Motor Recovery Of Upper Extremity Research Articles

Upper-extremity motor recovery after stroke: A systematic review and meta-analysis of usual care in trials and observational studies.

A better knowledge of upper-extremity (UE) recovery in patients with stroke receiving usual care (UC) is crucial for informing clinicians on expected recovery and serves as reference for future studies. This systematic review and meta-analysis aimed to assess rate and amount of recovery of UE with UC in the subacute phase of stroke and identify covariates of UE recovery. PRISMA-guidelines were used for search in PubMed, Cinahl and PEDro. Observational studies (OS) and UC groups of randomized control trials (RCT) of adults with subacute stroke and UE paresis were included, each reporting UE function at least at two time points. Placebo-, sham-controlled, dose-matched trials and trials with <10 participants were excluded. From 1220 records, 54 papers (19 OS and 35 RCTs) involving 2774 subacute stroke patients were included. Fugl-Meyer Assessment of Upper Extremity (FMA-UE) and Action Research Arm Test (ARAT) were most frequently reported UE outcomes. Across RCTs, FMA-UE and ARAT improved 10 and 8 points, respectively, on average at 4-weeks from baseline. In OS, FMA-UE, improved 12 points at 12weeks and 16 points at 24weeks from baseline. Stroke severity, UE function, and lesion load of the cortico-spinal tract at baseline were associated with UE recovery. UE function in subacute stroke showed improvements that exceeded the threshold for clinically important change across RCTs and OS. This review provides estimates of expected change in UC groups for sample size calculations and planning of future trials, thereby enhancing statistical power and comparability of findings.

Development and External Validation of a Motor Intention–Integrated Prediction Model for Upper Extremity Motor Recovery After Intention-Driven Robotic Hand Training for Chronic Stroke

ObjectiveTo derive and validate a prediction model for minimal clinically important differences (MCIDs) in upper extremity (UE) motor function after intention-driven robotic hand training using residual voluntary electromyography (EMG) signals from affected UE. DesignA prospective longitudinal multicenter cohort study. We collected preintervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from 8 time windows during MVC-EMG (0.1-5s) to identify subjects’ motor intention. Classification and regression tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor improvements was further investigated. SettingNine rehabilitation centers. ParticipantsChronic stroke survivors (N=131), including 87 for derivation sample, and 44 for validation sample. InterventionsAll participants underwent 20-session robotic hand training (40min/session, 3-5sessions/wk). Main Outcome MeasuresPrediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy. ResultsThe best model comprised FMAUE (cutoff score, 46) and peak activity of ED from 1-second MVC-EMG (MVC-EMG 4.604 times higher than resting EMG), which demonstrated significantly higher prediction accuracy (AUC, 0.807) than other time windows or solely using clinical scores (AUC, 0.595). In external validation, this model displayed robust prediction (AUC, 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases. ConclusionsThis study presents a prediction model for intention-driven robotic hand training in chronic stroke survivors. It highlights significance of capturing motor intention through 1-second EMG window as a predictor for MCID improvement in UE motor function after 20-session robotic training. Survivors in 2 conditions showed high percentage of clinical motor improvement: moderate-to-high motor intention and low-to-moderate function; as well as high intention and high function.

VIRTUAL REALITY BASE REHABILITATION IN STROKE FOR UPPER LIMB MOTOR RECOVERY

Background of the study: The main cause of disability globally is stroke, with upper extremity motor impairment mostly involved. Virtual reality is an emerging technology that has been widely used in stroke rehabilitation with physical therapy for upper extremity functional restoration. The present systematic review is aimed at providing an evidence-based quality assessment of virtual reality based rehabilitation for upper extremity motor recovery in patients with cerebrovascular accident. Methodology: A comprehensive search was conducted in major electronic databases including Medline (PubMed), Pedro, Embase, and CINAHL published articles between 2018 to 2023 whose full text was available. This review comprised 9 studies. With the use of the Cochrane risk of bias tool, the caliber of the included studies was evaluated. Results: The current evidence suggests that VR-based interventions can significantly improve upper limb motor function. The systematic review featured few RCTs and fewer subjects, making generalization difficult, especially as most studies incorporated virtual reality with traditional therapy, and those focusing purely on virtual reality were similarly tiny. The review is the independent creation of authors. Conclusion: VR-based therapies have the potential to be an efficient and secure method for stroke patients to regain upper extremity motor function. To provide standardized procedures and result metrics, as well as to solve the practical difficulties related to implementing VR in stroke therapy, further research is required.

Abstract TMP28: Forced-Rate Aerobic Cycling Enhances Motor Recovery in Persons With Chronic Stroke: A Randomized Clinical Trial

Introduction: The potential for intensive aerobic exercise to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate aerobic exercise paired with an abbreviated session of upper extremity (UE) repetitive task practice (FE+RTP) compared to time-matched UE repetitive task practice (RTP only) on the recovery of motor function in individuals with chronic stroke. Hypothesis: We hypothesized that FE+RTP would yield greater improvements in UE motor recovery compared to time-matched RTP only. Methods: A randomized clinical trial was conducted in which participants (N=60) completed 24 sessions of FE followed by RTP (FE+RTP) or time-matched RTP alone. The FE+RTP group exercised at 60-80% of heart rate reserve on a motorized stationary semi-recumbent cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP. The primary UE outcomes were the Fugl-Meyer Assessment (FMA) and the Action Research Arm Test (ARAT). The Six-minute Walk Test (6MWT) assessed walking capacity. Results: Sixty individuals 60.5 (±10.6) years of age were enrolled, and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8±44.4 versus 222.8±28.4, P&lt;0.001) and time (72.7±6.7 versus 37.8±2.4 minutes, P&lt;0.001) compared to FE+RTP. Both groups improved on the FMA (FE+RTP, 36.2±10.1 to 44.0±11.8 and RTP only, 34.4±11.0 to 41.2±13.4, P&lt;0.001) and ARAT (FE+RTP, 32.5±16.6 to 37.7±17.9 and RTP only, 32.8±18.6 to 36.4±18.5, P&lt;0.001). A group main effect was not observed. The FE+RTP group demonstrated greater improvements on the 6MWT (274.9±122.0 to 327.1±141.2 meters) compared to the RTP only group (285.5±160.3 to 316.9±170.0, P=0.004). Conclusions: While both interventions elicited comparable improvements in UE motor recovery, the summative value of FE+RTP in improving UE and lower extremity function was demonstrated.

Determining the effects of targeted high-definition transcranial direct current stimulation on reducing post-stroke upper limb motor impairments—a randomized cross-over study

BackgroundStroke is one of the leading causes of death in the USA and is a major cause of serious disability for adults. This randomized crossover study examines the effect of targeted high-definition transcranial direct current transcranial brain stimulation (tDCS) on upper extremity motor recovery in patients in the post-acute phase of stroke recovery.MethodsThis randomized double-blinded cross-over study includes four intervention arms: anodal, cathodal, and bilateral brain stimulation, as well as a placebo stimulation. Participants receive each intervention in a randomized order, with a 2-week washout period between each intervention. The primary outcome measure is change in Motor Evoked Potential. Secondary outcome measures include the Fugl-Meyer Upper Extremity (FM-UE) score, a subset of FM-UE (A), related to the muscle synergies, and the Modified Ashworth Scale.DiscussionWe hypothesize that anodal stimulation to the ipsilesional primary motor cortex will increase the excitability of the damaged cortico-spinal tract, reducing the UE flexion synergy and enhancing UE motor function. We further hypothesize that targeted cathodal stimulation to the contralesional premotor cortex will decrease activation of the cortico-reticulospinal tract (CRST) and the expression of the upper extremity (UE) flexion synergy and spasticity. Finally, we hypothesize bilateral stimulation will achieve both results simultaneously. Results from this study could improve understanding of the mechanism behind motor impairment and recovery in stroke and perfect the targeting of tDCS as a potential stroke intervention. With the use of appropriate screening, we anticipate no ethical or safety concerns. We plan to disseminate these research results to journals related to stroke recovery, engineering, and medicine.Trial registrationClinicalTrials.gov NCT05479006. Registered on 26 July 2022.

Effect of movement-based priming combined with task specific training on upper limb recovery in patients after stroke

Background: Rehabilitation of upper limb impairments and functional deficits is a top goal in stroke rehabilitation. Alternative therapeutic methods may be developed to facilitate upper limb recovery. Priming prepares the brain for better action. When some therapies accompany Priming, it results in a change in behaviour at the performance level by improving the effect of Neuro-Rehabilitation Therapies and enhancing change in the neural process. Objectives: To investigate the efficacy of movement-based priming combined with task-specific training on upper limb recovery in patients after stroke. Materials and methods: Twenty-four subjects in the early phase of stroke, attending the Department of Neurology in a tertiary care hospital of Bhubaneswar, Odisha participated in a single-blind randomized controlled trial. 24 subjects after stroke were recruited to the study and randomly allocated to a control group receiving task-specific training only (TST) and an experimental group receiving Movement-Based Priming with task-specific training (MBP+TST). The control group received only task-specific training for 45 minutes per session three days a week for six weeks, while the experimental group received 15 minutes of priming and 30 minutes of task-specific training. Fugl-Mayer Assessment of upper extremity (FMA-UE)was used to measure upper extremity motor recovery, and the Motor Activity Log (MAL) was used to measure the use of arm and hand during activities of daily living at baseline and after six weeks of therapy. Results: Both the TST group and the MBP+TST group had significantly improved their capacity to move and use their upper limbs functionally (p&lt;0.001). FMA-UE and MAL scores improved more favorably in the MBP+TST group than in the TST group (p&lt;0.001). Conclusion: Priming in combination with task-specific training results in better upper limb recovery than task-specific training alone.

Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial

Background: Mirror therapy (MT) is an intervention used for upper extremity rehabilitation in stroke patients and has been studied in various fields. Recently, effective MT methods have been introduced in combination with neuromuscular electrical stimulation or with electromyography (EMG)-triggered biofeedback. The purpose of this study was to investigate the effects of functional electrical stimulation (FES)-based MT incorporating a motion recognition biofeedback device on upper extremity motor recovery to chronic stroke patients. Methods: Twenty-six chronic stroke patients with onset of more than 6 months were randomly assigned into experimental group (n = 13) and control group (n = 13). Both groups participated in conventional rehabilitation program, while the control group received conventional MT intervention and the experimental group received FES-based MT with motion recognition biofeedback device. All interventions were conducted for 30 min/d, 5 d/wk, for 4 weeks. Upper limb motor recovery, upper limb function, active-range of motion (ROM), and activities of daily living independence were measured before and after the intervention and compared between the 2 groups. Results: The Fugl-Meyer assessment (FMA), manual function test (MFT), K-MBI, and active-ROM (excluding deviation) were significantly improved in both groups (P &lt; .05). Only the experimental group showed significant improvement in upper extremity recovery, ulnar and radial deviation (P &lt; .05). There was a significant difference of change in Brunstrom’s recovery level, FMA, MFT, and active-ROM in the experimental group compared to the control group (P &lt; .05). Conclusion: FES-based MT using gesture recognition biofeedback is an effective intervention method for improving upper extremity motor recovery and function, active-ROM in patients with chronic stroke. This study suggests that incorporating gesture-recognition biofeedback into FES-based MT can provide additional benefits to patients with chronic stroke.

Efektifitas Motor Relearning Program dalam Meningkatkan Pemulihan Motorik Ekstremitas Atas dan Kemandirian Aktivitas Berpakaian Pasien Pasca Stroke

Abstract Background: Upper extremity motor disorders are the main complaint in the majority of post-stroke patients. Motoric ability is an important prerequisite in daily activities (activities of daily living), including dressing. Motor Relearning Program (MRP) is a method to train the motor skills of post-stroke patients. Objectives: The aim of this study was to examine the effectiveness of MRP on upper extremity motor recovery and its effect on the ability to dress activities in post-stroke patients. Methods: The study was conducted with a one-group pretest-posttest pre-experimental design. The research sample was obtained by purposive sampling. The instruments used in this study were the Fugl-Meyer Upper Extremity (FMA-UE) and the Nottingham Stroke Dressing Assessment (NSDA). Data processing was carried out by means of comparative tests and regression tests using SPSS 25 software. Results: The majority of the respondents were male (65%), elderly (65%), &lt;24 months of onset (75%), and with right hemisphere lesions (60%). The mean ± SD FMA-UE score was 37.75 ± 8.63 (pretest) and 47 ± 6.44 (posttest). The mean ± SD NSDA were 8.10 ± 2.94 (pretest) and 12.40 ± 2.89 (posttest). The comparison test showed a significant difference in the FMA-UE score (z=-3.924, p&lt;0.05) and the NSDA score (z=-3.927, p&lt;0.05). The linear regression test shows p-value = 0.001 with a determinant coefficient of 0.459. Conclusion: The MRP method is effective in improving the recovery of upper extremity motor skills in post-stroke patients, which has an effect of up to 45.9% on improving the dressing ability of post-stroke patients. Keywords : Stroke, Motoric, MRP, Dressing

High-Frequency Ipsilesional versus Low-Frequency Contralesional Transcranial Magnetic Stimulation after Stroke: Differential Effects on Ipsilesional Upper Extremity Motor Recovery.

Background and Objectives: Stroke is a major cause of death and disability worldwide; therefore, transcranial magnetic stimulation (TMS) is being widely studied and clinically applied to improve motor deficits in the affected arm. However, recent studies indicate that the function of both arms can be affected after stroke. It currently remains unknown how various TMS methods affect the function of the ipsilesional upper extremity. Materials and Methods: Thirty-five subacute stroke patients with upper extremity motor deficits were enrolled in this study and randomly allocated into three groups, receiving either (1) low-frequency rTMS over the contralesional hemisphere; (2) high-frequency rTMS over the ipsilesional hemisphere; or (3) no stimulation. Experimental groups received 10 rTMS sessions over two weeks alongside standard rehabilitation, and the control group received the same procedures except for rTMS. Both affected and unaffected upper extremity motor function was evaluated using hand grip strength and Functional Independence Measure (FIM) tests before and after rehabilitation (7 weeks apart). Results: All groups showed significant improvement in both the affected and unaffected hand grip and FIM scores (p < 0.05). HF-rTMS led to a notably higher increase in unaffected hand grip strength than the control group (p = 0.007). There was no difference in the improvement in affected upper extremity motor function between the groups. The FIM score increase was lower in the control group compared to experimental groups, although not statistically significant. Conclusions: This study demonstrates the positive effect of ipsilesional HF-rTMS on the improvement in unaffected arm motor function and reveals the positive effect of both LF- and HF-rTMS on the affected upper extremity motor function recovery.

Do kinematic measures, added to clinical measures, better predict upper extremity motor impairments at three months post-stroke?

ObjectivePredicting post-stroke recovery through prediction models is crucial for choosing appropriate treatment options. However, the existing models predominantly incorporate clinical measures although measurement of movement quality using kinematic measures is essential for distinguishing various types of recovery. Thus, this study aimed at determining if, by considering varied aspects of recovery, adding kinematic measurements over clinical measures would better predict upper extremity (UE) motor impairments at three months post-stroke. Materials and methodsEighty-nine stroke survivors (58.9 ± 11.8 years) were assessed for clinical predictors between 4 and 7 days, kinematic predictors within 1 month, and the impairment outcome of the Fugl Meyer Assessment of the UE (FM-UE) at three months post-stroke. Significant predictors (p<0.05) with a variation inflation factor (VIF) <10 were selected for model development. After performing further step-wise selection, three models incorporating clinical outcomes, kinematic measurements, and a combination of these two, respectively, were formulated. ResultsThe clinical model (R2 = 0.70) included shoulder abduction finger extension (SAFE) scores, the National Institutes of Health Stroke Scale (NIHSS), and the Montreal Cognitive Assessment (MoCA). The kinematic model (R2 = 0.34) included total displacement, total time, and reaction time. The combined model (R2 = 0.72) comprised of SAFE score and shoulder flexion. All the models had a minimal mean squared error on cross validation, which indicated a good validity. ConclusionThe performance of clinical and combined prediction models for predicting three-month post-stroke UE motor recovery was nearly similar. However, in order to detect minimal changes over time and to understand all aspects of motor recovery, there is a need to add instrument-based kinematic measures.

Skin Tone: The Missing Piece in Action Observation Intervention Poststroke

Abstract Date Presented 04/22/2023 Action observation has been documented as an evidence-based intervention for upper extremity motor recovery poststroke. The results from this Critically Appraised Topic demonstrate a lack of documentation regarding the skin tone displayed in the videos used for action observation intervention. Consideration should be given to displaying videos with concordant race, skin tone, and gender of the client. Such inclusivity may increase positive outcomes for participants. Primary Author and Speaker: Krystal Robinson-Bert

Does a Cognitive Network Contribute to Motor Recovery After Ischemic Stroke?

Background In stroke patients, preserved cognitive function plays a role in motor recovery, but there is insufficient evidence on the involved mechanisms. These mechanisms require investigation in the human brain, which is composed of large-scale functionally specialized networks. Objective In this study, we investigated the role of cognition-related networks on upper extremity motor recovery using neuroimaging data of subacute stroke patients. Methods This study retrospectively analyzed cohort data of 108 subacute ischemic stroke patients. All patients underwent resting-state functional MRI and motor function assessments using the Fugl-Meyer assessment (FMA) at 2 weeks after stroke onset. The FMA upper extremity (FMA-UE) score was obtained again at three months after stroke onset to assess motor recovery. To construct a resting-state network, cortical surface parcellation was performed using the Gordon atlas, which included 333 regions of interest, and 12 resting-state networks were extracted. Linear regression was used to identify the relationships between the FMA-UE recovery score and resting-state networks. Results Cognition-related networks were correlated with the FMA-UE recovery score, as were motor-related networks. Interaction effects between motor- and cognition-related network states existed in motor recovery. Specifically, cognition-related networks were associated with motor recovery in patients with a lower strength of motor-related networks. Conclusions These results suggested that the greater the damage to the motor network caused by stroke is, the more important the cognition-related networks are in motor recovery.

Effect of different constraint-induced movement therapy protocols on recovery of stroke survivors with upper extremity dysfunction: a systematic review and network meta-analysis.

We aimed to assess and rank comparative efficacy of different constraint-induced movement therapy (CIMT) protocols on motor function of upper extremity and activities of daily living (ADL) in stroke survivors. A comprehensive search was conducted in PubMed, EMBASE, Web of Science and Cochrane Library to identify randomized controlled trials on CIMT. Included studies were evaluated using the revised Cochrane risk of bias tool. Then a random-effects network meta-analysis was performed within a frequentist framework using Stata v16.0. Of the 1150 studies retrieved, 44 studies with 1779 participants were included. In terms of motor recovery of upper extremity, CIMT combined with trunk restraint, in which the less affected arm was constrained at least 4 h but no more than 6 h per day, ranked as the most effective intervention for the improvement of the Fugl-Meyer Assessment-Upper Extremity and the Action Research Arm Test score. In terms of ADL improvement, constraining the less affected arm for at least 4 h but no more than 6 h per day in CIMT combined with trunk restraint, was found to significantly improve the Motor Activity Log of quality of movement scale and amount of use scale score. The protocol of CIMT combined with trunk restraint, in which the less affected arm was constrained at least 4 h but no more than 6 h per day, ranked the highest in this analysis and might be considered in practice.

Comparison of immersive and non-immersive virtual reality for upper extremity functional recovery in patients with stroke: a systematic review and network meta-analysis.

This systematic review aimed to compare the effects of immersive and non-immersive virtual reality on upper extremity function in stroke survivors by employing a network meta-analysis approach. MEDLINE, Embase, CINAHL Plus, APA PsycINFO, and Scopus were searched. Virtual reality was used for upper extremity rehabilitation; dose-matched conventional rehabilitation was used for comparison. Fugl-Meyer Assessment was used to assess upper extremity function. Searches were limited to English language randomized controlled trials. Two independent reviewers conducted study selection, data extraction, and quality assessment. Methodological quality was assessed using the Physiotherapy Evidence Database scale. A random-effects frequentist network meta-analysis was conducted by assuming a common random-effects standard deviation for all comparisons in the network. Twenty randomized controlled trials with 813 participants were included, with each study evaluated as good quality. Immersive virtual reality systems were most effective at improving upper extremity function, followed by non-immersive virtual reality systems, then non-immersive gaming consoles of Microsoft Kinect and Nintendo Wii. Conventional rehabilitation was least effective. Immersive virtual reality was estimated to induce 1.39 (95% confidence interval (CI): 0.25, 2.53) and 1.38 (95% CI: 0.55, 2.20) standard mean differences of improvements in upper extremity function, compared to Nintendo Wii intervention and conventional rehabilitation, respectively. This systematic review and network meta-analysis highlights the superior effects of immersive virtual reality to non-immersive virtual reality systems and gaming consoles on upper extremity motor recovery.

Is the robotic rehabilitation that is added to intensive body rehabilitation effective for maximization of upper extremity motor recovery following a stroke? A randomized controlled study.

Trunk stabilization, which is a factor that directly affects the performance of affected upper-limb movements in stroke patients, is of critical importance in the performance of selective motor control. This study aimed to investigate the effects on upper-limb motor function of the addition of robotic rehabilitation (RR) and conventional rehabilitation (CR) to intensive trunk rehabilitation (ITR). A total of 41 subacute stroke patients were randomly allocated to two groups: RR and CR. Both groups received the same ITR procedure. Following ITR, a robot-assisted rehabilitation program of 60min, 5days a week, for 6weeks, was applied to the RR group, and an individualized upper-limb rehabilitation to the CR group. Assessments were made at baseline and after 6weeks using the Trunk Impairment Scale (TIS), Fugl-Meyer Upper Extremity Motor Evaluation Scale (FMA-UE), and Wolf Motor Function Test (WMFT). Improvements were obtained in the TIS, FMA-UE, and WMFT scores for both groups (p < 0.001), with no superiority detected between the groups (p > 0.05). The RR group scores were relatively high, but not to a statistically significant. When added to intensive trunk rehabilitation, the robot-assisted systems, which are recommended as a stand-alone therapy method, produced similar results to conventional therapies. This technology can be used as an alternative to conventional methods under appropriate conditions of clinical opportunity, access, time management, and staff limitations. However, when RR is combined with traditional interventions such as intensive trunk rehabilitation, it is essential to investigate if the real effect is due to the robotic rehabilitation or the accumulation of positive effects of excessive movement or force spread associated with trained muscles. This trial was retrospectively registered in the ClinicalTrials.gov with NCT05559385 registration number (25/09/2022).

Prediction of post-stroke motor recovery benefits from measures of sub-acute widespread network damages.

Following a stroke in regions of the brain responsible for motor activity, patients can lose their ability to control parts of their body. Over time, some patients recover almost completely, while others barely recover at all. It is known that lesion volume, initial motor impairment and cortico-spinal tract asymmetry significantly impact motor changes over time. Recent work suggested that disabilities arise not only from focal structural changes but also from widespread alterations in inter-regional connectivity. Models that consider damage to the entire network instead of only local structural alterations lead to a more accurate prediction of patients' recovery. However, assessing white matter connections in stroke patients is challenging and time-consuming. Here, we evaluated in a data set of 37 patients whether we could predict upper extremity motor recovery from brain connectivity measures obtained by using the patient's lesion mask to introduce virtual lesions in 60 healthy streamline tractography connectomes. This indirect estimation of the stroke impact on the whole brain connectome is more readily available than direct measures of structural connectivity obtained with magnetic resonance imaging. We added these measures to benchmark structural features, and we used a ridge regression regularization to predict motor recovery at 3 months post-injury. As hypothesized, accuracy in prediction significantly increased (R 2 = 0.68) as compared to benchmark features (R 2 = 0.38). This improved prediction of recovery could be beneficial to clinical care and might allow for a better choice of intervention.

The effects of combined high-frequency repetitive transcranial magnetic stimulation and cervical nerve root magnetic stimulation on upper extremity motor recovery following stroke.

Upper limb motor impairments after stroke cause patients partial or total loss of the capability of performing daily living, working, and social activities, which significantly affects the quality of life (QoL) of patients and brings a heavy burden to their families and society. As a non-invasive neuromodulation technique, transcranial magnetic stimulation (TMS) can act not only on the cerebral cortex, but also on peripheral nerves, nerve roots, and muscle tissues. Previous studies have shown that magnetic stimulation on the cerebral cortex and peripheral tissues has a positive effect on the recovery of upper limb motor function after stroke, however, few studies have reported the combination of the two. This study was to investigate whether high frequency repetitive transcranial magnetic stimulation (HF-rTMS) combined with cervical nerve root magnetic stimulation more effectively ameliorates upper limb motor function in stroke patients. We hypothesized that the combination of the two can achieve a synergistic effect and further promotes functional recovery. Sixty patients with stroke were randomly divided into four groups and received real or sham rTMS stimulation and cervical nerve root magnetic stimulation consecutively before other therapies, once daily over five fractions per week for a total of 15 times. We evaluated the upper limb motor function and activities of daily living of the patients at the time of pre-treatment, post-treatment, and 3-month follow up. All patients completed study procedures without any adverse effects. The upper limb motor function and activities of daily living improved in patients of each group were improved after treatment (post 1) and 3 months after treatment (post 2). Combination treatment was significantly better than single treatments alone or sham. Both rTMS and cervical nerve root magnetic stimulation effectively promoted upper limb motor recovery in patients with stroke. The protocol combining the two is more beneficial for motor improvement and patients can easily tolerate it. https://www.chictr.org.cn/, identifier ChiCTR2100048558.

Is modified constraint-induced movement therapy effective in improving motor performance in patients with hemiplegia?

Aim: To investigate the effect of modified constraint-induced movement therapy (mCIMT) on upper extremity motor recovery, performance, and functional independence in addition to conventional rehabilitation in stroke patients.Methods: The study included 40 participants, including 20 chronic stroke cases in the intervention group (IG) (64.45±9.18 years) and 20 chronic stroke cases in the control group (CG) (64.45±9.18 years) who met the selection criteria. IG received mCIMT with regular physiotherapy, while CG received only regular physiotherapy. The patients were evaluated with the Motor Activity Log-28 (MAL-28), the Functional Independence Measure (FIM), and the Fugl-Meyer Upper Extremity Scale (FMUES) before treatment, immediately after treatment (post-treatment), and at three months after treatment (follow-up).Results: The MAL-28 and FIM scores significantly increased in both groups compared with the baseline values after treatment and at the third-month follow-up (p&amp;lt;0.05). After treatment and at the third-month follow-up, the FMUES scores significantly increased in both groups compared with the baseline values (p&amp;lt;0.001).Conclusion: This study showed that mCIMT added to conventional therapy improved upper extremity motor function, performance, and functional independence in chronic stroke patients; however, mCIMT had no additional benefit to conventional therapy.

The Impact of Mental Practice on Motor Function in Patients With Stroke: A Systematic Review and Meta-analysis.

Mental practice (MP), the cognitive rehearsal of physical activities without overt movements, has recently emerged as a promising rehabilitation method for patients with stroke. This paper presents a systematic review and meta-analysis critically evaluating the existing evidence to offer a comprehensive estimate of the overall effect of MP on motor function in stroke patients. A systematic search of 3 international databases (PubMed, Embase, and the Cochrane Library) was conducted for randomized controlled trials. We finally selected 31 randomized clinical trials and conducted meta-analysis to determine the effectiveness of MP on motor recovery of upper extremity, upper extremity function, activities of daily living, and gait velocity in stroke patients. The results of the systematic reviews showed that MP combined with conventional therapy has a positive impact on improving upper extremity motor function, with a moderate quality of evidence. However, the beneficial effect of MP on gait velocity was not demonstrated. It is recommended to treat with MP in addition to conventional rehabilitation therapy to improve the motor outcome of stroke depending on the patient's condition (Recommendation level: Conditional Recommend Evidence certainty: Moderate).

Hierarchical Properties of the Fugl-Meyer Assessment Upper Extremity Scale for People After Stroke

<h3>Research Objectives</h3> This study aimed (1) to investigate the hierarchical properties of FMA-UE and Brunnstrom stages, and (2) to develop a functional staging, a graphical plot, of FMA-UE and its relationships to severe (0–28), moderate (29–42), and mild (43–66) FMA-UE cut-off scores. <h3>Design</h3> Secondary analysis of cross-sectional data. <h3>Setting</h3> Outpatient rehabilitation settings. <h3>Participants</h3> The Locomotor Experience Applied Post-stroke (LEAPS) trial data included 408 patients with stroke with a mean age of 62 years old (SD = 12.7, range = 25 to 98). The mean onset of stroke was 64 days (SD = 8.5, range = 43 to 112). About 55% of the sample were male. The majority (80%) of the sample had an ischemic stroke. Approximately half of the sample had brain lesions in the right hemisphere, followed by the left hemisphere (35%), brainstem (15%), and bilateral (2%). Although most of the sample was White (58%), other racial groups were represented: Black (22%), Asian (13%), Native Hawaiian or other Pacific Islander (5%), and American Indian/Alaska Native (1%). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> The 33-item FMA-UE has four subsections: (1) shoulder-arm, (2) wrist, (3) hand, and (4) coordination and speed designed to measure impairment from proximal to distal, reflexive to voluntary, and synergistic to isolated voluntary movement. <h3>Results</h3> Overall, the item difficulty hierarchical order of the FMA-UE reflected the Brunnstrom stages. The items from easy to difficult were reflex activity items, followed by items assessing flexor and extensor synergy, movement combining synergies, and movement out of synergy. The ‘normal reflex activity', ‘shoulder flexion 90-180°', ‘coordination/speed' items represented the most difficult items. The three-level functional staging was judged to be clinically logical and to provide insight for clinical interpretation of patient progress. <h3>Conclusions</h3> Our findings suggest that the FMA-UE items reflect the upper extremity motor recovery stage. This study demonstrates how functional staging can be used to translate a standardized assessment into a useful, evidence-based tool for making clinical practice decisions. <h3>Author(s) Disclosures</h3> The authors declare that there is no conflict of interest.