Increase In Motor Function Research Articles

Assessing the impact of virtual reality on the restoration of motor function in the acute period of ischemic stroke

Aim: to evaluate the effectiveness of using virtual reality to restore motor function in patients in the acute period of ischemic stroke.Material and methods. We studied 207 patients in the acute period of ischemic stroke, who were divided into two groups by randomization: study group – 105 patients, comparison group – 102 patients. All patients received all necessary standardized therapy. Patients in the study group additionally received classes using the ReviVR device. Efficacy was assessed using the NIHSS, FMA-LE, and BBS scales.Results. On all scales studied, patients in the study group demonstrated better results in relation to the comparison group, both in terms of the final result and in terms of the level of change in indicators during the rehabilitation process. The use of virtual reality made it possible to reduce disability on the NIHSS scale to 7.0 (4.0; 9.0) points, which is better than the results of the comparison group – 9.0 (5.0; 13.0) points with a high level of significance p < 0.001. The increase in motor function according to FMA-LE in the study group was higher and amounted to 21.0 (15.0; 24.0) points versus 18.0 (7.0; 22.0) points in the comparison group with a significance level of p = 0.002. The study group also showed better results on the BBS scale – 26.0 (17.0; 34.0) versus 18.0 (5.0; 29.0) points with a significance level of p < 0.001.Conclusion. The use of virtual reality together with standardized therapy in the acute period of ischemic stroke is effective in restoring motor function of the affected lower limb, improving balance and reducing general disability in general.

Trajectories of motor function in children with Duchenne muscular dystrophy: A longitudinal study on a Colombian population

Duchenne Muscular Dystrophy (DMD) is characterized by an initial increase in motor function followed by a plateau phase and then entering a phase of steady decline. However, motor evolution of DMD have not been evaluated in developing countries. Therefore, this study aims to evaluate the trajectory of motor function in a sample of Colombian children with DMD. We included 119 children with DMD aged 4.8–19.3 years (mean follow-up = 1.7 years). A linear mixed model was used with age as the time scale and adjusted for covariates using a stepwise regression. Participants showed a progressive decline in motor skills from the age of 5 years with a decrease in speed around the age of 11 years (p < 0.001). After age 11, the decline in motor function was observed to continue until age 20 but at a slower rate (βAge = −9.64. and βAge2 = 0.18, p < 0.001 for both). Educational inclusion, glucocorticoid treatment and the number of mutated exons were shown to be associated with the motor performance. These findings may indicate that the evolution of DMD maintains similar patterns between high income countries and the Colombian population. They allow us to adapt and develop treatments that impact the population with DMD in Colombia, based in international evidence.

0987 Asking the Right Questions: A Case of Restless Legs Syndrome and Spinal Muscular Atrophy

Abstract Introduction The association between iron deficiency and restless legs syndrome (RLS) is well established. However, there is limited data on the association between motor neuron diseases such as spinal muscular atrophy (SMA) and RLS. A forty-three-year-old with Type 2 SMA presented to clinic for management of chronic respiratory failure. She had recently undergone surgery and chemotherapy for newly diagnosed anal cancer. However, she reported persistent abdominal pain, anorexia, weight loss, and rectal bleeding. She reported “muscle twitching” and bilateral lower extremity pain and tingling that was worse at night. Her husband would awaken every 2 hours to massage her legs. She assumed these symptoms had emerged as a result of an increase in motor function due to risdiplam, a survival motor neuron 2 splicing modifier drug. Further questioning led to the diagnosis of RLS. Bloodwork revealed severe iron deficiency anemia (hemoglobin of 6.0 g/dL, iron 13 mcg/dL, and ferritin 3 ng/ml). She received a blood transfusion and underwent sigmoidoscopy for evaluation of cancer recurrence given the report of bleeding. Fortunately, her cancer remained in remission. Her symptoms of RLS significantly improved after blood transfusions and iron supplementation. Report of case(s) n/a Conclusion RLS is a complex sensorimotor syndrome. The diagnosis of RLS is clinical, relying on diagnostic criteria that requires lower extremity movement. The case is a reminder of the variable presentation of RLS in individuals with neuromuscular disorders, including SMA. How are symptoms of restless legs disclosed in patients with the inability to move and with potentially altered sensorium? The focus of the patient encounter could have anchored on the common and expected sequalae of SMA, chronic respiratory failure. Unfortunately, anchoring bias would have delayed the diagnosis and treatment of what could have been a potentially fatal disease – metastatic cancer. Ironically, the patient’s longing for motor function repressed her ability to lament. To the patient, symptoms of frequent nighttime awakenings and limb discomfort were perceived as a desired side effect of a medication that would increase movement. This case emphasizes the importance of the patient interview and its value of uncovering subtle complaints that may broaden the differential diagnosis and guide further work-up. Support (if any)

Flexible endoscopic evaluation of swallowing in children with type 1 spinal muscular atrophy

PurposeThis study aimed to report on implementing flexible endoscopic evaluation of swallowing (FEES) in infants and toddlers with type 1 spinal muscular atrophy (SMA). In addition, a comparison of FEES results and clinical scores was carried out.MethodsA prospective pilot study was conducted including ten symptomatic children with SMA type 1 (two SMN2 copies). They started treatment with one of the three currently approved therapies for SMA at a median age of 3.8 months (range 0.7–8.9). FEES was performed according to a standard protocol using Penetration–Aspiration Scale (PAS) and Murray Secretion Scale as a primary outcome. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) for motor function, Neuromuscular Disease Swallowing Status Scale (NdSSS), Oral and Swallowing Abilities Tool (OrSAT), and single clinical swallowing-related parameters were also assessed.ResultsDistinct swallowing disorders were already evident in eight children at inclusion. The most common findings from FEES were pharyngeal secretion pooling, penetration, and aspiration of saliva and food as well as delayed initiation of swallowing. Despite an average increase in motor function, no comparable improvement was found in swallowing function. None of the surveyed clinical scores showed a significant dependence on PAS in a mixed linear model.ConclusionsValuable information regarding the status of dysphagia can be gathered endoscopically, particularly concerning secretion management and when oral intake is limited. Currently available clinical tools for children with type 1 may represent a change in nutritional status but are not yet mature enough to conclude swallowing ability. Further development is still required.

EFFECT OF MIRROR THERAPY THROUGH FUNCTIONAL ACTIVITIES TO IMPROVE MOVEMENT AS CENTRAL POST-STROKE PAIN TREATMENT: A CASE REPORT

Background: Stroke patients generally have disorders related to decreased functionality, motor disturbances being the most common. One symptom of stroke is sudden weakness of one side of the body on the face, arms and legs. Central post-stroke pain is a condition of central neuropathic pain arising directly from lesions of the cerebrovascular central somatosensory nervous system. Mirror therapy is a non-pharmacological therapy in the form of imaging of the limbs, where a mirror medium is used to convey visual stimulation to the brain through observing body parts of patients who are not disabled while doing a series of movements. Mirror therapy helps in reducing disability in the limbs of stroke patients and as a treatment. for post-stroke central pain, thereby helping to improve functional limbs and shorten the rehabilitation period. Summary of case: A 54-year-old man with painful spastic left hand has been diagnosed with infarct stroke in the right thalamus 2 years ago. Mirror therapy has been done for two weeks, precisely six days per week with a duration about 30 minutes. Mirror therapy is done by using a mirror media that is placed on both arms and hands of the patient symmetrically and the patient observes the reflection of a healthy limb through flexion, extension, finger counts, and grasping objects. Visual Analogue Scale (VAS Score) is used to measure the level of pain before and after mirror therapy. After one month of mirror therapy the patient experienced an increase in motor function and decrease in pain scale. Conclusion: Mirror therapy is a promising non-pharmacological method in reducing disability and central pain after stroke.

Nusinersen efficacy data for 24-month in type 2 and 3 spinal muscular atrophy.

The study reports real world data in type 2 and 3 SMA patients treated for at least 2 years with nusinersen. Increase in motor function was observed after 12 months and during the second year. The magnitude of change was variable across age and functional subgroup, with the largest changes observed in young patients with higher function at baseline. When compared to natural history data, the difference between study cohort and untreated patients swas significant on both Hammersmith Functional Motor Scale and Revised Upper Limb Module both at 12 months and at 24 months.

SMA – OUTCOME MEASURES AND REGISTRIES: EP.256 Investigation of motor functions items in children with spinal muscular atrophy type 2

It is important to examine the development of motor function in children diagnosed with spinal muscular atrophy (SMA) type 2 with the Hammersmith Functional Motor Scale(HFMS) sub-dimensions in patient follow-up. The aim of this study was to examine the change in individuals diagnosed with SMA type 2. A total of 4 patients with a diagnosis of SMA type 2 were included in the study. HFMS was used to evaluate motor function. The test scores of the patients were calculated after the first and second follow-up. The sub-dimensions of the scale items were determined as sitting, rolling, in-bed transfer, upper and lower extremity postural reactions, head-neck movements, standing on hands and knees, crawling, standing, stepping, half-kneeling activities, transition from standing to sitting, squat, jumping and rail activities. The change was analyzed with paired sample t and Wilcoxon tests. One of the participants was a girl and three were boys (mean age: 69.55±37.07 months). There was no significant difference between the first and second scores in terms of total and sub-dimension HFMS scores (p>0.05). The biggest change was seen in the crawling sub-dimension (mean change=0.75±1.26). Rolling, lower extremity postural reactions, half-kneeling activities, and jumping sub-dimensions were the other sub-dimensions with the higher changes. The increase in motor function is not significant in terms of the total HFMS score and sub-dimensions between the first and the second follow-up. The results need to be evaluated in further follow-up and with a higher number of participants.

Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients

Background/Aims Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients. Methods In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy. Results A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105). Conclusions Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.

A rule-based, dose-finding design for use in stroke rehabilitation research: methodological development

BackgroundDose-optimisation studies as precursors to clinical trials are rare in stroke rehabilitation. ObjectiveTo develop a rule-based, dose-finding design for stroke rehabilitation research. Design3+3 rule-based, dose-finding study. Dose escalation/de-escalation was undertaken according to preset rules and a mathematical sequence (modified Fibonacci sequence). The target starting daily dose was 50 repetitions for the first cohort. Adherence was recorded by an electronic counter. At the end of the 2-week training period, the adherence record indicated dose tolerability (adherence to target dose) and the outcome measure indicated dose benefit (10% increase in motor function). The preset increment/decrease and checking rules were then applied to set the dose for the subsequent cohort. The process was repeated until preset stopping rules were met. ParticipantsParticipants had a mean age of 68 (range 48 to 81) years, and were a mean of 70 (range 9 to 289) months post stroke with moderate upper limb paresis. Model taskA custom-built model of exercise-based training to enhance ability to open the paretic hand. Outcome measureRepetitions per minute of extension/flexion of paretic digits against resistance. AnalysisUsability of the preset rules and whether the maximally tolerated dose was identifiable. ResultsFive cohorts of three participants were involved. Discernibly different doses were set for each subsequent cohort (i.e. 50, 100, 167, 251 and 209 repetitions/day). The maximally tolerated dose for the model training task was 209 repetitions/day. ConclusionsThis dose-finding design is a feasible method for use in stroke rehabilitation research.

Human neural progenitors differentiate into astrocytes and protect motor neurons in aging rats

Age-associated health decline presents a significant challenge to healthcare, although there are few animal models that can be used to test potential treatments. Here, we show that there is a significant reduction in both spinal cord motor neurons and motor function over time in the aging rat. One explanation for this motor neuron loss could be reduced support from surrounding aging astrocytes. Indeed, we have previously shown using in vitro models that aging rat astrocytes are less supportive to rat motor neuron function and survival over time. Here, we test whether rejuvenating the astrocyte niche can improve the survival of motor neurons in an aging spinal cord. We transplanted fetal-derived human neural progenitor cells (hNPCs) into the aging rat spinal cord and found that the cells survive and differentiate into astrocytes with a much higher efficiency than when transplanted into younger animals, suggesting that the aging environment stimulates astrocyte maturation. Importantly, the engrafted astrocytes were able to protect against motor neuron loss associated with aging, although this did not result in an increase in motor function based on behavioral assays. We also transplanted hNPCs genetically modified to secrete glial cell line-derived neurotrophic factor (GDNF) into the aging rat spinal cord, as this combination of cell and protein delivery can protect motor neurons in animal models of ALS. During aging, GDNF-expressing hNPCs protected motor neurons, though to the same extent as hNPCs alone, and again had no effect on motor function. We conclude that hNPCs can survive well in the aging spinal cord, protect motor neurons and mature faster into astrocytes when compared to transplantation into the young spinal cord. While there was no functional improvement, there were no functional deficits either, further supporting a good safety profile of hNPC transplantation even into the older patient population.

Vitamin D&amp;lt;sub&amp;gt;3&amp;lt;/sub&amp;gt; Receptor Activation Rescued Corticostriatal Neural Activity and Improved Motor Function in –D&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt;R Tardive Dyskinesia Mice Model

Haloperidol-induced dyskinesia has been linked to a reduction in dopamine activity characterized by the inhibition of dopamine receptive sites on D2-receptor (D2R). As a result of D2R inhibition, calcium-linked neural activity is affected and seen as a decline in mo-tor-cognitive function after prolonged haloperidol use in the treatment of psychotic disorders. In this study, we have elucidated the relationship between haloperidol-induced tardive dyskinesia and the neural activity in motor cortex (M1), basal nucleus (CPu), prefrontal cortex (PFC) and hippocampus (CA1). Also, we explored the role of Vitamin D3 receptor (VD3R) activation as a therapeutic target in improving motor-cognitive functions in dyskinetic mice. Dyskinesia was induced in adult BALB/c mice after 28 days of haloperidol treatment (10 mg/Kg; intraperitoneal). We established the presence of abnormal involuntary movements (AIMs) in the haloperidol treated mice (-D2) through assessment of the threshold and amplitude of abnormal involuntary movements (AIMs) for the Limbs (Li) and Orolingual (Ol) area (Li and Ol AIMs). As a confirmatory test, the dyskinetic mice (-D2) showed high global AIMs score when compared with the VD3RA intervention group (-D2/+VDR) for Li and Ol AIMs. Furthermore, in the behavioral tests, the dyskinetic mice exhibited a decrease in latency of fall (LOF; Rotarod-P 2/+VDR), 100 mg/Kg for 7 days, CPu-CA1 burst activity was restored leading to a decrease in abnormal movement, and an increase in motor function. Ultimately, we deduced that VD3RA activation reduced the threshold of abnormal movement in haloperidol induced dyskinesia.

Carpal Tunnel Release in Patients With Diabetes: A 5-Year Follow-Up With Matched Controls

To compare clinical outcomes 5 years after carpal tunnel release among patients with and without diabetes. In a prospective consecutive series, 35 patients with diabetes (median age, 54 y; 15type 1 and 20 type 2 diabetes) with carpal tunnel syndrome were age- and sex-matched with 31 control patients without diabetes (median age, 51 y) with idiopathic carpal tunnel syndrome. Exclusion criteria were other nerve entrapment, cervical radiculopathy, inflammatory joint disease, thyroid disorder, previous wrist fracture, and long-term exposure to vibrating tools. Participants were examined independently at baseline, 1 year, and 5 years after surgery for sensory function (Semmes-Weinstein), motor function (abductor pollicis brevis muscle strength and grip strength), cold intolerance, and completion of the Boston Carpal Tunnel Questionnaire symptom severity and functional status score. Five years after surgery, the overall attendance rate for clinical examinations and completion of the Boston Carpal Tunnel Questionnaire were 86% and 95%, respectively. Between 1 and 5 years after surgery, there was a tendency toward a decrease in sensory function but an increase in motor function, with no statistically significant difference between groups. Cold intolerance demonstrated long-term significant improvement for patients with diabetes. The improvement in symptom severity and functional status score, as well as the large effect size, were maintained at 5 years in both patient groups. Long-term improvement in patients with diabetes remained after carpal tunnel release to the same extent as for patients without diabetes. Furthermore, improvement in cold intolerance in patients with diabetes suggests the potential for the long-term regeneration of small nerve fibers. Prognostic I.

Motor cortex-induced plasticity by noninvasive brain stimulation

The aim of this study was to test and compare the effects of a within-subject design of repetitive transcranial magnetic stimulation (rTMS) [coupled with sham transcranial direct current stimulation (tDCS)] and tDCS (coupled with sham rTMS) on the motor cortex excitability and also compare the results against sham tDCS/sham rTMS. We conducted a double-blinded, randomized, sham-controlled, cross-over trial. Eleven right-handed, healthy individuals (five women, mean age: 39.8 years, SD 13.4) received the three interventions (cross-over design) in a randomized order: (a) high-frequency (HF) rTMS (+sham tDCS), (b) anodal tDCS (+sham rTMS), and (c) sham stimulation (sham rTMS+sham tDCS). Cortical excitability measurements [motor threshold, motor evoked potential (MEP), intracortical facilitation and inhibition, and transcallosal inhibition] and motor behavioral assessments were used as outcome measures. Between-group analysis of variance showed that MEP amplitude after HF rTMS was significantly higher than MEP amplitude after anodal tDCS (P=0.001). Post-hoc analysis showed a significant increase in MEP amplitude after HF rTMS (25.3%, P=0.036) and a significant decrease in MEP amplitude after anodal tDCS (-32.7%, P=0.001). There was a similar increase in motor function as indexed by Jebsen-Taylor Hand Function Test in the two active groups compared with sham stimulation. In conclusion, here, we showed that although both techniques induced similar motor gains, they induce opposing results in cortical excitability. HF rTMS is associated with an increase in corticospinal excitability, whereas 20 min of tDCS induces the opposite effect. We discuss potential implications of these results to future clinical experiments using rTMS or tDCS for motor function enhancement.

Development and evaluation of the Primary Healthcare-based Physiotherapy Intervention and its effects on selected indices of stroke recovery

Aim: To develop a Primary Healthcare-Based Physiotherapy Intervention (PHCPI) that requires simple, inexpensive, easy-to-use equipment for stroke rehabilitation and evaluate its effects on selected clinical indices of recovery among post-acute stroke survivors over a 10-week period. Methods: Three databases (Medline, Pubmed and PEDro) were used to identify treatment approaches with proven efficacy. The authors synthesised these treatment approaches to develop the PHCPI, which was used in a repeated measure design involving 25 (mean age=60.6 ± 10.2 years) consenting individuals with first-incidence stroke. These individuals were treated at a primary health centre, twice weekly for 10 consecutive weeks. Outcomes were assessed using the Modified Motor Assessment Scale (MMAS), the Short Form Postural Assessment Scale for Stroke (SF-PASS) and the Reintegration to Normal Living Index (RNLI), before the intervention and fortnightly thereafter. Walking speed and quality of life were also assessed before the intervention and at week 10 of it. Results: Within-subject multivariate analysis, after controlling for gender, showed a significant increase in motor function, postural balance, walking speed and quality of life. Their community reintegration scores also improved over the period. Conclusion: The PHCPI resulted in improved motor function, community reintegration, walking speed, postural balance and quality of life among community-dwelling stroke survivors. This intervention can be used for stroke rehabilitation at primary health centres.

트레드밀 운동학습 훈련이 경직성 뇌성마비 아동의 기능과 균형에 미치는 영향

본 연구는 트레드밀을 이용한 운동학습 훈련이 경직성 뇌성마비 아동의 운동기능과 균형능력에 미치는 영향을 알아보고자 하였다. 대동작기능분류체계(GMFCS) 제 III, IV 단계의 경직성 뇌성마비 아동 16명을 대상으로 운동학습훈련군과 대조군으로 각각 무작위로 8명씩 분류하여, 대조군은 주 4회 근력강화운동을 30분/1회 적용하였고, 운동학습훈련군은 근력강화운동과 트레드밀을 이용한 운동학습훈련을 주 4회 15분/1회 적용하였다. 뇌성마비 아동의 운동기능은 대동작기능평가를 이용하여 측정하였고, 균형능력은 good balance system(Meitur Ltd., Finland)의 전산화 측정장비를 이용하여 측정하였다. 적용방법에 따른 운동학습훈련군과 대조군의 전 후 유의성 검증은 Wilcox Signed Rank Test와 Mann-Whitney U test를 실시하였다. 그 결과, 운동학습훈련군은 훈련 적용 후 운동기능과 균형이 유의하게 항상되었고(p<.05), 대조군에 비해 운동학습훈련군에서 훈련 적용 후 운동기능과 균형이 유의하게 향상되었다(p<.05). 트레드밀을 이용한 운동학습훈련은 경직성 뇌성마비아동의 운동기능과 균형능력을 향상시키는데 도움을 주고, 소아치료 중재방법으로 유용하게 사용될 수 있음을 알 수 있었다. The purpose of this study was to apply treadmill training through motor learning to cerebral palsy children and examine its effects on their motor Functions and balance. The subjects of this study were 16 spastic diplegia children who had difficulty in independent gait, and GMFCS level III, IV. The participant's were allocated randomy to 2 groups: a motor learning group(n=8) and the control group(n=8), Both groups received muscle strengthening exercise for 3 session, 30 minutes per week over 7 weeks period. Data collected from the 16 spastic diplegia children the results were as follows. The motor learning group showed significant increase in motor function(p<.05). The motor learning group showed significant increase in balance(p<.05). Between motor learning group and control group, motor functions and balance was a statistically significant difference(p<.05).

Hypoalgesic and Motor Effects of Kaltenborn Mobilization on Elderly Patients with Secondary Thumb Carpometacarpal Osteoarthritis: A Randomized Controlled Trial

Objective This study evaluated the effects of Kaltenborn manual therapy on sensory and motor function in elderly patients with secondary carpometacarpal osteoarthritis (CMC OA). Method Twenty-nine female patients with secondary CMC OA (70-90 years old) were randomized into Kaltenborn manual therapy and sham groups. This study was designed as a double-blind, randomized controlled trial (RCT). Therapy consisted of Kaltenborn mobilization of posterior-anterior gliding with distraction in grade 3 of the carpometacarpal (CMC) joint of the dominant hand during 6 sessions over 2 weeks. Pain was measured by algometry, as the pressure pain threshold (PPT) at the CMC joint and tubercle of the scaphoid bone. The tip and tripod pinch strength was also measured. Grip strength was measured by a grip dynamometer. Measurements were taken before treatment and after 1 week (first follow-up [FU]) and 2 weeks (second FU). Results All values in the sham group remained unchanged during the treatment period. In the treated group, the PPT in the CMC joint was 2.98 ± 0.30 kg/cm 2, which increased after treatment to 4.07 ± 0.53, and was maintained at the same level during the first FU (3.46 ± 0.31) and second FU (3.84 ± 0.36). Similarly, the PPT in the scaphoid bone was 3.61 ± 0.29 kg/cm 2, which increased after treatment to 4.87 ± 0.37, and was maintained at the same level during the first FU (4.44 ± 0.43) and second FU (4.22 ± 0.32). In contrast, we found no differences in the tip, tripod pinch, and grip strength measurements between the treatment and sham groups. Conclusions This study showed that Kaltenborn manual therapy decreased pain in the CMC joint and scaphoid bone areas of elderly female patients; however, it did not confer an increase in motor function in patients with CMC OA.

Long-Term Effects on Cortical Excitability and Motor Recovery Induced by Repeated Muscle Vibration in Chronic Stroke Patients

Background. Muscle vibration modifies corticomotor excitability in healthy subjects and reduces muscle tonus in stroke patients. Objective. This study examined whether repeated muscle vibration (rMV) applied over the flexor carpi radialis (FCR) and biceps brachii (BB) can induce long-lasting changes, using transcranial magnetic stimulation (TMS), in patients with chronic stroke. Methods. Thirty hemiparetic patients who offered at least minimal wrist and elbow isometric voluntary contractions were randomly assigned to either an experimental group, which received rMV in addition to physiotherapy (rMV + PT), or a control group that underwent PT alone. The following parameters of the FCR, BB, and extensor digitorum communis (EDC) were measured through TMS before, and 1 hour, 1 week, and 2 weeks after the end of intervention: resting motor threshold (RMT), map area, map volume, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Muscle tonus and motor function were assessed on the same day as TMS. Results. Pre–post analysis revealed a reduction in RMT and an increase in motor map areas occurred in the vibrated muscles only in the rMV + PT group, with an increase in map volumes of all muscles. Moreover, SICI increased in the flexors and decreased in the extensor. These neurophysiological changes lasted for at least 2 weeks after the end of rMV + PT and paralleled the reduction in spasticity and increase in motor function. A significant correlation was found between the degree of spasticity and the amount of intracortical inhibition. Conclusion. rMV with PT may be used as a nonpharmacological intervention in the neurorehabilitation of mild to moderate hemiparesis.

Effects of amphetamine and/or l-dopa and physiotherapy after stroke ? a blinded randomized study

Major therapeutic advances in the rehabilitation of subacute stroke are lacking. A promising approach is treatment with facilitating drugs like amphetamine or levodopa in combination with physiotherapy. In a randomized, double-blind, placebo-controlled clinical trail, the effect of 10 sessions with either 20 mg of D-amphetamine, 100 mg of L-dopa or 10 mg of D-amphetamine + 50 mg of L-dopa combined with physiotherapy during a 2-week period was investigated in 25 patients admitted to a stroke rehabilitation unit. Motor function (Fugl-Meyer score) and activities of daily living (Barthel's index) were assessed. All patients improved significantly over the intervention period. Drug-treated patients did not show any additional increase in motor function or ADL. It is feasible and safe to perform larger clinical trials with this type of four-arm design. However, the lack of significant effects could be because of type, dosage, and time of drugs as well as the physical intervention strategy.

A Double-Blind Placebo-Controlled Study of the Effects of Amphetamine and Physiotherapy after Stroke

Major therapeutic advances in the rehabilitation of subacute stroke are lacking. One promising approach is treatment with amphetamine in combination with physiotherapy so as to promote motor function. In a randomized, double-blind, placebo-controlled clinical trial, the effect of 10 sessions with 10 mg of amphetamine combined with physiotherapy during a 5-week period was investigated in 39 geriatric patients who had been admitted to a stroke rehabilitation unit. Motor function (Fugl-Meyer motor performance score) and activities of daily living (ADL; Barthel’s index) were assessed at baseline and at the end of treatment. All patients improved significantly over the intervention period. Amphetamine-treated patients did not show any increase in motor function or ADL as compared to the control group. Rehabilitation with amphetamine at this dosage and interval, combined with physiotherapy, did not promote motor recovery or functional capacity in patients suffering from stroke.

Variations in motility of the small intestine and the effect of impulses in intestinal nerves during stimulation of the mechanoceptors of a loop of small intestine

Acute experiments were carried out on cats and dogs. Movements of the small intestine were compared with changes in the potentials recorded from the splanchnic nerve. It was found that an increase of impulses was accompanied by a depression of motor function, and that increased motility was associated with a depression of the impulses. It was also established that stimulation of the mechanoceptors of the small intestine which caused an increased rate of firing of efferent impulses led to the inhibition of motor function. Ganglion block caused by dicoline administration sharply decreased the level of impulsation, caused a marked increase of motor function, and eliminated the response to stimulation of mechanoceptors of the segment of intestine.