Motor Function Of Upper Limb Research Articles

Fuzzy Adaptive Passive Control Strategy Design for Upper-Limb End-Effector Rehabilitation Robot.

Robot-assisted rehabilitation therapy has been proven to effectively improve upper-limb motor function in stroke patients. However, most current rehabilitation robotic controllers will provide too much assistance force and focus only on the patient's position tracking performance while ignoring the patient's interactive force situation, resulting in the inability to accurately assess the patient's true motor intention and difficulty stimulating the patient's initiative, thus negatively affecting the patient's rehabilitation outcome. Therefore, this paper proposes a fuzzy adaptive passive (FAP) control strategy based on subjects' task performance and impulse. To ensure the safety of subjects, a passive controller based on the potential field is designed to guide and assist patients in their movements, and the stability of the controller is demonstrated in a passive formalism. Then, using the subject's task performance and impulse as evaluation indicators, fuzzy logic rules were designed and used as an evaluation algorithm to quantitively assess the subject's motor ability and to adaptively modify the stiffness coefficient of the potential field and thus change the magnitude of the assistance force to stimulate the subject's initiative. Through experiments, this control strategy has been shown to not only improve the subject's initiative during the training process and ensure their safety during training but also enhance the subject's motor learning ability.

Deep learning prediction of motor performance in stroke individuals using neuroimaging data

The degree of motor impairment and profile of recovery after stroke are difficult to predict for each individual. Measures obtained from clinical assessments, as well as neurophysiological and neuroimaging techniques have been used as potential biomarkers of motor recovery, with limited accuracy up to date. To address this, the present study aimed to develop a deep learning model based on structural brain images obtained from stroke participants and healthy volunteers. The following inputs were used in a multi-channel 3D convolutional neural network (CNN) model: fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity maps obtained from Diffusion Tensor Imaging (DTI) images, white and gray matter intensity values obtained from Magnetic Resonance Imaging, as well as demographic data (e.g., age, gender). Upper limb motor function was classified into “Poor” and “Good” categories. To assess the performance of the DL model, we compared it to more standard machine learning (ML) classifiers including k-nearest neighbor, support vector machines (SVM), Decision Trees, Random Forests, Ada Boosting, and Naïve Bayes, whereby the inputs of these classifiers were the features taken from the fully connected layer of the CNN model. The highest accuracy and area under the curve values were 0.92 and 0.92 for the 3D-CNN and 0.91 and 0.91 for the SVM, respectively. The multi-channel 3D-CNN with residual blocks and SVM supported by DL was more accurate than traditional ML methods to classify upper limb motor impairment in the stroke population. These results suggest that combining volumetric DTI maps and measures of white and gray matter integrity can improve the prediction of the degree of motor impairment after stroke. Identifying the potential of recovery early on after a stroke could promote the allocation of resources to optimize the functional independence of these individuals and their quality of life.

107 Nerve Transfers in Spinal Cord Injury: Analysis of Factors Influencing Motor Recovery

INTRODUCTION: Nerve transfers have the potential to reanimate lost upper limb function following cervical spinal cord injury (SCI). However, the factors influencing motor recovery following nerve transfers in cervical SCI remains unknown. METHODS: A prospective cohort of cervical SCI patients 18 years of age with American Spinal Injury Association [ASIA] grade A-C underwent nerve transfers and followed-up until 48-months. Preoperative variables included age, time-delay post-SCI, neurological level-of-injury, ASIA grades, international classification of surgery of hand in tetraplegia (ICSHT) indicating preserved upper limb function, and recipient-nerve-electrodiagnosis. Univariate analyses were performed followed by multivariable proportional-odds logistic-regression of significant predictors. The primary outcome was motor recovery in medical research council (MRC) grades categorized as: poor-recovery (MRC grades 0-2); good-recovery (grade 3); and excellent-recovery (grades 4-5). The ICSHT was categorized into very-high-level (ICSHT-0; absent-function); high-level (ICSHT 1-2; intact biceps/brachioradialis); and low-level-injury (ICSHT 3-4; intact wrist-extension/pronation). RESULTS: 21 cervical SCI patients underwent 57 nerve transfers (33 upper limbs) at median of 21 (range: 6-142) months post-SCI. At final follow-up, median-gain in triceps MRC was: 3 ([IQR] 2.5-4, p = 0.011), finger-extensors: 4 (2-4, p < 0.001), and finger-flexors: 2 (1-3, p < 0.001). On univariate analysis, age, time-delay post-SCI, and ICSHT were significantly associated with motor recovery. On multivariable analysis, the low-level-injury (ICSHT 3-4) was significantly associated with superior motor outcomes as compared to higher-level injuries (Odds ratio [OR] 12.2, 95% CI, 2.34-91.4; p = 0.005). Each month delay increased 5% odds of superior motor function (OR 1.05, 95% CI, 1.01-1.11; p = 0.03). CONCLUSIONS: The preserved motor function in upper limb (ICSHT-grouping) significantly predicts motor outcomes following nerve transfers in cervical SCI. Nerve transfers in chronic SCI (12 months) results in comparable motor outcomes to earlier reinnervation.

Effect of Proprioceptive Neuromuscular Facilitation Technique Combined with Kinesio Taping on Upper Limb Motor Function of Patients with Stroke

Effect of Proprioceptive Neuromuscular Facilitation Technique Combined with Kinesio Taping on Upper Limb Motor Function of Patients with Stroke

Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: a randomized controlled trial

BackgroundSeeking positive and comprehensive rehabilitation methods after stroke is an urgent problem to be solved, which is very important to improve the dysfunction of stroke. The aim of this study was to investigate the effects of motor imagery-based brain-computer interface training (MI-BCI) on upper limb function and attention in stroke patients with hemiplegia.MethodsSixty stroke patients with impairment of upper extremity function and decreased attention were randomly assigned to the control group (CR group) or the experimental group (BCI group) in a 1:1 ratio. Patients in the CR group received conventional rehabilitation. Patients in the BCI group received 20 min of MI-BCI training five times a week for 3 weeks (15 sessions) in addition to conventional rehabilitation. The primary outcome measures were the changes in Fugl-Meyer Motor Function Assessment of Upper Extremities (FMA-UE) and Attention Network Test (ANT) from baseline to 3 weeks.ResultsAbout 93% of the patients completed the allocated training. Compared with the CR group, among those in the BCI group, FMA-UE was increased by 8.0 points (95%CI, 5.0 to 10.0; P < 0.001). Alert network response time (32.4ms; 95%CI, 58.4 to 85.6; P < 0.001), orienting network response (5.6ms; 95%CI, 29.8 to 55.8; P = 0.010), and corrects number (8.0; 95%CI, 17.0 to 28.0; P < 0.001) also increased in the BCI group compared with the CR group. Additionally, the executive control network response time (− 105.9ms; 95%CI, − 68.3 to − 23.6; P = 0.002), the total average response time (− 244.8ms; 95%CI, − 155.8 to − 66.2; P = 0.002), and total time (− 122.0ms; 95%CI, − 80.0 to − 35.0; P = 0.001) were reduced in the BCI group compared with the CR group.ConclusionMI-BCI combined with conventional rehabilitation training could better enhance upper limb motor function and attention in stroke patients. This training method may be feasible and suitable for individuals with stroke.Trial registration: This study was registered in the Chinese Clinical Trial Registry with Portal Number ChiCTR2100050430(27/08/2021).

Effectiveness and electrophysiological mechanisms of focal vibration on upper limb motor dysfunction in patients with subacute stroke: A randomized controlled trial

Upper limb motor dysfunction is a common complication after stroke, which has a negative impact on the daily life of the patients. Focal vibration (FV) has been used to improve upper limb motor function in acute and chronic stroke patients, but its application in subacute stroke patients has not been extensively explored. Therefore, the purpose of this study was to explore the therapeutic effect of FV on upper limb motor function in subacute stroke patients and its underlying electrophysiological mechanism. Twenty-nine patients were enrolled and randomized into two groups: a control group and a vibration group. The control group were treated with conventional therapy including passive and active physical activity training, standing and sitting balance exercises, muscle strength training, hand extension and grasping exercises. The vibration group were given conventional rehabilitation and vibration therapy. A deep muscle stimulator (DMS) with a frequency of 60 Hz and an amplitude of 6 mm was used to provide vibration stimulation, which was sequentially applied along the biceps muscle to the flexor radialis of the affected limb for 10 min, once a day, and 6 times a week. Both groups received treatments for 4 consecutive weeks. In the vibration group, the motor evoked potential (MEP) latency and the somatosensory evoked potential (SEP) latency were significantly shortened (P < 0.05) immediately and 30 min after vibration; the SEP amplitude and MEP amplitude were significantly increased (P < 0.05) immediately and 30 min after vibration. The MEP latency (P = 0.001) and SEP N20 latency (P = 0.001) were shortened, and the MEP amplitude (P = 0.011) and SEP N20 amplitude (P = 0.017) were significantly increased after 4 weeks in the vibration group. After 4 consecutive weeks, the vibration group showed significant improvements in Modified Ashworth Scale (MAS) (P = 0.037), Brunnstrom stage for upper extremity (BS-UE) (P = 0.020), Fugl-Meyer assessment for upper extremity (FMA-UE) (P = 0.029), Modified Barthel Index (MBI) (P = 0.024), and SEP N20 (P = 0.046) compared to the control group. The Brunnstrom stage for hand (BS-H) (P = 0.451) did not show significant differences between the two groups. This study showed that FV was effective in improving upper limb motor function in subacute stroke patients. The underlying mechanism of FV may be that it enhances the efficacy of sensory pathways and induces plastic changes in the sensorimotor cortex.

Effects of cerebellar transcranial direct current stimulation on rehabilitation of upper limb motor function after stroke.

The cerebellum is involved in the control and coordination of movements but it remains unclear whether stimulation of the cerebellum could improve the recovery of upper limb motor function. Therefore, this study aimed to explore whether cerebellar transcranial direct current stimulation (tDCS) therapy could promote the recovery of upper limb motor function in patients who suffered a stroke. In this randomized, double-blind, and sham-controlled prospective study, 77 stroke patients were recruited and randomly assigned to the tDCS group (n = 39) or the control group (n = 38). The patients received anodal (2 mA, 20 min) or sham tDCS therapy for 4 weeks. The primary outcome was the change in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score from baseline to the first day after 4 weeks of treatment (T1) and 60 days after 4 weeks of treatment (T2). The secondary outcomes were the FMA-UE response rates assessed at T1 and T2. Adverse events (AEs) related to the tDCS treatment were also recorded. At T1, the mean FMA-UE score increased by 10.7 points [standard error of the mean (SEM) = 1.4] in the tDCS group and by 5.8 points (SEM = 1.3) in the control group (difference between the two groups was 4.9 points, P = 0.013). At T2, the mean FMA-UE score increased by 18.9 points (SEM = 2.1) in the tDCS group and by 12.7 points (SEM = 2.1) in the control group (the difference between the two groups was 6.2 points, P = 0.043). At T1, 26 (70.3%) patients in the tDCS group had a clinically meaningful response to the FMA-UE score compared to 12 (34.3%) patients in the control group (the difference between the two groups was 36.0%, P =0.002). At T2, 33 (89.2%) patients in the tDCS group had a clinically meaningful response to the FMA-UE score compared with 19 (54.3%) patients in the control group (the difference between the two groups was 34.9%, P = 0.001). There was no statistically significant difference in the incidence of adverse events between the two groups. In the subgroup analysis of different hemiplegic sides, the rehabilitation effect of patients with right hemiplegia was better than that of patients with left hemiplegia (P < 0.05); in the age subgroup analysis, different age groups of patients did not show a significant difference in the rehabilitation effect (P > 0.05). Cerebellar tDCS can be used as an effective and safe treatment to promote recovery of upper limb motor function in stroke patients. ChiCTR.org.cn, identifier: ChiCTR2200061838.

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.

How Do Motor and Sensory Function Correlate with Daily Performance Recovery after Post-Stroke Robotic Intervention? A Secondary Analysis of a Non-Randomized Controlled Trial.

New technologies have been developed to complement conventional interventions to better target the specific needs of people with stroke, and they have been shown to improve both function and performance. However, it is unknown whether the baseline levels of sensorimotor function and performance interrelate with the improvement in upper limb and daily performance. Thus, the aim of this study was to examine the relationship between baseline levels of sensorimotor function and daily performance and its impact on post-intervention improvement in people with stroke following a robotic intervention. A single-blind, non-randomized, controlled clinical trial was conducted. Participants in the experimental group (n = 9) received a robotic intervention in addition to conventional treatment. Sensorimotor function was measured with Semmes-Weinstein Monofilaments® and the Fugl-Meyer Assessment Upper Extremity Scale. Upper limb and daily performance were measured with the MAL and SIS-16 scales. The multivariate regression models showed that baseline levels of upper limb performance and motor function predicted >95% of the variance in upper limb performance (p < 0.001), while pre-intervention levels of daily performance explained >75% of the post-intervention variance (p < 0.05). These findings indicate that basal upper limb motor function is associated with improved performance following a combined intervention of conventional treatment and robotic intervention.

Is the robotic rehabilitation that is added to intensive body rehabilitation effective for maximization of upper extremity motor recovery following a stroke? A randomized controlled study.

Trunk stabilization, which is a factor that directly affects the performance of affected upper-limb movements in stroke patients, is of critical importance in the performance of selective motor control. This study aimed to investigate the effects on upper-limb motor function of the addition of robotic rehabilitation (RR) and conventional rehabilitation (CR) to intensive trunk rehabilitation (ITR). A total of 41 subacute stroke patients were randomly allocated to two groups: RR and CR. Both groups received the same ITR procedure. Following ITR, a robot-assisted rehabilitation program of 60min, 5days a week, for 6weeks, was applied to the RR group, and an individualized upper-limb rehabilitation to the CR group. Assessments were made at baseline and after 6weeks using the Trunk Impairment Scale (TIS), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FMA-UE), and Wolf Motor Function Test (WMFT). Improvements were obtained in the TIS, FMA-UE, and WMFT scores for both groups (p < 0.001), with no superiority detected between the groups (p > 0.05). The RR group scores were relatively high, but not to a statistically significant. When added to intensive trunk rehabilitation, the robot-assisted systems, which are recommended as a stand-alone therapy method, produced similar results to conventional therapies. This technology can be used as an alternative to conventional methods under appropriate conditions of clinical opportunity, access, time management, and staff limitations. However, when RR is combined with traditional interventions such as intensive trunk rehabilitation, it is essential to investigate if the real effect is due to the robotic rehabilitation or the accumulation of positive effects of excessive movement or force spread associated with trained muscles. This trial was retrospectively registered in the ClinicalTrials.gov with NCT05559385 registration number (25/09/2022).

Comparison of Task Specific Training Vs Neuro Developmental Training Approach Along with Conventional Therapy for Upper Limb Motor Function Among Chronic Stroke Patients

Objective The purpose of the study is to determine the effect of Proprioceptive Neuromuscular Facilitation Vs Balance Exercise along with Conventional Therapy for balance and gait in Chronic Parkinson’s patients. Study Design Randomized Controlled Trial (RCT). Place and Duration of study This study took place in Lahore, Pakistan and the duration of the study was 6 months. Method This study is a Randomized Controlled Trial utilized a non-probability purposive sampling technique, the primary outcome measure was Berg Balance Scale and Functional Gait Assessment which were used to check the balance and gait. The findings were then statistically analysed by non parametric tests Mann Whitney U Test and Friedman Test were used for between group and within the group comparisons respectively. Results A total of 60 patients participated in the study among which after randomized allocation of 30(50%) in PNF group and 30(50%) in Balance T group. The data shows that there is a big difference mean value difference between the two groups i.e. Balance T group showed better results than the PNF group and the p value is 0.000 which is less than 0.05 hence suggesting that the difference between both the experimental the groups after 12 weeks is highly significant. Hence we are rejecting the Null hypothesis and accepting the alternating hypothesis. . The data shows that there is a difference mean value difference between the two groups i.e. Balance T group showed better results than the PNF group and the p value is 0.492 which is more than 0.05 hence suggesting that the difference between both the experimental the groups after 12 weeks is non-significant. Hence we are rejecting the Alternate Hypothesis and accepting the Null Hypothesis. Conclusion Both of the treatment approaches have proven to be effective in treatment of balance of lower limb among chronic Parkinson’s patients but the Balance Exercises has proven to be significantly more effective than of Proprioceptive Neuromuscular Facilitation and show effective results in the treatment of balance more efficiently but among two of these treatment strategies none of them has been proven to be better than other for gait. Discussion In the current study where PNF and Balance exercise are compared to each other shows that Balance exercise is highly effective for the treatment of balance in chronic Parkinson’s patients as compared to PNF. However Del Carmen et.al. Conducted a research in 2019 i.e. “the development of ballet exercises with Proprioceptive Neuromuscular Facilitation techniques for patients with Parkinson’s disease” which indicated that of Proprioceptive Neuromuscular Facilitation technique also improve balance and gait in Parkinson’s disease patients [1].

Effect of Rehabilitation Interventions on Post-Stroke Upper Limb Dysfunction and Cognitive Functions: a Systematic Review and Meta-Analysis

INTRODUCTION. The prevalence of upper limb dysfunction and cognitive impairments are frequently observed following stroke, but are often considered as distinct entities, and there is little evidence regarding how they are related, as well as rehabilitation methods are aimed at monodomain restoration of any of these impairments. AIM. To analyze the data of recent years on the impact of rehabilitation interventions on cognitive and the upper limb (UL) motor functions in patients with stroke, and to establish how they are related. MATERIAL AND METHODS. The search was carried out in the Medline, Web of Science, PubMed and Scopus sources in accordance with the PRISMA principles and initially revealed 2,841 records. Of these, 35 articles were included in the study with publication 2011–2022. Keywords were used: stroke, movement, motor, upper limb, cognition, cognitive, cognitive-motor, motor-cognitive function. The relationship between cognitive impairments and the degree of restoration of the UL motor function under the influence of various rehabilitation interventions was assessed. RESULTS. Five studies were selected for meta-analysis with the inclusion of 180 stroke patients. It is shown that the improvement of cognitive tests (MoCA) is accompanied by an improvement in UL motor impairments (FMA, Jebsen-Taylor Hand Function Test), while hand dexterity (Box and blocks, NHPT, Minnesota manual dexterity test) remained without statistically significant changes during medical rehabilitation. CONCLUSION. The meta-analysis provides evidence of the relationship and mutual influence of cognitive functions on motor recovery and manual dexterity. However, the small sample size and heterogeneity of available studies are still limiting factors for obtaining unambiguous conclusions.

Exploring structural connectomes in children with unilateral cerebral palsy using graph theory.

We explored structural brain connectomes in children with spastic unilateral cerebral palsy (uCP) and its relation to sensory-motor function using graph theory. In 46 children with uCP (meanage=10 years 7 months ± 2 years 9 months; Manual Ability Classification System I=15, II=16, III=15)we assessed upper limb somatosensory and motor function. We collected multi-shell diffusion-weighted, T1-weighted and T2-FLAIR MRI and identified the corticospinal tract (CST) wiring pattern using transcranial magnetic stimulation. Structural connectomes were constructed using Virtual Brain Grafting-modified FreeSurfer parcellations and multi-shell multi-tissue constrained spherical deconvolution-based anatomically-constrained tractography. Graph metrics (characteristic path length, global/local efficiency and clustering coefficient) of the whole brain, the ipsilesional/contralesional hemisphere, and the full/ipsilesional/contralesional sensory-motor network were compared between lesion types (periventricular white matter (PWM)=28, cortical and deep gray matter (CDGM)=18) and CST-wiring patterns (ipsilateral=14, bilateral=14, contralateral=12, unknown=6) using ANCOVA with age as covariate. Using elastic-net regularized regression we investigated how graph metrics, lesion volume, lesion type, CST-wiring pattern and age predicted sensory-motor function. In both the whole brain and subnetworks, we observed a hyperconnectivity pattern in children with CDGM-lesions compared with PWM-lesions, with higher clustering coefficient (p=[<.001-.047], =[0.09-0.27]), characteristic path length (p=.003, =0.19) and local efficiency (p=[.001-.02], =[0.11-0.21]), and a lower global efficiency with age (p=[.01-.04], =[0.09-0.15]). No differences were found between CST-wiring groups. Overall, good predictions of sensory-motor function were obtained with elastic-net regression (R2 =.40-.87). CST-wiring pattern was the strongest predictor for motor function. For somatosensory function, all independent variables contributed equally to the model. Inconclusion, we demonstrated the potential of structural connectomics in understanding disease severity and brain development in children with uCP.

Predicting patient-reported outcome of activities of daily living in stroke rehabilitation: a machine learning study

BackgroundMachine Learning is increasingly used to predict rehabilitation outcomes in stroke in the context of precision rehabilitation and patient-centered care. However, predictors for patient-centered outcome measures for activities and participation in stroke rehabilitation requires further investigation.MethodsThis study retrospectively analyzed data collected for our previous studies from 124 participants. Machine Learning models were built to predict postintervention improvement of patient-reported outcome measures of daily activities (i.e, the Motor Activity Log and the Nottingham Extended Activities of Daily Living) and participation (i.e, the Activities of Daily Living domain of the Stroke Impact Scale). Three groups of 18 potential predictors were included: patient demographics, stroke characteristics, and baseline assessment scores that encompass all three domains under the framework of International Classification of Functioning, Disability and Health. For each target variable, classification models were built with four algorithms, logistic regression, k-nearest neighbors, support vector machine, and random forest, and with all 18 potential predictors and the most important predictors identified by feature selection.ResultsPredictors for the four target variables partially overlapped. For all target variables, their own baseline scores were among the most important predictors. Upper-limb motor function and selected demographic and stroke characteristics were also among the important predictors across the target variables. For the four target variables, prediction accuracies of the best-performing models with 18 features ranged between 0.72 and 0.96. Those of the best-performing models with fewer features ranged between 0.72 and 0.84.ConclusionsOur findings support the feasibility of using Machine Learning for the prediction of stroke rehabilitation outcomes. The study was the first to use Machine Learning to identify important predictors for postintervention improvement on four patient-reported outcome measures of activities and participation in chronic stroke. The study contributes to precision rehabilitation and patient-centered care, and the findings may provide insights into the identification of patients that are likely to benefit from stroke rehabilitation.

Relationship between manual dexterity and left–right asymmetry of anatomical and functional properties of corticofugal tracts revealed by T2-weighted brain images

The corticofugal tracts (CFT) are key agents of upper limb motor function. Although the tracts form high-intensity regions relative to surrounding tissue in T2-weighted magnetic resonance images (T2WI), the precise relations of signal intensities of the left and right CFT regions to hand function are unknown. Here, we tested the hypothesis that the different signal intensities between the left and right CFT signify clinically important differences of hand motor function. Eleven right-handed and eleven left-handed healthy volunteers participated in the study. Based on horizontal T2WI estimates, we confirmed the relationship between the signal intensity ratios of the peak values of each CFT in the posterior limbs of the internal capsules (right CFT vs. left CFT). The ratios included the asymmetry indices of the hand motor functions, including grip and pinch strength, as well as the target test (TT) that expressed the speed and accuracy of hitting a target ([right-hand score − left-hand score]/[right-hand score + left-hand score]), using simple linear regression. The signal intensity ratios of each CFT structure maintained significant linear relations with the asymmetry index of the speed (R2 = 0.493, P = 0.0003) and accuracy (R2 = 0.348, P = 0.004) of the TT. We found no significant association between left and right CFT structures for grip or pinch strengths. The findings are consistent with the hypothesis that the different signal intensities of the left and right CFT images captured by T2WI serve as biological markers that reflect the dominance of manual dexterity.

The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke.

Upper limb motor impairments after stroke cause patients partial or total loss of the capability of performing daily living, working, and social activities, which significantly affects the quality of life (QoL) of patients and brings a heavy burden to their families and society. As a non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can act not only on the cerebral cortex, but also on peripheral nerves, nerve roots, and muscle tissues. Previous studies have shown that magnetic stimulation on the cerebral cortex and peripheral tissues has a positive effect on the recovery of upper limb motor function after stroke, however, few studies have reported the combination of the two. This study was to investigate whether high frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with cervical nerve root magnetic stimulation more effectively ameliorates upper limb motor function in stroke patients. We hypothesized that the combination of the two can achieve a synergistic effect and further promotes functional recovery. Sixty patients with stroke were randomly divided into four groups and received real or sham rTMS stimulation and cervical nerve root magnetic stimulation consecutively before other therapies, once daily over five fractions per week for a total of 15 times. We evaluated the upper limb motor function and activities of daily living of the patients at the time of pre-treatment, post-treatment, and 3-month follow up. All patients completed study procedures without any adverse effects. The upper limb motor function and activities of daily living improved in patients of each group were improved after treatment (post 1) and 3 months after treatment (post 2). Combination treatment was significantly better than single treatments alone or sham. Both rTMS and cervical nerve root magnetic stimulation effectively promoted upper limb motor recovery in patients with stroke. The protocol combining the two is more beneficial for motor improvement and patients can easily tolerate it. https://www.chictr.org.cn/, identifier ChiCTR2100048558.

Therapeutic Effectiveness of Mirror Therapy Combined with Music Therapy on Upper Limb Motor Function in Hemiplegic Patients with Stroke

Therapeutic Effectiveness of Mirror Therapy Combined with Music Therapy on Upper Limb Motor Function in Hemiplegic Patients with Stroke

Is mirror therapy combined with a routine physiotherapy protocol effective for children with obstetrical upper brachial plexus palsy?

Study designRandomized controlled study. IntroductionMirror therapy is a rehabilitation strategy based on the repeated use of the mirror illusion and also one of the treatment choice of brachial plexus injuries. PurposeWe aimed to determine the effects of mirror therapy combined with a routine rehabilitation program on upper limb motor function in children with obstetric brachial plexus injury. MethodsTwenty children with obstetric brachial palsy were included in this study. They were randomly allocated to either control (n = 10) or mirror therapy (n = 10) group. The following clinical tools were used to assess the upper extremity function: Active Movement Scale (AMS), Modified Mallet Scale (MMS), Hand Grip Strength (HGS) Test, Finger Grip Strength (FGSM) Test, Box and Block Test (BBT), Nine Hole Peg Test (9-HPT), and goniometric measurement. Both groups received the same routine physiotherapy program for 8 weeks. The study group underwent mirror therapy in addition to the rehabilitation program. ResultsThe mean age of the study population was 11.35 ± 4.12 years. There was no change in the goniometric values, AMS and MMS scores after the treatment in both groups (p > 0.05), except for the improvement of the wrist extension in the study group (p < 0.05). There was an increase in both HGS and FGS scores in the study group. Only FGS scores improved in the control group after the intervention (p < 0.05). 9-HPT and BBT scores improved in both groups (p < 0.05). All other parameters tested were comparable between the two groups after the treatment. ConclusionsThe results of this study did not show any additional benefits of mirror therapy combined with a rehabilitation protocol compared to routine physiotherapy treatment, but was not adequately powered to do so.

Clinical Predictors for Upper Limb Recovery after Stroke Rehabilitation: Retrospective Cohort Study.

After stroke, recovery of upper limb (UL) motor function is enhanced by a high dose of rehabilitation and is supposed to be supported by attentive functions. However, their mutual influence during rehabilitation is not well known yet. The aim of this retrospective observational cohort study was to investigate the association between rehabilitation dose and motor and cognitive functions, during UL motor recovery. Inpatients with first unilateral stroke, without time restrictions from onset, and undergoing at least 15 h of rehabilitation were enrolled. Data on dose and modalities of rehabilitation received, together with motor and cognitive outcomes before and after therapy, were collected. Fugl-Meyer values for the Upper Extremity were the primary outcome measure. Logistic regression models were used to detect any associations between UL motor improvement and motor and cognitive-linguistic features at acceptance, regarding dose of rehabilitation received. Thirty-five patients were enrolled and received 80.57 ± 30.1 h of rehabilitation on average. Manual dexterity, level of independence and UL motor function improved after rehabilitation, with no influence of attentive functions on motor recovery. The total amount of rehabilitation delivered was the strongest factor (p = 0.031) influencing the recovery of UL motor function after stroke, whereas cognitive-linguistic characteristics were not found to influence UL motor gains.

Similar Cognitive Skill Impairment in Children with Upper Limb Motor Disorders Due to Arthrogryposis Multiplex Congenita and Obstetrical Brachial Plexus Palsy.

Arthrogryposis multiplex congenita (AMC) and obstetrical brachial plexus palsy (OBPP) are motor disorders with similar symptoms (contractures and the disturbance of upper limb function). Both conditions present as flaccid paresis but differ from each other in the pathogenesis: AMC is a congenital condition, while OBPP results from trauma during childbirth. Despite this difference, these diseases are identical in terms of their manifestations and treatment programmes. We compared the cognitive skills of children with AMC and OBPP diagnoses with those of healthy children; we also compared the motor skills of impaired children with those of healthy ones. The patients in both groups significantly differed from the healthy children with regard to psychological parameters, such as 'visual memory capacity' and 'thinking'. Moreover, the two groups with children with AMC and OBPP significantly differed from each other in motor skill parameters, such as 'delayed motor development', 'general motor development', and the 'level of paresis'. Upper limb motor function in the OBPP children was less impaired compared to that of the AMC children. However, we did not find any significant differences in cognitive deficits between the AMC children and the OBPP children. This may indicate that motor impairment is more significant than the underlying cause for the development of cognitive impairment; however, the factors causing this phenomenon require further study (e.g., social environment, treatment, and rehabilitation programme).