Fugl-Meyer Assessment Of Upper Extremity Research Articles

Mirror therapy simultaneously combined with electrical stimulation for upper limb motor function recovery after stroke: a systematic review and meta-analysis of randomized controlled trials

Objective: To evaluate the current evidence on the effectiveness of simultaneous combination of mirror therapy and electrical stimulation in the recovery of upper limb motor function after stroke, compared with conventional therapy, mirror therapy or electrical stimulation isolated. Data sources: Articles published in PubMed, Web of Science, Scopus, Physiotherapy Evidence Database (PEDro), Cochrane Central register of controlled trials and ScienceDirect up to July 2020. Review methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Methodological quality was assessed using the PEDro tool. The RevMan 5.4 statistical software was used to obtain the meta-analysis, through the standardized mean difference and 95% confidence intervals (CI), and to evaluate the risk of bias. The GRADE approach was employed to assess the certainty of evidence. Results: Eight articles were included in this systematic review, seven were included in the meta-analysis. A total of 314 participants were analyzed. The overall quality of the articles included in this review was good. There was no overall significant mean difference on upper limb motor function after stroke using the Upper-Extremity Fugl-Meyer Assessment by 1.56 (95% CI = –2.08, 5.20; P = 0.40; moderate-certainty evidence) and the Box and Block Test results by 1.39 (95% CI = –2.14, 4.92; P = 0.44; high-certainty evidence). There was overall significant difference in the Action Research Arm Test by 3.54 (95% CI = 0.18, 6.90; P = 0.04; high-certainty evidence). Conclusion: Direct scientific evidence about the effectiveness of the combined therapy of mirror therapy and electrical stimulation simultaneously for the improvement of the upper limb motor function after stroke is lacking. Further high-quality and well-designed research is needed.

Longitudinal Electroencephalography Analysis in Subacute Stroke Patients During Intervention of Brain-Computer Interface With Exoskeleton Feedback.

BackgroundBrain–computer interface (BCI) has been regarded as a newly developing intervention in promoting motor recovery in stroke survivors. Several studies have been performed in chronic stroke to explore its clinical and subclinical efficacy. However, evidence in subacute stroke was poor, and the longitudinal sensorimotor rhythm changes in subacute stroke after BCI with exoskeleton feedback were still unclear.Materials and MethodsFourteen stroke patients in subacute stage were recruited and randomly allocated to BCI group (n = 7) and the control group (n = 7). Brain–computer interface training with exoskeleton feedback was applied in the BCI group three times a week for 4 weeks. The Fugl–Meyer Assessment of Upper Extremity (FMA-UE) scale was used to assess motor function improvement. Brain–computer interface performance was calculated across the 12-time interventions. Sensorimotor rhythm changes were explored by event-related desynchronization (ERD) changes and topographies.ResultsAfter 1 month BCI intervention, both the BCI group (p = 0.032) and the control group (p = 0.048) improved in FMA-UE scores. The BCI group (12.77%) showed larger percentage of improvement than the control group (7.14%), and more patients obtained good motor recovery in the BCI group (57.1%) than did the control group (28.6%). Patients with good recovery showed relatively higher online BCI performance, which were greater than 70%. And they showed a continuous improvement in offline BCI performance and obtained a highest value in the last six sessions of interventions during BCI training. However, patients with poor recovery reached a platform in the first six sessions of interventions and did not improve any more or even showed a decrease. In sensorimotor rhythm, patients with good recovery showed an enhanced ERD along with time change. Topographies showed that the ipsilesional hemisphere presented stronger activations after BCI intervention.ConclusionBrain–computer interface training with exoskeleton feedback was feasible in subacute stroke patients. Brain–computer interface performance can be an index to evaluate the efficacy of BCI intervention. Patients who presented increasingly stronger or continuously strong activations (ERD) may obtain better motor recovery.

Equal Opportunities for Stroke Survivors’ Rehabilitation: A Study on the Validity of the Upper Extremity Fugl-Meyer Assessment Scale Translated and Adapted into Romanian

Background and objectives: The Upper Extremity Fugl-Meyer Assessment (UEFMA) is one of the most recommended and used methods of clinical evaluation not only for post-stroke motor function disability conditions but also for physiotherapy goal-setting. Up to the present, an official Romanian version has not been officially available. This study aims to carry out a translation, adaptation, and validation of UEFMA in Romanian, thus giving both patients and medical practitioners the equal opportunity of benefiting from its proficiency. Material and methods: The English version of the motor component of UEFMA was back and forth translated in the assent of best practice translation guidelines. The research was performed on a group of 64 post-stroke in-patients regarding psychometric properties for content validation and an exploratory and confirmatory factorial analysis was performed using the Bayesian model. To assess internal consistency and test–retest reliability, we used the Cronbach Alpha index and Intraclass Correlation Coefficient (ICC). We used Pearson correlation with the Functional Independence Measure (FIM) and Modified Rankin Scale (MRS) to determine concurrent validation. Standardized response mean (SRM) was applied to determine the responsiveness of the instrument used. Results: After performing the exploratory factor analysis, a single factor was extracted, with an Eigenvalue of 19.363, which explained 64.543% of the variation. The model was confirmed by Bayesian exploration, with Root Mean Square Residual (RMR) 0.051, Goodness-of-fit Index (GFI) 0.980, Normed-Fit Index (NFI) 0.978 and Relative Fit Index (RFI) 0.977. The Cronbach Alpha value was 0.981, the Intraclass Correlation Coefficient (ICC) index for average measures was 0.992, the Pearson correlation with FIM 0.789, and MRS −0.787, while the SRM was 1.117. Conclusions: The Romanian version of the UEFMA scale is a reliable, responsive and valid tool which can be used as a standardized assessment in post-stroke patients across Romania.

Proactive Motor Functional Recovery Following Immersive Virtual Reality-Based Limb Mirroring Therapy in Patients with Subacute Stroke.

Virtual reality (VR) is considered to be a promising therapeutic technology for the rehabilitation of upper extremities (UEs) post-stroke. Recently, we designed and then implemented a neuroscientifically grounded VR protocol for the rehabilitation of patients with stroke. The system provides unilateral and bilateral limb mirroring exercises in a fully immersive virtual environment that may stimulate and activate the mirror neuron system in the brain to help patients for their rehabilitation. Twelve patients with subacute stroke underwent the newly implemented VR treatment in addition to conventional rehabilitation for 8 consecutive weekdays. The treatment effect on brain reorganization and motor function was investigated using resting-state fMRI (rs-fMRI) and the Fugl-Meyer assessment for Upper Extremity (FM-UE), respectively. Fifteen healthy controls (HCs) also underwent rs-fMRI scanning one time. The study finally obtained usable data from 8 patients and 13 HCs. After the intervention, patients demonstrated significant improvement in their FM-UE scores (p values < 0.042). Voxel-wise functional connectivity (FC) analysis based on the rs-fMRI data found that HCs showed widespread bilateral FC patterns associated with the dominant hemispheric primary motor cortex (M1). However, the FC patterns in patients revealed intra-hemispheric association with the ipsilesional M1 seed and this association became visible in the contra-hemisphere after the intervention. Moreover, the change of FC values between the bilateral M1 was significantly correlated with the changes in FM-UE scores (p values < 0.037). We conclude that unilateral and bilateral limb mirroring exercise in an immersive virtual environment may enhance cortical reorganization and lead to improved motor function.

Therapeutic Effects of Diagonal-Transcranial Direct Current Stimulation on Functional Recovery in Acute Stroke: A Pilot Study

Background: Peak neurologic recovery from acute stroke occurs within the first 3 months, and continues at a slower pace for 6 months. Objective/Hypothesis: The aim of this pilot study is to clarify the safety and feasibility of multiple diagonal-transcranial direct current stimulation (d-tDCS) sessions up to 3 months with electrodes placed diagonally over the lesional dorsolateral prefrontal cortex and contralesional primary motor cortex for upper limb hemiparesis in acute stroke. Methods: Five patients with acute stroke (2 with intracerebral hemorrhage and 3 with cerebral infarction) with upper limb paresis participated. d-tDCS (1 mA, 20 min per day) combined with conventional rehabilitation was given starting 7–21 days after stroke onset. Each session consisted of 10 d-tDCS over 2 weeks and patients received 2 sessions in the acute phase and 2 sessions in the subacute phase for a total 40 treatments. Motor function was assessed using Fugl-Meyer Assessment for upper extremity (FMA-UE) before and after each session, and the period to achieve 70% of maximal potential recovery in FMA-UE was evaluated. Results: All 5 patients completed the intervention and showed no adverse effects throughout the protocol. Of these, 3 (60%) achieved 70% predicted scores within 2 months. Regarding therapeutic gains of FMA-UE in each of the 10 sessions in the acute phase, 4 sessions showed great recovery, 3 sessions showed moderate recovery, and 3 sessions showed poor recovery. Conclusion: These findings suggest that d-tDCS over 3 months may be safe and feasible for acute stroke patients in the acute to subacute phases and have therapeutic potential to promote recovery of upper limb function, although further randomized, double-blind, sham-controlled trial is warranted with larger sample size.

The effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity

BackgroundPost-stroke scapular dyskinesia is a predisposing factor for the affection of motor and somatosensory functions of the hemiparetic upper extremity.ObjectiveThe purpose of the study was to investigate the effect of scapular dyskinesia on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity.Subjects and methodsSixty patients with spasticity post-stroke participated in this study. The patients were assigned to one of the two groups as determined by the lateral scapular slide test (LSST) using the palpation meter (PALM); group A with scapular dyskinesia and group B stroke patients without scapular dyskinesia. The scapular position was determined by a measurement of scapular balance angle (SBA), and the upper extremity sensorimotor function was evaluated using Fugl-Meyer Assessment upper extremity (FMAUE) scale. The scapular balance angle and Fugl-Meyer upper extremity scores were compared between groups.ResultsThere was a significant increase in the scapular balance angle of group A compared with that of group B (p < 0.001). Also, there was a significant decrease in sensory and motor functions of group A as measured by Fugl-Meyer upper extremity compared with that of group B (p < 0.001).ConclusionScapular dyskinesia had a significant effect on the scapular balance angle and upper extremity sensorimotor function in stroke patients with spasticity. Management of scapular dyskinesia should be emphasized in the rehabilitation program for stroke patients with spasticity.

EEG Biomarkers Related With the Functional State of Stroke Patients.

IntroductionRecent studies explored promising new quantitative methods to analyze electroencephalography (EEG) signals. This paper analyzes the correlation of two EEG parameters, Brain Symmetry Index (BSI) and Laterality Coefficient (LC), with established functional scales for the stroke assessment.MethodsThirty-two healthy subjects and thirty-six stroke patients with upper extremity hemiparesis were recruited for this study. The stroke patients where subdivided in three groups according to the stroke location: Cortical, Subcortical, and Cortical + Subcortical. The participants performed assessment visits to record the EEG in the resting state and perform functional tests using rehabilitation scales. Then, stroke patients performed 25 sessions using a motor-imagery based Brain Computer Interface system (BCI). BSI was calculated with the EEG data in resting state and LC was calculated with the Event-Related Synchronization maps.ResultsThe results of this study demonstrated significant differences in the BSI between the healthy group and Subcortical group (P = 0.001), and also between the healthy and Cortical+Subcortical group (P = 0.019). No significant differences were found between the healthy group and the Cortical group (P = 0.505). Furthermore, the BSI analysis in the healthy group based on gender showed statistical differences (P = 0.027). In the stroke group, the correlation between the BSI and the functional state of the upper extremity assessed by Fugl-Meyer Assessment (FMA) was also significant, ρ = −0.430 and P = 0.046. The correlation between the BSI and the FMA-Lower extremity was not significant (ρ = −0.063, P = 0.852). Similarly, the LC calculated in the alpha band has significative correlation with FMA of upper extremity (ρ = −0.623 and P < 0.001) and FMA of lower extremity (ρ = −0.509 and P = 0.026). Other important significant correlations between LC and functional scales were observed. In addition, the patients showed an improvement in the FMA-upper extremity after the BCI therapy (ΔFMA = 1 median [IQR: 0–8], P = 0.002).ConclusionThe quantitative EEG tools used here may help support our understanding of stroke and how the brain changes during rehabilitation therapy. These tools can help identify changes in EEG biomarkers and parameters during therapy that might lead to improved therapy methods and functional prognoses.

Rhythmic Auditory Stimulation as an Adjuvant Therapy Improved Post-stroke Motor Functions of the Upper Extremity: A Randomized Controlled Pilot Study.

ObjectivesTo explore whether rhythmic auditory stimulation (RAS) could improve motor functions of post-stroke hemiparetic upper extremity.DesignA prospective, randomized controlled, assessor-blinded pilot study.MethodsThirty stroke patients were randomly distributed into the RAS group (n = 15) and the control group (n = 15). Both groups received regular therapies. The RAS group received additional 30 min of RAS training, while the control group received additional 30 min of regular therapies for 5 days per week for 4 weeks. The Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI) were used. The co-activation interval and co-contraction index were calculated from surface electromyography (sEMG) recordings on the affected biceps and triceps during elbow flexion and extension. Assessments were performed before and after the treatments.ResultsSignificant improvements in motor functions were observed within both groups (p < 0.05 in the FMA-UE, WMFT, and BI, respectively), as well as between groups after the treatments (higher scores in the RAS group, all p < 0.05 except for p = 0.052 in the FMA-UE; group × time interaction, all p < 0.05). Statistical significance was found in the co-activation interval between groups after the treatments (lower in the RAS group; p = 0.022 during elbow extension; p = 0.001 during elbow flexion; group × time interaction, p < 0.05 only during elbow extension). No statistical significance was found in the co-contraction index between groups; an inversed pattern of changes was observed between groups supported by relatively higher increments in the triceps recruitments to the biceps.ConclusionUsing RAS in task-oriented exercises was effective in moderating co-contraction, facilitating task-oriented movements of the hemiparetic upper extremity, and improving ADLs among those who had emerging isolated joint movements. The effects were evident on sEMG possibly by adjusting the balance of recruitments between the agonist and the antagonist.Clinical Trial RegistrationThe study was registered at the Chinese Clinical Trial Registry (No. 1900026665).

Efficacy of functional magnetic stimulation in improving upper extremity function after stroke: a randomized, single-blind, controlled study.

ObjectiveTo clarify the efficacy of functional magnetic stimulation (FMS) in improving hemiplegic upper extremity function in patients with sub-acute stroke.MethodsIn this randomized controlled trial, 40 sub-acute stroke patients with hemiplegia were recruited from inpatient wards in the Department of Rehabilitation and randomly assigned to two groups. In the FMS group, magnetic stimulation was applied to extensor muscle groups of the affected upper extremity. In the low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) group, stimulation was applied to the contralesional primary motor cortex. All patients received occupational therapy. Hand and upper extremity motor function was evaluated using the Fugl–Meyer Assessment for upper extremity (FMA-UE), and the Barthel Index (BI) evaluated daily living abilities.ResultsThe FMA-UE and BI scores were significantly increased in both groups following stimulation. Furthermore, a significant between-group difference was observed in both FMA-UE and BI scores after 2 weeks of therapy. In the FMS group, 6 of 19 patients regained wrist and finger extension abilities, but only 2 patients regained equivalent motor skills in the LF-rTMS groupConclusionsFMS improves paretic upper extremity function and leads to better recovery of motor activity than LF-rTMS. FMS may be a novel modality to improve motor function.

High-frequency rTMS with two different inter-train intervals improves upper limb motor function at the early stage of stroke

ObjectiveThis study aimed to explore the therapeutic effect of high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) with two different inter-train intervals (ITIs) on upper limb motor function in the early period of stroke.MethodsWe recruited 48 post-stroke patients in the early period and randomly divided them into three cohorts: the sham group, the short ITI (8 s) group, and the long ITI (28 s) group. HF-rTMS was delivered at 20 Hz. The amplitude of motor evoked potentials at the affected cortical region, representing the abductor pollicis brevis muscle, reflected cortical excitability. At baseline, immediately after treatment, and 1 month after treatment, we evaluated the recovery of upper limb motor function using Brunnstrom recovery stages (BRSs) and the Fugl–Meyer Assessment for upper extremity (FMA-UE), and assessed functional independence using the Barthel Index (BI).ResultsHF-rTMS with two different ITIs significantly improved upper limb functional recovery relative to the sham group, but there was no significant difference in cortical excitability changes or BRS, FMA-UE, or BI scores between the different ITI groups.ConclusionsAt the early post-stroke stage, HF-rTMS with short ITIs generates a similar therapeutic effect to HF-rTMS with long ITIs, suggesting that treatment times can be decreased.

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

Background. Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. Objective. To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9). Methods. All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log. Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year. Conclusions. VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.

Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis.

Objectives Spontaneous arm use in patients with poststroke hemiparesis is crucial to the recovery of functional interaction. Patients with stroke and subsequent right hemiparesis have more difficulty adapting to a right-handed environment. The aim of this study was to use wearable devices to assess the asymmetry and difference in the amount of activity of the nondominant and dominant affected hands among patients with stroke and right hemiparesis. The real activity of both hands was measured to assess the correlation with various aspects of the International Classification of Functioning, Disability and Health (ICF). Subjects and Methods. Patients with stroke and right hemiparesis were recruited. They were divided into two groups according to the affected hand. Groups A and B comprised patients with affected nondominant and dominant hands, respectively. The Fugl-Meyer assessment-Upper Extremity (FM-UE) scores, Motor Activity Log (MAL), and hand function domain scores on the Stroke Impact Scale (SIS) were used for assessment. Patients were asked to wear smart wearable devices on both hands 24 hours a day for a month. The amount of activity in both hands was recorded and analyzed. Results A total of 29 patients with stroke were divided into group A (n = 14) and group B (n = 15). FM-UE scores were significantly and strongly correlated with the amount of use (AOU) in the MAL. The recorded differential real activity of both hands in group B was significantly lower than that in group A. The asymmetry index of hand use was significantly less favorable in group B. However, no significant differences in AOU in the MAL, FM-UE, and hand function domain in the SIS were identified between the nondominant and dominant affected hands. Conclusions The asymmetry and differential activity of both hands were worse in the patients with poststroke right hemiparesis, whose dominant hand was affected. However, no differences of three aspects of the ICF were found between dominant and nondominant affected hands.

The fourier M2 robotic machine combined with occupational therapy on post-stroke upper limb function and independence-related quality of life: A randomized clinical trial

ABSTRACT Most post-stroke patients experience upper limb functionality challenges. Emergent therapies using upper limb-based robot machines present opportunities to resolve the limitations inherent in Occupational therapy such as increased therapist-patient exhaustion, monotonous methods, and so forth. The aim of this parallel trial was to compare the effects of the upper limb robotic training with matched Occupational therapy training on upper limb function and independence-related quality of life in post-stroke patients within the Brunnstrom arm motor recovery stages 1 to 4. During one-year (2018–2019), 50 post-stroke patients were enrolled and randomly assigned to 2 groups; robot and Occupational therapy (n = 25) and Occupational therapy (n = 25). Both groups were trained for 50–70 minutes per day, 5 days a week for 6 weeks. The Chinese-adapted Fugl-Meyer Assessment-Upper Extremity (FMA-UE) was the primary outcome measure. The secondary outcome measures were the Brunnstrom Recovery Stages Scale (BRS) and the Chinese-adapted Barthel Index (BI). The treatment effect sizes of both groups were large in the following variables; transfers (1), BI total score (2.2), FMA-UE upper limb (1.1), wrist (1.8), elbow (1), fingers (0.9), and FMA-UE total scores (1.4). The treatment group in comparison to the control group had larger BRS changes, significant improvements in upper limb function, and partial independence in activities of daily living during the baseline to post-treatment period. Robotic-assisted training with occupational therapy may improve the upper limb movement foundation blocks; however, it does not translate into complete functional independence and improved quality of life. This study has been registered at the ISRCTN registry, https://doi.org/10.1186/ISRCTN84804731

Optimization of Upper Extremity Rehabilitation by Combining Telerehabilitation With an Exergame in People With Chronic Stroke: Protocol for a Mixed Methods Study.

BackgroundExergames have the potential to provide an accessible, remote approach for poststroke upper extremity (UE) rehabilitation. However, the use of exergames without any follow-up by a health professional could lead to compensatory movements during the exercises, inadequate choice of difficulty level, exercises not being completed, and lack of motivation to pursue exercise programs, thereby decreasing their benefits. Combining telerehabilitation with exergames could allow continuous adjustment of the exercises and monitoring of the participant’s completion and adherence. At present, there is limited evidence regarding the feasibility or efficacy of combining telerehabilitation and exergames for stroke rehabilitation.ObjectiveThis study aims to (1) determine the preliminary efficacy of using telerehabilitation combined with exergames on UE motor recovery, function, quality of life, and motivation in participants with chronic stroke, compared with conventional therapy (the graded repetitive arm supplementary program; GRASP); (2) examine the feasibility of using the technology with participants diagnosed with stroke at home; and (3) identify the obstacles and facilitators for its use by participants diagnosed with stroke and stroke therapists and understand the shared decision-making process.MethodsA mixed methods study protocol is proposed, including a randomized, blinded feasibility trial with an embedded multiple case study. The intervention consists of the provision of a remote rehabilitation program, during which participants will use the Jintronix exergame for UE training and the Reacts Application to conduct videoconferenced sessions with the therapists (physical or occupational therapists). We plan to recruit 52 participants diagnosed with stroke, randomly assigned to a control group (n=26; 2-month on-paper home exercise program: the GRASP with no supervision) and an experimental group (n=26; 2-month home program using the technology). The primary outcome is the Fugl-Meyer UE Assessment, a performance-based measure of UE impairment. The secondary outcomes are self-reported questionnaires and include the Motor Activity Log-28 (quality and frequency of use of the UE), Stroke Impact Scale-16 (the quality of life), and Treatment Self-Regulation Questionnaire (motivation). Feasibility data include process, resources, management, and scientific outcomes. Qualitative data will be collected by interviews with both participants and therapists.ResultsAt present, data collection was ongoing with one participant who had completed the exergame- telerehabilitation based intervention. We expect to collect preliminary efficacy data of this technology on the functional and motor recovery of the UE, following a stroke; collect feasibility data with users at home (adherence, safety, and technical difficulties); and identify the obstacles and facilitators for the technology use and understand the shared decision-making process.ConclusionsThis paper describes the protocol underlying the study of a telerehabilitation-exergame technology to contribute to understanding its feasibility and preliminary efficacy for UE stroke rehabilitation.Trial RegistrationClinicalTrials.gov NCT03759106; http://clinicaltrials.gov/show/NCT03759106.International Registered Report Identifier (IRRID)DERR1-10.2196/14629

An Automated Data Acquisition System for Pinch Grip Assessment Based on Fugl Meyer Protocol: A Feasibility Study

The Upper Extremity Fugl Meyer Assessment (UE-FMA) is the most comprehensive assessment for pinch impairment after stroke. The pinch test of UE-FMA is manually performed by pulling a pincer object away from the patient’s fingers while providing a visual observation that results in a subjective assessment. In this study, an automated data acquisition system that consists of a linear electric actuator applying automatic pulling to the customized pincer object held by the volunteer was developed. The pinch force was measured such that a strain gauge was placed on the pincer object while pulling force was measured using pulling force load cell connected in between the linear electric actuator and customized pincer object. The pincer object’s slip onset was detected using a displacement slip sensor. The mean pinch and pulling force values at the slip onset were 12.17 and 6.25 N for right hands, while mean pinch and pulling force values were 11.67 and 5.92 N for left hands of 50 healthy volunteers, respectively. Based on the paired t-test, there is no significant difference between right and left hands. The automated data acquisition system can objectively apply a pulling force, detect the slip onset, and measure the pinch and pulling forces.

What is the feasibility and observed effect of two implementation packages for stroke rehabilitation therapists implementing upper limb guidelines? A cluster controlled feasibility study

BackgroundHand and arm activity after stroke improves with evidence-based rehabilitation. Therapists face known barriers when providing evidence-based rehabilitation and require support to implement guidelines. The aim of this study was...

EFFECT OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OF THE CONTRALESIONAL MOTOR CORTEX ON RECOVERY FROM POST-STROKE SEVERE MOTOR IMPAIRMENT

Background: The traditional inhibition of contralesional primary motor area (cM1) with low frequency repetitive transcranial magnetic stimulation (rTMS) fails to improve post-stroke severe motor impairment. The role of contralesional motor areas in post-stroke motor recovery is still questionable. While the previous data suggested that cM1 exerts transcallosal inhibitory effect on ipsilesional M1 (iM1) following stroke, there isan evidence that contralesional motor areas, particularly the contralesional dorsal premotor area (cPMd), have compensatory roles in severely impaired patients who have extensive ipsilesional damage. Objectives: To study whether facilitating cPMd with high frequency rTMS as a novel approach, instead of conventionally suppressing cM1, has beneficial effect on motor recovery of post-stroke severely impaired upper extremity (UE) or not. Patients and Methods: Forty right handed, first ever stroke patients (3 months post event) with severe stroke symptoms, severe motor deficit, and radio logically evident massive right cerebral infarctions at baseline were randomly assigned to two equal groups, to receive, as adjunct to ordinary rehabilitation techniques, ten consecutive sessions of either: (1) High frequency rTMS at 5 Hz on cPMd; or (2) Sham rTMS. The Medical Research Council (MRC) for muscle strength and UE- Fugl Meyer Assessment (UE-FMA) were assessed before and after the intervention. Results: By using the one way analysis of covariance (ANCOVA), we found significant improvements in grand means of MRC in the active rTMS group in relation to the sham group. The improvements included in particular the mean proximal MRC, whereas no significant improvement in the mean distal MRC. Similarly, we found that the UE-FMA totals were markedly improved in the active group in relation to the sham group, mainly in the proximal UE-FMA. Stepwise regression showed that lower baseline MRC of the affected UE muscles is an independent predictor of better response to the novel rTMS approach. Conclusion: Applying high frequency rTMS to cPMd can improve motor functions of the disabled UE, mainly proximal functions, in more severely impaired stroke patients.

EFFECT OF HIGH FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION OF THE CONTRALESIONAL MOTOR CORTEX ON RECOVERY FROM POST-STROKE SEVERE MOTOR IMPAIRMENT

Background: The traditional inhibition of contralesional primary motor area (cM1) with low frequency repetitive transcranial magnetic stimulation (rTMS) fails to improve post-stroke severe motor impairment. The role of contralesional motor areas in post-stroke motor recovery is still questionable. While the previous data suggested that cM1 exerts transcallosal inhibitory effect on ipsilesional M1 (iM1) following stroke, there isan evidence that contralesional motor areas, particularly the contralesional dorsal premotor area (cPMd), have compensatory roles in severely impaired patients who have extensive ipsilesional damage. Objectives: To study whether facilitating cPMd with high frequency rTMS as a novel approach, instead of conventionally suppressing cM1, has beneficial effect on motor recovery of post-stroke severely impaired upper extremity (UE) or not. Patients and Methods: Forty right handed, first ever stroke patients (3 months post event) with severe stroke symptoms, severe motor deficit, and radio logically evident massive right cerebral infarctions at baseline were randomly assigned to two equal groups, to receive, as adjunct to ordinary rehabilitation techniques, ten consecutive sessions of either: (1) High frequency rTMS at 5 Hz on cPMd; or (2) Sham rTMS. The Medical Research Council (MRC) for muscle strength and UE- Fugl Meyer Assessment (UE-FMA) were assessed before and after the intervention. Results: By using the one way analysis of covariance (ANCOVA), we found significant improvements in grand means of MRC in the active rTMS group in relation to the sham group. The improvements included in particular the mean proximal MRC, whereas no significant improvement in the mean distal MRC. Similarly, we found that the UE-FMA totals were markedly improved in the active group in relation to the sham group, mainly in the proximal UE-FMA. Stepwise regression showed that lower baseline MRC of the affected UE muscles is an independent predictor of better response to the novel rTMS approach. Conclusion: Applying high frequency rTMS to cPMd can improve motor functions of the disabled UE, mainly proximal functions, in more severely impaired stroke patients.

What are the determinants of explicit and implicit motor imagery ability in stroke patients?: a controlled study

Purpose: The purposes of the study were to (a) investigate both explicit and implicit motor imagery ability (MIA) impairment after stroke, (b) examine predictive effects of clinical characteristics for MIA after stroke.Materials and Methods: Forty one patients with stroke (PwS) (mean age 59.41 ± 10.19 years; %41 female) and 36 healthy participants (mean age 62.47 ± 9.29 years; %47 female) completed Chaotic Motor Imagery Assessment-Hand Rotation for implicit MIA and Movement Imagery Questionnaire-3 (MIQ-3) and Box and Block Test (BBT) for explicit MIA. The severity of motor and sensory impairments were determined by the Fugl-Meyer Assessment-Upper Extremity (FMAUE) scores. The Turkish version of Motor Activity Log-28 was used to assess amount of use (AUS) and quality of movement in daily life.Results: Our results indicated that both implicit and explicit MIA (except kinaesthetic imagery of MIQ-3) in PwS were statistically impaired compared to controls (p < 0.05). The sensorimotor impairment level, amount of use and movement quality of the affected upper limb were found to be correlated with MIA in various degrees. Total motor scores in FMAUE and AUS were significant predictors of explicit MIA (p < 0.01). Additionally, explicit MIA scores of stroke subgroups were statistically different between severely and mildly impaired patients, in favour of mildly impaired group (p < 0.05).Conclusion: In conclusion, both motor impairment level and amount of daily use of upper extremity were found to be predictive factors for explicit MIA. Further investigation with brain imaging techniques is needed to explore the validity of these findings in establishing MIA.

Effect of Motor Imagery Training on Somatosensory Evoked Potentials and Upper Limb Function in Stroke Patients

Background: Motor imagery is the mental representation of an action without overt movement or muscle activation. However, few previous studies have demonstrated motor imagery training effects as an objective assessment tool in patients with early stroke. Objective: To investigate the effect of motor imagery training on Somatosensory Evoked Potentials (SSEP) and upper limb function of stroke patients. Design: A quasi-experimental study. Methods: Twenty-four patients with stroke were enrolled in this study. All subjects were assigned to the experimental or control group. All participants received traditional occupational therapy for 30 minutes, 5 times a week. The experimental group performed an additional task of motor imagery training (MIT) 20 minutes per day, 5 days a week, for 4 weeks. Both groups were assessed using the SSEP amplitude, Fugl-Meyer assessment of upper extremity (FMA UE) and Wolf motor function test. Results: After the intervention, the experimental group showed significant improvement in SSEP amplitude and FMA UE than did the control group. Conclusion: These findings suggest that the MIT effectively improve the SSEP and upper limb function of stroke patients.