptom mapping showed that lesioned white matter below cortical hand knob correlated positively with NC.Conclusion: Severe hand spasticity early after stroke is negatively associated with hand motor recovery and positively associated with the development of secondary complications. Corticospinal tract damage predicts development of spasticity. Early quantitative hand spasticity measurement may have potential to predict motor recovery and could guide targeted rehabilitation interventions after stroke.

The therapeutic application of functional electrical stimulation and transcranial magnetic stimulation in rehabilitation of the hand function in incomplete cervical spinal cord injury

BackgroundFunctional electrical stimulation (FES) therapy has a potential to improve voluntary grasping and induce plastic changes among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Also, evidence suggests that the use of high frequency repetitive transcranial magnetic stimulation (rTMS) to increase corticomotor excitability improves hand function in persons with cervical SCI.PurposeOur randomized controlled trial was carried out to compare the two rehabilitation programs, the first applied to FES and real rTMS whereas the second applied to FES and sham rTMS, with repect to hand function in chronic traumatic incomplete cervical SCI patients, and also with respect to changes in cortical excitability, and its relation to hand function before and after the rehabilitation programs.Patients and methodsOur study included 22 patients with chronic traumatic incomplete SCI. Patients were randomly assigned into two groups, 11 patients each. Group I patients received FES for 12 weeks with an additional real rTMS therapy for the last two weeks, at 10 Hz frequency, subthreshold intensity for a total of 1500 pulse per session for 10 sessions. Whereas group II patients received FES for 12 weeks with an additional sham rTMS therapy for the last two weeks. All were followed by an intensive hand training program. Patients were assessed: using hand function tests (action research arm test, modified Sollerman hand function test, nine-hole pegboard scale, and finger tapping test) and corticomotor excitability tests (using amplitude of motor evoked potential).ConclusionOur study showed statistically significant improvements in hand function tests in group I, who received FES in addition to real rTMS therapy in comparison with group II, who received FES in addition to sham rTMS at 12-week assessment. This could support the evidence of the additional benefit of real rTMS therapy for 10 sessions/2 weeks in improving hand function and motor recovery following SCI.

Mirror Illusion for Sensori-Motor Training in Stroke: A Randomized Controlled Trial

BackgroundPoststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects. Methods DesignRandomized controlled trial. SettingFunctional therapy laboratory of Rehabilitation Institute. ParticipantsThirty-one chronic poststroke subjects (17 experimental and 14 controls), aged between 30 and 60years, with ≤ diminished light touch in the hand. Outcome MeasureSemmes Weinstein Monofilament (cutaneous threshold), 2-Point discrimination test (touch discrimination) and Fugl-Meyer Assessment (hand motor recovery). InterventionThe experimental group received sensory stimulus such as tactile perception and motor tasks on the less-affected hand using mirror box. The control counterparts underwent only dose-matched conventional program. 30 sessions with a frequency of 5/week were imparted to the groups. ResultsPost intervention, there was a significant (P < .004) increase up to 30% positive touch-response for the hand quadrants among the experimental group in comparison to only 13.5% rise for the same among the controls. The cutaneous threshold of the less-affected palm also improved significantly among the experimental subjects in comparison to the controls (P = .04). ConclusionMT may be considered as a promising regime for enhancing cutaneous sensibility in stroke. The mirror illusion induced by MT may be utilized for sensory and motor deficits as well as for the more-affected and less-affected hands.

Spasticity severity after stroke and relation to hand motor recovery and corticospinal tract integrity

Spasticity of muscles controlling the hand is common after stroke, however, its impact on hand motor recovery and its neural correlates are poorly understood. This longitudinal observational study investigated hand spasticity after stroke in relation to motor recovery, secondary complications and lesion location. Sixty-one patients were assessed at three weeks (T1), three (T2) and six months (T3) after stroke. Neural (NC) and viscoelastic (EC and VC) stretch-resistance in wrist and finger flexors were quantified with the NeuroFlexor method. Clinical evaluation included Fugl–Meyer (FMA-HAND), Box and Block Test (BBT), passive range of movement (ROM) and pain (FMA-subscale). Magnetic Resonance Imaging data were analyzed for weighted corticospinal tract lesion load (wCST-LL) and voxel-based lesion symptom mapping (VLSM). Four spasticity subgroups were defined: early severe (SS, n = 10), early moderate (MS, n = 10), late developing (LS, n = 17) and no spasticity (NS, n = 24). All groups except SS improved in FMA-HAND to T3. SS and LS had no recovery in BBT. SS showed a larger loss of ROM and more frequent arm pain at T3. wCST-LL predicted NC at T3, also when including FMA-HAND and lesion volume as covariates. VLSM showed that lesioned white matter below the cortical hand knob correlated positively with spasticity. Severe hand spasticity impairs motor recovery, ROM and may increase risk for development of arm pain. This study provides the first data showing that spasticity is related to lesion load of the CST. The significance of early quantification of spasticity for prediction of motor outcome and rehabilitation planning will be discussed.

Cortical excitability of motor anticipatory in subacute stroke patients after virtual reality training: A preliminary movement-related potential study

Virtual reality (VR) training has a prominent role in promoting functional recovery post stroke. Stroke survivors with upper limb hemiplegia lack the cognitive ability to anticipate the required control. The Cortical Excitability of the anticipatory phase for upper limb movement after VR training remains unknown. This study aims to investigate the changes of cortical excitability of VR training on the motion anticipation of upper limb hemiplegic in subacute stroke survivors. In this randomized, controlled, single blind trial, 40 stroke survivors with upper limb hemiparesis resulting from the first occurrence of unilateral brain lesion within 1 to 6 months were recruited. Participants was randomized to either a group receiving VR training or dose matched conventional occupational training in addition to standard rehabilitation, 30 min per day and 5 days a week for 3 weeks. The primary outcome measure was the movement-related potentials (MRPS), the electroencephalogram recordings during the acquisition phase, subjects were asked to performed a self-paced voluntary palmar grasp; secondary outcome measures were the the Action Research Arm Test (ARAT) and the Upper Limb Fugl-Meyer Assessment (UL-FMA). Participants were assessed at baseline and after intervention. There were a long latency and large peak amplitude MRPS of hand motor impairment at baseline and hand motor recovery over time. After treatment, the VR group exhibited a significant difference in the decrease of the latency and the peak amplitude ( P < 0.05), not significant difference in the control group ( P > 0.05). A significant improvement in the ARAT and UL-FMA within both groups before and after treatment. VR training is a promising tools for rehabilitation could pomote motor anticipatory and upper limb motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance cortical reorganization after stroke. Clinicians may consider adding VR training as an adjucnt to routine rehabilitation training.

Hand Motor Recovery Following Extensive Frontoparietal Cortical Injury Is Accompanied by Upregulated Corticoreticular Projections in Monkey.

We tested the hypothesis that arm/hand motor recovery after injury of the lateral sensorimotor cortex is associated with upregulation of the corticoreticular projection (CRP) from the supplementary motor cortex (M2) to the gigantocellular reticular nucleus of the medulla (Gi). Three groups of rhesus monkeys of both genders were studied: five controls, four cases with lesions of the arm/hand area of the primary motor cortex (M1) and the lateral premotor cortex (LPMC; F2 lesion group), and five cases with lesions of the arm/hand area of M1, LPMC, S1, and anterior parietal cortex (F2P2 lesion group). CRP strength was assessed using high-resolution anterograde tracers injected into the arm/hand area of M2 and stereology to estimate of the number of synaptic boutons in the Gi. M2 projected bilaterally to the Gi, primarily targeting the medial Gi subsector and, to a lesser extent, lateral, dorsal, and ventral subsectors. Total CRP bouton numbers were similar in controls and F2 lesion cases but F2P2 lesion cases had twice as many boutons as the other two groups (p = 0.0002). Recovery of reaching and fine hand/digit function was strongly correlated with estimated numbers of CRP boutons in the F2P2 lesion cases. Because we previously showed that F2P2 lesion cases experience decreased strength of the M2 corticospinal projection (CSP), whereas F2 lesion monkeys experienced increased strength of the M2 CSP, these results suggest one mechanism underlying arm/hand motor recovery after F2P2 injury is upregulation of the M2 CRP. This M2-CRP response may influence an important reticulospinal tract contribution to upper-limb motor recovery following frontoparietal injury.SIGNIFICANCE STATEMENT We previously showed that after brain injury affecting the lateral motor cortex controlling arm/hand motor function, recovery is variable and closely associated with increased strength of corticospinal projection (CSP) from an uninjured medial cortical motor area. Hand motor recovery also varies after brain injury affecting the lateral sensorimotor cortex, but medial motor cortex CSP strength decreases and cannot account for recovery. Here we observed that motor recovery following sensorimotor cortex injury is closely associated with increased strength of the descending projection from an uninjured medial cortical motor area to a brainstem reticular nucleus involved in control of arm/hand function, suggesting an enhanced corticoreticular projection may compensate for injury to the sensorimotor cortex to enable recovery of arm/hand motor function.

Cortico-spinal excitability and hand motor recovery in stroke: a longitudinal study.

To describe the relationship between changes of cortico-spinal excitability and motor recovery of the affected hand after stroke. Eighteen hemiparetic stroke patients with a severe-to-mild upper limb motor impairment were randomized. Cortico-spinal excitability measures (resting motor thresholds and motor evoked potentials) obtained from a distal (abductor pollicis brevis) and proximal (biceps brachii) upper limb muscle were assessed for both hemispheres. Motor function of the affected hand was tested by the Wolf Motor Function and Action Research Arm tests. The evaluations were performed at baseline and weekly over 7weeks of in-patient neurological rehabilitation. Severe hand dysfunction was associated with a strong suppression of ipsilesional cortico-spinal excitability and a shift of excitability towards the contralesional hemisphere. Mild hand impairment was associated with a shift of cortico-spinal excitability towards the ipsilesional hemisphere. Favorable motor recovery correlated with an increase of ipsilesional cortico-spinal excitability.