Paretic Hand In Patients Research Articles

A New Idea for Stroke Rehabilitation: Bilateral Transfer Analysis from Healthy Hand to the Paretic One with a Randomized and Controlled Trial

Background: Bilateral transfer of a motor skill is a phenomenon according to which, one hand can teach a skill to the other hand. In this research, controlled and randomized, we tested the ability of bilateral transfer (BT) to improve the coordination of the paretic hand in patients that suffered a stroke, with the aim of restricting the field for further research on the impact of BT in rehabilitation, we analyzed the differences in the expression of BT phenomenon among sexes and side of hemyparesis. Methods: 34 right-handed patients, at the end of the rehabilitation period, were randomly divided into two groups: test and control. They all had a stroke in a single hemisphere in the previous six months and they were selected by a physical examination, the time elapsed from the stroke and cognitive requirements. The experiment consisted in training the healthy hand of each patient from the test group to execute the nine hole peg test (NHPT) 10 times a day, for 3 consecutive days, and then test the paretic hand with the same test and with bimanual tasks. The control group was not trained but went through the same analysis. Results: In the test group we found that the execution speed of NHPT with the paretic hand, after training the healthy hand, was on average 22.6% faster than the value recorded at baseline. Meanwhile, no significant difference was found in the control group. The analysis showed a greater impact of BT among male patients, who were in average 31% faster than controls, and in non dominant paretic hands, that were 30% faster after training. Conclusions: BT was present in hemiparethic patients with moderate stroke after a short time span, it was more evident among male subjects, and from the dominant hand to the paretic non-dominant one.

脳機能解析と神経リハビリテーション

Recent studies of functional neuroimaging and clinical neurophysiology have implied that functional recovery after stroke is associated with use-dependent plasticity of the damaged brain. However the property of the reorganized neural network depends on site and size of the lesion, which makes it difficult to assess what the adaptive plasticity is. From clinical point of view there is accumulating randomized controlled trials for the benefit of task-oriented rehabilitative intervention including constraint-induced movement therapy, robotics, and body-weight supported treadmill training. However dose-matched control intervention is usually as effective as a specific intervention. This raises a question regarding the specificity of a task-oriented intervention. Second question is whether such intervention goes beyond the biological destiny of human. Specifically there is no known strategy enhancing recovery of severely impaired hand. To augment functional gain, several methods of neuro-modulation may bring break-through on the assumption that they induce greater adaptive plasticity. Such neuro-modulative methods include neuropharmacological modulation, brain stimulation using transcranial magnetic stimulation and direct current stimulation, peripheral nerve stimulation, neurofeedback using real-time fMRI and real-time fNIRS, and brain-machine interface. A preliminary randomized controlled trial regarding real-time feedback of premotor activities revealed promising results for recovery of paretic hand in patients with stroke.

Transcranial magnetic stimulation in mild to severe hemiparesis early after stroke: a proof of principle and novel approach to improve motor function

Low-frequency repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere can enhance function of the paretic hand in patients with mild motor impairment. Effects of low-frequency rTMS to the contralesional motor cortex at an early stage of mild to severe hemiparesis after stroke are unknown. In this pilot, randomized, double-blind clinical trial we compared the effects of low-frequency rTMS or sham rTMS as add-on therapies to outpatient customary rehabilitation, in 30 patients within 5-45 days after ischemic stroke, and mild to severe hand paresis. The primary feasibility outcome was compliance with the interventions. The primary safety outcome was the proportion of intervention-related adverse events. Performance of the paretic hand in the Jebsen-Taylor test and pinch strength were secondary outcomes. Outcomes were assessed at baseline, after ten sessions of treatment administered over 2 weeks and at 1 month after end of treatment. Baseline clinical features were comparable across groups. For the primary feasibility outcome, compliance with treatment was 100% in the active group and 94% in the sham group. There were no serious intervention-related adverse events. There were significant improvements in performance in the Jebsen-Taylor test (mean, 12.3% 1 month after treatment) and pinch force (mean, 0.5 Newtons) in the active group, but not in the sham group. Low-frequency rTMS to the contralesional motor cortex early after stroke is feasible, safe and potentially effective to improve function of the paretic hand, in patients with mild to severe hemiparesis. These promising results will be valuable to design larger randomized clinical trials.

Transkranielle Stimulation in der Neurorehabilitation

Schlaganfall ist der Hauptgrund für Langzeitbehinderung und schränkt das berufliche, private und soziale Leben der Patienten signifikant ein. In Deutschland erleiden jedes Jahr zwischen 200 000 und 250 000 Menschen einen Schlaganfall. Leider erholt sich nur ein kleiner Teil der Patient so, dass sie ihr vorheriges berufliches und soziales Leben wieder voll aufnehmen können. Trotz grosser Anstrengungen zur Entwicklung neuer, effizienter Therapieverfahren ist das Ausmaß der funktionellen Regeneration nach Schlaganfall noch nicht zufrieden stellend. Daher hat die Entwicklung neuer, innovativer und effizienter Therapieverfahren eine grosse Bedeutung für Patienten, deren Umfeld und für das Gesundheitssystem. In ersten ,Proof-of-Principle-Studien‘ konnte nicht-invasive kortikale Hirnstimulation als eine viel versprechende Methode zur Verbesserung der funktionellen Regeneration nach Schlaganfall identifiziert werden. Zur Anwendung kommen die transkranielle Magnetstimulation (TMS) und die transkranielle Gleichstromstimulation (TDCS). In der folgenden Übersichtsarbeit sollen interventionelle Strategien, basierend auf kortikaler Hirnstimulation, im Hinblick auf funktionelle Regeneration nach Schlaganfall vorgestellt und diskutiert werden.

Repetitive transcranial magnetic stimulation over bilateral hemispheres enhances motor function and training effect of paretic hand in patients after stroke

The interhemispheric competition model proposes that the functional recovery of motor deficits in patients after stroke can be achieved by increasing the excitability of the affected hemisphere or decreasing the excitability of the unaffected hemisphere. We investigated whether bilateral repetitive transcranial magnetic stimulation might improve the paretic hand in patients after stroke. A double-blind study. Thirty patients with chronic subcortical stroke. The patients were randomly assigned to receive 1 Hz repetitive transcranial magnetic stimulation over the unaffected hemisphere, 10 Hz repetitive transcranial magnetic stimulation over the affected hemisphere, or bilateral repetitive transcranial magnetic stimulation comprising both the 1 Hz and 10 Hz repetitive transcranial magnetic stimulation. All patients underwent motor training following repetitive transcranial magnetic stimulation. Bilateral repetitive transcranial magnetic stimulation and 1 Hz repetitive transcranial magnetic stimulation immediately improved acceleration in the paretic hand. Compared with 1 Hz repetitive transcranial magnetic stimulation, bilateral repetitive transcranial magnetic stimulation decreased the inhibitory function of the affected motor cortex and enhanced the effect of motor training on pinch force. Moreover, this effect of motor training lasted for one week. On the other hand, 10 Hz repetitive transcranial magnetic stimulation had no effect on the motor function. Bilateral repetitive transcranial magnetic stimulation improved the motor training effect on the paretic hand of patients after stroke more than unilateral stimulation in pinch force; this might indicate a new neurorehabilitative strategy for stroke.

EEG-based Brain–Machine Interface induces neurorehabilitative recovery of paretic hand in patients with chronic stroke

EEG-based Brain–Machine Interface induces neurorehabilitative recovery of paretic hand in patients with chronic stroke

Inhibition of the unaffected motor cortex by 1 Hz repetitive transcranical magnetic stimulation enhances motor performance and training effect of the paretic hand in patients with chronic stroke

Recent reports demonstrated that low-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected hemisphere improved the affected hand function in chronic stroke patients. We investigated whether 1 Hz rTMS improved the motor learning of the affected hand in patients after stroke. A double-blind study. Twenty patients with chronic subcortical stroke. The patients were randomly assigned to receive either a sub-threshold rTMS over the unaffected hemisphere (1 Hz, 25 minutes) or sham stimulation, and all patients performed a pinching task after stimulation. We evaluated the motor function of the affected hand and the excitatory and inhibitory function of the affected motor cortex by transcranial magnetic stimulation. Compared with sham stimulation, rTMS induced an increase in the excitability of the affected motor cortex(p < 0.001) and an improvement in acceleration of the affected hand (p = 0.006). Moreover, the effect of motor training on pinch force was enhanced by rTMS (p < 0.001). These improvement in the motor function lasted for one week after rTMS and motor training (p < 0.001). rTMS improved the motor learning of the affected hand in patients after stroke; thus, it can apply as anew rehabilitation strategy for patients after stroke.

Therapeutic Use of High-Frequency Repetitive Transcranial Magnetic Stimulation in Stroke

To the Editor: We read with great interest the article published by Kim et al on repetitive transcranial magnetic stimulation (rTMS)–induced corticomotor excitability and associated motor skill acquisition in chronic stroke.1 The authors used high-frequency (10 Hz) rTMS over the primary motor cortex contralateral to the paretic hand in patients with chronic subcortical stroke and reported an immediate enhancement of excitability associated with an improvement in motor skill of the paretic hand. The induced enhancement of corticomotor excitability and the related improvement in performance open new and fascinating possibilities for future rehabilitation …

Transcallosal inhibition in chronic subcortical stroke

Movements of the paretic hand in patients with chronic subcortical stroke are associated with high interhemispheric inhibition (IHI) targeting the motor cortex in the lesioned hemisphere relative to healthy controls. The purpose of this investigation was to determine whether this abnormality also involves IHI operating during movements of the non-paretic hand. Here, we studied IHI in the process of generation of voluntary index finger movements by the paretic and non-paretic hands in a simple reaction time paradigm in a group of patients with chronic subcortical stroke. With movements of the non-paretic index finger, IHI targeting the contralateral primary motor cortex ( cM1) decreased progressively to turn into facilitation at around movement onset, similar to healthy controls. In contrast, movements of the paretic index finger resulted in significantly deeper inhibition at all premovement timings relative to the non-paretic hand. In conclusion, these results document a deeper premovement IHI with paretic than non-paretic hand movements of patients with chronic subcortical stroke, a possible mechanism underlying deficits in motor control.