Motor Function Of Upper Extremity Research Articles

Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke.

Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty-three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1-M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R2 =0.36-0.46) and gait speed (R2 =0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120-132, 2018. © 2017 Wiley Periodicals, Inc.

Effects of action observation therapy and mirror therapy after stroke on rehabilitation outcomes and neural mechanisms by MEG: study protocol for a randomized controlled trial

BackgroundLoss of upper-extremity motor function is one of the most debilitating deficits following stroke. Two promising treatment approaches, action observation therapy (AOT) and mirror therapy (MT), aim to enhance motor learning and promote neural reorganization in patients through different afferent inputs and patterns of visual feedback. Both approaches involve different patterns of motor observation, imitation, and execution but share some similar neural bases of the mirror neuron system. AOT and MT used in stroke rehabilitation may confer differential benefits and neural activities that remain to be determined. This clinical trial aims to investigate and compare treatment effects and neural activity changes of AOT and MT with those of the control intervention in patients with subacute stroke.Methods/designAn estimated total of 90 patients with subacute stroke will be recruited for this study. All participants will be randomly assigned to receive AOT, MT, or control intervention for a 3-week training period (15 sessions). Outcome measurements will be taken at baseline, immediately after treatment, and at the 3-month follow-up. For the magnetoencephalography (MEG) study, we anticipate that we will recruit 12 to 15 patients per group. The primary outcome will be the Fugl-Meyer Assessment score. Secondary outcomes will include the modified Rankin Scale, the Box and Block Test, the ABILHAND questionnaire, the Questionnaire Upon Mental Imagery, the Functional Independence Measure, activity monitors, the Stroke Impact Scale version 3.0, and MEG signals.DiscussionThis clinical trial will provide scientific evidence of treatment effects on motor, functional outcomes, and neural activity mechanisms after AOT and MT in patients with subacute stroke. Further application and use of AOT and MT may include telerehabilitation or home-based rehabilitation through web-based or video teaching.Trial registrationClinicalTrials.gov, ID: NCT02871700. Registered on 1 August 2016.

Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients.

Background:The aim of this study was to explore the effects of action observation therapy on motor function of upper extremity, activities of daily living, and motion evoked potential in cerebral infarction patients.Method:Cerebral infarction survivors were randomly assigned to an experimental group (28 patients) or a control group (25 patients). The conventional rehabilitation treatments were applied in both groups, but the experimental group received an additional action observation therapy for 8 weeks (6 times per week, 20 minutes per time). Fugl-Meyer assessment (FMA), Wolf Motor Function Test (WMFT), Modified Barthel Index (MBI), and motor evoked potential (MEP) were used to evaluate the upper limb movement function and daily life activity.Results:There were no significant differences between experiment and control group in the indexes, including FMA, WMFT, and MBI scores, before the intervention. However, after 8 weeks treatments, these indexes were improved significantly. MEP latency and center-motion conduction time (CMCT) decreased from 23.82 ± 2.16 and 11.15 ± 1.68 to 22.69 ± 2.11 and 10.12 ± 1.46 ms. MEP amplitude increased from 0.61 ± 0.22 to 1.25 ± 0.38 mV. A remarkable relationship between the evaluations indexes of MEP and FMA was found.Conclusions:Combination of motion observation and traditional upper limb rehabilitation treatment technology can significantly elevate the movement function of cerebral infarction patients in subacute seizure phase with upper limb dysfunction, which expanded the application range of motion observation therapy and provided an effective therapy strategy for upper extremities hemiplegia in stroke patients.

Relationship between upper extremity motor function and oral hygiene among stroke survivors undergoing rehabilitation

Background: Stroke burden and its long-term effects on physical and psycho-social functions are well documented. Traditionally, the assessment of stroke rehabilitation outcomes is based on indicators of physical function; such measures undermine the all-inclusive impact of stroke as they do not include other health concerns like personal hygiene inclusive of oral hygiene.

Movement Therapy of the Upper Extremities with a Robotic Ball in Stroke Patients: Results of a Randomized Controlled Crossover Study

Abstract Background Stroke is associated with motor impairments of the upper extremities. The defining goal of rehabilitation is independent execution of activities of daily living. New therapy procedures use different hardware components to implement digital therapy contents. These can be useful complements to established therapy protocols. Objectives The aim of this study was to examine the effect of movement therapy with a robotic ball on motor function parameters in stroke patients. Materials and Methods 25 patients (60.0±10.0 years, 172.5±13.8 cm, 79.5±13.8 kg, 89.8±72.6 months post-stroke) took part in this crossover study. The intervention and control periods comprised 12 weeks each. Training with the robotic ball was done in addition to standard therapy two times a week for 45 min each. Different game activities were carried out with the help of a tablet and a smartphone. Results Isometric grip strength improved by 4.5±3.6 kg (p=0.000), and unilateral dexterity increased by 7.5±6.3 successful tries (p=0.000) in the round block test. The self-reported disabilities of the arm, shoulder and hand were assessed using the QuickDASH questionnaire and showed improvements by 12.4±13.0 points (p=0.001). Conclusions Additional therapy using the robotic ball improved upper extremity motor function and self-perceived health status in chronic stroke patients. However, performance stagnated when standard therapy was implemented alone. Moderately affected patients seem to benefit the most. The presence of very severe motor or cognitive symptoms led, in part, to some dropouts. The results need to be verified using larger patient populations.

The Effects of Task-Based Mirror Therapy on Upper Extremity Motor Function and Use in Daily Living in Adults With Stroke

The Effects of Task-Based Mirror Therapy on Upper Extremity Motor Function and Use in Daily Living in Adults With Stroke

Automated Evaluation of Upper-Limb Motor Function Impairment Using Fugl-Meyer Assessment.

The Fugl-Meyer assessment (FMA) is the most popular instrument for evaluating upper extremity motor function in stroke patients. However, it is a labor-intensive and time-consuming method. This paper proposes a novel automated FMA system to overcome these limitations of the FMA. For automation, we used Kinect v2 and force sensing resistor sensors owing to their convenient installation as compared with body-worn sensors. Based on the linguistic guideline of the FMA, a rule-based binary logic classification algorithm was developed to assign FMA scores using the extracted features obtained from the sensors. The algorithm is appropriate for clinical use, because it is not based on machine learning, which requires additional learning processes with a large amount of clinical data. The proposed system was able to automate 79% of the FMA tests because of optimized sensor selection and the classification algorithm. In clinical trials conducted with nine stroke patients, the proposed system exhibited high scoring accuracy (92%) and time efficiency (85% reduction in clinicians' required time).

O204 Simultaneous bi-hemispheric repetitive transcranial magnetic stimulation for upper limb motor recovery in chronic stroke: A double blind placebo controlled study

Objective repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for the treatment of post-stroke motor deficits. Since the crucial role of non-primary motor cortices and contralesional brain areas is emerging for motor recovery in chronic stroke; we assessed safety and efficacy of bilateral rTMS over the motor areas associated to physical training (PT) on upper extremity (UE) motor function. Methods double-blind, placebo-controlled trial on 20 patients with chronic stroke conditioning moderate to mild upper limb motor impairment. Eleven sessions of high frequency rTMS were delivered with the H-coil over the motor areas bilaterally. Subjects were randomly allocated to the real rTMS plus PT or the placebo (sham) rTMS plus PT. UE impairment was evaluated by the Fugl-Meyer assessment for UE (FM-UE), Modified Ashworth Scale (MAS) and hand grip strength at baseline (T0), after treatment (T1) and one-month follow-up (T2). Results no serious adverse events were reported. At T1 FM-UE significantly improved in both groups, while at T2 the improvement was significant only for the real group. The improvement was significantly higher in the real compared with the sham group. In the real group, greater improvement in FM-UE was found in patients moderately impaired compared with less impaired at baseline. Spasticity and hand grip strength also significantly improved in the real group at T1 and amelioration of spasticity persisted also at T2. Conclusion bilateral high-frequency rTMS with H-coil associated with PT is safe and enhances the effect of PT alone. Although plegic patients were not included, subjects with moderate rather than mild motor impairment may mainly benefit from this stimulation protocol.

Portable objective assessment of upper extremity motor function in Parkinson's disease

IntroductionObjective, portable measures of motor function for out-of-office assessments are needed in Parkinson's Disease (PD). This study had 3 objectives. First, to examine change in objective motor measurements in PD (as assessed with the Objective PD Measurement (OPDM) system). Second, to correlate objective measures with clinical features and putative PD cerebrospinal fluid (CSF) and dopaminergic imaging biomarkers. Third, to assess participant compliance with and perceptions of serial in-home motor assessments. MethodsDe novo PD subjects participating in this pilot study of the Parkinson Progression Markers Initiative (PPMI) completed OPDM assessments at home weekly for 3 months and in the clinic at baseline and 3-, 6-, and 12-months. Tasks included (i)digitography (ii)a repetitive hand tapping task and (iii)timed pegboard task. A global objective motor score (OMS) was derived from the latter three. MDS-UPDRS-III score was obtained at each time point, and CSF and dopamine transporter (DAT) SPECT at baseline. Results27 participants, mean age 62.6 years, 19 male were included. A mean of 10.5 in-home assessments were completed. There was no significant change in in-home OMS over 12 weeks (p = 0.48). There was strong correlation between mean baseline OMS and MDS-UPDRS-III scores (spearman's rho = 0.60, p=<0.0001). Baseline OMS predicted 6-month MDS-UPDRS-III (β = 0.80, p = 0.0002) but not change in MDS-UPDRS-III score, DAT SPECT, or putative CSF biomarkers. ConclusionsThis study suggests that administration of in-home motor tasks as part of a large multi-center study is feasible and scores derived from these assessments may serve as surrogates of in-person clinician-assessed motor score.

Brain–Computer Interface With Functional Electrical Stimulation Training for Upper-Extremity Rehabilitation Performance Outcomes

Abstract Date Presented 3/31/2017 A study was conducted to evaluate the efficacy of a 6-wk brain–computer interface with functional electrical stimulation (BCI–FES) therapy in improving upper-extremity (UE) motor function in adults poststroke. Data suggest BCI–FES therapy is promising for UE rehabilitation poststroke. Primary Author and Speaker: Samantha Evander Elmore Additional Authors and Speakers: Laura Kiekhoefer, Jessica Abrams, Rebecca Vermilyea Contributing Authors: Dorothy Farrar-Edwards, Muhammad Al-Heizan, Brittany Young, Alexander Remsik

Characteristics of Residual Symptoms After Laminoplasty in Diabetic Patients With Cervical Spondylotic Myelopathy: A Prospective Cohort Study.

A prospective cohort study. The purpose of this study was to compare cervical laminoplasty outcomes between diabetic and nondiabetic patients with cervical spondylotic myelopathy (CSM), and to characterize residual symptoms of diabetic patients. Diabetes is one of the most frequent comorbidities in CSM patients. However, no report has elucidated residual symptoms following surgery in diabetic patients with CSM. .: A total of 505 consecutive patients with CSM (331 males, 189 females; mean age, 66.6 years; age range, 41-91 years; >1-year follow up after laminoplasty) were enrolled and divided into diabetic group (n = 105) and nondiabetic group (n = 400). The Japanese Orthopedic Association (JOA) scores and recovery rate (RR) of each function were compared between the groups. To quantitatively assess performance, the 10-s grip and release (G&R) test and the 10-s step test were evaluated. There was no significant difference in the mean RRs of upper extremity motor function between diabetic and nondiabetic patients (59.2% vs. 60.5%, respectively; P = 0.789). The RR of lower extremity motor function was lower in the diabetic group than in the nondiabetic group (36.1% vs. 43.4%, respectively; P = 0.047); the RR of upper extremity sensory function also was lower (36.8% vs. 49.6%, respectively; P = 0.006). However, the mean RRs of sensory functions of lower extremities were 59.7% (diabetic) and 59.2% (nondiabetic) (P = 0.953). There was no significant difference in the mean RRs of trunk sensory function between the groups (69.3% vs. 74.1%, respectively; P = 0.303). The mean RRs of urinary bladder function were 42.1% (diabetic) and 53.7% (nondiabetic) (P = 0.035). The preoperative mean number of the 10-s step test was lower in the diabetic group than in the nondiabetic group, and the postoperative mean number also was significantly lower in the diabetic group. Gait disturbance, hand numbness, and bladder dysfunction after surgery persisted more than other symptoms in the diabetic than in the nondiabetic patients. 2.

Validity of Robot-Based Assessments of Upper Extremity Function

ObjectiveTo examine the validity of 5 robot-based assessments of arm motor function poststroke. DesignCross-sectional study. SettingOutpatient clinical research center. ParticipantsVolunteer sample of participants (N=40; age, >18y; 3–6mo poststroke) with arm motor deficits that had reached a stable plateau. InterventionsNot applicable. Main Outcome MeasuresClinical standards included the arm motor domain of the Fugl-Meyer Assessment (FMA) and 5 secondary motor outcomes: hand/wrist subsection of the arm motor domain of the FMA, Action Research Arm Test, Box and Block test (BBT), hand motor subscale of the Stroke Impact Scale Version 2.0, and Barthel Index. Robot-based assessments included wrist targeting, finger targeting, finger movement speed, reaction time, and a robotic version of the BBT. Anatomical measures included percent injury to the corticospinal tract (CST) and extent of injury of the hand region of the primary motor cortex obtained from magnetic resonance imaging. ResultsParticipants had moderate to severe impairment (arm motor domain of the FMA scores, 35.6±14.4; range, 13.5–60). Performance on the robot-based tests, including speed (r=.82; P<.0001), wrist targeting (r=.72; P<.0001), and finger targeting (r=.67; P<.0001), correlated significantly with the arm motor domain of the FMA scores. Wrist targeting (r=.57–.82) and finger targeting (r=.49–.68) correlated significantly with all 5 secondary motor outcomes and with percent CST injury. The robotic version of the BBT correlated significantly with the clinical BBT but was less prone to floor effects. Robot-based assessments were comparable to the arm motor domain of the FMA score in relation to percent CST injury and superior in relation to extent of injury to the hand region of the primary motor cortex. ConclusionsThe present findings support using a battery of robot-based methods for assessing the upper extremity motor function in participants with chronic stroke.

Refining 3 Measures to Construct an Efficient Functional Assessment of Stroke.

The Fugl-Meyer Assessment motor scale, Postural Assessment Scale for Stroke patients, and Barthel Index are widely used to assess patients' upper extremity and lower extremity motor function, balance, and basic activities of daily living after stroke, respectively. However, these 3 measures (72 items) require a great amount of time for assessment. Therefore, we aimed to develop an efficient test, the Functional Assessment of Stroke (FAS). The FAS was constructed from 4 short-form tests of the Fugl-Meyer Assessment-upper extremity, Fugl-Meyer Assessment-lower extremity, Postural Assessment Scale for Stroke patients, and Barthel Index based on the results of Rasch analyses and the items' content. We examined the psychometric properties of the FAS, including Rasch reliability, concurrent validity, convergent validity, known-group validity, and responsiveness. The FAS contained 29 items (10, 6, 8, and 5 items for the 4 short-form tests, respectively). The FAS demonstrated high Rasch reliability (0.92-0.94), concurrent validity (r=0.90-0.97 with the original tests), convergent validity (r=0.62-0.94 with the 5-scale Fugl-Meyer Assessment), and known-group validity (significant difference in the FAS scores among 3 groups of disability levels; P<0.001). In addition, the responsiveness of the FAS (standardized response mean=0.55-1.93) was similar or significantly superior to those of the original tests (standardized response mean=0.46-1.39). The FAS contains 29 items and has sufficient Rasch reliability, validities, and responsiveness. These findings support that the FAS is efficient for reliably and validly assessing upper extremity/lower extremity motor function, balance, and basic activities of daily living and for sensitively detecting change in those functions in patients with stroke.

Effects of Task-Oriented Robot-Assisted Therapy for Motor Function of Upper Extremities and ADL Performance of Stroke Patients: A Systematic Review and Meta-Analysis

Effects of Task-Oriented Robot-Assisted Therapy for Motor Function of Upper Extremities and ADL Performance of Stroke Patients: A Systematic Review and Meta-Analysis

Contralateral peripheral neurotization for a hemiplegic hindlimb after central neurological injury.

OBJECTIVE Contralateral peripheral neurotization surgery has been successfully applied to rescue motor function of the hemiplegic upper extremity in patients with central neurological injury (CNI). It may contribute to strengthened neural pathways between the contralesional cortex and paretic limbs. However, the effect of this surgery in the lower extremities remains unknown. In the present study the authors explored the effectiveness and safety of contralateral peripheral neurotization in treating a hemiplegic lower extremity following CNI in adult rats. METHODS Controlled cortical impact (CCI) was performed on the hindlimb motor cortex of 36 adult Sprague-Dawley rats to create severe unilateral traumatic brain injury models. These CCI rats were randomly divided into 3 groups. At 1 month post-CCI, the experimental group (Group 1, 12 rats) underwent contralateral L-6 to L-6 transfer, 1 control group (Group 2, 12 rats) underwent bilateral L-6 nerve transection, and another control group (Group 3, 12 rats) underwent an L-6 laminectomy without injuring the L-6 nerves. Bilateral L-6 nerve transection rats without CCI (Group 4, 12 rats) and naïve rats (Group 5, 12 rats) were used as 2 additional control groups. Beam and ladder rung walking tests and CatWalk gait analysis were performed in each rat at baseline and at 0.5, 1, 2, 4, 6, 8, and 10 months to detect the skilled walking functions and gait parameters of both hindlimbs. Histological and electromyography studies were used at the final followup to verify establishment of the traumatic brain injury model and regeneration of the L6-L6 neural pathway. RESULTS In behavioral tests, comparable motor injury in the paretic hindlimbs was observed after CCI in Groups 1-3. Group 1 started to show significantly lower slip and error rates in the beam and ladder rung walking tests than Groups 2 and 3 at 6 months post-CCI (p < 0.05). In the CatWalk analysis, Group 1 also showed a higher mean intensity and swing speed after 8 months post-CCI and a longer stride length after 6 months post-CCI than Groups 2 and 3 (p < 0.05). Transection of L-6 resulted in transient skilled walking impairment in the intact hindlimbs in Groups 1 and 2 (compared with Group 3) and in the bilateral hindlimbs in Group 4 (compared with Group 5). All recovered to baseline level within 2 months. Histological study of the rat brains verified comparable injured volumes among Groups 1-3 at final examinations, and electromyography and toluidine blue staining indicated successful regeneration of the L6-L6 neural pathways in Group 1. CONCLUSIONS Contralateral L-6 neurotization could be a promising and safe surgical approach for improving motor recovery of the hemiplegic hindlimb after unilateral CNI in adult rats. Further investigations are needed before extrapolating the present conclusions to humans.

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

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

Poststroke depression: risk factors and potential effects on functional recovery.

The factors that may cause poststroke depression were investigated in the literature focusing on lesion localization, age, stroke severity, and impairments in physical and cognitive function. The aim of this study was to examine the risk factors influencing the development of poststroke depression and to determine the effect of depression on the patients' functional improvement after rehabilitation. Patients in the first 6-month period after stroke who were hospitalized in the Physical Medicine and Rehabilitation Clinic were included in this study. Patients who were admitted to the hospital within 0-30 and 30-120 days from the date of stroke were considered early and late rehabilitation entrants, respectively. The sample of this study included 93 patients. Patients' demographic and clinical characteristics, complications, and medical history were recorded. Upper extremity motor function, ambulation, and mood were evaluated according to the Frenchay Arm Test, the Functional Ambulation Scale, and the Beck Depression Inventory, respectively. The Functional Independence Measure (FIM) was applied to patients at admission to the hospital, at discharge, and 1 month after discharge (follow-up). The mean age of the patients was 58 years and the mean disease duration was 53 days. Depression was diagnosed in 49 (53%) patients. Except for age and disease duration, none of the factors of sex, hemiplegic side, stroke severity, stroke etiology, neglect, spasticity, sedentary lifestyle, poststroke immobility, and early-onset or late-onset to rehabilitation was found to induce statistically significant differences in the development of depression. Statistically significant changes occurred in total FIM levels between the groups with and without depression between admission and discharge, admission and follow-up, and discharge and follow-up. The levels were significantly higher in patients without depression than in patients with depression. Depression was found in a high frequency in stroke patients. Younger age and long disease duration were found to be factors affecting the development of depression. FIM scores were observed to be lower in stroke patients with depression.

Correlation Between Lower And Higher Order Sensory Functions And Fine And Gross Motor Function In Dominant And Non-Dominant Hand Of Patients With Choronic Stroke

Introduction: To investigate the correlation between lower and higher order sensory functions and manual dexterity as well as Identify factors affecting upper extremity motor function(UEMF) in subjects with chronic stroke.Methods: In this correlational study, seventy chronic stroke subjects (48 male and 22 female) by mean age of 56.94 (±12.92) years and mean time after stroke of 3.01 (±2.64) years were selected by simple nonprobability method. Lower order sensory function (i.e., light touch threshold), higher order sensory functions (i.e., tactile acuity, weight and texture discrimination, haptic performance and wrist proprioception) were measured by Weinstein enhanced sensory test, two point discrimination, wrist position sense test, hand active sensation test and haptic object test, respectively. The gross and fine manual dexterity were measured by Wolf Motor Function Test (WMFT), Box and Block Test(BBT) and Purdue Pegboard (PPB) test. The step by step regression model was used to investigate the sensory determinants of motor function.Results: A weak to high significant correlation (r =0.25 to 0.80) was found between sensory predictors and motor outcomes. The regression models explained 19.8%, 30.3% and 52.3% of variancein motor function measures of the PPB, BBT and WMFT, respectively. The tactile threshold (p&lt;0.001) was the most relevant predictor in all stepwise models for all motor outcomes in dominant or non-dominant hand , followed by tactile acuity, haptic performance and wrist proprioception (p&lt; 0.05). The weight and texture discrimination was not included in any outcome models. Conclusion: The results of present study showed that tactile threshold as lowr order sensory function is the most relevant predictor for UEMF in stroke. The results reinforce that rehabilitation interventions focused on tactile threshold may be best able to impact UEMF in stroke subjects.

Correlation Between Lower And Higher Order Sensory Functions And Fine And Gross Motor Function In Dominant And Non-Dominant Hand Of Patients With Choronic Stroke

Introduction: To investigate the correlation between lower and higher order sensory functions and manual dexterity as well as Identify factors affecting upper extremity motor function(UEMF) in subjects with chronic stroke.Methods: In this correlational study, seventy chronic stroke subjects (48 male and 22 female) by mean age of 56.94 (±12.92) years and mean time after stroke of 3.01 (±2.64) years were selected by simple nonprobability method. Lower order sensory function (i.e., light touch threshold), higher order sensory functions (i.e., tactile acuity, weight and texture discrimination, haptic performance and wrist proprioception) were measured by Weinstein enhanced sensory test, two point discrimination, wrist position sense test, hand active sensation test and haptic object test, respectively. The gross and fine manual dexterity were measured by Wolf Motor Function Test (WMFT), Box and Block Test(BBT) and Purdue Pegboard (PPB) test. The step by step regression model was used to investigate the sensory determinants of motor function.Results: A weak to high significant correlation (r =0.25 to 0.80) was found between sensory predictors and motor outcomes. The regression models explained 19.8%, 30.3% and 52.3% of variancein motor function measures of the PPB, BBT and WMFT, respectively. The tactile threshold (p&lt;0.001) was the most relevant predictor in all stepwise models for all motor outcomes in dominant or non-dominant hand , followed by tactile acuity, haptic performance and wrist proprioception (p&lt; 0.05). The weight and texture discrimination was not included in any outcome models.Conclusion: The results of present study showed that tactile threshold as lowr order sensory function is the most relevant predictor for UEMF in stroke. The results reinforce that rehabilitation interventions focused on tactile threshold may be best able to impact UEMF in stroke subjects.

Abstract 150: Diffusion Abnormalities and Quality of Life Outcomes After Intracerebral Hemorrhage

Background: Diffusion weighted imaging (DWI) abnormalities, consistent with acute brain infarcts, occur in approximately one-quarter of patients with intracerebral hemorrhage (ICH). Prior studies have observed that DWI lesions remote from the hematoma predict long-term disability. Their impact on health-related quality of life (HRQOL) outcomes, however, has not been described. We tested the hypothesis that DWI lesions remote from the hematoma worsen HRQOL after ICH. Methods: From a prospective registry of consecutive patients admitted to a single center with spontaneous ICH, we identified patients in whom DWI was performed within 1 week of admission, 1 or 3 month modified Rankin (mRS) and Neuro-QOL measures for upper extremity (UE) and lower extremity(LE) motor function were obtained. We excluded patients who underwent MRI after craniotomy or angiography. Two raters independently evaluated each MRI for DWI abnormalities remote from the hematoma blinded to outcome data. We assessed whether DWI lesions independently predicted outcomes using ordinal regression for mRS and linear regression of Neuro-QOL T-scores. Results: Among 106 patients with ICH, 95 met inclusion criteria (mean age 61.6±14.6 years; 51.6% male; 58.9% white; median ICH score 1). DWI lesions remote from the hematoma were found in 23 (24.2%) patients. Poor outcome (mRS &gt;2) was more common (61.9% vs. 36.1%, P=0.035) and T-scores were lower in those with versus without DWI lesions (UE: 31.7 vs. 40.5, P=0.011; LE: 32.4 vs. 41.0, P=0.021). Adjusted for ICH score and initial NIHSS score, DWI abnormality was an independent predictor of mRS (P=0.044) and UE (P=0.017) and LE T-scores (P=0.040). Discussion: We confirm that DWI lesions remote from the hematoma are common after spontaneous ICH and predict disability at 3 months independent of the ICH score and stroke severity. In addition, DWI lesions worsen Neuro-QOL motor function scores. Further research is needed to understand mechanisms of secondary brain ischemia after ICH and targeted approaches to prevent its occurrence.