Paretic Arm Research Articles

Corticospinal and corticoreticulospinal projections have discrete but complementary roles in chronic motor behaviors after stroke.

After corticospinal tract (CST) stroke, several motor deficits can emerge in the upper extremity (UE), including diminished muscle strength, motor control, and muscle individuation. Both the ipsilesional CST and contralesional corticoreticulospinal tract (CReST) innervate the paretic UE, but their relationship to motor behaviors after stroke remains uncertain. In this cross-sectional study of 15 chronic stroke and 28 healthy subjects, we examined two questions: whether the ipsilesional CST and contralesional CReST differentially relate to chronic motor behaviors in the paretic arm and hand, and whether the severity of motor deficits differ by proximal versus distal location. In the paretic biceps and first dorsal interosseous muscles, we therefore used transcranial magnetic stimulation to measure the projection strengths of the ipsilesional CST and contralesional CReST. We also used quantitative testing to measure strength, motor control, and muscle individuation in each muscle. Stroke subjects had comparable muscle strength to healthy subjects but poorer motor control and muscle individuation. In both muscles, stronger ipsilesional CST projections related to better motor control, whereas stronger contralesional CReST projections related to better muscle strength. Stronger CST projections related to better individuation in the biceps alone. The severity of motor control and individuation deficits was comparable in the arm and hand. These findings suggest that the ipsilesional CST and contralesional CReST have specialized but complementary roles in motor behaviors of the paretic arm and hand. They also suggest that deficits in motor control or muscle individuation are not segmentally biased, underscoring the functional reach and efficacy of the pathways.

Reaching the cognitive-motor interface: effects of cognitive load on arm choice and motor performance after stroke.

A vexing characteristic of motor disability after stroke is that many individuals fail to use their affected arm effectively despite having the capacity to do so, a phenomenon termed arm nonuse. Based on the hypothesis that nonuse is influenced by the competing cognitive demands of many daily activities, we examined the effects of cognitive load on arm choice and motor performance in individuals with stroke using a novel virtual reality paradigm that mimics the demands of real-life visual search, object selection, and reaching to targets. Twenty individuals with single left or right hemispheric chronic stroke (11 left cerebrovascular accident; 9 right cerebrovascular accident) and 10 age-matched neurotypical participants completed the Virtual Reality Arm Choice task, in which they reached for target objects in an array under varied cognitive demand. To manipulate cognitive demand, we varied the semantic similarity of objects in the reaching space and the presence or absence of a secondary task. The results showed reduced use of the paretic arm under increased demand. Under cognitive load, participants with stroke also showed slower reach initiation, slower movements, increased reach curvature, and increased performance differences between the paretic and non-paretic arms. The arm choice of neurotypical individuals was also modulated under cognitive load. These data indicate that cognitive factors influence arm choice and motor performance in naturalistic reaching tasks in individuals with chronic stroke. Performance decrements under cognitive load may in turn influence reduced paretic arm use during daily activities.

Heightened Reticulospinal Excitability after Severe Corticospinal Damage in Chronic Stroke.

After severe corticospinal tract damage poststroke in humans, some recovery of strength and movement proximally is evident. It is possible that alternate motor pathways, such as the reticulospinal tract, may be upregulated to compensate for the loss of corticospinal tract input. We investigated the extent of reticulospinal tract excitability modulation and its inter-dependence on the severity of corticospinal tract damage after stroke in humans. We used a novel startle conditioned transcranial magnetic stimulation paradigm to elicit ipsilateral motor evoked potentials, an index of reticulospinal tract excitability, in 22 chronic stroke participants with mild to severe corticospinal tract damage and 14 neurotypical age-matched controls. We found that ipsilateral motor evoked potential presence was higher in the paretic arm of people with severe corticospinal tract damage compared to their non-paretic arm, people with mild corticospinal tract damage, and age-matched controls. Interestingly, ipsilateral motor evoked potential presence was correlated with motor impairment across the entire stroke cohort, whereby individuals with worse impairment exhibited more frequent ipsilateral motor evoked potentials (ie, higher reticulospinal tract excitability). Following severe corticospinal tract damage, upregulated reticulospinal tract activity may compensate for a loss of corticospinal tract input, providing some proximal recovery of isolated and within-synergy movements, but deficits in performing out of synergy movements and finger fractionation remain. Interventions aimed at modulating the reticulospinal tract could be beneficial or detrimental to ameliorating motor impairment depending on the degree of reliance on this pathway for residual motor output. ANN NEUROL 2024.

Gamified Practice Improves Paretic Arm Motor Behavior in Individuals With Stroke

Background Stroke is a heterogeneous condition, making choice of treatment, and determination of how to structure rehabilitation outcomes difficult. Individualized goal-directed and repetitive physical practice is an important determinant of motor learning. Yet, many investigations of motor learning after stroke deliver task practice without consideration of individual capability of the learner. Objective We developed a gamified arm rehabilitation task for people with stroke that is personalized to individual capacity for paretic arm movement, provides a high dose of practice, progresses through increasingly difficulty levels that are dependent on the performance of the individual, and is practiced in an engaging environment. The objectives of the current study were to determine if 10 days of gamified, object intercept training using the paretic arm would improve arm movement speed and clinical outcome measures of impairment or function. Methods Individuals with chronic stroke and age-matched controls engaged in 10 days of gamified, skilled motor practice of a semi-immersive virtual reality-based intercept and release task. The paretic arm was assessed using the Fugl-Meyer Assessment (motor impairment) and Wolf Motor Function Test (motor function) before and after training. Results Both groups showed faster arm movement speed with practice; individuals with stroke demonstrated reduced paretic arm motor impairment and increased function after the intervention. Age and sex (for both groups), and time post-stroke were not related to changes in movement speed. Conclusions Findings indicate that gamified motor training positively affects paretic arm motor behavior in individuals with mild to severe chronic stroke.

The Perspectives of Individuals with Chronic Stroke on Motor Recovery: A Qualitative Analysis.

The priorities of individuals with chronic stroke are not always reflected in clinical practice. This study provides insight into meaningful factors related to long-term motor recovery in stroke survivors. Thirty individuals with chronic stroke participated in semi-structured interviews about movement, recovery, and barriers to and facilitators of mobility and paretic arm use. The interviews were analyzed using inductive thematic analysis. Three categories, the individual, environment, and task, defined five emergent themes. Individual: (1) mindset is a strong and consistent influencer of daily physical activity and overall recovery; (2) severe physical impairment limits physical activity and recovery, regardless of other factors; and (3) a negative perception of disability impacts mindset and willingness to move in public. Environment: (4) social and physical environments influence physical activity and recovery. Task: (5) participation in meaningful activities increases physical activity and promotes long-term recovery. Strategies to incorporate paretic arm use, exercise, and encouragement from others facilitate physical activity. Insufficient paretic limb function, environmental obstacles, and fear are barriers to physical activity. Neurorehabilitation must address the factors that are meaningful to stroke survivors. Building motor capacity is essential and must be integrated with factors such as a positive mindset and proper environment. Individual differences reinforce the need for personalized care.

Recuperación funcional del brazo parético mediante la Terapia de Movimiento Inducido por Restricción en modalidad remota versus presencial: Un estudio en pacientes post- ictus de nivel socioeconómico bajo o medio.

Background: Evidence suggests that low socioeconomic status (SES), being associated with lower digital alphabetization, may affect post-stroke telerehabilitation outcomes. Objectives: To compare in patients of low and medium SES (1) the functional recovery of the paretic arm when applying Modified Constraint-Induced Movement Therapy (CIMTm) in remote versus face-to-face modality and (2) to examine the role of patient's experience with the remote modality in this recovery. Material and methods: Randomized clinical trial composed of two intervention groups exposed to TeleCIMTm (n=22) and CIMTm (n=26). Assestment of upper limb function in the paretic arm was done at baseline (T1), at the end of de intervention, and one month later. Additionally, in T2 a survey was applied for measure the user experience on the remote modality. Results: Following the intervention (T2) it was found that both modalities increased the function of the paretic arm. However, when comparing data by sex in the TeleCIMTm group, men increased function to a greater extent, while in the CIMTm group there were no significant differences by sex. At the follow-up assessment (T3), participants continued to improve function regardless of modality and gender. In relation to the user experience, women reported a greater frequency of unfavorable events. Conclusions: The effectiveness of TeleCIMTm is comparable to the in-person version. The digital skills of patients with low and medium SES seem to be sufficient to benefit functionally from TeleCIMTm if optimal contextual conditions are guaranteed for carrying out the sessions. Key words: telerehabilitation, stroke, upper extremity (arm), occupational therapy, physiotherapy

New technology to address affected vs nonaffected arm contributions to ergometer performance in people poststroke

ABSTRACT Background When pedaling a coupled-crank arm ergometer, individuals with hemiplegia may experience nonparetic arm overcompensation, and paretic arm resistance, due to neuromechanical deficits. Technologies that foster independent limb contributions may increase the effectiveness of exercise for people poststroke. Objective Examine the speed during uncoupled pedaling with the Advanced Virtual Exercise Environment Device among individuals poststroke and non-impaired comparisons. Methods We recruited 2 groups:Poststroke and Comparison. Participants attended one lab session and performed peak speed tests and a graded exercise repeated for bilateral pedaling, unilateral (left, right). Results Thirty-one participants completed the protocol (16 women, 15 men). Poststroke participants pedaled slower during the bilateral speed test (64 ± 39 RPM, p < .001), and graded exercise, (54 ± 28 RPM, p < .001) versus comparisons (141 ± 19, 104 ± 12 RPM). Poststroke individuals had lower peak RPM during the unilateral speed test with their paretic arm (70 ± 46 RPM, p < .001) and graded exercise (58 ± 33 RPM, p < .001) compared to their unilateral speed test (130 ± 37 RPM) and graded exercise (108 ± 25 RPM) with their nonparetic arm. Comparisons did not differ between arms during speed tests and graded exercise. Poststroke participants demonstrated lower peak speed with their affected arm during the bilateral speed test (52 ± 42 RPM, p < .001) and graded exercise (49 ± 28 RPM, p = .008) compared to the same arm during unilateral speed (70 ± 46 RPM) and graded exercise (58 ± 33 RPM). Conclusions Poststroke participants pedaled faster with their affected arm unilaterally versus bilateral pedaling, suggesting interhemispheric interference that reduces the ability to recruit the paretic arm during bilateral exercise.

Applying a Motivational Instructional Design Model to Stroke Rehabilitation: A Feasibility Study on Occupational and Swallowing Therapies

ObjectiveTo investigate the feasibility of poststroke interventions using a motivational instructional design model with occupational therapy (OT) and swallowing therapy (ST) and the model's potential physical and mental health effects. DesignAn open-label, single-arm, feasibility study on the Attention, Relevance, Confidence, and Satisfaction model. SettingTwo convalescent rehabilitation wards. ParticipantsTwenty-five patients with stroke (N=25) (19 men; mean age, 62.4±11.9y; 61.9±36.8d from the first stroke) were recruited. InterventionsTwelve participants received a motivational approach based on the Attention, Relevance, Confidence, and Satisfaction model during OT (OT group), and 13 received it during ST (ST group). The intervention lasted 40-60 minutes daily, 5 days weekly, for 4 weeks. Main Outcome MeasuresThe primary outcomes included the dropout rate, an adverse event, and the participants’ acceptability of the intervention. Paretic arm function was assessed in the OT group; swallowing ability was assessed in the ST group; and activities of daily living, depressive symptoms, and apathy were assessed in both groups. ResultsNo participants dropped out of the intervention or experienced an adverse event. Twenty-one participants (84%) were satisfied with the intervention, and 19 (76%) hoped to continue receiving it. The OT group showed statistically significant improvements in paretic arm function and activities of daily living (Cohen's r=0.68-0.77), whereas the ST group improved in swallowing ability, activities of daily living, and depressive symptoms (Cohen's r=0.62-0.85). ConclusionsThe interventions using the motivational instructional model with OT and ST were feasible and could improve poststroke paretic arm function, swallowing ability, and activities of daily living after stroke.

Exergames as a rehabilitation tool to enhance the upper limbs functionality and performance in chronic stroke survivors: a preliminary study.

Post-stroke hemiplegia commonly occurs in stroke survivors, negatively impacting the quality of life. Despite the benefits of initial specific post-acute treatments at the hospitals, motor functions, and physical mobility need to be constantly stimulated to avoid regression and subsequent hospitalizations for further rehabilitation treatments. This preliminary study proposes using gamified tasks in a virtual environment to stimulate and maintain upper limb mobility through a single RGB-D camera-based vision system (using Microsoft Azure Kinect DK). This solution is suitable for easy deployment and use in home environments. A cohort of 10 post-stroke subjects attended a 2-week gaming protocol consisting of Lateral Weightlifting (LWL) and Frontal Weightlifting (FWL) gamified tasks and gait as the instrumental evaluation task. Despite its short duration, there were statistically significant results (p < 0.05) between the baseline (T0) and the end of the protocol (TF) for Berg Balance Scale and Time Up-and-Go (9.8 and -12.3%, respectively). LWL and FWL showed significant results for unilateral executions: rate in FWL had an overall improvement of 38.5% (p < 0.001) and 34.9% (p < 0.01) for the paretic and non-paretic arm, respectively; similarly, rate in LWL improved by 19.9% (p < 0.05) for the paretic arm and 29.9% (p < 0.01) for non-paretic arm. Instead, bilateral executions had significant results for rate and speed: considering FWL, there was an improvement in rate with p < 0.01 (31.7% for paretic arm and 37.4% for non-paretic arm), whereas speed improved by 31.2% (p < 0.05) and 41.7% (p < 0.001) for the paretic and non-paretic arm, respectively; likewise, LWL showed improvement in rate with p < 0.001 (29.0% for paretic arm and 27.8% for non-paretic arm) and in speed with 23.6% (p < 0.05) and 23.5% (p < 0.01) for the paretic and non-paretic arms, respectively. No significant results were recorded for gait task, although an overall good improvement was detected for arm swing asymmetry (-22.6%). Hence, this study suggests the potential benefits of continuous stimulation of upper limb function through gamified exercises and performance monitoring over medium-long periods in the home environment, thus facilitating the patient's general mobility in daily activities.

1897 Older stroke survivors and rehabilitation therapists’ views on home-based resistance exercise for upper limbs

Abstract Introduction Upper limb recovery after stroke depends on participating in personalised task-specific exercise programmes. However, older adults with stroke find it challenging to maintain an optimal level of engagement with such exercise programmes due to personal and environmental factors. The aim of this study was to explore the views of stroke survivors and rehabilitation therapists on home-based resistance exercises for upper limbs. Method A qualitative study of semi-structured virtual and in-person interviews was conducted between January and March 2023 in England. Participants were 11 older adults &amp;gt;65 years (6 females (55%), with chronic stroke (&amp;gt;1 year after a stroke) and moderate to severe disabilities. Twenty rehabilitation therapists were also interviewed (3 physiotherapists, and 17 Action for Rehabilitation from Neurological Injury (ARNI) instructors). The group was asked about perceived personal and environmental barriers and facilitators as well as expectations of resistance exercises in relation to upper limb neurorehabilitation programmes. Interview sessions were audio recorded for transcription and thematic data analysis. The study was approved by Sheffield Hallam University ethics committee (reference number: AA43961583). Results Both groups mentioned that the main barrier to performing upper-limb exercises is weakness in the paretic arm affecting grip strength with consequent adverse impact on adherence to a home-based programme and poor patient motivation. Patients also reported safety concerns such as dropping equipment and being dependent on a carer to undertake regular exercises. Stroke survivors preferred a program that activates the paretic arm and is relevant to their daily functional activities. They preferred simple exercise instructions and demonstrations through visual aids and video materials. Patients also valued regular feedback on adjusting their exercise dose, monitoring progress over time, and ongoing encouragement. Conclusions Our study showed that designing home-based resistance exercises for upper limb in older stroke survivors should be individualised, functionally orientated, and motivational.

Effectiveness of Constraint Induced Movement Therapy and Proprioceptive Neuromuscular Facilitation on Upper Extremity Functions in Stroke

Background: Stroke is the quickly developing clinical indication of a focal disruption of brain function that lastsmore than 24 hours or results in death, with no discernible cause other than vascular origin. Despite the fact thatthe majority of patients are able to walk again, 30% to 60% of survivors are no longer able to use the arm that wasinjured. CIMT aims at improves both the motor and functional capacities of a paretic arm. PNF exercises alter theorder in which muscles are stimulated, increases the efficiency of joint movement.Purpose: To compare the effectiveness of Constraint Induced Movement Therapy and ProprioceptiveNeuromuscular Facilitation for treating upper extremity functions in stroke.Materials and Methods: A total of 30 participants were selected from Sree Annai Physiotherapy Clinic Chennai.According to the inclusion and exclusion criteria. Subjects willing to participate were allocated into two groupsConstraint Induced Movement Therapy group and Proprioceptive Neuromuscular Facilitation group. Theparticipants underwent Pre-test measurement with Fugl-Meyer Assessment Upper Extremity FMA-UE and wererepeated for Post-test measurement. Study period : November 2022 to April 2023.Results: When comparing the mean differences of the two groups, Constraint Induced Movement Therapygroup displays a greater difference than Proprioceptive Neuromuscular Facilitation group. Therefore, it can besaid that Constraint Induced Movement Therapy is more advantageous for the upper extremity functions thanProprioceptive Neuromuscular Facilitation.Conclusion: The study concluded that Constraint Induced Movement Therapy is found to be more effective thanProprioceptive neuromuscular facilitation technique for upper extremity function recovery.

Wearable Technology to Capture Arm Use of People With Stroke in Home and Community Settings: Feasibility and Early Insights on Motor Performance.

The objectives of this study were to establish the short-term feasibility and usability of wrist-worn wearable sensors for capturing the arm and hand activity of people with stroke and to explore the association between factors related to the use of the paretic arm and hand. Thirty people with chronic stroke were monitored with wrist-worn wearable sensors for 12hours per day for a 7-day period. Participants also completed standardized assessments to capture stroke severity, arm motor impairments, self-perceived arm use, and self-efficacy. The usability of the wearable sensors was assessed using the adapted System Usability Scale and an exit interview. Associations between motor performance and capacity (arm and hand impairments and activity limitations) were assessed using Spearman correlations. Minimal technical issues or lack of adherence to the wearing schedule occurred, with 87.6% of days procuring valid data from both sensors. The average sensor wear time was 12.6 (standard deviation [SD] = 0.2) hours per day. Three participants experienced discomfort with 1 of the wristbands, and 3 other participants had unrelated adverse events. There were positive self-reported usability scores (mean = 85.4/100) and high user satisfaction. Significant correlations were observed for measures of motor capacity and self-efficacy with paretic arm use in the home and the community (Spearman correlation coefficients = 0.44-0.71). This work demonstrates the feasibility and usability of a consumer-grade wearable sensor for capturing paretic arm activity outside the laboratory. It provides early insight into the everyday arm use of people with stroke and related factors, such as motor capacity and self-efficacy. The integration of wearable technologies into clinical practice offers new possibilities to complement in-person clinical assessments and to better understand how each person is moving outside of therapy and throughout the recovery and reintegration phase. Insight gained from monitoring the arm and hand use of people with stroke in the home and community is the first step toward informing future research with an emphasis on causal mechanisms with clinical relevance.

Inter-arm blood pressure difference in post-stroke patients with hemiparesis.

The aim of this study was to investigate that inter-arm blood pressure (BP) difference (IAD) and reference arm in 420 post-stroke patients with hemiparesis. Synchronous bilateral-arm BP was measured with two automatic BP devices, and the systolic BP difference of ≥10 mm Hg was recorded as increased sIAD. The arm with higher systolic BP (SBP) was assigned as the reference arm. Our results showed that the prevalence of sIAD was 18.1% in the total group. The paretic arms had similar mean SBP levels (133.6±18.4 vs. 133.8±18.4 mm Hg, NS) and DBP (77.8±11.5 vs. 77.2±10.9 mm Hg, NS) as compared with the unaffected arms. The detection rate of hypertension or uncontrolled hypertension on the SBP values of the reference arm was higher than that on the unaffected arm (41.8% vs. 36.3%). It is concluded that in the post-stroke patients with hemiparesis in the rehabilitation period, the prevalence of sIAD ≥10 mmHg was relatively higher, and using the unaffected arm, rather than the unaffected arm, for BP measurement could induce correctly detection of hypertension.

The Results of Targeted Training in the Rehabilitation of Patients with a Combination of Motor and Speech Disorders

AIM. To evaluate the effectiveness of using a rehabilitation glove in patients with central paresis of the arm and motor aphasia due to ischemic stroke, and also to study the rate of motor production in the upper limb in these patients.&#x0D; MATERIALS AND METHODS. We examined 49 patients with hemiparesis and motor aphasia in the early recovery period of ischemic stroke in the left middle cerebral artery. Depending on the fact of conducting training with the use of a rehabilitation glove, patients were randomly distributed into two groups (1, where this training option was implemented, and 2 — without it), comparable in the severity of motor and speech disorders. Within each of them, patients were additionally divided into subgroups, depending on the degree of paresis in the distal part of the affected upper limb: L-mild (in group 1L — 18 people, 2L — 16) and U-moderate (in group 1U — 8, and 2U — 7 patients). On days 1 and 10 of training, all patients underwent functional testing. Treatment and rehabilitation were carried out according to the order of care. Patients of groups 1L and 1U additionally received a course of 10 sessions, including 2 exercises of 15 minutes each for a paretic arm 5 times a week.&#x0D; RESULTS. Patients of groups 1L and 1U demonstrated statistically significant improvements in the Medical Research Committee Scale, the ARAT Arm Motor Activity Test, the Wasserman Speech Impairment Rating Scale, and the Montreal Cognitive Function Rating Scale. According to amplitude indicators, there was a tendency towards their increase in all groups. A decrease in the number of errors and an increase in the percentage of correct task completion accompanied the development of a motor act. They stabilized in patients with mild paresis of the hand by 5–6 sessions and in patients with moderate paresis by 6–7 sessions.&#x0D; CONCLUSION. In patients with mild to moderate paresis of the right hand in combination with motor aphasia in the early recovery period of ischemic stroke, when using a rehabilitation glove, there was an improvement in the strength and motor activity of the paretic hand, cognitive functions and speech. Stabilization of task performance indicators should be taken into account when determining the duration of training and timely correction of the motor rehabilitation program.

A metric for characterizing the arm nonuse workspace in poststroke individuals using a robot arm.

An overreliance on the less-affected limb for functional tasks at the expense of the paretic limb and in spite of recovered capacity is an often-observed phenomenon in survivors of hemispheric stroke. The difference between capacity for use and actual spontaneous use is referred to as arm nonuse. Obtaining an ecologically valid evaluation of arm nonuse is challenging because it requires the observation of spontaneous arm choice for different tasks, which can easily be influenced by instructions, presumed expectations, and awareness that one is being tested. To better quantify arm nonuse, we developed the bimanual arm reaching test with a robot (BARTR) for quantitatively assessing arm nonuse in chronic stroke survivors. The BARTR is an instrument that uses a robot arm as a means of remote and unbiased data collection of nuanced spatial data for clinical evaluations of arm nonuse. This approach shows promise for determining the efficacy of interventions designed to reduce paretic arm nonuse and enhance functional recovery after stroke. We show that the BARTR satisfies the criteria of an appropriate metric for neurorehabilitative contexts: It is valid, reliable, and simple to use.

Post-stroke deficits in the anticipatory control and bimanual coordination during naturalistic cooperative bimanual action

BackgroundUnilateral stroke leads to asymmetric deficits in movement performance; yet its effects on naturalistic bimanual actions, a key aspect of everyday functions, are understudied. Particularly, how naturalistic bimanual actions that require the two hands to cooperatively interact with each other while manipulating a single common object are planned, executed, and coordinated after stroke is not known. In the present study, we compared the anticipatory planning, execution, and coordination of force between individuals with left and right hemisphere stroke and neurotypical controls in a naturalistic bimanual common-goal task, lifting a box.MethodThirty-three individuals with chronic stroke (15 LCVA, 18 RCVA) and 8 neurotypical age-matched controls used both hands to lift a box fitted with force transducers under unweighted and weighted conditions. Primary dependent variables included measures of anticipation (peak grip and load force rate), execution (peak grip force, load force), and measures of within-hand (grip-load force coordination) and between-hand coordination (force rate cross-correlations). Primary analyses were performed using linear mixed effects modeling. Exploratory backward stepwise regression examined predictors of individual variability within participants with stroke.ResultsParticipants with stroke, particularly the RCVA group, showed impaired scaling of grip and load force rates with the addition of weight, indicating deficits in anticipatory control. While there were no group differences in peak grip force, participants with stroke showed significant impairments in peak load force and in grip-load force coordination with specific deficits in the evolution of load force prior to object lift-off. Finally, there were differences in spatial coordination of load force rates for participants with stroke, and especially the RCVA group, as compared to controls. Unimanual motor performance of the paretic arm and hemisphere of lesion (right hemisphere) were the key predictors of impairments in anticipatory planning of grip force and bimanual coordination among participants with stroke.ConclusionsThese results suggest that individuals with stroke, particularly those with right hemisphere damage, have impairments in anticipatory planning and interlimb coordination of symmetric cooperative bimanual tasks.

Feasibility of Shoulder Kinematics Assessment Using Magnetic Inertial Measurement Units in Hemiplegic Patients after Stroke: A Pilot Study

Scapulothoracic movements are altered after stroke, with resulting shoulder dysfunction. The scapulohumeral rhythm (SHR) is complex and poorly studied. Magnetic inertial measurement units (MIMUs) allow a rapid and accurate analysis of shoulder kinematics. MIMUs were used to assess the SHR during active shoulder flexion and abduction of over 60°. SHR values obtained from the hemiplegic shoulders of stroke patients (n = 7) were compared with those from healthy controls (n = 25) and correlated with clinical–functional measurements. The impairment of paretic arms was assessed using the Fugl-Meyer Assessment (FMA). We found that in paretic shoulders, the scapular tilt was significantly lower at maximal arm flexion and at 60° and 90° of arm abduction. On the paretic side, the SHR was also consistently lower for all measured arm movements. The FMA was correlated with the scapular anterior–posterior tilt at 60° and 90° of shoulder abduction (Rho = 0.847, p = 0.016, and Rho = 0.757, p = 0.049, respectively). This pilot study demonstrates the feasibility of MIMUs in assessing SHR in stroke patients and confirms previous findings on scapular dysfunction in stroke patients.

Delirium detection using wearable sensors and machine learning in patients with intracerebral hemorrhage

ObjectiveDelirium is associated with worse outcomes in patients with stroke and neurocritical illness, but delirium detection in these patients can be challenging with existing screening tools. To address this gap, we aimed to develop and evaluate machine learning models that detect episodes of post-stroke delirium based on data from wearable activity monitors in conjunction with stroke-related clinical features.DesignProspective observational cohort study.SettingNeurocritical Care and Stroke Units at an academic medical center.PatientsWe recruited 39 patients with moderate-to-severe acute intracerebral hemorrhage (ICH) and hemiparesis over a 1-year period [mean (SD) age 71.3 (12.20), 54% male, median (IQR) initial NIH Stroke Scale 14.5 (6), median (IQR) ICH score 2 (1)].Measurements and main resultsEach patient received daily assessments for delirium by an attending neurologist, while activity data were recorded throughout each patient's hospitalization using wrist-worn actigraph devices (on both paretic and non-paretic arms). We compared the predictive accuracy of Random Forest, SVM and XGBoost machine learning methods in classifying daily delirium status using clinical information alone and combined with actigraph data. Among our study cohort, 85% of patients (n = 33) had at least one delirium episode, while 71% of monitoring days (n = 209) were rated as days with delirium. Clinical information alone had a low accuracy in detecting delirium on a day-to-day basis [accuracy mean (SD) 62% (18%), F1 score mean (SD) 50% (17%)]. Prediction performance improved significantly (p &amp;lt; 0.001) with the addition of actigraph data [accuracy mean (SD) 74% (10%), F1 score 65% (10%)]. Among actigraphy features, night-time actigraph data were especially relevant for classification accuracy.ConclusionsWe found that actigraphy in conjunction with machine learning models improves clinical detection of delirium in patients with stroke, thus paving the way to make actigraph-assisted predictions clinically actionable.

Shear wave ultrasound elastography of the biceps brachii can be used as a precise proxy for passive elbow torque in individuals with hemiparetic stroke.

Muscle tissue is prone to changes in composition and architecture following stroke. Changes in muscle tissue of the extremities are thought to increase resistance to muscle elongation or joint torque under passive conditions. These effects likely compound neuromuscular impairments, exacerbating movement function. Unfortunately, conventional rehabilitation is devoid of precise measures and relies on subjective assessments of passive joint torques. Shear wave ultrasound elastography, a tool to measure muscle mechanical properties, may be readily available for use in the rehabilitation setting as a precise measure, albeit at the muscle-tissue level. To support this postulation, we evaluated the criterion validity of shear wave ultrasound elastography of the biceps brachii; we investigated its relationship with a laboratory-based criterion measure for quantifying elbow joint torque in individuals with moderate to severe chronic stroke. Additionally, we evaluated construct validity, with the specific sub-type of hypothesis testing of known groups, by testing the difference between arms. Measurements were performed under passive conditions at seven positions spanning the arc of elbow joint flexion-extension in both arms of nine individuals with hemiparetic stroke. Surface electromyography was utilized for threshold-based confirmation of muscle quiescence. A moderate relationship between the shear wave velocity and elbow joint torque was identified, and both metrics were greater in the paretic arm. Data supports the progression toward a clinical application of shear wave ultrasound elastography in evaluating altered muscle mechanical properties in stroke, while acknowledging that undetectable muscle activation or hypertonicity may contribute to the measurement. Shear wave ultrasound elastography may augment the conventional method of manually testing joint mobility by providing a high-resolution precise value. Tissue-level measurement may also assist in identifying new therapeutic targets for patient-specific impairment-based interventions.

Botulinum Toxin-A Treatment of Post-Stroke Spasticity Is Associated with Changes in Interhemispheric Parietal Cortex Connectivity (P12-8.001)

<h3>Objective:</h3> To assess resting-state functional connectivity (rsFC) of the ipsilesional superior parietal lobule (SPL) and intraparietal sulcus (IPS) using functional magnetic resonance imaging (fMRI) in chronic stroke patients with hemiparesis both with and without post-stroke spasticity (PSS) and to explore the relationship between SPL/IPS resting-state functional connectivity (rsFC) and PSS severity. <h3>Background:</h3> Posts-stroke spasticity hampers effective rehabilitation of the paretic arm and lowers the quality of life. Effective PSS treatment with botulinum neurotoxin (BoNT) is associated with transient decrease in task-related fMRI activation of the ipsilesional SPL and IPS. We hypothesized that this would be reflected in changes in rsFC of the SPL/IPS. <h3>Design/Methods:</h3> Fourteen chronic stroke patients with upper limb weakness and PSS (the PSS group) and 8 patients with comparable weakness but no PSS (the control group) underwent clinical and spasticity evaluation and 3 fMRI examinations, at baseline (W0) and 4 and 11 weeks after BoNT (W4 and W11, respectively). Seed-based rsFC of the atlas-based SPL and IPS was evaluated using a group×time interaction analysis and the change in rsFC of SPL/IPS was correlated with change in PSS (modified Ashworth scale), integrity of the ipsilesional somatosensory afferent pathway (evoked potential N20 latency), and age. <h3>Results:</h3> In the PSS group, transient improvement in PSS was associated with increase in rsFC between the ipsilesional IPS and the contralesional SPL at W4. The interhemispheric connectivity was negatively correlated with PSS severity at baseline and with PSS improvement at W4. These changes in the posterior parietal interhemispheric rsFC suggest that previously observed task-related changes in SPL/IPS were independent of actual task performance. <h3>Conclusions:</h3> We propose adaptation of the internal forward model as the possible underlying mechanism and discuss its potential association with increased limb use or improved motor performance, as well as its potential contribution to the clinical effects of BoNT. <b>Disclosure:</b> The institution of Prof. Hlustik has received research support from Czech Health Research Council (AZV CR). Dr. Hok has nothing to disclose. Tomas Veverka has nothing to disclose. Markéta Trnecková has nothing to disclose. Pavel Otruba has nothing to disclose. Jana Zapletalova has nothing to disclose. Zbynek Tudos has nothing to disclose. Prof. Lotze has received publishing royalties from a publication relating to health care. Dr. Kanovsky has nothing to disclose.