Limb Motor Research Articles

Clinical study on the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence

To explore the effects of cluster needling at scalp points with needle retaining combined with the training of the upper-limb intelligent rehabilitation robot on shoulder function in stroke patients during convalescence. Ninety stroke patients during convalescence were collected and randomized into scalp point group, robot training group and combined intervention group, with 30 cases each. In the scalp point group, the cluster needling was delivered at scalp points with the needles retained. In the robot training group, the patients were trained with the upper-limb intelligent rehabilitation robot. In the combined intervention group, the patients received both the cluster needling and the training of the upper-limb intelligent rehabilitation robot. In each group, the treatment was given once daily, 5 treatments a week with 2 days rest, for consecutive 4 weeks. Separately, before and after treatment, the score of Fugl-Meyer assessment upper extremity scale (FMA-UE) and the score of activity of daily living (ADL) were evaluated. Using the in-built assessment system of the upper-limb intelligent rehabilitation robot, the range of motion (ROM) of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint were evaluated. With surface electromyogram (sEMG), the sEMG value of the deltoid muscle and the pectoralis major on the affected side were detected. Compared with the values before treatment, ADL score and FMA-UA score increased in patients of the three groups (P<0.05), and ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint was larger (P<0.05), the sEMG value of the fasciculi pectoralis major anterior of patients in the combined intervention group was reduced (P<0.05), and the sEMG of anterior deltoid tract was elevated in the three groups (P<0.05). When compared with the scalp point group and the robot group, in the combined intervention group, after treatment, ADL score and FMA-UA score were higher (P<0.05), ROM of forward flexion, horizontal abduction and horizontal adduction of the affected shoulder joint elevated (P<0.05) and sEMG value of the fasciculi pectoralis major anterior reduced (P<0.05), while which of the anterior deltoid tract was elevated (P<0.05). The cluster needling at scalp points with needle retaining, combined with the training of the upper-limb intelligent rehabilitation robot, improves the upper limb motor function and the range of motion of the shoulder joint in stroke patients during convalescence.

Efficacy and safety of very early rehabilitation for acute ischemic stroke: a systematic review and meta-analysis

BackgroundEarly rehabilitation after acute ischemic stroke (AIS) contributes to functional recovery. However, the optimal time for starting rehabilitation remains a topic of ongoing investigation. This article aims to shed light on the safety and efficacy of very early rehabilitation (VER) initiated within 48 h of stroke onset.MethodsA systematic search in PubMed, Embase, Cochrane Library, and Web of Science databases was conducted from inception to January 20, 2024. Relevant literature on VER in patients with AIS was reviewed and the data related to favorable and adverse clinical outcomes were collected for meta-analysis. Subgroup analysis was conducted at different time points, namely at discharge and at three and 12 months. Statistical analyses were performed with the help of the Meta Package in STATA Version 15.0.ResultsA total of 14 randomized controlled trial (RCT) studies and 3,039 participants were included in the analysis. VER demonstrated a significant association with mortality [risk ratio (RR) = 1.27, 95% confidence interval (CI) (1.00, 1.61)], ability of daily living [weighted mean difference (WMD) = 6.90, 95% CI (0.22, 13.57)], and limb motor function [WMD = 5.02, 95% CI (1.63, 8.40)]. However, no significant difference was observed between the VER group and the control group in adverse events [RR = 0.89, 95% CI (0.79, 1.01)], severity of stroke [WMD = 0.52, 95% CI (−0.04, 1.08)], degree of disability [RR = 1.06, 95% CI (0.93, 1.20)], or recovery of walking [RR = 0.98, 95% CI (0.94, 1.03)] after stroke. Subgroup analysis revealed that VER reduced the risk of adverse events in the late stage (at three and 12 months) [RR = 0.86, 95% CI (0.74, 0.99)] and degree of disability at 12 months [RR = 1.28, 95% CI (1.03, 1.60)], and improved daily living ability at 3 months [WMD = 4.26, 95% CI (0.17, 8.35)], while increasing severity of stroke during hospitalization [WMD = 0.81, 95% CI (0.01, 1.61)].ConclusionVER improves activities of daily living (ADLs) and lowers the incidence of long-term complications in stroke survivors. However, premature or overly intense rehabilitation may increase mortality in patients with AIS during the acute phase. PROSPERO registration number: CRD42024508180.Systematic review registrationThis systematic review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/). PROSPERO registration number: CRD42024508180.

The effect of family posture control combined with GAME therapy on motor function in children with severe cerebral palsy.

This paper has a purpose to explore the effects of home posture control combined with goal-activity-exercise-environment therapy on motor function in children with severe cerebral palsy (CP). Data of 80 children with severe CP treated from January 2022 to December 2023 were collected. They were divided into experimental group (EG) and control group according to different treatment methods, with 40 people in each group. The controlled group (CG) obtained routine treating means, including occupational therapy, electromyographic biofeedback therapy, and other treatment items. The EG received a combination of home posture control and goal-activity-exercise-environment therapy on the basis of conventional treatment. Meanwhile, parents received professional training to manage their children's posture and received reinforcement training through goal-activity-exercise-environment therapy. The Gross motor function measure-88, Peabody developmental motor scale-fine motor, pediatric balance scale, Fugl-Meyer assessment and other scales were used to evaluate the motor function, balance ability, daily living activity ability, and developmental level of patients. After 3 months of treatment, the Gross motor function measure-88 scores of these 2 groups were 70.96 ± 18.29 and 57.42 ± 21.41, respectively. The Peabody developmental motor scale-fine motor scores were 76.48 ± 14.42 and 59.77 ± 14.89, respectively. The balance ability index, upper limb motor function index, daily living activity ability, and developmental level of the EG were significantly higher than the CG's, and the P-values were all <.05. The combination of home posture control and GAME therapy can significantly improve the motor function and daily living activities of children with severe CP. This helps to maintain the normal growth and development of the child, and has certain clinical value.

USO DA TERAPIA ESPELHO EM MEMBRO SUPERIOR EM PACIENTES COM SEQUELAS APÓS ACIDENTE VASCULAR ENCEFÁLICO: UMA REVISÃO INTEGRATIVA

Introduction: Stroke has become a public health problem worldwide, being the second leading cause of functional limitation, which results in motor dysfunctions in the upper limbs, affecting the notion of space and body senses. These alterations are related to touch, temperature, pain and proprioception, extensor/flexor spasms, increased tendon reflexes, spastic co-contraction, dystonia, fatigability or spasticity. Mirror therapy has been considered a very effective form of treatment for motor dysfunctions. Thus, the present study aims to evaluate the use of mirror therapy in the functional recovery of the upper limbs in patients with sequelae after stroke, in addition to its impact on the quality of life of the participants. Methodology: This study is an integrative literature review with searches in the following databases: PubMed, Medline, Cochrane and Pedro, with articles published between 2019 and 2024. Results and discussion: Thirteen studies were selected, which presented mirror therapy associated with other therapeutic approaches, demonstrating their results in relation to motor functionality, manual dexterity, motor control and grasping. Final Considerations: Based on the findings, it was possible to observe that mirror therapy can contribute significantly to the rehabilitation of upper limb motor function and quality of life of patients after stroke.

Anatomic Study and Clinical Application of C7 Nerve Transfer Surgery via the Anterior Vertebral Approach for Central Upper Limb Spastic Paralysis

Objective: To explore the anatomic characteristics of C7 nerve localization, course, and length during cross-transfer surgery of the C7 nerve through the anterior vertebral approach and investigate the feasibility, safety, and clinical efficacy of C7 nerve transfer surgery through the anterior vertebral approach for the treatment of central upper limb spastic paralysis. Methods: Four fresh-frozen adult head and neck samples were selected. C7 nerve transfer surgery was simulated through the anterior vertebral approach. The vertical distance between the C7 nerve and the medial edge of the clavicle, the length of the C7 nerve, and the shortest distance of C7 nerve transfer required through the anterior vertebral approach were measured. This was a retrospective analysis of the clinical data of 2 patients with central upper limb spastic paralysis after C7 nerve transfer surgery at Northern Jiangsu People’s Hospital affiliated with Yangzhou University. The patients were all female, aged 50 to 51 years, with upper limb paralysis on the affected side. The muscle strength was grade 0 or grade 1, and the muscle tension was relatively high. Both patients underwent C7 nerve transfer surgery through the anterior vertebral approach. Upper limb sensation and motor function were observed. Results: Bilateral C7 nerves can be fully exposed and located through the anterior vertebral approach. The C7 nerve runs between the anterior and middle scalene muscles, with a vertical distance of 1.7 to 2.5 (2.1±0.3) cm from the inner edge of the clavicle. The length of the C7 nerve is 5.6 to 6.8 (6.4±0.5) cm, and the shortest distance of C7 nerve transfer through the anterior vertebral approach is 4.8 to 5.7 (5.3±0.4 cm). Two patients with central upper limb paralysis successfully underwent C7 nerve transfer surgery using the anterior vertebral approach. Two patients had normal motor function in the healthy upper limb after surgery but experienced pain and numbness in the healthy upper limb. Both patients recovered within 1 month. Two patients experienced significant relief of spasticity symptoms in the affected upper limb. One patient was followed up for 15 months, and, at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 3 and distal muscle strength at level 2. Another patient was followed up for 11 months, and at the last follow-up, sensation in the affected upper limb was normal, with proximal muscle strength at level 1+ and distal muscle strength at level 1. Conclusion: For central upper limb spastic paralysis, C7 nerve transfer surgery through the anterior vertebral approach is safe and feasible and is a good treatment option. Related anatomic research can effectively guide clinical surgery and assist in locating the C7 nerve, and incising the musculus longus colli can shorten the distance of C7 nerve transfer.

From Imagination to Innovation: Using Participatory Design Fiction to Envision the Future of Accessible Gaming Wearables for Players with Upper Limb Motor Disabilities

The interest in enhancing video game interactions through wearable technology has grown, yet accessible gaming with wearables remains underexplored. This study employs participatory design fiction, enabling disabled gamers to envision a future with tailored gaming wearables while critiquing technology. We conducted a two-phase study. Phase one involved in-depth interviews with upper limb motor disability participants; we developed a fictitious gaming wearable by analyzing the data using reflexive thematic analysis. A smaller group iterated on the wearable in phase two to ideate on ideal futures with accessible gaming wearables. Using data and dialogic/performance analysis, we crafted a design fiction diegetic prototype as a tech review video. This research highlights disabled gamers' unique needs and experiences around gaming wearables. It offers an innovative diegetic prototype for accessible gaming tech. Our methodological contribution merges narrative inquiry and dialogic/performance analysis in participatory design fiction research, providing a valuable approach for future studies.

Effect of nursing care based on goal-oriented mind mapping model on the prognosis of patients with severe brain injury.

The objective of this study was to observe the effect of nursing care based on goal-oriented mind-mapping on the prognosis of patients with severe brain injury. Clinical data of 116 patients with severe brain injury admitted to Qinghe County Central Hospital between March 2021 and August 2023 were retrospectively analyzed. Based on the nursing mode the patients received, they were divided into an Observation group (n = 58, patients received nursing based on the goal-oriented mind mapping mode) and a Control group (n = 58, patients received routine care). Data on length of hospital stay, complications, functional recovery, cerebral oxygen metabolism, and quality of life scores of the 2 groups were collected and analyzed. The length of hospital stay of the Observation group was shorter than that of the Control group (P < .05). The total incidence of complications in the Observation group was lower than that in the Control group (P < .05). After intervention, neurological function, cerebral oxygen metabolism indicators, and quality of life of the 2 groups improved significantly compared with those before the intervention; furthermore, the neurological function and cerebral oxygen metabolism indexes of the Observation group were better than those of the Control group (P < .05). The nursing care based on goal-oriented mind-mapping model for patients with severe brain injury can effectively shorten the length of hospital stay, reduce the occurrence of prognostic complications, and improve the recovery of neurological and limb motor functions, and ultimately achieve the goal of improving the quality of life.

Effect of intermittent theta burst stimulation on upper limb function in stroke patients: a systematic review and meta-analysis.

Stroke is a serious health issue that affects individuals, families, and society. Particularly, the upper limb dysfunction caused by stroke significantly reduces the quality of life for patients and may lead to psychological issues. Current treatment modalities are not fully effective in helping patients regain upper limb motor function to optimal levels. Therefore, there is an urgent need to explore new rehabilitation methods to address this issue. The purpose of this meta-analysis and systematic review is to explore the effects of intermittent theta burst stimulation (iTBS) on upper limb function in stroke patients. We searched PubMed, Cochrane Library, Embase, Web of Science, PEDro and China National Knowledge Internet as of April 8, 2024. Retrieved a total of 100 articles. Standardized mean differences (SMDs) and 95% confidence intervals (CI) were calculated. The study included a total of 9 trials and involved 224 patients. The results demonstrate that compared to the control group, iTBS therapy significantly improved Fugl-Meyer assessment-upper extremity (FMA-UE) scores (SMD = 0.88; 95% CI = 0.11-1.66; P = 0.03, I 2 = 84%), Action Research Arm Test (ARAT) scores (SMD = 0.83; 95% CI = 0.16-1.50; P = 0.02, I 2 = 57%), and Barthel Index (BI) scores (SMD = 0.93; 95% CI = 0.53-1.32; P < 0.0001, I 2 = 0%) in stroke patients. The comprehensive evidence suggests that iTBS has superior effects in improving upper limb function and activities of daily living in stroke patients.

Modeling Upper Limb Rehabilitation-Induced Recovery after Stroke: The Role of Attention as a Clinical Confounder.

People who have survived stroke may have motor and cognitive impairments. High dose of motor rehabilitation was found to provide clinically relevant improvement to upper limb (UL) motor function. Besides, mounting evidence suggests that clinical, neural, and neurophysiological features are associated with spontaneous recovery. However, the association between these features and rehabilitation-induced, rather than spontaneous, recovery has never been fully investigated.The objective was to explore the association between rehabilitation dose and UL motor outcome after stroke, as well as to identify which variables can be considered potential candidate predictors of motor recovery. People who survived stroke were assessed before and after a period of rehabilitation using motor, cognitive, neuroanatomical, and neurophysiological measures. We investigated the association between dose of rehabilitation and UL response (ie, Fugl-Meyer Assessment for upper extremity [FMA-UE]), using ordinary least squares regression as the primary analysis. To obtain unbiased estimates, adjusting covariates were selected using a directed acyclic graph. Baseline FMA-UE was the only factor associated with motor recovery (b = 0.99; 95% CI = 0.83 to 1.15 points). Attention emerged as a confounder of the association between rehabilitation and final FMA-UE (b = 5.5; 95% CI = -0.8 to 11.9 points), influencing both rehabilitation and UL response. Preserved attention in people who have survived stroke might lead to greater UL motor recovery, albeit estimates have high levels of variability. Moreover, the increase in the dose of rehabilitation can lead to 5.5 points improvement on the FMA-UE, a nonsignificant but potentially meaningful finding. The approach described here discloses a new framework for investigating the effect of rehabilitation treatment as a potential driver of recovery. Attentional resources could play a key role in UL motor recovery. There is a potential association between amount of UL recovery and dose of rehabilitation delivered, needing further exploration. Preserved attention and rehabilitation dose are candidate predictors of UL motor recovery.

Improving manual dexterity using ergonomic wearable glove in patients with multiple sclerosis: A quasi-randomized clinical trial

One main problem faced by people with multiple sclerosis (PwMS) is upper limb dysfunction, which can occur in the first decade of the disease and with the highest prevalence of disability in the progressive type of the disease. Then, PwMS may benefit from personalised and intensive treatment as provided by robotic devices. These innovative devices have increasingly been brought into the neurorehabilitation field, due to their ability to provide repetitive and task-oriented training. In this quasi-randomized study, we aim to evaluate the effects of robotic-assisted hand training, using the Hand TutorTM device, on hand functionality, active RoM, and manual dexterity, compared to conventional rehabilitation in PwMS. We enrolled 30 MS patients, who received 20 training sessions, each lasting 45 min with robotic-assisted hand training with Hand Tutor (n 15, experimental group) or conventional rehabilitation therapy (n 15, control group). All patients were evaluated at pre- and post-intervention with clinical scales for upper limb functionality (DASH, BBT, NHPT, and MI). In addition, only patients in the experimental group received an objective kinematic analysis of the hand and wrist movements, delivered by the Hand Tutor glove, both pre- and post-intervention. We found that PwMS in both groups statistically improved their upper limb functions, however the experimental group achieved better results in terms of manual dexterity. This promising rehabilitation training with Hand Tutor glove led to positive effects on upper limbs motor outcomes and kinematic parameters in patients with MS.

Safety and efficacy of viltolarsen in ambulatory and nonambulatory males with Duchenne muscular dystrophy.

Duchenne muscular dystrophy (DMD) is an X-linked recessive disease characterized by mutations in the dystrophin gene, causing motor and pulmonary function decline. Viltolarsen is indicated for patients with dystrophin gene mutations amenable to exon 53 skipping. Here, we report safety, motor function, and the first pulmonary function results from the open-label, phase II Galactic53 trial of viltolarsen (NCT04956289). Male participants aged ≥ 8years with DMD received 80mg/kg intravenous viltolarsen once weekly for 48weeks. Results from participants receiving viltolarsen were compared with an external control cohort group-matched for multiple variables. All treatment-emergent adverse events were mild or moderate, 4 were considered treatment-related, and no participants discontinued. Participants receiving viltolarsen experienced clinically meaningful benefits in pulmonary function with higher percent predicted forced vital capacity and higher peak cough flow at Week 49 compared with the control cohort for both ambulatory and nonambulatory participants. Viltolarsen also stabilized upper limb motor function over the Treatment Period. These results support viltolarsen as an important part of the treatment armamentarium for both ambulatory as well as nonambulatory patients with DMD.

New Assessment Method for Upper Limb Function in Patients with Cervical Spondylotic Myelopathy: The 10 Coins Test.

Retrospective cohort study. Although there are several methods available to assess upper limb function in patients with cervical spondylotic myelopathy, few methods can evaluate the degree of upper limb functional impairment in activities of daily living. We devised and evaluated the utility of a new assessment method called the 10 Coins Test, which is based on daily movements. The study included 39 patients who underwent spinal surgery for cervical spondylotic myelopathy and who were followed up for 1 year postoperatively. The mean age was 65.2±11.5 years, with 31 (79.5%) male and 8 (20.5%) female patients. The 10 Coins Test is a simple examination that measures the time it takes to pick up and move 10 coins forward. Patient satisfaction with surgery was evaluated on a 5-point scale. We compared the 10 Coins Test results, patient satisfaction, and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) results before and after surgery. The mean time to perform the 10 Coins Test was 27.4 seconds for the dominant hand and 24.5 seconds for the non-dominant hand preoperatively. In control group, the average time was 14.6 seconds for the dominant hand and 15.0 seconds for the non-dominant hand. The cut-off value was 16.2 seconds. There was a significant difference in the 10 Coins Test time and satisfaction for both hands at 1 week postoperatively compared with preoperatively. The JOACMEQ upper limb motor function showed a significant improvement 3 months postoperatively compared with preoperatively. The 10 Coins Test result was correlated with satisfaction and the JOACMEQ upper limb motor function. The 10 Coins Test allows for the quantitative evaluation of complex movements. It is convenient and highly useful for assessing upper limb function in patients with cervical spondylotic myelopathy.

Differences in motor network reorganization between patients with good and poor upper extremity impairment outcomes after stroke.

Changes in cortical excitability after stroke are closely associated with motor function recovery. This study aimed to clarify the motor network reorganization mechanisms corresponding to the different clinical outcomes of upper limb motor impairment in patients with subacute stroke. Motor function was assessed before rehabilitation (pre), after rehabilitation (post), and at the 1-year follow-up (follow-up) using the Fugl-Meyer assessment upper extremity scale. Further, resting-state functional magnetic resonance imaging (fMRI) data were collected in both pre- and post-conditions. Twenty patients with stroke were categorized into good and poor outcome groups based on motor impairments at the 1-year follow-up. Functional connections between motor-related regions of interest and the rest of the brain were subsequently calculated. Finally, the correlation between motor network reorganization and behavioral improvement at the 1-year follow-up was analyzed. The good outcome group exhibited a positive precondition motor function and continuous improvement, whereas the poor outcome group showed a weak precondition motor function and insignificant improvement. Contralesional hemisphere-related connections were found to be higher in the good outcome group pre-conditioning, with both groups showing minimal change post-conditioning, while no relationship with motor impairment was found. Long interhemispheric connections were decreased and increased in the good and poor outcome groups respectively, and were negatively correlated with motor impairment. Different motor network reorganizations during the subacute phase can influence the varying motor outcomes in the affected upper limb after stroke. These findings may serve as the theoretical basis for future neuromodulatory research.

Effect of Yiqi Huoxue Decoction on Neurological Function for Cervical Spinal Cord Injury

Cervical spinal cord injury (CSCI) can lead to neurological dysfunction, such as limb numbness, muscle stiffness, and motor disorders. Although early decompression surgery has demonstrated efficacy in alleviating symptoms for patients with CSCI, there are still some limitations in the recovery of motor function. It has been reported that traditional Chinese medicine (TCM) has advantages in the treatment of CSCI due to its safety and efficacy and its ability to modulate the immune system and promote neuroregeneration. In this study, we investigate the clinical efficacy of combining Yiqi Huoxue Decoction with acupoint massage therapy in patients with CSCI after decompression and fixation surgery. A total of 140 patients who were first diagnosed with CSCI at our hospital and underwent early decompression and internal fixation surgery from October 2022 to June 2023 were included in this study. They were divided into two groups: Group A (n = 70) received conventional Western medicine treatment, and Group B (n = 70) received Yiqi Huoxue Decoction and acupoint massage therapy. We observed significant improvements in the American Spinal Injury Association scores after the combined treatment. Moreover, the levels of neuron-specific enolase decreased, while the levels of nerve growth factor and insulin-like growth factor-1 increased. Additionally, the levels of CD3+, CD4+, and CD8+ T cells exhibited a notable decrease. Furthermore, acupoint massage was found to stimulate nerve endings, thereby promoting nerve regeneration and repair. In summary, this combined treatment effectively improves the neurological function of patients with CSCI.

Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children’s upper limb motor skills, a randomized controlled trial

Purpose This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions. Materials and methods Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success. Results Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group. Conclusions This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

Effects of wearable device training on upper limb motor function in patients with stroke: a systematic review and meta-analysis.

To evaluate the effect of wearable device training on improving upper limb motor function in patients who experienced strokes. The PubMed, Embase, Cochrane Library, Web of Science, MEDLINE, SCOPUS, China National Knowledge Infrastructure, WanFang, and VIP databases were searched for randomized controlled trials (RCTs) that assessed the effectiveness of wearable device training in improving upper limb motor function in patients with stroke. Two investigators independently screened studies by their titles and abstracts and cross-checked, downloaded, and evaluated the results. Disagreements were resolved by a third highly experienced researcher. Risk of bias was evaluated using the Cochrane risk-of-bias tool. This meta-analysis was registered in PROSPERO (registration No. CRD42023421633). This study comprised 508 patients from 14 RCTs. The experimental group assessed various wearable devices, including 3D-printed dynamic orthoses, inertial measurement unit (IMU) sensors, electrical stimulation devices, and virtual reality (VR) devices for virtual interactive training. The control group received traditional rehabilitation therapies, including physical and conventional rehabilitation. The experimental group scored better on the Fugl-Meyer Assessment (FMA-UE) scale (standardized mean difference [SMD] 0.26, 95% confidence interval [CI] 0.07, 0.45) and Box and Block Test (BBT) (SMD 0.43, 95% CI 0.17, 0.69) versus controls. No significant intergroup differences were observed in the Action Research Arm Test (SMD 0.20, 95% CI -0.15, 0.55), motor activity log (mean difference [MD] 0.32, 95% CI -0.54, 0.33), and modified Ashworth scale (MD -0.08, 95% CI -0.81, 0.64). The probability rankings of wearable devices that improved FMA-UE scores in patients with stroke were: orthotic devices, with the highest probability ranking of 0.45, followed by sensor devices at 0.23, electrical stimulation devices at 0.21, and VR devices at 0.11. Wearable device training was found to significantly improve upper limb motor function in patients with stroke, particularly for large-range movements. Improvements in FMA-UE and BBT scores reflected reduced impairment and enhanced manual dexterity, respectively. However, the training had no significant effect on hand movement frequency, fine motor skills, or spasticity. Among the different wearable devices tested, orthoses produced the most effective results.

Inter-rater reliability of hand motor function assessment in Parkinson’s disease: Impact of clinician training

Medication adjustments in Parkinson’s disease (PD) are driven by patient subjective report and clinicians’ rating of motor feature severity (such as bradykinesia and tremor). ObjectiveAs patients may be seen by different clinicians at different visits, this study aims to determine the inter-rater reliability of upper limb motor function assessment among clinicians treating people with PD (PwPD). MethodsPwPD performed six standardised hand movements from the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), while two cameras simultaneously recorded. Eight clinicians independently rated tremor and bradykinesia severity using a visual analogue scale. We compared intraclass correlation coefficient (ICC) before and after a training/calibration session where high-variance participant videos were reviewed and MDS-UPDRS instructions discussed. ResultsIn the first round, poor agreement was observed for most hand movements, with best agreement for resting tremor (ICC 0.66 bilaterally; right hand 95 % CI 0.50–0.82; left hand: 0.50–0.81). Postural tremor (left hand) had poor agreement (ICC 0.14; 95 % CI 0.04–0.33), as did wrist pronation-supination (right hand ICC 0.34; 95 % CI 0.19–0.56). In post-training rating exercises, agreements improved, especially for the right hand. Best agreement was observed for hand open-close ratings in the left hand (ICC 0.82, 95 % CI 0.64–0.94) and resting tremor in the right hand (ICC 0.92, 95 % CI 0.83–0.98). Discrimination between right and left hand features by raters also improved, except in resting tremor (disimprovement) and wrist pronation-supination (no change). ConclusionsClinicians vary in rating video-recorded PD upper limb motor features, especially bradykinesia, but this can be improved somewhat with training.

Tract-specific magnetization transfer ratio provides insights into the severity of degenerative cervical myelopathy.

Cross-sectional study. This study's goal is to report whether Magnetization Transfer Ratio (MTR) can evaluate the severity of white matter (WM) injury in degenerative cervical myelopathy (DCM). Laureate Institute of Brain Research, USA; Department of Neurosurgery, University of Oklahoma Health Sciences Center, USA. 27 DCM patients were aged-matched with 20 healthy controls (HC) and categorized into treatment groups based on modified Japanese Orthopedic Association (mJOA) severity (11 mild and 16 moderate/severe). Regional and tract MTRs were extracted from the two vertebral levels containing maximum compression within magnetization transfer images. MTR differences between groups were assessed using a one-way ANOVA or Kruskal-Wallis test. The association between MTR and mJOA measures was evaluated using Spearman's correlation. Significant decreases in MTR were found between HC and moderate/severe groups in the overall (p = 0.0065) and ventral (p = 0.0009) WM regions; and ventral corticospinal (p = 0.0101), ventral reticulospinal (p = 0.0084), spinal lemniscus (p = 0.0079), and fasciculus cuneatus (p = 0.0219) tracts. The spinal lemniscus MTR also significantly decreased between HC and mild groups (p = 0.038). Ventral reticulospinal tract MTR correlated with upper (r = 0.439; p = 0.022) and lower (r = 0.386; p = 0.047) limb motor mJOA scores. Significant tract-based MTR changes and correlations align with known DCM symptoms, are demonstrated to be lost at the regional level, and display the inhomogeneous compressive damage occurring within DCM spinal cords.

Association between depression and adherence to upper limb exercises among community-dwelling stroke survivors: A cross-sectional study.

Upper limb recovery after stroke tends to be slower and incomplete. Participation in motor rehabilitation and exercise adherence are crucial to improve motor recovery. However, post-stroke depression (PSD) could impede active participation in exercises. Therefore, this study investigates the association between depression and exercise adherence among community-dwelling stroke survivors. This cross-sectional study was conducted among 215 stroke survivors undergoing motor rehabilitation between February 2021 and January 2023. Patient Health Questionnaire-9 (PHQ-9) and Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) were measured to assess depression symptoms and exercise adherence, respectively. Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was administered to identify the influence of impairment on these factors. Chi-square and multinomial and binary logistic regression analyses were applied to determine the relationships between these measurements. Using the Chi-square test, the PHQ-9 was significantly associated with SS-MAHE (p < 0.05). Logistic regression analysis revealed that patients with moderate depression had lower odds of exercise adherence (OR:0.69, 95%CI:0.56, 0.85, p < 0.01) compared to those with no depression. Type of exercises such as movement-based (OR:2.00, 95%CI:1.80, 2.24, p < 0.001) and task-based exercises (OR:1.80, 95%CI:1.53, 2.13, p < 0.001), had higher adherence odds compared to those not exercising. Severe impairment (FMA-UE) was significantly associated with lower exercise adherence (OR:0.71, 95%CI:0.54, 0.94, p < 0.05) and an increased risk of minimal depression (RR:11.09, 95%CI:1.17, 105.04, p < 0.05) compared to mild impairment. PSD significantly impacts exercise adherence, with moderate depression notably reducing adherence rates. Incorporating mental health support into stroke rehabilitation could improve exercise adherence and potentially enhance upper limb motor recovery outcomes.

Chronic stroke survivors underestimate their upper limb motor ability in a simple 2D motor task

BackgroundStroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities.ObjectiveWe asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb.Methods20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability).ResultsConfidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment.ConclusionsOur results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living.