Motor Performance Of Upper Extremities Research Articles

Upper Extremity Motor Performance among Spastic Quadriplegic Cerebral Palsy Patients with and without Head Control

Background: Cerebral Palsy refers to chronic abnormalities of movement and posture resulting from non-progressive disruptions in the developing fetus or immature brain. A key component of overcoming activity restriction is head control, which is essential for locomotor abilities and motor activities including grasping and sitting. Objective: To determine upper extremity motor performance among spastic quadriplegic cerebral palsy patients, with and without head control. Methods: A comparative cross-sectional study with 35 participants was conducted to investigate the interplay between head control and upper extremity function in children with spastic quadriplegic cerebral palsy. Two groups were formed based on the presence or absence of head control. Inclusion criteria comprised of both genders aged 1.09-10.02 with spastic quadriplegic CP, excluding those with contractures, botulin toxin injections, orthopedic surgery, or serious medical problem/seizures. Data entry and descriptive statistical analysis were conducted using Statistical Package for Social Sciences (SPSS) version 26. Results:There was a statistically significant difference between the groups, one including participants with control and other without it as the P value is <0.017. The group A, with head control, showed higher values of QUEST; therefore, showed significant correspondence. Conclusion: The study found a significant positive relationship between head control and upper extremity function in children with spastic quadriplegic cerebral palsy.

A computerized assessment tool for the upper extremities motor performance in individuals with Parkinson's disease

ObjectiveComputerized assessment of Parkinson's disease (PD) patients' motor performance can pave the way to subject-specific design of the rehabilitative interventions. The objective is to propose a computerized assessment tool for upper extremities motor performance in PD. It is based on kinematic indices and a virtual reality exergaming system. The reliability, construct and discriminative validity of the proposed tool were investigated. MethodsA set of virtual tasks was designed and integrated to the therapeutic programs of the participants including uni/bimanual, in-phase/anti-phase hand movements on the less/more affected sides. 33 persons with PD participated in a test re-test study to determine the reliability, discriminative validity on the medication states, and validity of the kinematic indices. Clinical assessments, including Box and Block Test, 9-Hole Peg Test, Movement Disorders Society motor section of the Unified PD Rating Scale (MDS-UPDRS III), were performed for validity assessment. ResultsTask type has a significant impact on the validity of the indices. Reaching tasks were shown to be superior. Besides, it was demonstrated that a minimum of 3 repeats is needed for reliable results in the proposed setting. Jerk indices, curvature, and spectral speed metrics lack either reliability or validity. Temporal speed metrics have superior reliability (Intraclass Correlation Coefficient ICC ≥ 0.9) and validity (Pearson ≥ 0.6) in reaching tasks. ConclusionTemporal speed metrics and point reaching virtual tasks were shown to have high potentials for objective assessment of upper extremity (UE) motor performance in PD in the context of a virtual reality exergaming rehab program.

Cost-Effective and Efficient Solutions for the Assessment and Practice of Upper Extremity Motor Performance

Cost-Effective and Efficient Solutions for the Assessment and Practice of Upper Extremity Motor Performance

Effect of 4 Weeks of Scapular Proprioceptive Neuromuscular Facilitation on Scapular Alignment and Upper Extremity Motor Performance in Patients with Stroke: A Repeated Measure Design

Context: Stroke is the major cause for the impairments in adults, typically accompanying loss of motor function which leads to reduce the upper limb function and disturbance in scapular alignment. Aim: To study the effect of 4 weeks of Scapular Proprioceptive Neuromuscular Facilitation on scapular alignment and upper extremity motor performance in patients with Stroke at the intervals of 2 weeks and 4 weeks. Settings and Design: This Repeated Measure Design study conducted in physiotherapy OPD and IPD. Methods and Material: After getting the approval from the ethical committee of college, 27 participants diagnosed with stroke were screened according inclusion and exclusion criteria. Written consent were taken from the participants parents and the procedure of the study was explained to the patient. Subjects were assessed using Lateral Scapular Slide Test, Palpation Meter and Fugl Meyer Motor assessment at baseline, 2 weeks and then 4 weeks after the treatment. Scapular Proprioceptive Neuromuscular Facilitation was given in two diagonals with 20 repetitions. Statistical Analysis Used: The analysis was done using GraphPad Instat 3. For analysing the comparison between Baseline, 2 weeks and 4 weeks, the Repeated Measure ANOVA along with posthoc test was used. Results: At the end of 4 weeks, Scapular alignment and upper extremity motor performance shows significant improvement (p < 0.05). Conclusions: This study concludes that 4 weeks of Scapular Proprioceptive Neuromuscular Facilitation Technique is effective intervention in improving scapular alignment and upper extremity motor performance in patients with stroke, with major improvement occurring in first 2 weeks. Hence, scapular PNF should be included in acute stage of stroke.

Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial

Purpose Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. Methods Twenty-four patients (35–65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. Results The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). Conclusions Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1 IMPLICATION FOR REHABILITATION Upper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily living Applying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions

Spinal cord H-reflex post-activation depression is linked with hand motor control in adults with cerebral palsy

ObjectiveCerebral palsy (CP) is associated with upper extremity motor impairments that are largely assumed to arise from alterations in the supraspinal networks. The objective of this study was to determine if post-activation depression of the spinal H-reflexes is altered in adults with CP and connected with altered upper extremity function. MethodsThe post-activation depression of the flexor carpi radialis (FCR) H-reflex of adults with CP and healthy adults (HA) controls were assessed by 1) a 1 Hz continuous single-pulse stimulus train and 2) 0.11 Hz / 1 Hz paired-pulse stimuli. Secondarily, we measured the maximum key grip force and the box and blocks assessment of manual dexterity. ResultsOur results revealed that adults with CP had reduced post-activation depression of the FCR H-reflex during the stimulus train and the paired pulse protocol. A greater reduction in H-reflex post-activation depression was connected to lower manual dexterity and weaker grip forces. ConclusionsOur results indicate that the post-activation depression of the upper extremity spinal H-reflex pathways is altered in adults with CP and possibly linked with their uncharacteristic upper extremity motor performance. Alterations in the spinal networks may also play a significant role in the altered motor control of adults with CP. SignificanceOur results identify spinal H-reflex modulation as a possible locus for hand motor control in CP.

Dual-Task Upper Extremity Motor Performance Measured by Video Processing as Cognitive-Motor Markers for Older Adults

Introduction: The use of dual-task model such as dual-task gait has been extensively studied to assess cognitive-motor performance among older adults. However, space restriction and safety factor limit its applications in remote assessment. To address the gap, we propose a video processing-based approach to remotely quantify cognitive-motor performance using a 20-s repetitive elbow flexion-extension test with dual-task condition, called video-based motoric-cognitive meter (MCM). Methods: Eighteen older participants (age: 78.6 ± 6.5 years) who were clinically diagnosed as having either mild cognitive impairment or dementia were included in this study. Participants were asked to perform 20-s repetitive elbow flexion-extension exercise with a memory exercise by counting backward from a two-digit number. During the test, all movements of the forearm were recorded by a video camera. As a comparator, a validated wrist-worn sensor was used, which allowed quantifying upper extremity kinematics. Results: The results showed a good agreement (r ≥ 0.530 and ICC2,1 ≥ 0.681) between the derived dual-task upper extremity motor performance from the proposed video-based MCM and a clinically validated sensor-based MCM. We also observed moderate correlations (r ≥ 0.496) between some measures of video-based MCM (flexion time, extension time, and flexion-extension time) and clinical cognitive scale (Mini-Mental State Examination [MMSE]). Additionally, some measures of dual-task upper extremity motor performance (speed, flexion time, extension time, and flexion-extension time) were associated with dual-task gait speed (r ≥ 0.557), which has been found to be correlated with cognitive impairment. Lastly, the selected dual-task motor performance metric (flexion time) was sensitive to predict MMSE scores in linear regression analyses with statistical significance (adjusted R2 = 0.306, p = 0.025). Conclusion: This study proposes a video processing-based approach to analyze dual-task upper extremity motor performance from a simple and convenient upper extremity function test. The results indicate concurrent validity of the proposed video-based MCM compared with the sensor-based MCM, and associations between dual-task upper extremity motor performance and clinically validated cognitive markers (MMSE scores and dual-task gait). Future studies are warranted to explore sensitivity of this solution to promote remote assessment of cognitive-motor performance among older adults in telehealth applications.

Deep Neural Network-based Video Processing to Obtain Upper-Extremity Motor Performance Toward Assessment of Cognitive and Motor Function.

Dementia is an increasing global health challenge. Motoric Cognitive Risk Syndrome (MCR) is a predementia stage that can be used to predict future occurrence of dementia. Traditionally, gait speed and subjective memory complaints are used to identify old adults with MCR. Our previous studies indicated that dual-task upper-extremity motor performance (DTUEMP) quantified by a single wrist-worn sensor was correlated with both motor and cognitive function. Therefore, the DTUEMP had a potential to be used in the diagnosis of MCR. Instead of using inertial sensors to capture kinematic data of upper-extremity movements, here we proposed a deep neural network-based video processing model to obtain DTUEMP metrics from a 20-second repetitive elbow flexion-extension test under dual-task condition. In details, we used a deep residual neural network to obtain joint coordinate set of the elbow and wrist in each frame, and then used optical flow method to correct the joint coordinates generated by the neural network. The coordinate sets of all frames in a video recording are used to generate angle sequence which represents rotation angle of the line between the wrist and elbow. Then, the DTUEMP metrics (the mean and SD of flexion and extension phase) are derived from angle sequence. Multi-task learning (MTL) is used to assess cognitive and motor function represented by MMSE and TUG scores based on DTUEMP metrics, with single-task learning (STL) linear model as a benchmark. The results showed a good agreement (r ≥ 0.80 and ICC ≥ 0.58) between the derived DTUEMP metrics from our proposed model and the ones from clinically validated sensor processing model. We also found that there were correlations with statistical significance (p < 0.05) between some of video-derived DTUEMP metrics (i.e. the mean of flexion time and extension time) and clinical cognitive scale (Mini-Mental State Examination, MMSE). Additionally, some of video-derived DTUEMP metrics (i.e. the mean and standard deviation of flexion time and extension time) was also associated with the scores of timed-up and go (TUG) which is a gold standard to measure functional mobility. Mean absolute percentage error (MAPE) of MTL surpassed that of STL (For MMSE, MTL: 18.63%, STL: 23.18%. For TUG, MTL: 17.88%, STL: 22.53%). The experiments with different light conditions and shot angles verified the robustness of our proposed video processing model to extract DTUEMP metrics in potentially various home environments (r ≥ 0.58 and ICC ≥ 0.71). This study shows possibility of replacing sensor processing model with video processing model for analyzing the DTUEMP and a promising future to adjuvant diagnosis of MCR via a mobile platform.

Quantitative Upper Limb Assessment With Natural User Interface in Children With Hemiparesis

Quantitative, efficient, and accurate measurement of upper limb motor performance is relevant for monitoring upper limb progress in daily activities of people with cerebral palsy, which is helpful to define an appropriate rehabilitation procedure. Currently, motion capture sensors using a Natural User Interface (NUI) are the most feasible solutions due to the low-cost implementation, portability, and effectiveness for upper limb motion analysis. A quantitatively assessment study of the upper limb motor performance for children with spastic hemiparesis using the NUI Kinect v2 sensor is described in this paper. The study participants were eighteen children with an average age of 8.28 ± 2.32 years having a Manual Ability Classification System level I and II. The assessment was done for each participant before and after the application of a Modified Constrained-Induced Movement Therapy (mCIMT) applied five days a week along twelve weeks. According to obtained results significant differences (p<0.05) in the Fugl-Meyer Assessment (FMA) score for motor performance in abduction movement of upper limb between the first and last sessions were quantitatively detected. The described NUI assessment method helped to quantitatively show that the applied therapy sessions were effective to improve upper extremity motor performance. Additionally, the upper limb movements motorically limited after the rehabilitation therapy were also identified. The main contribution of the described NUI assessment method is its potential use as a quantitative measurement tool, which might be used by specialists to objectively diagnose and consequently define an appropriate rehabilitation therapy for patients with hemiparesis.

Sensory and motor correlates of frailty: dissociation between frailty phenotype and frailty index

BackgroundFrailty has been associated with a decline in sensory and motor function. However, given that different frailty measures were shown to overlap but also differ in their diagnostic properties, sensory and motor correlates of frailty might be different depending on the operationalization of frailty. Our objective was to identify sensory and motor determinants of frailty and compare the results between frailty phenotype (FP) and frailty index (FI).MethodsData from 44 pre-frail and frail subjects aged 65 and above were used. Frailty was measured using the FP and the FI. Sensory function in the visual, auditory, and tactile domain was assessed using visual acuity, absolute hearing threshold and mechanical detection threshold. Upper extremity motor performance was evaluated by the Purdue Pegboard Test and the Short Physical Performance Battery was used to assess lower extremity motor function. Multiple logistic regression models were employed to determine associations of sensory and motor function with frailty vs. pre-frailty for both frailty measures.ResultsThe frailty measures were moderately correlated (0.497, p ≤ 0.01) and had a Kappa agreement of 0.467 (p = 0.002). Using the FP, frailty was significantly associated with reduced upper extremity motor function only (OR = 0.50, 95% CI 0.29–0.87, p = 0.014). Frailty as assessed by the FI was significantly related to higher hearing thresholds (OR = 1.21, 95% CI 1.02–1.43, p = 0.027) and reduced lower extremity performance (OR = 0.32, 95% CI 0.13–0.77, p = 0.012).ConclusionFrailty is related to reduced performance in measures of sensory and motor function. However, traditional measures of frailty might be differentially sensitive to capture sensory and motor decline, possibly contributing to the much-observed discordance between the diagnostic instruments. This should be taken into account by researchers and clinicians when planning and evaluating therapeutic interventions for frailty.Trial registrationClinicalTrials.gov NCT03666039. Registered 11 September 2018 – Retrospectively registered.

Effect of Bilateral Repetitive Protraction in Antispastic Position Of Suspended Upper Extremity on Motor Performance and Scapular Position in Stroke

Purpose: To find out the effect of bilateral repetitive protraction of suspended upper extremity in anti-spastic position with conventional therapy in patients with hemiplegia due to stroke. Methodology: A total of 36 subjects of hemiplegia due to stroke (post stroke duration more than 3 months) were recruited and distributed in two groups. Group 1 received bilateral repetitive scapular protraction in anti-spastic position of suspended upper extremity along with scapular mobilization in addition to conventional therapeutic exercises. Group 2 received Conventional therapeutic exercises consisted of task specific activity such as bilateral activity on pegboard, ball throwing activity and reaching activities, bilateral active range of motion exercises and weight bearing exercises for upper extremity. Outcome Measures: Universal Goniometer measurements and Fugl-Meyer upper extremity scale were taken prior to the beginning of treatment and after the completion of 4 weeks treatment protocol. Results: Overall results of the study showed significant improvement in active range of motion of the affected upper extremity for shoulder and elbow except wrist in experimental group only. Scapular spine distance improved in both the groups but more significantly in the experimental group. Fugl-Meyer assessment of upper extremity showed more significant improvement in experimental group post 4 week of intervention. Conclusion: Bilateral repetitive protraction in anti-spastic position of suspended upper extremity along with conventional therapeutic exercises for 4 weeks is more effective in improving scapular position and upper extremity motor performance as compared to conventional therapeutic exercise alone.

Influence of Physical Therapy and Cholinergic Medication on the Life Quality Parameters in Post-Stroke with the arm Motor Dysfunction

Motor dysfunction makes the greatest contribution to the patient’s functional independence and has a significant impact on the quality of life (QOL) of post-stroke patients.&#x0D; The objective of the research was to evaluate the impact of different physical therapy approaches and choline alphoscerate on the functional independence and quality of life in patients in 1 year after ischemic stroke.&#x0D; Materials and methods. There were 104 patients examined in 1-year period after first anterior circulation ischemic stroke. Neurological status, functional independence and QOL were assessed according to the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Functional Independence Measurement (FIM) and Stroke Specific Quality of Life Scale (SS-QOL). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for hand motility improvement for 2 months; patients in Group 3 received choline alphoscerate 400 mg twice a day for 2 months in addition to the abovementioned physical therapy.&#x0D; Results. 2 months of physical therapy in Group 1 resulted in increase of “Transfer” and subtotal motor scores. A significant increase in the “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in the patients in Group 2 and Group 3; the motor subtotal and total scores in Group 3 were 11.4% and 11.6 % higher than the same indices in Group 1, respectively.&#x0D; The most significant improvement of QOL parameters was observed in patients in Group 3, whose total score increased by 36.8% from the baseline (p&lt;0.05), and exceeded the same index of Group 1 by 17.1% (p&lt;0.05).&#x0D; Conclusions. Adding of hand exercise into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore functional independence. Stimulation of cholinergic neurotransmission with the choline alphoscerate may also increase the efficacy of physical therapy and contribute to patients’ general mobility, upper extremity function and QOL.

Effect of the complex physical therapy on the upper extremity function, functional independence and cognition in post-stroke patients

Motor dysfunction and cognitive impairment (CI) are the most prevalent and disabling among the stroke consequences. CI decreases the effectivity of motor rehabilitation, but motor dysfunction itself may also influence the manifestations and progression of CI. So development and study of novel physical therapy tactics, which are aiming to target both of these syndromes, becomes a subject of great interest nowadays.&#x0D; The aim of study was to evaluate the impact of different physical therapy approaches on the upper extremity function, cognition and functional independence in patients in 1 year after ischemic stroke.&#x0D; Materials and methods. Totally there were 72 patients examined in the 1-year period after first-ever anterior circulation ischemic stroke. Neurological status, upper extremity function and functional independence were assessed with the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), modified Rankin Scale (mRS) and the Functional Independence Measurement (FIM). Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Trail-making Test A and B tests (TMT). Patients in Group 1 received secondary stroke prevention therapy and performed the exercises complex for general muscle function improvement for 2 months; patients in Group 2 also performed the exercise complex for paretic hand function improvement for 2 months.&#x0D; Results. After 2 months of physical therapy a significant increase of the FIM “Self-care”, “Transfer” and therefore subtotal motor and total scores was observed in patients in Group 2; in Group 1 significant improvement was observed only in “Transfer” and subtotal motor scores. Adding of the hand exercise to the physical therapy complex (Group 2) appeared to be more beneficial for the upper extremity motor function. Patients in Group 2 after 2 months showed increase of the FMA “Wrist” score by 40 % (p&lt;0.05), “Hand” score by 42.8 % (p&lt;0.01) and “Total motor function” by 30.1 % (p&lt;0.05), and the “Total motor function” score in Group 2 was 10.9 % higher in comparison with the Group 1 (p&lt;0.05). In cognitive status significant differences compared to baseline level were observed only in Group 2; MoCA score increased by 14.3 % (p&lt;0.05) and TMT-B performance time decreased by 14.8 % (p&lt;0.05). Baseline MoCA score correlated with FMA “Wrist” (r=0.32; p=0.028), “Hand” (r=0.49; p=0.001) and “Total motor function” (r=0.46; p=0.004) scores. TMT-B score showed significant correlation with the FMA “Wrist” (r=-0.032; p=0.025), “Hand” (-0.45; p=0.009), “Speed/coordination” (r=-0.023; p=0.036) and “Total motor function” (r=-0.42; p=0.023).&#x0D; Conclusion. Adding of exercise for hand function improvement into the physical therapy complex for post-stroke patients contributes to better upper extremity motor performance and therefore is more favourable for patients’ functional independence. Upper extremity motor impairment, especially hand and wrist dysfunction, are associated with worse cognitive performance. Hand function and fine motor skills improvement could be beneficial for the patients’ cognition. Further research is needed in regard to the prognostic significance of these findings and their impact on the treatment and rehabilitation strategies.

Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke.

To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested patients with acute stroke on 2 motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury. We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at 3 time points with 2 tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the 2 tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomic sites associated with motor performance. Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately after stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function. Together, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.

Effects of attentional focus on upper extremity motor performance in post stroke patients: A randomized pilot study.

Introduction:To facilitate the command to the learner, therapist can use verbal cues for guidance: internal focus (own body) and external focus (consequence of movement in the environment).Objective:To examine the effects of different attentional focus on upper limb motor performance in post-stroke.Methods:Randomized controlled trial with 2 groups. Study realized at Integrated Clinic of the Faculty of Health Science at Trairi (Santa Cruz, Rio Grande do Norte, Brazil). Twelve participants allocated into 2 groups. Two motor tasks were used: task 1, reach-point; task 2, reach-grasp-fit, with the paretic extremity, using verbal commands directed by a trained therapist. In the first phase, Group 1 received commands with internal focus, while Group 2 was instructed with commands with external focus. After 1 week, the command type was changed between groups. The variables collected was movement time, velocity and number of peaks velocityResults:Both attentional focus promoted significant differences in movement time and velocity, however, only Internal Focus provided significant results in both tasks of the same variables.Discussion:The benefits of 1 attentional focus on the other are not fully confirmed. However, not receiving any kind of attention guidance compromises motor performance. The results support the hypothesis that the benefits of the External Focus are accentuated when preceded by the Internal Focus.Clinical Trial Registration:Research Ethics Committee of the Faculty of Helth Science at Trairi (Facisa - UFRN)- Number CAAE 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials - RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/).

Early post-stroke rehabilitation for upper limb motor function using virtual reality and exoskeleton: equally efficient in older patients.

To evaluate the effectiveness of virtual reality therapy (VRT) Armeo Spring® upper limb exoskeleton (Armeo), in early post-stroke rehabilitation with a focus on the elderly. Convalescence from a stroke is a complex process driven by a spontaneous recovery supported by multifactorial activation. Novel technology-based rehabilitation methods are being introduced to support brain plasticity. Using a randomised controlled study design, participants within 30 days after stroke with arm paresis were, in addition to a daily rehabilitation programme, assigned to an intervention group (45 minutes Armeo IG n = 25; mean age 66.5 years) performing VRT, or to a conventional physiotherapy (45 minutes) control group (Armeo CG, n = 25, mean age 68.1 years). Montreal Cognitive Assessment (MoCA), Functional Independence Measure (FIM) and Fugl Mayer Assessment Upper Extremity Scale (FMA-UE) were performed before and after the three-week therapy with 12 therapeutic sessions. Results of participants < 65 and ≥ 65 years old were compared. Paretic upper arm function improved significantly in both the IG and CG groups, the improvement in FMA-UE was significantly higher in the IG compared to the CG (p = 0.02), and patients ≥ 65 years old presented an equal magnitude of improvement in paretic arm function compared to younger patients. Early post-stroke rehabilitation strategies using, in addition to the daily rehabilitation programme, VRT with visual biofeedback is more effective on upper extremity motor performance than conventional physiotherapy, and the effectiveness does not diminish with patient age. This may be a promising addition to conventional physiotherapy in older stroke patients as well as in younger.

Influence of Purposeful Activities on Upper Extremity Motor Performance: A Systematic Review.

Following upper extremity injury, exercise-approaches are commonly used to address motor impairments. Occupation-based approaches are also used but less widely promoted and their mechanisms of action not well-understood. Movement performed during purposeful activities and occupations may yield better motor performance than during nonpurposeful tasks. This review investigated the influence of engagement in purposeful activities and occupations on upper extremity motor performance in healthy and musculoskeletal populations. Databases were searched for studies in healthy or upper extremity musculoskeletal-injured adults that compared motor performance during purposeful activities against nonpurposeful movements. Twenty-one studies of moderate quality, conducted predominantly in healthy populations, were included. Upper extremity movement quantity and quality were enhanced when performed during purposeful conditions. Purposeful activities have potential to be used following injury to enhance movement and address motor impairments to a greater extent than is currently promoted. Research in musculoskeletal populations is required.

Poststroke Fatigue Is Related to Motor and Cognitive Performance: A Secondary Analysis.

Poststroke fatigue (PSF) is a common debilitating and persistent symptom after stroke. The relationship between PSF and motor and cognitive function remains inconclusive partly due to lack of control for effects of depression and use of insensitive measures. We examined the relationship between PSF and motor and cognitive performance using a comprehensive set of behavioral measures and excluding individuals with depression. Fifty-three individuals poststroke (16 female) were included (median age: 63 years, median months poststroke: 20 months). Poststroke fatigue was quantified using the Fatigue Severity Scale (FSS) and cognitive performance was measured with the Montreal Cognitive Assessment, simple and choice reaction time (SRT and CRT) tasks. Lower extremity motor performance included Fugl-Meyer Motor Assessment, 5 times sit-to-stand test (5 × STS), Berg Balance Scale, Functional Ambulation Category, and gait speed. Upper extremity motor performance was indexed with Fugl-Meyer, grip strength, and Box and Block test. Spearman correlation and stepwise linear regression analyses were performed to examine relationships. Two motor performance measures, Berg Balance Scale and Functional Ambulation Category, were significantly correlated with FSS (ρ = -0.31 and -0.27, respectively) while all cognitive measures were significantly correlated with FSS (ρ = -0.28 for Montreal Cognitive Assessment, 0.29 for SRT, and 0.29 for CRT). Regression analysis showed that Berg Balance Scale was the only significant determinant for FSS (R = 0.11). Functional gait, balance, and cognitive performance are associated with PSF. Fatigue should be considered when planning and delivering interventions for individuals with stroke. Future studies are needed to explore the potential efficacy of balance and cognitive training in PSF management.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A287).

Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study

This study was a randomized, controlled pilot trial to investigate the timing-dependent interaction effects of dual transcranial direct current stimulation (tDCS) in mirror therapy (MT) for hemiplegic upper extremity in patients with chronic stroke. Thirty patients with chronic stroke were randomly assigned to three groups: tDCS applied before MT (prior-tDCS group), tDCS applied during MT (concurrent-tDCS group), and sham tDCS applied randomly prior to or concurrent with MT (sham-tDCS group). Dual tDCS at 1 mA was applied bilaterally over the ipsilesional M1 (anodal electrode) and the contralesional M1 (cathodal electrode) for 30 min. The intervention was delivered five days per week for two weeks. Upper extremity motor performance was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT), and the Box and Block Test (BBT). Assessments were administered at baseline, post-intervention, and two weeks follow-up. The results indicated that concurrent-tDCS group showed significant improvements in the ARAT in relation to the prior-tDCS group and sham-tDCS group at post-intervention. Besides, a trend toward greater improvement was also found in the FMA-UE for the concurrent-tDCS group. However, no statistically significant difference in the FMA-UE and BBT was identified among the three groups at either post-intervention or follow-up. The concurrent-tDCS seems to be more advantageous and time-efficient in the context of clinical trials combining with MT. The timing-dependent interaction factor of tDCS to facilitate motor recovery should be considered in future clinical application.

Concurrent Validity of Sensor Glove-Derived Measures of Upper-Extremity Motor Performance

Abstract Date Presented 04/06/19 Motion tracking sensors were added to a commercial SaeboGlove, enabling patients to engage in manual practice of instrumental activities of daily living in a computer-generated virtual world. Sensor-derived performance in completing functional tasks in the virtual environment was compared to real-world performance assessed using gold-standard measures. Statistical analysis of data collected during use by 15 stroke patients confirms the concurrent validity of the computer-generated measures. Primary Author and Speaker: Allison Ellington Additional Authors and Speakers: Richard Adams Contributing Authors: Kate Armstead, Kristen Sheffield, Heather Standish