Motor Recovery Of Upper Extremity Research Articles

Constraint-induced Movement Therapy, Neuroplasticity, and Upper Extremity Motor Recovery after Stroke

Constraint-induced Movement Therapy, Neuroplasticity, and Upper Extremity Motor Recovery after Stroke

Abstract WP110: Spontaneous Motor Recovery After Cerebrolysin Treatment in a Mouse Model of Stroke

Background and Purpose: Most functional upper extremity motor recovery occurs in the first 4 weeks after ischemic stroke in humans and in the first week in rodent models. The majority of functional recovery in humans is spontaneous (i.e. occurs as a result of endogenous repair processes rather than rehabilitative interventions). In mouse models of stroke, recovery is impaired when post-stroke rehabilitation is delayed and there is very little spontaneous recovery. Cerebrolysin is a polypeptide preparation shown to enhance neuronal plasticity and to promote motor recovery in patients after stroke. In mice, we tested the hypothesis that Cerebrolysin can act early after stroke to enhance spontaneous motor recovery. Methods: Adult C57Bl/6 mice were trained to perform a skilled prehension task to an asymptotic level of performance, after which they underwent photocoagulation-induced stroke in the caudal forelimb area (rodent primary motor cortex). The mice were then randomized to receive Cerebrolysin or saline injections beginning 24-hours post-stroke. Both groups were then retrained at the same prehension task by a blinded investigator. Stroke volumes were compared using immunohistochemistry. Results: We have previously shown that training-associated recovery of prehension is complete if training is initiated after a 1-day delay but incomplete if training is initiated after a 7-day delay, even with additional training days. However, daily Cerebrolysin administration after stroke was associated with complete recovery of prehension by day 8, even in the absence of training. Stroke volumes were similar across all groups. Conclusions: We conclude that Cerebrolysin administration during an early time window can lead to spontaneous recovery of motor function without a protective effect on stroke volume. This is one of the first demonstrations of spontaneous motor recovery in a rodent stroke model. Our mouse model, with all of the attendant genetic benefits, should allow us to determine at the cellular and molecular level how endogenous plasticity and medications like Cerebrolysin interact to mediate recovery.

Effects of Kinect-based virtual reality game training on upper extremity motor recovery in chronic stroke

Background: Therapeutic benefits of Kinect-based virtual reality (VR) game training in rehabilitation encourage its use to improve motor function.Objective: To assess the effects of Kinect-based VR training on motor recovery of the upper extremity and functional outcomes in patients with chronic stroke.Methods: In this randomized controlled trial, group A received 20 sessions of physical therapy (PT) + 20 sessions of Kinect-based VR training and group B received only 20 sessions of PT. Clinical outcome measures were assessed at baseline and at the end of the treatments. Primary outcome measures that assess stroke patients’ motor function included upper extremity (UE) Fugl-Meyer Assessment (FMA). Secondary outcome measures were Brunnstrom Recovery Stages (BRS), Modified Ashworth Scale (MAS), Box and Block test (BBT), Motricity index (MI), and active range of motion (AROM) measurement.Results: Statistically significant improvements in game scores (p < 0.05) were observed in group A. In within-group analysis, there were statistically significant improvements in all clinical outcome measures except for the BRS-hand, MAS-distal, and MAS-hand in group A; MAS-(proximal, distal, hand) and BRS-(UE, hand) in group B compared with baseline values. Differences from baseline of FMA, MI, and AROM (except adduction of shoulder and extension of elbow) were greater in group A (p < 0.05).Conclusions: To conclude, our results suggest that the adjunct use of Kinect-based VR training may contribute to the improvement of UE motor function and AROM in chronic stroke patients. Further studies with a larger number of subjects with longer follow-up periods are needed to establish its effectiveness in neurorehabilitation.

Effect of transcranial direct current stimulation combined with neuromuscular electrical stimulation on upper extremity motor recovery in an individual with chronic stroke

Background: Transcranial direct current stimulation (tDCS) is an innovative neurorehabilitation approach to facilitate sensorimotor recovery for patients after stroke .The feasibility and effect of tDCS combined with neuromuscular electrical stimulation (NMES) on upper extremity motor recovery in people with stroke have not been investigated.

Home programs for upper extremity recovery post-stroke: a survey of occupational therapy practitioners

Background: Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented.Objectives: The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used.Methods: An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors.Results: A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients’ goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program.Conclusions: Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders’ perspectives on home programs and determine effective strategies for ensuring adherence is needed.

Force Myography for Monitoring Grasping in Individuals with Stroke with Mild to Moderate Upper-Extremity Impairments: A Preliminary Investigation in a Controlled Environment.

There is increasing research interest in technologies that can detect grasping, to encourage functional use of the hand as part of daily living, and thus promote upper-extremity motor recovery in individuals with stroke. Force myography (FMG) has been shown to be effective for providing biofeedback to improve fine motor function in structured rehabilitation settings, involving isolated repetitions of a single grasp type, elicited at a predictable time, without upper-extremity movements. The use of FMG, with machine learning techniques, to detect and distinguish between grasping and no grasping, continues to be an active area of research, in healthy individuals. The feasibility of classifying FMG for grasp detection in populations with upper-extremity impairments, in the presence of upper-extremity movements, as would be expected in daily living, has yet to be established. We explore the feasibility of FMG for this application by establishing and comparing (1) FMG-based grasp detection accuracy and (2) the amount of training data necessary for accurate grasp classification, in individuals with stroke and healthy individuals. FMG data were collected using a flexible forearm band, embedded with six force-sensitive resistors (FSRs). Eight participants with stroke, with mild to moderate upper-extremity impairments, and eight healthy participants performed 20 repetitions of three tasks that involved reaching, grasping, and moving an object in different planes of movement. A validation sensor was placed on the object to label data as corresponding to a grasp or no grasp. Grasp detection performance was evaluated using linear and non-linear classifiers. The effect of training set size on classification accuracy was also determined. FMG-based grasp detection demonstrated high accuracy of 92.2% (σ = 3.5%) for participants with stroke and 96.0% (σ = 1.6%) for healthy volunteers using a support vector machine (SVM). The use of a training set that was 50% the size of the testing set resulted in 91.7% (σ = 3.9%) accuracy for participants with stroke and 95.6% (σ = 1.6%) for healthy participants. These promising results indicate that FMG may be feasible for monitoring grasping, in the presence of upper-extremity movements, in individuals with stroke with mild to moderate upper-extremity impairments.

Understanding Occupational Therapy Practitioners’ Use of Upper Extremity–Focused Home Programs for Persons Post Stroke

Abstract Date Presented 3/31/2017 A national survey of occupational therapy practitioners was completed to describe current practice on how home programs for upper-extremity motor recovery are designed, implemented, and monitored, specifically for persons who experienced stroke. Primary Author and Speaker: Renae Fichter Additional Authors and Speakers: Elena V. Donoso Brown

No Difference Between Noxious and Innocuous Thermal Stimulation on Motor Recovery of Upper Extremity in Patients With Acute Stroke: A Randomized Controlled Trial With 6-Month Follow-up

BackgroundThermal stimulation (TS) has been developed and incorporated into stroke rehabilitation. However, whether noxious and innocuous TS induce the same effects on motor function recovery after stroke is still unknown. A comparative study of different temperature combination regimens is needed. ObjectiveTo compare the short- and long-term effectiveness between noxious and innocuous TS on motor recovery of upper extremity in patients with acute stroke. DesignRandomized, controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. SettingA university hospital rehabilitation department in Taiwan. ParticipantsA total of 79 patients with acute ischemic stroke were recruited. The majority had moderate to severe motor impairment of the upper extremity (UE). InterventionIn addition to traditional rehabilitation, the experimental group (n = 39) underwent noxious TS (heat pain 46-47°C/cold pain 7-8°C), and the control group (n = 40) received innocuous TS (heat 40-41°C/cold 20-21°C). TS intervention was applied for 30 minutes once per day and for a total of 20-24 times during hospital stay. A custom-made TS instrument, comprising 2 thermal stimulators and their respective thermal pads constructed in a closed-loop system, was used. OutcomesThe Fugl-Meyer upper extremity score (the primary outcome), Action Research Arm Test, Motricity Index, Barthel Index, and modified Ashworth scale (the secondary outcomes) were administered by a blinded assessor at baseline, post–12th TS, post-intervention, 1-month, and 6-month follow-ups. ResultsNo significant differences between groups were found on the primary outcome at postintervention and follow-up assessments. At 1-month follow-up, the innocuous group showed a small effect (partial η2 = 0.02) that was greater than that of the noxious group, but that effect was eliminated at 6 months. Both groups presented significant within-group improvements over time (both P < .001). ConclusionsCombining noxious TS with traditional rehabilitation did not yield better short-term or long-term results than combining innocuous TS with traditional rehabilitation on UE functional recovery for individuals with acute stroke. Level of EvidenceII

Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial

Background: Repetitive transcranial magnetic stimulation (rTMS) was suggested as a preconditioning method that would increase brain plasticity and that it would be optimal to combine rTMS with intensive rehabilitation.Objective: To assess the efficacy of inhibitory rTMS on upper extremity motor recovery and functional outcomes in chronic ischemic stroke patients.Methods: In this randomized controlled trial, experimental group received low-frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT), and control group received PT.Results: No statistically significant difference was found in baseline demographical and clinical characteristics of the subjects including stroke severity or severity of paralysis prior to intervention. There were statistically significant improvements in all clinical outcome measures except for the Brunnstrom Recovery Stages. Fugl–Meyer Assessment, Box and Block test, motor and total scores of Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS) scores were significantly increased in both groups, however, these changes were significantly greater in the rTMS group except for FAS score. FIM cognitive scores and standardized mini-mental test scores were significantly increased and distal and hand Modified Ashworth Scale scores were significantly decreased only in the rTMS group (p < .05).Conclusions: LF-rTMS can safely facilitate upper extremity motor recovery in patients with chronic ischemic stroke. TMS seems to be a promising treatment for motor, functional, and cognitive deficits in chronic stroke. Further studies with a larger number of patients with longer follow-up periods are needed to establish its effectiveness in stroke rehabilitation.

Effects of low-frequency repetitive transcranial magnetic stimulation and neuromuscular electrical stimulation on upper extremity motor recovery in the early period after stroke: a preliminary study

Objective: To assess the efficacy of inhibitory repetitive transcranial magnetic stimulation (rTMS) and neuromuscular electrical stimulation (NMES) on upper extremity motor function in patients with acute/subacute ischemic stroke.Methods: Twenty-five ischemic acute/subacute stroke subjects were enrolled in this randomized controlled trial. Experimental group 1 received low frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT) including activities to improve strength, flexibility, transfers, posture, balance, coordination, and activities of daily living, mainly focusing on upper limb movements; experimental group 2 received the same protocol combined with NMES to hand extensor muscles; and the control group received only PT. Functional magnetic resonance imaging (fMRI) scan was used to evaluate the activation or inhibition of the affected and unaffected primary motor cortex.Results: No adverse effect was reported. Most of the clinical outcome scores improved significantly in all groups, however no statistically significant difference was found between groups due to the small sample sizes. The highest percent improvement scores were observed in TMS + NMES group (varying between 48 and 99.3%) and the lowest scores in control group (varying between 13.1 and 28.1%). Hand motor recovery was significant in both experimental groups while it did not change in control group. Some motor cortex excitability changes were also observed in fMRI.Conclusion: LF-rTMS with or without NMES seems to facilitate the motor recovery in the paretic hand of patients with acute/subacute ischemic stroke. TMS or the combination of TMS + NMES may be a promising additional therapy in upper limb motor training. Further studies with larger numbers of patients are needed to establish their effectiveness in upper limb motor rehabilitation of stroke.

Safety and tolerability of transcranial direct current stimulation to stroke patients – A phase I current escalation study

Background and objectiveA prior meta-analysis revealed that higher doses of transcranial direct current stimulation (tDCS) have a better post-stroke upper-extremity motor recovery. While this finding suggests that currents greater than the typically used 2 mA may be more efficacious, the safety and tolerability of higher currents have not been assessed in stroke patients. We aim to assess the safety and tolerability of single session of up to 4 mA in stroke patients. MethodsWe adapted a traditional 3 + 3 study design with a current escalation schedule of 1»2»2.5»3»3.5»4 mA for this tDCS safety study. We administered one 30-min session of bihemispheric montage tDCS and simultaneous customary occupational therapy to patients with first-ever ischemic stroke. We assessed safety with pre-defined stopping rules and investigated tolerability through a questionnaire. Additionally, we monitored body resistance and skin temperature in real-time at the electrode contact site. ResultsEighteen patients completed the study. The current was escalated to 4 mA without meeting the pre-defined stopping rules or causing any major safety concern. 50% of patients experienced transient skin redness without injury. No rise in temperature (range 26°C–35 °C) was noted and skin barrier function remained intact (i.e. body resistance >1 kΩ). ConclusionOur phase I safety study supports that single session of bihemispheric tDCS with current up to 4 mA is safe and tolerable in stroke patients. A phase II study to further test the safety and preliminary efficacy with multi-session tDCS at 4 mA (as compared with lower current and sham stimulation) is a logical next step.ClinicalTrials.gov Identifier: NCT02763826.

Forced Aerobic Exercise Preceding Task Practice Improves Motor Recovery Poststroke.

To understand how two types of aerobic exercise affect upper-extremity motor recovery post-stroke. Our aims were to (1) evaluate the feasibility of having people who had a stroke complete an aerobic exercise intervention and (2) determine whether forced or voluntary exercise differentially facilitates upper-extremity recovery when paired with task practice. Seventeen participants with chronic stroke completed twenty-four 90-min sessions over 8 wk. Aerobic exercise was immediately followed by task practice. Participants were randomized to forced or voluntary aerobic exercise groups or to task practice only. Improvement on the Fugl-Meyer Assessment exceeded the minimal clinically important difference: 12.3, 4.8, and 4.4 for the forced exercise, voluntary exercise, and repetitive task practice-only groups, respectively. Only the forced exercise group exhibited a statistically significant improvement. People with chronic stroke can safely complete intensive aerobic exercise. Forced aerobic exercise may be optimal in facilitating motor recovery associated with task practice.

Characterizing differential poststroke corticomotor drive to the dorsi- and plantarflexor muscles during resting and volitional muscle activation.

Imbalance of corticomotor excitability between the paretic and nonparetic limbs has been associated with the extent of upper extremity motor recovery poststroke, is greatly influenced by specific testing conditions such as the presence or absence of volitional muscle activation, and may vary across muscle groups. However, despite its clinical importance, poststroke corticomotor drive to lower extremity muscles has not been thoroughly investigated. Additionally, whereas conventional gait rehabilitation strategies for stroke survivors focus on paretic limb foot drop and dorsiflexion impairments, most contemporary literature has indicated that paretic limb propulsion and plantarflexion impairments are the most significant limiters to poststroke walking function. The purpose of this study was to compare corticomotor excitability of the dorsi- and plantarflexor muscles during resting and active conditions in individuals with good and poor poststroke walking recovery and in neurologically intact controls. We found that plantarflexor muscles showed reduced corticomotor symmetry between paretic and nonparetic limbs compared with dorsiflexor muscles in individuals with poor poststroke walking recovery during active muscle contraction but not during rest. Reduced plantarflexor corticomotor symmetry during active muscle contraction was a result of reduced corticomotor drive to the paretic muscles and enhanced corticomotor drive to the nonparetic muscles compared with the neurologically intact controls. These results demonstrate that atypical corticomotor drive exists in both the paretic and nonparetic lower limbs and implicate greater severity of corticomotor impairments to plantarflexor vs. dorsiflexor muscles during muscle activation in stroke survivors with poor walking recovery.NEW & NOTEWORTHY The present study observed that lower-limb corticomotor asymmetry resulted from both reduced paretic and enhanced nonparetic limb corticomotor excitability compared with neurologically intact controls. The most asymmetrical corticomotor drive was observed in the plantarflexor muscles of individuals with poor poststroke walking recovery. This suggests that neural function of dorsi- and plantarflexor muscles in both paretic and nonparetic limbs may play a role in poststroke walking function, which may have important implications when developing targeted poststroke rehabilitation programs to improve walking ability.

The Effect of Mirror Therapy on Functional Recovery of Upper Extremity after Stroke: A Randomized Pilot Study

Object: The purpose of this study is to confirm the effect of mirror therapy on motor recovery of upper extremity and to suggest a standard mirror therapy program for stroke patients. Method: Total 19 chronic stroke patients participate in this study and were randomly divided in two groups mirror therapy group and sham therapy group randomly. The participants of received during 30-minutes, 5 times per week for 4 weeks. The muscle strength, range of motion and muscle tone, grip strength, manual dexterity, functional independence levels were evaluated for compare of effects after interventions. Result: The mirror therapy group showed significant differences in muscle strength and range of motion of wrist extension, muscle tone of wrist flexor compare to sham therapy group as revealed by electric muscle test Dualer IQ Inclinometer and Modified Ashworth Scale (p<0.05). And the mirror therapy group showed significant improvement in grip strength, manual dexterity, functional independence levels compare to sham therapy group as revealed by electro dynamometer, Box and Block Test and functional Independence Measure( p<0.05). Conclusion: The mirror therapy can bring positive changes for motor recovery of upper extremity, the mirror therapy program in this study is effective for functional recovery of upper extremity after stroke.

Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation: A pilot study.

Background:Eclectic treatment method is a flexible approach that uses techniques drawn from various schools of thought involving several treatment methods and allows the therapist to adapt to each client's individual needs. Wider application for eclectic approach is however limited in stroke rehabilitation.Aim:The objective is to find out whether eclectic approach improves upper extremity (UE) functional recovery in acute stroke rehabilitation.Methodology:Twenty-five postacute unilateral supratentorial stroke subjects recruited from tertiary care hospitals recovered with Stage 2–5 in Brunnstorm stage of UE motor recovery (BRS-UE) underwent 45 min of eclectic approach for UE every day involving seven different treatment methods (5 min for each method) for 6 days consecutively. The outcome was UE subscale of the Fugl-Meyer Motor test (UE-FM), UE subscale of the Stroke Rehabilitation Assessment of Movement (UE-STREAM), Wolf Motor Function test (WMFT-FAS), and Stroke Impact Scale-16 (SIS-16) was collected at the end of the sixth session.Results:All the participants showed significant improvement in all the outcome measures. The Stage 2 and 3 subjects showed UE-STREAM (P = 0.007) WMFT-FAS (P < 0.001), SIS (P = 0.023) respectively and for Stage 4 and 5 the subjects have shown UE FM (P < 0.001), WMFT-FAS (P < 0.001), SIS (P = 0.004) with large magnitude of treatment effect for all stages of BRS-UE.Conclusion:Our study findings are in favor of integrating eclectic approach than single intervention/approach in clinical practice to improve the UE functional recovery for motor rehabilitation when the stroke occurs.

Clinically Important Difference of the Arm Motor Ability Test in Stroke Survivors

Background. The Arm Motor Ability Test (AMAT) is used to assess and quantify upper-extremity (UE) functional limitation in stroke and other conditions. However, the AMAT score change indicative of important and clinically meaningful change has not been determined. Objective. To determine the clinically important difference (CID) for the AMAT for individuals with stroke exhibiting mild to moderate hemiparesis. Methods. A total of 146 chronic stroke survivors exhibiting stable, mild to moderate UE hemiparesis were administered the AMAT before and after interventions targeting their affected UEs. Patients and treating therapists rated perceived amount of UE motor recovery for each participant on a global rating of change (GROC) scale evaluating several facets of UE movement (grasp, release, move the affected UE, perform 5 important functional tasks, overall UE function). Estimated CID of the Functional Ability Scale of the AMAT was calculated using the receiver operating characteristics curve with the GROC scale as the anchor. Distribution-based methods were also used to estimate the CID. Results. Mean baseline, postintervention, and change in AMAT values for all participants were 3.0 (0.68), 3.3 (0.73), and 0.33 (0.43) respectively. The CID was estimated as an improvement of 0.32 to 0.42 when anchored by the therapist’s perception of improvement and 0.29 to 0.40 when anchored by the patient’s perception of improvement. The CID using distribution-based methods ranged from 0.40 to 0.44. Conclusions. A change of 0.44 or greater on the AMAT indicates a clinically meaningful improvement in UE functional movements. Clinicians should use this value to determine goals and interpret change scores.

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke

Purpose: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects.Methods: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits).Results: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F = 29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F = 20.6; p< .0001).Conclusions: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke.Implications for RehabilitationResidual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1.It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

Prediction of upper extremity motor recovery after subacute intracerebral hemorrhage through diffusion tensor imaging: a systematic review and meta-analysis.

Early assessment of the pyramidal tracts is important for intracerebral hemorrhage (ICH) patients in order to decide the optimal treatment or to assess appropriate rehabilitation strategies, and management of patient expectations and goals. The purpose of this study was to systematically review and summarize the current available literature on the value of Fractional Anisotropy (FA) parameter of the diffusion tensor imaging (DTI) in predicting upper extremity (UE) motor recovery after subacute ICH. PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane CENTRAL searches were conducted from 1 January 1950 to 31 March 2016 which were supplemented with relevant articles identified in the references. Pooled estimate using correlation between DTI parameter FA and UE motor recovery was done using comprehensive meta-analysis software. Out of 97 citations, only eight studies met the criteria for inclusion in the systematic review and six studies were included in the meta-analysis. A random effects model revealed that DTI parameter FA is a significant predictor for UE motor recovery after subacute ICH (correlation coefficient = 0.56; 95% confidence interval 0.44 to 0.65, P value <0.001). However, moderate heterogeneity was observed between the studies (Tau-squared = 0.28, I-squared = 70.3). The studies reported so far on correlation between FA parameter of DTI and UE motor recovery in ICH patients are few with small sample sizes. This meta-analysis suggests a strong correlation between DTI parameter FA and UE motor recovery in ICH patients. Further well-designed prospective studies embedded with larger sample size are needed to confirm these findings.

Role of contralesional hemisphere in paretic arm reaching in patients with severe arm paresis due to stroke: A preliminary report

Stroke is highly prevalent and a leading cause of serious, long-term disability among American adults. Impaired movement (i.e. paresis) of the stroke-affected arm is a major contributor to post-stroke disability, yet the mechanisms of upper extremity motor recovery are poorly understood, particularly in severely impaired patients who lack hand function. To address this problem, we examined the functional relevance of the contralesional hemisphere in paretic arm motor performance in individuals with severe arm paresis. Twelve individuals with severe stroke-induced arm paresis (Upper Extremity Fugl-Meyer Assessment=17.1±8.5; maximum score=66) participated in the study. Participants performed a reaching response time task with their paretic arm. At varying time intervals following a ‘Go' cue, a pair of transcranial magnetic stimulation (TMS) pulses were delivered to contralesional hemisphere primary motor (M1) or dorsal pre-motor cortex (PMd) to momentarily disrupt the pattern of neural firing. Response time components and hand-path characteristics were compared across the 2 sites for trials with and without TMS disruption. There was no significant effect of TMS disruption on overall Response time or Reaction time, but Movement time was significantly longer (i.e. slower) with disruption of the contralesional hemisphere (p=0.015), regardless of which area was stimulated. Peak hand-path velocity and hand-path smoothness were also significantly lower (p=0.005 and p<0.0001, respectively) with TMS disruption of the contralesional hemisphere. The data from this study provide evidence supporting a functionally relevant role of contralesional hemisphere motor areas in paretic arm reaching movements in individuals with severe post-stroke arm impairment.

EFFECT OF MIRROR THERAPY ON HEMIPARETIC UPPER EXTREMITY IN SUBACUTE STROKE PATIENTS

Background and Objective: Stroke is one of the most common causes for chronic disability. Only 5 to 20% of stroke survivors attain complete functional recovery of their affected upper extremity. The primary objective of this study was to investigate the effect of mirror therapy on hemiparetic upper extremity motor recovery and functions in patients with subacute stroke. Materials and Methods: A total of 30 participants were selected for the study. They were randomly assigned to Mirror Therapy Group (MTG) and Sham Mirror Therapy Group (SMTG) with fifteen participants in each group. All the participants equally took part in conventional stroke rehabilitation program 5 days a week for 4 weeks. In addition to the conventional stroke rehabilitation program, MTG participated in 30 minutes of mirror therapy and SMTG received 30 minutes of sham mirror therapy for the affected hemiparetic upper limb. The participants were measured for upper extremity motor recovery and functions by Fugl-Meyer Assessment (FMA-UE) and Upper Extremity Functional Index (UEFI) scales respectively. Results: Wilcoxon signed ranks test and Mann Whitney U test were used to statistically analyze the data. Spearman correlational technique was used to analyze the relationship between upper limb functions and motor recovery of hand. Based on Wilcoxon signed ranks test, the results were highly significant (p<0.05. On the basis of Mann Whitney U test, Mirror therapy group showed high significance (p<0.05) than sham mirror therapy group. The spearman’s rho value was 0.65 which indicated moderate to maximum positive correlation between the two variables and the alpha level was set at 0.01. Conclusion: This study concludes that incorporating mirror therapy in subacute stroke rehabilitation program improves the hemiparetic upper extremity motor recovery and its functions and also motor recovery of hand can directly influence the upper limb functions.