Motor Function Test Research Articles

Comparative Analysis of Wolf Motor Function Test and Fugl Meyer Assessment Tool for Evaluating Upper Limb Disability in Stroke Patients

Comparative Analysis of Wolf Motor Function Test and Fugl Meyer Assessment Tool for Evaluating Upper Limb Disability in Stroke Patients

Neurobehavioural and Histological Study of the Effects of Low-Dose and High-Dose Vanadium in Brain, Liver and Kidney of Mice.

Vanadium is a ubiquitous transition metal that has been generating contrasting research interest. Therapeutically, vanadium possess antidiabetic, antitumor, antiparasitic and even neuroprotective activities. On the flip side, vanadium has been reported to cause multisystemic toxicities with a strong predilection for the nervous system. Despite several reports on potential benefits of low-dose vanadium (LDV) and toxic effects of high-dose vanadium (HDV), there are no comparative studies done thus far. This study therefore explored the comparative effects of LDV and HDV exposure in mice during postnatal development. A total of nine (9) nursing mice were used in this study; with three nursing mice and their pups (n = 12 pups per group) randomly assigned to each of the three test groups. The nursing dam were given intraperitoneal (i.p) injection of vanadium at 0.15mg/kg and 3mg/kg for LDV and HDV respectively, and subseqently to the pups from postnatal day (PND) 15 till sacrifice on PND 90. We discovered that neurodevelopmental motor function test of mice-pups exposed to LDV here showed improved motor development, muscular strength and memory capacities whereas HDV led to motor function impairment, reduced muscular strength and memory capacities. LDV-exposed mice showed mild histological lesions in cerebral cortex whereas high-dose showed distinct histological lesions in different parts of the brain ranging from cerebellar Purkinje neuronal pathology (central chromatolysis), pyramidal neuronal loss in CA1 region, architectural distortion as well as fewer neurons in olfactory bulb. We saw mild lesions with LDV in both liver and kidney, however, with HDV exposure, there was diffuse hepatocellular vacuolar degeneration and congestion of blood vessels in liver, shrinkage of renal glomerulus and degenerated epithelial cells of kidney. Conclusively, beneficial effect of vanadium is proven as it facilitated body weight gain which translate in organ weight at low-dose, while high-dose caused decreased neurobehaviour and histological lesions.

Diagnostic accuracy of small-for-gestational-age status for infant mortality and school-age outcomes of live births

ObjectivesTo determine the diagnostic accuracy of small-for-gestational-age (SGA; <10th centile) status for infant mortality and adverse school-age outcomes in infants born extremely preterm (EP; <28 weeks’ gestation).DesignGeographical cohort studies.SettingThe state...

Comparison of Repeated Task Oriented Training for the improvement of motor function with mirror Therapy and Conventional Treatment On upper limb in patients with stroke - A Randomized Controlled Trial (RCT)

Background: This study's goal is to illustrate how mirror treatment can be used with someone who has upper-extremity hemiparesis three months after suffering a cerebrovascular accident (stroke). These patients frequently fail to use their affected upper extremity to its full extent, possibly as a result of the "learned nonuse phenomenon. On each weekday of the 9-day intervention period, the patient performed tasks with the paretic upper extremity for 6 hours while being closely watched. Methods: Study population was patients from Mayo hospital Lahore. Study design was Randomized Controlled Trial. RCT:. 34 patients who met the requirements for inclusion were examined in this study. Before beginning any physical examination, each participant in this study gave their written, informed consent. Patients were divided equally into two groups. The Wolf Motor Function Test and the Numeric Pain Scale were used to measure pain and motor function on the first day. Group A received treatment using mirror therapy, whereas Group B received traditional care. Results: Mirror therapy was significantly effective in lowering pain and boosting functional activity in stroke patients, as evidenced by the comparison of the pre- and post-treatment scores on the NPRS and WMFT for groups A and B. Practical Implication: Stroke leads to multiple dysfunctions depending upon severity of lesion. It may decrease the range of motion and leads to functional dependency or disability. Physical therapy is important in the management of stroke including Strengthening, Stretching, ROMs and Manipulation and Mirror Therapy. This study provided an opportunity to share my personal experience with community. This study was conducted purely in clinical setting of Physiotherapy Department Mayo Hospital, Lahore. Conclusion: The study has proved that mirror therapy is more effective when combined with conventional treatment in management of stroke as compared to only use of conventional treatment. Keywords: Task oriented training, Motor function, Mirror therapy, conventional therapy, stroke, RCT

Development of a Short Form Assessment Combining the Fugl-Meyer Assessment–Upper Extremity and the Wolf Motor Function Test for Evaluating Stroke Recovery

ObjectiveTo use Rasch methodologies to combine the items of the Fugl-Meyer Assessment–Upper Extremity (FMA-UE, motor skill) and the Wolf Motor Function Test (WMFT, motor function) onto a single measurement metric and create an FMA-UE+WMFT short form. DesignSecondary analysis of preintervention data from 2 upper extremity stroke rehabilitation trials. Confirmatory factor analysis and Rasch rating scale analysis were first applied to examine the properties of the pooled item bank and then item response theory methodologies were used to develop the short form. Confirmatory factor analysis and Rasch analysis were then applied to the short form to examine the dimensionality and measurement properties. SettingOutpatient academic medical research center. ParticipantsData from 167 participants who completed the FMA-UE and WMFT (rating scale score) were pooled (N=167). Participants were eligible if they had a stroke ≥3 months prior and had upper extremity (UE) hemiparesis and excluded if they had severe UE hemiparesis, severe UE spasticity, or UE pain. InterventionNot applicable. Main Outcome MeasuresThe dimensionality and measurement properties of the pooled 30-item FMA-UE and the 15-item WMFT and short form were examined. ResultsFive items from the pool of 45 items were misfit and were removed. The 40-item pool demonstrated adequate measurement properties. A 15-item short form was then developed and met rating diagnostic scale criteria. All items on the 15-item short form met the Rasch fit criteria, and the assessment met criteria for reliability (Cronbach alpha=.94), separation (person separation = 3.7), and strata (number of strata = 5). ConclusionsItems from the FMA-UE and WMFT can be pooled to create a psychometrically sound 15-item short form.

Effect of task-based bilateral arm training on upper limb recovery after stroke: A systematic review and meta-analysis

ObjectiveUpper limb recovery is a crucial component of stroke rehabilitation aimed to maximize functional activities and reduce disability. Using both arms post stroke is essential to carry out many functional activities but the evidence on bilateral arm training (BAT) is understudied. To investigate the evidence for efficacy of task-based BAT on upper limb recovery, function, and participation post stroke. MethodsWe included 13 randomized controlled trials, and methodological quality was assessed using Cochrane risk of bias tool and the PEDro scale. The outcome measures such as Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), Box and Block Test (BBT), Modified Barthel Index (MBI), Functional Independence Measure (FIM), and Stroke Impact Scale (SIS) were synthesized and analysed based on ICF. ResultsWhen comparing BAT with control group, BAT showed improvement in the pooled standard mean difference (SMD) of FMA-UE (SMD= 0.62, 95% confidence interval (CI), 0.12 to 1.12, p = 0.01; I2=83%). The control group showed significant improvement in MAL-QOM (SMD= -0.10, 95%CI, -0.77 to 0.58, p = 0.78; I2=89%). Compared to conventional group, BAT showed a significant improvement in BBT (SMD= 0.52, 95%CI, 0.04 to 1.00, p = 0.03; I2=0%). When compared with BAT, unimanual training yielded a significant improvement (SMD= -0.60, 95%CI, -0.98 to -0.22, p = 0.002; I2=0%) in MAL-QOM. In real-life participation, the control group showed improvement in SIS (SMD= -0.17, 95% (CI), -0.70 to 0.37, p = 0.54; I2=48%) over BAT. ConclusionsTask-based BAT appears to improve upper limb motor function post stroke. The benefits of task-based BAT on activity performance and participation in real life are not statistically significant.

Development of a compensation-aware virtual rehabilitation system for upper extremity rehabilitation in community-dwelling older adults with stroke

BackgroundCompensatory movements are commonly observed in older adults with stroke during upper extremity (UE) motor rehabilitation, which could limit their motor recovery.AimThis study aims to develop a compensation-aware virtual rehabilitation system (VRS) that can detect compensatory movements and improve the outcome of UE rehabilitation in community-dwelling older adults with stroke.MethodsThe VRS development includes three main components: (1) the use of thresholds for determining compensatory movements, (2) the algorithm for processing the kinematic data stream from Kinect to detect compensation in real-time, and (3) the audio-visual feedback to assist older adults with stroke to be aware of the compensation. Two studies were conducted following the VRS development, where Study 1 identified the value of thresholds for determining compensatory movements in two planar motor exercises, and Study 2 provided preliminary validation for the developed VRS by comparing two groups undergoing VR training or conventional training (CT) in a community rehabilitation center.ResultsThe VRS could effectively detect all determined compensatory movements and timely trigger feedback in response to the detected compensatory movements. The VR participants showed significant improvements in Fugl-Meyer Assessment-Upper Extremity (FMA-UE, p = 0.045) and Wolf Motor Function Test (WMFT, p = 0.009). However, the VR and CT groups had no significant differences in outcome measures.ConclusionThe VRS demonstrates the ability to detect compensation and the potential of assisting older adults with stroke to improve motor functions. Suggestions are given for further improvements of the VRS to support the older adult with stroke to reduce compensation.

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: 2- and 3-Year Follow-up From the Pilot Study

ObjectiveTo assess whether a long-term home-based intervention using Paired VNS therapy is feasible and whether the benefits of Paired VNS therapy are maintained beyond 1 year. DesignA long-term follow-up study. SettingThree centers in the United States and 1 in the United Kingdom. ParticipantsAdults with chronic ischemic stroke (n=15) with moderate to severe arm and hand impairment. InterventionsParticipants were implanted with a VNS device followed by 6 weeks of in-clinic therapy with Paired (Active) or control VNS followed by home-based rehabilitation through day 90 (blinded phase). The control VNS group then crossed over to receive 6 weeks of in-clinic Active VNS. Participants in both groups then continued a long-term home exercise program with self-administered Active VNS. Main Outcome MeasuresFugl-Meyer Assessment for Upper Extremity (FMA-UE) and Wolf Motor Function Test (WMFT) Functional scores were evaluated at the end of in-clinic therapy and day 90. Since both groups were subsequently receiving home-based rehabilitation with Active VNS during the long term, follow-up outcome assessments were pooled for the analyses at 6, 9, and 12 months, as previously reported. Here, we report pooled analysis of outcomes beyond 1 year. ResultsOne year after Paired VNS therapy, FMA-UE improved by an average of 9.2±8.2 points, as previously reported. Overall, the 2- and 3-year FMA-UE gain from baseline was 11.4±8.7 (P<.001) and 14.8±10.2 points (P<.001), respectively. At years 2 and 3, FMA-UE improved by an additional 2.9 (P=.03 for change vs year 1, n=14) and 4.7 (P=.02 for change vs year 1, n=14) points, respectively. At year 1, 73% (11/15) of participants were responders (FMA-UE change ≥6) and by year 3, 85.7% (12/14) were responders. At years 2 and 3, the WMFT score improved by an additional 0.21 points (P=.03 for change vs year 1, n=15) and 0.42 points (P=.01 for change vs year 1, n=13), respectively. Responder rate (WMFT change ≥0.4) was 46.6% (7/15), 73.3% (11/15), and 69.2% (9/13) at years 1, 2, and 3, respectively. Long-term significant improvements were also observed for Motor Activity Log (MAL) and Stroke Impact Scale, Hand section (SIS-Hand). There were no serious long-term adverse events from the stimulation. ConclusionsSignificant effects of Paired VNS therapy at 1 year were maintained at years 2 and 3, and further improvements in both impairment and function were observed in years 2 and 3. These changes were associated with improvements in measures of activity and participation.

Concurrent Validity of Measures of Upper Extremity Function Derived from Videogame-Based Motion Capture for Children with Hemiplegia.

Objective: Pediatric hemiplegia is associated with wide-ranging deficits in arm and hand motor function, neg-atively impacting participation in daily occupations and quality of life. This study investigated whether performance measures generated during therapy videogame play by children with hemiplegia can be valid indicators of upper extremity motor function. Materials and Methods: Ten children with hemiplegia used a custom therapy game system alternatively using their affected and non-affected hand to provide motion capture data that spans a wide range of motor function status. The children also completed a series of standardized outcome measure assessments with each hand, including the Quality of Upper Extremity Skills Test, the Jebsen Taylor Hand Function Test, and the Wolf Motor Function Test. Results: Statistical analysis using the nonparametric Spearman rank correlation revealed high and significant correlation between videogame-derived motion capture measures, characterizing the speed and smoothness of movements, and the standardized outcome measure assessments. Conclusion: The results suggest that a low-cost motion capture system can be used to monitor a child's motor function status and progress during a therapy program.

Timing and Dose of Constraint-Induced Movement Therapy after Stroke: A Systematic Review and Meta-Regression.

The aim of this study is to investigate the effects of constraint-induced movement therapy on stroke patients who had intact cognition and some voluntary finger extension and to identify optimal protocols to apply this therapy method. We searched PubMed, Cochrane Library, and Embase for randomized controlled trials conducted prior to January 2022. The outcomes included the Motor Activity Log, Fugl-Meyer Assessment, and Wolf Motor Function Test. The inverse variance method fixed-effect model as well as the DerSimonian and Laird estimator random-effects model were applied, and the mean difference was calculated with 95% confidence interval to measure continuous outcomes. Six randomized controlled trials involving a total of 169 patients with stroke were enrolled. Compared with conventional rehabilitation methods, there was no significant effect of constraint-induced movement therapy when evaluated by the Motor Activity Log, including the amount of use (random-effect, standardized mean difference 0.65; 95%, confidence interval: -0.23-1.52) and quality of movement (random-effect, standardized mean difference 0.60; 95% confidence interval: -0.19-1.39). However, among patients with chronic stroke symptoms, meta-regression analyses showed better performance with a constraint time of at least 6 h per day and 6 h training per week when assessing the amount of use (p = 0.0035) and quality of movement (p = 0.0031). Daily intervention time did not lead to a significant difference in functional upper limb performance. An efficient protocol of constraint-induced movement therapy designed as 6 h of training per week with 6 h constraint per day could bring significant stroke symptom improvement to patients with chronic stroke.

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).

Functional Benefit and Orthotic Effect of Dorsiflexion-FES in Children with Hemiplegic Cerebral Palsy

Functional electrical stimulation of the ankle dorsiflexor (DF-FES) may have advantages over ankle foot orthoses (AFOs) in managing pediatric cerebral palsy (CP). This study assessed the functional benefit and orthotic effect of DF-FES in children with hemiplegic CP. We conducted an open-label prospective study on children with hemiplegic CP ≥ 6 years who used DF-FES for five months. The functional benefit was assessed by repeated motor function tests and the measurement of ankle biomechanical parameters. Kinematic and spatiotemporal parameters were assessed by gait analysis after one and five months. The orthotic effect was defined by dorsiflexion ≥ 0° with DF-FES at either the mid or terminal swing. Among 26 eligible patients, 15 (median age 8.2 years, range 6-15.6) completed the study. After five months of DF-FES use, the results on the Community Balance and Mobility Scale improved, and the distance in the Six-Minute Walk Test decreased (six-point median difference, 95% CI (1.89, 8.1), -30 m, 95% CI (-83.67, -2.6), respectively, p < 0.05) compared to baseline. No significant changes were seen in biomechanical and kinematic parameters. Twelve patients (80%) who showed an orthotic effect at the final gait analysis experienced more supported walking over time, with a trend toward slower walking. We conclude that the continuous use of DF-FES increases postural control and may cause slower but more controlled gait.

Effects of a 14-week community health program of exercise and learning/education in older adults: A single-arm pre-post comparison study

This study was initiated in 2022 in Miyaki Town, Saga Prefecture, Japan, to determine the impact of an intervention that combined brain and physical function training and health education in older residents. Miyaki has a population of approximately 26,000, 35% of whom are considered to be aging. A 14-week program consisting of strength training, brain function training, and health lectures was conducted with 34 older residents of the community. Body composition, motor function, brain function, and various blood tests were evaluated before and after the intervention. Brain function was assessed using the Trail Making Test-A. Physical function was assessed by Open-Close Stepping, Functional Reach Test, Open-Leg Standing Time, and Two-Step Test. The intervention group showed significant improvements in brain function (p< 0.0001), physical function (p = 0.0037), body composition (p = 0.0053), and LDL-C (p = 0.017). This study provides substantial evidence that community-based combined programs can be beneficial for older adults.

Morphofunctional regeneration by mesenchymal stem cell and IGF-1 inoculation in a model of facial nerve crush injury in rats.

To analyze the morphofunctional regeneration process of facial nerve injury in the presence of insulin-like growth factor-1 and mesenchymal stem cells. Fourteen Wistar rats suffered unilateral facial nerve crushing and were randomly divided into two groups. All received insulin-like growth factor-1 inoculation, but only half of the animals received an additional inoculation of mesenchymal stem cells. The animals were followed for 90 days and facial nerve regeneration was analyzed via spontaneous facial motor function tests and immunohistochemistry in the nerve motor nucleus. The group that received the growth factor and stem cells showed a statistically superior mean in vibrissae movements (p < 0.01), touch reflex (p = 0.05) and eye closure (p < 0.01), in addition to better immunohistochemistry reactivity. There was a statistically significant difference in the mean number of cells in the facial nerve nucleus between the experimental groups (p = 0.025), with the group that received the growth factor and stem cells showing the highest mean. The association between growth factor and stem cells potentiates the morphofunctional regeneration of the facial nerve, occurring faster and more effectively. 4, degree of recommendation C.

Differential Impact of Brain Network Efficiency on Poststroke Motor and Attentional Deficits.

Most studies on stroke have been designed to examine one deficit in isolation; yet, survivors often have multiple deficits in different domains. While the mechanisms underlying multiple-domain deficits remain poorly understood, network-theoretical methods may open new avenues of understanding. Fifty subacute stroke patients (7±3days poststroke) underwent diffusion-weighted magnetic resonance imaging and a battery of clinical tests of motor and cognitive functions. We defined indices of impairment in strength, dexterity, and attention. We also computed imaging-based probabilistic tractography and whole-brain connectomes. To efficiently integrate inputs from different sources, brain networks rely on a rich-club of a few hub nodes. Lesions harm efficiency, particularly when they target the rich-club. Overlaying individual lesion masks onto the tractograms enabled us to split the connectomes into their affected and unaffected parts and associate them to impairment. We computed efficiency of the unaffected connectome and found it was more strongly correlated to impairment in strength, dexterity, and attention than efficiency of the total connectome. The magnitude of the correlation between efficiency and impairment followed the order attention>dexterity ≈ strength (strength: |r|=.03, P=0.02, dexterity: |r|=.30, P=0.05, attention: |r|=.55, P<0.001). Network weights associated with the rich-club were more strongly correlated to efficiency than non-rich-club weights. Attentional impairment is more sensitive to disruption of coordinated networks between brain regions than motor impairment, which is sensitive to disruption of localized networks. Providing more accurate reflections of actually functioning parts of the network enables the incorporation of information about the impact of brain lesions on connectomics contributing to a better understanding of underlying stroke mechanisms.

Psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index in people with chronic stroke.

To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index (C-UEFI) in people with chronic stroke. Cross-sectional study. University-affiliated neurorehabilitation research laboratory. The participants (N = 151) were people with chronic stroke (N = 101) and healthy controls (n = 50). We assessed the C-UEFI, Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Six-Minute Walk Test (6MWT), Motor Activity Log (MAL), Activity-Specific Balance Confidence (ABC) scale, Lawton Instrumental Activities of Daily Living (IADL) scale, Survey of Activities and Fear of Falling in the Elderly (SAFFE), Stroke Impact Scale (SIS) and Community Integration Measure (CIM) as outcome measures. The C-UEFI items demonstrated good test-retest reliability (intraclass correlation coefficient [ICC]3, 1 = 0.872) and excellent internal consistency (Cronbach's α = 0.922). People with chronic stroke had poorer C-UEFI scores than the healthy controls. The overall C-UEFI mean score of 101 people with stroke was significantly correlated with the mean scores of the FMA-UE, WMFT, MAL, ABC scale, IADL scale, SAFFE, SIS and CIM and the distance covered in the 6MWT. The C-UEFI cut-off score to distinguish between people with chronic stroke and healthy older adults according to upper extremity function was 57.5 out of 59 (sensitivity: 88.1%; specificity: 84%). The C-UEFI had good content validity, with an acceptable fit to the two-factor structure model. The C-UEFI is reliable and valid for assessing functional recovery of upper extremity activity in Chinese people with chronic stroke.

Elbow Joint Stiffness Functional Scales Based on Hill's Muscle Model and Genetic Optimization.

The ultimate goal of rehabilitation engineering is to provide objective assessment tools for the level of injury and/or the degree of neurorehabilitation recovery based on a combination of different sensing technologies that enable the monitoring of relevant measurable variables, as well as the assessment of non-measurable variables (such as muscle effort/force and joint mechanical stiffness). This paper aims to present a feasibility study for a general assessment methodology for subject-specific non-measurable elbow model parameter prediction and elbow joint stiffness estimation. Ten participants without sensorimotor disorders performed a modified "Reach and retrieve" task of the Wolf Motor Function Test while electromyography (EMG) data of an antagonistic muscle pair (the triceps brachii long head and biceps brachii long head muscle) and elbow angle were simultaneously acquired. A complete list of the Hill's muscle model and passive joint structure model parameters was generated using a genetic algorithm (GA) on the acquired training dataset with a maximum deviation of 6.1% of the full elbow angle range values during the modified task 8 of the Wolf Motor Function Test, and it was also verified using two experimental test scenarios (a task tempo variation scenario and a load variation scenario with a maximum deviation of 8.1%). The recursive least square (RLS) algorithm was used to estimate elbow joint stiffness (Stiffness) based on the estimated joint torque and the estimated elbow angle. Finally, novel Stiffness scales (general patterns) for upper limb functional assessment in the two performed test scenarios were proposed. The stiffness scales showed an exponentially increasing trend with increasing movement tempo, as well as with increasing weights. The obtained general Stiffness patterns from the group of participants without sensorimotor disorders could significantly contribute to the further monitoring of motor recovery in patients with sensorimotor disorders.

Abstract 150: Vagus Nerve Stimulation (VNS) Paired With Upper Extremity Rehabilitation In Chronic Stroke: Improvements In Wrist And Hand Impairment And Function

Introduction: In the VNS-REHAB trial, vagus nerve stimulation (VNS) paired with task-specific arm and hand rehabilitation (Paired VNS) led to clinically meaningful improvements in both impairment and function of the upper extremity in people with chronic ischemic stroke. In this post hoc analysis of trial data, we assessed whether improvements were driven by proximal (shoulder and elbow) and/or distal (wrist and hand) components of the Upper Extremity Fugl-Meyer Assessment (FMA-UE). We also wanted to determine whether FMA-UE improvements correlated with improvements in functional outcome. Methods: Chronic stroke participants (n=108) with moderate-severe UE impairment (FMA-UE 35.1±8) were implanted with the VNS device and randomized to Paired VNS (n=53) or Controls (n=55). Participants underwent 6 weeks of in-clinic therapy followed by 90 days of a home exercise program. Outcomes, including the FMA-UE and Wolf Motor Function Test (WMFT), were collected after in-clinic therapy (Post-1) and 90 days of home therapy (Post-90). Results: Distal FMA-UE change was significantly greater after Paired VNS compared to Controls, both at Post-1 (2.43±2.52 vs. 0.64±2.33; 95% CI 0.87-2.72, p&lt;0.001, Cohen’s d=0.74) and Post-90 (2.58±2.88 vs. 0.93±3.16; 95% CI 0.5-2.81, p=0.005, Cohen’s d=0.55). Proximal FMA-UE change was also greater after Paired VNS compared to Controls but did not reach statistical significance at either timepoint. At Post-90, both proximal (r=0.50, p&lt;0.0001) and distal (r=0.42, p=0.001) FMA-UE change significantly correlated with WMFT change after Paired VNS, but not in Controls (proximal: r=0.24, p=0.06; distal: r=0.14, p=0.24). Conclusions: The data suggest that Paired VNS leads to greater improvement in the distal upper extremity compared to rehabilitation alone and that improvements in FMA-UE scores are correlated with improvements in function. These findings suggest that the improvements seen with Paired VNS are of functional importance. A greater understanding of region-specific arm and hand recovery after Paired VNS therapy will facilitate planning and implementation of a personalized neurorehabilitation approach based on patient-specific impairments.

Cortical reorganization correlates with motor recovery after low-frequency repetitive transcranial magnetic stimulation combined with occupational therapy in chronic subcortical stroke patients

The combination of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (iOT) has been shown to ameliorate upper limb hemiparesis in patients with chronic subcortical stroke. However, the neural mechanisms underlying its efficacy are poorly understood. Our aim was to examine the cortical reorganization after LF-rTMS and iOT, as well as to explore its association with the degree of motor recovery using functional magnetic resonance imaging (fMRI). Thirty chronic subcortical stroke patients with mild-to-moderate upper limb hemiparesis underwent 18 treatment sessions. Each session included LF-rTMS to the unaffected hemisphere for 20 min as well as iOT for 120 min. The patients were evaluated before and after therapy using behavioral assessments, including the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), and task-based fMRI. The fMRI data obtained during hand movement were used to calculate the laterality index (LI). After the treatment, the motor function test scores of FMA and WMFT improved significantly. The LI during movements of the affected hand increased significantly, suggesting changes in the activation balance within the primary motor, primary sensory, and premotor cortexes toward the lesioned hemisphere. Moreover, the LI changes in the aforementioned areas significantly correlated with gains in the WMFT. These results suggest that the motor improvements produced by the combination of LF-rTMS and iOT in chronic subcortical stroke patients are closely linked to cortical reorganization, in which a more physiological activation pattern is reinstated in the ipsilesional hemisphere by suppression of the aberrant activation of the contralesional hemisphere.

Relationship between clinical outcome measurements and muscle thickness in cerebral palsy

BACKGROUND: The World Health Organization (WHO) uses the International Classification of Functioning, Disability, and Health (ICF) model to provide physical therapy diagnoses and interventions. However, the relationship between clinical assessment and imaging remains unclear. OBJECTIVE: This study aimed to determine the relationships between body function/structure, activity, and participation outcomes following neurorehabilitation in children with cerebral palsy (CP). METHODS: Nineteen children (9 girls mean age 8.8 ± 1.8 years) with CP participated in this study. Clinical motor function tests included the quality of upper extremity skills test (QUEST), Wolf motor function test (WMFT), Functional Independence Measure for Children (WeeFIM), and the Jebsen-Taylor Hand Function Test (JTHFT). Ultrasound imaging was used to measure muscle thickness, which characterizes the body structure, and activity domain variables. RESULTS: The correlations between body structure domain (muscle thickness), activity domain (QUEST, WMFT, WeeFIM) and participants variable (JTHFT) were significant, ranging from r=-0.484 to 0.893, P&lt; 0.05. CONCLUSIONS: These novel findings suggest that muscle thickness ultrasound imaging is closely associated with WMFT, WeeFIM, and QUEST variables. This finding provides important clinical insights when using broad clinical assessment and imaging in children with CP.