Movements In Stroke Patients Research Articles

脳卒中片麻痺患者における座位での骨盤傾斜角度と 基本動作能力との関連

［目的］脳卒中片麻痺患者の座位での骨盤傾斜角度と基本動作能力との関連について検討した。［対象］脳卒中片麻痺患者２８名（男性１７名，女性１１名）とした。［方法］測定項目は，端座位での自動運動による骨盤前傾角度，骨盤後傾角度，骨盤運動可動域，基本動作能力（立ち上がり，着座，立位保持，片脚立位，歩行），Brunnstrom stage および下肢筋力とし，基本動作の可否に関連する因子を分析した。［結果］片脚立位以外の基本動作能力と骨盤前傾角度に有意な関連を認めた。一方で，各測定項目と骨盤後傾角度および骨盤運動可動域とは有意な関係は認められなかった。［結語］脳卒中片麻痺患者の自動運動による骨盤前傾能力は，基本動作能力に関連している可能性が示された。

Detection of movement intention from single-trial movement-related cortical potentials

Detection of movement intention from neural signals combined with assistive technologies may be used for effective neurofeedback in rehabilitation. In order to promote plasticity, a causal relation between intended actions (detected for example from the EEG) and the corresponding feedback should be established. This requires reliable detection of motor intentions. In this study, we propose a method to detect movements from EEG with limited latency. In a self-paced asynchronous BCI paradigm, the initial negative phase of the movement-related cortical potentials (MRCPs), extracted from multi-channel scalp EEG was used to detect motor execution/imagination in healthy subjects and stroke patients. For MRCP detection, it was demonstrated that a new optimized spatial filtering technique led to better accuracy than a large Laplacian spatial filter and common spatial pattern. With the optimized spatial filter, the true positive rate (TPR) for detection of movement execution in healthy subjects (n = 15) was 82.5 ± 7.8%, with latency of −66.6 ± 121 ms. Although TPR decreased with motor imagination in healthy subject (n = 10, 64.5 ± 5.33%) and with attempted movements in stroke patients (n = 5, 55.01 ± 12.01%), the results are promising for the application of this approach to provide patient-driven real-time neurofeedback.

Weakening of Synergist Muscle Coupling During Reaching Movement in Stroke Patients

Background. After hemiparetic stroke, coordination of the shoulder flexor and elbow extensor muscles during a reaching movement is impaired and contributes to poor performance. Objective. The aim was to determine whether functional coupling between electromyographic signals of synergist muscles during reaching was weakened in stroke patients who had poor motor coordination. Methods. Surface electromyography (EMG) from the anterior deltoid, triceps brachii, biceps brachii, pectoralis major, supraspinatus, and latissimus dorsi of the affected upper limb in 11 stroke patients (mean Fugl-Meyer upper extremity score 27 ± 8) and in the dominant arm of 8 healthy controls were measured. Results. Coherence between the EMG of the anterior deltoid and triceps brachii, 2 synergists for reaching, was lower in patients compared with controls, in the 0- to 11-Hz range. Detailed segmented frequency-range analysis indicated significant differences in the coherence between groups in 0- to 3.9-Hz and 4- to 7.9-Hz ranges. Conclusions. This weakened functional coupling may contribute to poor reaching performance and could be a consequence of a loss of common drive at the frequency bands as a result of interruption of information flow in the corticospinal pathway.

Quantifying the quality of hand movement in stroke patients through three-dimensional curvature

BackgroundTo more accurately evaluate rehabilitation outcomes in stroke patients, movement irregularities should be quantified. Previous work in stroke patients has revealed a reduction in the trajectory smoothness and segmentation of continuous movements. Clinically, the Stroke Impairment Assessment Set (SIAS) evaluates the clumsiness of arm movements using an ordinal scale based on the examiner's observations. In this study, we focused on three-dimensional curvature of hand trajectory to quantify movement, and aimed to establish a novel measurement that is independent of movement duration. We compared the proposed measurement with the SIAS score and the jerk measure representing temporal smoothness.MethodsSixteen stroke patients with SIAS upper limb proximal motor function (Knee-Mouth test) scores ranging from 2 (incomplete performance) to 4 (mild clumsiness) were recruited. Nine healthy participant with a SIAS score of 5 (normal) also participated. Participants were asked to grasp a plastic glass and repetitively move it from the lap to the mouth and back at a conformable speed for 30 s, during which the hand movement was measured using OPTOTRAK. The position data was numerically differentiated and the three-dimensional curvature was computed. To compare against a previously proposed measure, the mean squared jerk normalized by its minimum value was computed. Age-matched healthy participants were instructed to move the glass at three different movement speeds.ResultsThere was an inverse relationship between the curvature of the movement trajectory and the patient's SIAS score. The median of the -log of curvature (MedianLC) correlated well with the SIAS score, upper extremity subsection of Fugl-Meyer Assessment, and the jerk measure in the paretic arm. When the healthy participants moved slowly, the increase in the jerk measure was comparable to the paretic movements with a SIAS score of 2 to 4, while the MedianLC was distinguishable from paretic movements.ConclusionsMeasurement based on curvature was able to quantify movement irregularities and matched well with the examiner's observations. The results suggest that the quality of paretic movements is well characterized using spatial smoothness represented by curvature. The smaller computational costs associated with this measurement suggest that this method has potential clinical utility.

Correlation of motor function with transcallosal and intracortical inhibition after stroke

The inhibitory role of neuronal networks in motor recovery after stroke remains to be elucidated. We examined the influence of transcallosal inhibition and short intracortical inhibition on motor recovery after stroke. We also investigated the correlation between transcallosal inhibition and mirror activity. A cross-sectional study. Thirty-eight chronic stroke patients. Transcallosal inhibition was evaluated using single transcranial magnetic stimulation, and short intracortical inhibition was assessed using paired-pulse transcranial magnetic stimulation. Mirror activity was measured during tonic contraction of the contralateral hand. Transcallosal inhibition from the contralesional to the ipsilesional motor cortex correlated positively with motor function of the paretic hand; in contrast, transcallosal inhibition to the ipsilesional motor cortex correlated negatively with mirror activity of the paretic hand in both cortical and subcortical stroke patients. Short intracortical inhibition of the ipsilesional motor cortex correlated negatively with motor function of the paretic hand in only the subcortical stroke patients. Transcallosal inhibition from the contralesional to the ipsilesional motor cortex may inhibit mirror movements in stroke patients with good motor function. The weak transcallosal inhibition in patients after stroke with poor motor function may be ineffective for inhibiting mirror movement; however, it may have the advantage of facilitating motor recovery.

Cortical activation pattern of compensatory movement in stroke patients

Little is known about the cortical activation pattern of compensatory movement (CM) in stroke patients. We attempted to investigate the cortical activation pattern of compensatory movement in stroke patients, using functional MRI (fMRI). Eight hemiparetic stroke patients were recruited for this study. We measured the shoulder abduction angle when each subject was simulating eating in a sitting position, which was considered as the degree of CM. The fMRI was performed at 1.5T using an elbow motor task at a frequency of 0.5 Hz. There was an inverse correlation between the shoulder abduction angle of the affected side and the LI (Laterality Index) (r=-0.745; p< 0.05). The shoulder abduction angle of the affected side was significantly related to the sum of activated voxels in all regions of interest (r=0.776; p< 0.05) and the activated voxels of the supplementary motor area (r=951; p< 0.05). However, we did not find any correlation between the shoulder abduction angle and the activated voxels of other brain areas. We demonstrated that a greater shoulder abduction angle on the affected side requires more cortical activation. Therefore, CM appears to be related to the change of the cortical motor control toward greater recruitment of cortical neurons.

Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study

BackgroundIn the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life). Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion) of the different DoFs (degrees of Freedom).MethodsThe IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE), Abduction/Adduction (AA) and Pronation/Supination (PS). Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns.ResultsThree stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the beginning and at the end of the test therapy session and the results suggest a positive trend.ConclusionThe positive outcomes of the preliminary tests motivate the planning of a clinical trial and provide experimental evidence for defining appropriate inclusion/exclusion criteria.

Voice Guidance and Emotional Prosody during Finger Movement in Stroke Patients: an fMRI Study

Voice Guidance and Emotional Prosody during Finger Movement in Stroke Patients: an fMRI Study

The Role of Therapeutic Instrumental Music Performance in Hemiparetic Arm Rehabilitation

ABSTRACT: This study describes the clinical application of Therapeutic Instrumental Music Performance (TIMP) on functional upper extremity movement in stroke patients. Participants for this study included 3 post-stroke outpatients showing pronounced hemiparesis in their upper extremities. Participants underwent six, 35-minute music therapy sessions in which they received training in flexion and extension exercises of their paretic arm using a Roland TD-5 Percussion Sound Module Musical Instrument Digital Interface (MIDI) drum set for TIMP exercises. Functional arm movements were assessed in the pretest and posttest using the Barthel Index, the Fugl-Meyer Test, and the Modified Ashworth Scale. MIDI data on total movement time, variability of movement time, and force were also collected during the pretest and posttest as well as at the halfway point of the treatment program. Results indicated significant improvements on the wrist and hand portion of the Fugl-Meyer Test (t = 5, p = .0377), and MIDI data showed observable improvements throughout the treatment period. These findings suggest that the addition of Neurologic Music Therapy to current rehabilitation training programs is possible and may prove beneficial in rehabilitation practices addressing functional arm movements in stroke patients. Stroke is a major leading cause of disabilities and death in the United States and it is estimated that about 700,000 new or recurrent strokes occur each year (American Heart Association, 2005; Truelsen et al., 2003; U.S. Department of Health and Human Resources, 1996). Forty-three percent of stroke patients are left with moderate to severe neurological functional impairments and 50% with hemiparesis (Hurst, 1994; Kelly-Hayes et al., 2003). About 75% of stroke patients have upper extremity weakness accompanied by muscle tone (spasticity), decreased muscle strength, decreased range of motion (ROM), and decreased ability to maintain posture and control of movements (Charness, 1995; Dewald, Sheshadri, Dawson, & Beer, 2001; Lawrence et al., 2001). A classic study by Twitchell (1951) pointed out the severity of upper extremity weakness at the onset of a stroke as an important predictor in upper extremity motor recovery following a stroke. In typical motor recovery, the upper extremity is more involved than the lower extremity at the onset and eventually this reverses. Even though most recovery takes place in the first three months, recovery may continue over a longer period of time (eMedicine, 2004). In a study conducted by Broeks, Lankhorst, Rumping, and Prevo (1999), patients showed good recovery of arm functions 16 weeks post-stroke. They also found that even patients four years post-stroke still showed good arm function recovery; therefore, continued outpatient therapy is very beneficial for recovering stroke patients. Because there are parallel neural processes in motor and auditory temporal processing which allows them to be coupled, the motor system is very responsive to the auditory system (Thaut, Kenyon, Schauer, & Mcintosh, 1999). Since temporal information of rhythms and timing information of motor movements have similar neural pathways, they also have parallel neural impulses; thus, motor responses can be entrained (synchronized) to auditory rhythms, making the movement more stable and steady (Thaut, 2003). Because the ability to respond to a rhythm and to discriminate between rhythms is innate (Cassidy & Standley, 1995; Standley, 2003; Trehub, 1 993; Trehub & Thorpe, 1989), it has been speculated that internal auditory rhythm can be a good temporal reference used to produce the complex timing and skilled movement of a motor response (Shaffer, 1982). This innate ability to entrain motor movement to an external rhythm can be effectively used for specific therapeutic goals (Thaut, 2003). Repetitive motor learning and structured training have been generally known to improve motor deficits in stroke rehabilitation (Butefisch, Hummelsheim, Denzler, & Mauritz, 1995; Platz, Bock, & Prass, 2001) through cortical rearrangement (brain plasticity). …

Activity-Based Electrical Stimulation Training in a Stroke Patient With Minimal Movement in the Paretic Upper Extremity

Background. Existing task-specific practice interventions do not increase movement in stroke patients exhibiting minimal distal movement in the paretic upper extremity. Although often used, an important limitation of conventional electrical stimulation is that it does not involve task-specific practice. Objective. To determine the impact of an activity-specific electrical stimulation program on paretic limb impairment, functional limitation, and ability to perform valued activities in a subacute stroke patient exhibiting minimal paretic wrist and hand movement. Method. A female subject exhibiting trace paretic hand and finger movement was administered, 9 months after stroke, the upper extremity section of the Fugl-Meyer Impairment Scale (FM), the Action Research Arm Test (ARAT), and the Arm Motor Ability Test (AMAT). She then engaged in paretic upper extremity, task-specific training incorporating an electrical stimulation neuroprosthesis. Training occurred 3 hours per day, 5 days per week for 3 weeks. The FM, ARAT, and AMAT were again administered. Results. After intervention, she exhibited reduced impairment (evidenced by an FM score change of 22 to 29), decreased functional limitation (evidenced by an ARAT score change of 4 to 10), and increased ability and speed in performing valued AMAT activities. She also reported using the paretic hand and fingers more and new abilities to perform valued activities such as playing piano. Conclusion. Although conventional paretic upper extremity training strategies are ineffective in patients at this level, electrical stimulation training incorporating a neuroprosthesis appears promising.

Leg muscle activation patterns of sit-to-stand movement in stroke patients.

To describe the characteristics of leg muscle activation patterns in hemiplegic stroke patients during the movement of rising from a chair and to determine the differences of leg muscle activation patterns between stroke fallers and nonfallers. Subjects stood up from an armless chair at a comfortable, self-paced speed. Leg muscle activation time and patterns during the sit-to-stand movement were analyzed using multichannel surface electromyography and a force platform. The differences between stroke fallers and nonfallers were compared. The mean onset time of muscle activity in the affected limbs of stroke fallers was markedly delayed for the tibialis anterior muscle and earlier for the soleus muscle. The muscle activation patterns in the affected side of the stroke fallers exhibited a wide range of variation. Seventy percent of our stroke fallers exhibited no or merely low-amplitude activity in their tibialis anterior muscle when the patients were rising from a chair. Half of the stroke fallers exhibited premature or excessive activation of their soleus muscle when the rising activity was initiated. Stroke patients who exhibited no or low-amplitude muscle activity in the tibialis anterior, associated with premature or excessive activation of the soleus muscle in their hemiplegic limbs, when rising from a chair were prone to falling. The compensatory excessive tibialis anterior and quadriceps muscle activation in the unaffected limbs of stroke patients might have a role in preventing them from falling.

Reduction of spastic hypertonia during repeated passive knee movements in stroke patients

Nuyens GE, De Weerdt WJ, Spaepen AJ Jr, Kiekens C, Feys HM. Reduction of spastic hypertonia during repeated passive knee movements in stroke patients. Arch Phys Med Rehabil 2002;83:930-5. Objectives: To quantify changes in spastic hypertonia during repeated passive isokinetic knee movements in stroke patients and to assess the role of muscle activity. Design: A between-groups design with repeated measures. Setting: Rehabilitation center for stroke patients. Participants: Ten stroke patients with hypertonia and 10 healthy subjects matched for age and gender. Intervention: With an isokinetic apparatus, movements were imposed on the knee in series of 10 repetitions at speeds of 60°/s, 180°/s, and 300°/s. Main Outcome Measures: Spastic hypertonia was assessed on the basis of torque measurement and electromyographic activity of the quadriceps, hamstrings, and gastrocnemius muscles. Results: Compared with the controls, stroke patients presented a significantly stronger torque reduction during the mid- and endphases of movements at all speeds tested (P<.05). The strongest torque decline occurred during knee flexion and during the first movements. The effect increased toward the end phase of movements and with increasing speeds. The effect of movement repetitions on torque measurements was unchanged after electromyographic activity was included in the statistical analysis, except during extension movements at 180°/s and 300°/s. Conclusion: Passive movements of the knee induced a decrease of spastic hypertonia in stroke patients through a combination of reflexive and mechanical factors. The role of these mechanisms is velocity dependent and differs for flexion and extension movements. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Event-related fMRI of monitored movements in stroke patients and healthy controls

Event-related fMRI of monitored movements in stroke patients and healthy controls

Unilateral saccadic pursuit in patients with sensory stroke: sign of a pontine tegmentum lesion.

Pure hemisensory syndrome can be caused by small strokes occurring in a number of regions, including the thalamus and pons. Differentiation of the pontine sensory syndrome from the thalamic sensory syndrome has generally been made on the basis of distribution of sensory loss and involvement of specific sensory modalities but not without uncertainties and difficulties. Because the pontine tegmentum plays a pivotal role in generating horizontal eye movement, we attempted to discriminate these 2 syndromes by analyzing horizontal eye movements in stroke patients with pure hemisensory syndrome. Horizontal saccade, pursuit, vestibulo-ocular reflex (VOR), and VOR cancellation (VORC) were evaluated using electro-oculography in 6 patients with hemisensory syndromes, 3 due to pontine stroke and 3 due to thalamic stroke, and all were verified by MRI or CT. In addition, somatosensory evoked potentials (SEPs) were recorded. Smooth pursuit and VORC directed toward the side of the lesion were impaired unilaterally in patients with pontine sensory stroke, whereas those 2 movements were intact bilaterally in patients with thalamic sensory stroke. Saccade and VOR were preserved in all patients. SEPs were normal in all patients with pontine and thalamic sensory strokes. No difference was found in the pattern of sensory disturbance between the 2 types of stroke patients. Ipsilateral impairment of the smooth pursuit system may be a sign of a pontine lesion in patients with hemisensory stroke.

The sit-to-stand movement in stroke patients and its correlation with falling

Objective: To use kinetic assessment of the sit-to-stand movement as a means of sorting out those stroke patients at risk for falling. Design: A retrospective study, using a force platform to assess sit-to-stand performance and to determine its correlation with falls in stroke patients. Setting: Hospital-based rehabilitation units. Methods: Thirty-three stroke patients (18 fallers, 15 nonfallers) and 25 age-matched healthy subjects were included in this study. Subjects sat in an adjustable chair with their feet on two force plates and performed the standing up/sitting down movement at a self-paced, comfortable speed. Results: The rate of rise in force (dF/dT) was significantly lower in stroke fallers than in stroke nonfallers and healthy subjects (23.78 ± 17.38, 55.23 ± 31.24, and 85.96 ± 42.4 percent body weight per second, respectively [ p < .005]). The center of pressure sway in mediolateral direction during rising/ sitting down was much greater in stroke fallers than in stroke nonfallers or healthy subjects ( p < .05). Body weight distribution was asymmetric on the feet of stroke patients, with much more body weight on their sound side. Conclusions: The significantly lower rate of rise in force and greater postural sway while rising/sitting down may be useful in identifying stroke patients who are at risk for falling.

Modification of motor control of wrist extension by mesh-glove electrical afferent stimulation in stroke patients

Objective: To study the effect of mesh-glove afferent stimulation on motor control of voluntary wrist movement in stroke patients who have chronic neurological deficits. Design: Case series. Motor control was evaluated by surface EMG of the arm muscles and kinematics of voluntary wrist movements on 3 occasions: before and immediately after the initial session of mesh-glove stimulation, and then after a daily mesh-glove stimulation program conducted over several months. Setting: Tertiary care center. Patients: The inclusion criteria were: a history of stroke lasting longer than 6 months; completion of a rehabilitation program during early recovery; and preserved cognitive and communicative ability. Fourteen referred patients (age 63 ± 9yr; time since stroke 31 ± 22 mo) fulfilled the criteria and completed the daily stimulation program. Intervention: A single initial and then daily mesh-glove electrical afferent stimulation was applied to the hand of the involved upper limb for 20 to 30min. Main Outcome Measures: Surface EMGs from the affected biceps brachii and wrist extensor muscles and amplitudes of wrist movements were analyzed. Results: The single, initial mesh-glove application had no effect on outcome measures. Following a daily mesh-glove stimulation program, however, both the amplitude of wrist extension movement and wrist extensor integrated EMG were significantly increased while coactivation of biceps brachii decreased. These findings were most prominent in subjects with partially preserved voluntary wrist movements. Conclusion: We conclude that daily mesh-glove stimulation can modify altered motor control and improve voluntary wrist extension movement in stroke subjects with chronic neurological deficits.