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Sulfikar Ali A, Bhat M, Palaniswamy HP, Ramachandran S, Kumaran SD. Does Action Observation of the Whole Task Influence Mirror Neuron System and Upper Limb Muscle Activity Better Than Part Task in People With Stroke? Stroke Res Treat 2024; 2024:9967369. [PMID: 39399483 PMCID: PMC11470815 DOI: 10.1155/2024/9967369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 07/13/2024] [Accepted: 09/05/2024] [Indexed: 10/15/2024] Open
Abstract
Background: Task-based action observation and imitation (AOI) is a promising intervention to enhance upper limb (UL) motor function poststroke. However, whether whole/part task must be trained in the AOI therapy needs further substantiation. Objective: The objective of this study is to assess and compare the mirror neuron activity and UL muscle activity during AOI of reaching task in terms of whole task (complete movement) and part task (proximal arm movements and distal arm movements). Methods: In this cross-sectional study, 26 participants with first-time unilateral stroke were asked to observe the prerecorded videos of a reaching task in terms of a whole task and proximal and distal components, followed by imitation of the task, respectively. Electroencephalographic (EEG) mu rhythm suppression and electromyographic amplitude of six UL muscles were measured during the task. Results: The analysis of EEG revealed a statistically significant mu suppression score, indicating mirror neuron system activity, during AOI of the whole task in C3 (p = <0.001) and C4 (p = <0.001) electrodes compared to the part task. Percentage maximum voluntary contraction amplitudes of the deltoid (p = 0.002), supraspinatus (p = <0.001), triceps brachii (p = 0.002), brachioradialis (p = 0.006), and extensor carpi radialis (p = <0.001) muscles showed a significant increase in muscle activity during AOI of the whole task. Also, there seems to be a task observation-specific activation of muscles following AOI of proximal or distal tasks. Conclusion: The practice of the whole task should be given emphasis while framing the AOI treatment module to enhance reaching in people with stroke. Trial registration: Clinical Trials Registry-India (CTRI) identifier: CTRI/2018/04/013466.
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Affiliation(s)
- A. Sulfikar Ali
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal 576104, India
- Department of Physiotherapy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal 576104, India
| | - Mayur Bhat
- Department of Audiology and Speech Language Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Karnataka, Manipal 576104, India
| | - Hari Prakash Palaniswamy
- Department of Speech and Hearing, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal 576104, India
| | - Selvam Ramachandran
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal 576104, India
| | - Senthil D. Kumaran
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Karnataka, Manipal 576104, India
- Department of Medical Rehabilitation-Physical Therapy Program, School of Rehabilitation and Medical Sciences, College of Health Sciences, University of Nizwa, Nizwa, Oman
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Lee SI, Liu Y, Vergara-Díaz G, Pugliese BL, Black-Schaffer R, Stoykov ME, Bonato P. Wearable-Based Kinematic Analysis of Upper-Limb Movements During Daily Activities Could Provide Insights into Stroke Survivors' Motor Ability. Neurorehabil Neural Repair 2024; 38:659-669. [PMID: 39109662 PMCID: PMC11405131 DOI: 10.1177/15459683241270066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND Frequent and objective monitoring of motor recovery progression holds significant importance in stroke rehabilitation. Despite extensive studies on wearable solutions in this context, the focus has been predominantly on evaluating limb activity. This study aims to address this limitation by delving into a novel measure of wrist kinematics more intricately related to patients' motor capacity. OBJECTIVE To explore a new wearable-based approach for objectively and reliably assessing upper-limb motor ability in stroke survivors using a single inertial sensor placed on the stroke-affected wrist. METHODS Seventeen stroke survivors performed a series of daily activities within a simulated home setting while wearing a six-axis inertial measurement unit on the wrist affected by stroke. Inertial data during point-to-point upper-limb movements were decomposed into movement segments, from which various kinematic variables were derived. A data-driven approach was then employed to identify a kinematic variable demonstrating robust internal reliability, construct validity, and convergent validity. RESULTS We have identified a key kinematic variable, namely the 90th percentile of movement segment distance during point-to-point movements. This variable exhibited robust reliability (intra-class correlation coefficient of .93) and strong correlations with established clinical measures of motor capacity (Pearson's correlation coefficients of .81 with the Fugl-Meyer Assessment for Upper-Extremity; .77 with the Functional Ability component of the Wolf Motor Function Test; and -.68 with the Performance Time component of the Wolf Motor Function Test). CONCLUSIONS The findings underscore the potential for continuous, objective, and convenient monitoring of stroke survivors' motor progression throughout rehabilitation.
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Affiliation(s)
- Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Yunda Liu
- College of Information and Computer Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Gloria Vergara-Díaz
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Benito Lorenzo Pugliese
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
- Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Randie Black-Schaffer
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Mary Ellen Stoykov
- Arm & Hands Lab, Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School at Spaulding Rehabilitation Hospital, Boston, MA, USA
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Liu HG, Liu JJ, Wang YP, Wang HY, Sun A, Zhou Y, Cai MM, Qi MM. Impact of task-oriented training based on acupuncture rehabilitation on upper extremity function and quality of life of patients with early stroke. World J Clin Cases 2024; 12:3776-3784. [PMID: 38994303 PMCID: PMC11235430 DOI: 10.12998/wjcc.v12.i19.3776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction, especially hand dysfunction, which has a very slow recovery, resulting in economic burden to families and society. AIM To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke. METHODS Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group, each with 50 cases. The control group underwent head acupuncture plus routine upper limb rehabilitation training (acupuncture therapy). In addition to acupuncture and rehabilitation, the observation group underwent upper limb task-oriented training (30 min). Each group underwent treatment 5 d/wk for 4 wk. Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Wolf Motor Function Rating Scale (WMFT), modified Barthel Index (MBI), and Canadian Occupational Performance Measure (COPM). Quality of life was evaluated using the Short-Form 36-Item Health Survey (SF-36). Clinical efficacy of the interventions was also evaluated. RESULTS Before intervention, no significant differences were observed in the FMA-UE, MBI, and WMFT scores between the two groups (P > 0.05). After intervention, the FMA-UE, WMFT, MBI, COPM-Functional Mobility and Satisfaction, and SF-36 scores increased in both groups (P < 0.05), with even higher scores in the observation group (P < 0.05). The observation group also obtained a higher total effective rate than the control group (P < 0.05). CONCLUSION Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility, quality of life, and clinical efficacy in patients with early stroke.
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Affiliation(s)
- Hong-Guang Liu
- Department of Rehabilitation Medicine, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
| | - Jing-Jing Liu
- Department of Neurology, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
| | - Yan-Ping Wang
- Department of Infectious Diseases, Jixi Hengshan District People's Hospital, Jixi 158100, Heilongjiang Province, China
| | - Hong-Ying Wang
- Department of Rehabilitation Medicine, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
| | - Ao Sun
- Department of Rehabilitation Medicine, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
| | - Yue Zhou
- Department of Rehabilitation Medicine, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
| | - Ming-Ming Cai
- Department of Medical Care, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
| | - Ming-Ming Qi
- Department of Science and Education, Ji Xi Ji Mine Hospital, Jixi 158100, Heilongjiang Province, China
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Ogahara K, Nakashima A, Suzuki T, Sugawara K, Yoshida N, Hatta A, Moriuchi T, Higashi T. Comparing movement-related cortical potential between real and simulated movement tasks from an ecological validity perspective. Front Hum Neurosci 2024; 17:1313835. [PMID: 38298203 PMCID: PMC10828031 DOI: 10.3389/fnhum.2023.1313835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Concerns regarding the ecological validity of movement-related cortical potential (MRCP) experimental tasks that are related to motor learning have recently been growing. Therefore, we compared MRCP during real movement task (RMT) and simulated movement task (SMT) from an ecological validity perspective. Methods The participants performed both RMT and SMT, and MRCP were measured using electroencephalogram (EEG). EEG was based on the 10-20 method, with electrodes placed in the motor cortex (C3 and C4) and supplementary motor cortex (FCz [between Fz and Cz] and Cz) areas. This experiment examined the MRCP using Bereitschaftspotential (BP) and negative slope (NS') onset times, and BP, NS', and motor potential (MP) amplitudes during the task. Results The results revealed that the SMT exhibited later BP and NS' onset times and smaller BP, NS', and MP amplitudes than the RMT. Furthermore, in RMT, the onset time of MRCP was delayed, and the amplitude of MRCP was smaller in the second half of the 200 times task than in the first half, whereas in SMT, there was no change in onset time and amplitude. The SMT showed a different MRCP than the RMT, suggesting that the ecological validity of the task should be fully considered when investigating the cortical activity associated with motor skill learning using MRCP. Conclusion Ecological validity of the study should be fully considered when investigating the cortical activity associated with motor skill learning using MRCP. Moreover, it is important to understand the differences between the two methods when applied clinically.
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Affiliation(s)
- Kakuya Ogahara
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
- Department of Occupational Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Akira Nakashima
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
| | - Tomotaka Suzuki
- Department of Physical Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Kenichi Sugawara
- Department of Physical Therapy, Kanagawa University of Human Services, Yokosuka, Japan
| | - Naoshin Yoshida
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
| | - Arihiro Hatta
- Department of Physical Recreation, School of Physical Education, Tokai University, Hiratsuka, Japan
| | - Takefumi Moriuchi
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
| | - Toshio Higashi
- Department of Health Sciences, Graduate School of Biomedical Sciences, Health Sciences, Nagasaki University, Nagasaki, Japan
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Choi H, Park D, Rha DW, Nam HS, Jo YJ, Kim DY. Kinematic analysis of movement patterns during a reach-and-grasp task in stroke patients. Front Neurol 2023; 14:1225425. [PMID: 37693760 PMCID: PMC10484108 DOI: 10.3389/fneur.2023.1225425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Background This study aimed to evaluate the kinematic movement patterns during a reach-and-grasp task in post-stroke patients according to the upper extremity impairment severity. Methods Subacute stroke patients (n = 46) and healthy controls (n = 20) were enrolled in this study. Spatiotemporal and kinematic data were obtained through 3D motion analysis during the reach-and-grasp task. Stroke patients were grouped using the Fugl-Meyer Assessment (FMA) scale, and a comparison of the groups was performed. Results The severe group showed a significantly longer movement time, lower peak velocity, and higher number of movement units than the mild group during the reach-and-grasp task (p < 0.05). Characteristic compensatory movement patterns, such as shoulder abduction, thoracic posterior tilting, and upward and external rotation were significantly greater during the forward transporting phase in the severe group than in the mild group (p < 0.05). The FMA score was significantly associated with the movement time during the forward transporting phase, number of movement units during the reaching phase, range of shoulder abduction-adduction and wrist flexion-extension movements during the reaching phase, and range of thoracic internal-external rotation during the backward transporting phase (p < 0.05). Conclusion Post-stroke patients have unique spatiotemporal and kinematic movement patterns during a reach-and grasp-task according to the impairment severity.
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Affiliation(s)
- Hyoseon Choi
- Department of Rehabilitation Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongho Park
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
- Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA, United States
| | - Dong-Wook Rha
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yea Jin Jo
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lacerenza M, Frabasile L, Buttafava M, Spinelli L, Bassani E, Micheloni F, Amendola C, Torricelli A, Contini D. Motor cortex hemodynamic response to goal-oriented and non-goal-oriented tasks in healthy subjects. Front Neurosci 2023; 17:1202705. [PMID: 37539388 PMCID: PMC10394236 DOI: 10.3389/fnins.2023.1202705] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
Background Motor disorders are one of the world's major scourges, and neuromotor rehabilitation is paramount for prevention and monitoring plans. In this scenario, exercises and motor tasks to be performed by patients are crucial to follow and assess treatments' progression and efficacy. Nowadays, in clinical environments, quantitative assessment of motor cortex activities during task execution is rare, due to the bulkiness of instrumentation and the need for immobility during measurements [e.g., functional magnetic resonance imaging (MRI)]. Functional near-infrared spectroscopy (fNIRS) can contribute to a better understanding of how neuromotor processes work by measuring motor cortex activity non-invasively in freely moving subjects. Aim Exploit fNIRS to measure functional activation of the motor cortex area during arm-raising actions. Design All subjects performed three different upper limbs motor tasks: arm raising (non-goal-oriented), arm raising and grasping (goal oriented), and assisted arm raising (passive task). Each task was repeated ten times. The block design for each task was divided into 5 seconds of baseline, 5 seconds of activity, and 15 seconds of recovery. Population Sixteen healthy subjects (11 males and 5 females) with an average (+/- standard deviation) of 37.9 (+/- 13.0) years old. Methods Cerebral hemodynamic responses have been recorded in two locations, motor cortex (activation area) and prefrontal cortex (control location) exploiting commercial time-domain fNIRS devices. Haemodynamic signals were analyzed, separating the brain cortex hemodynamic response from extracerebral hemodynamic variations. Results The hemodynamic response was recorded in the cortical motor area for goal-oriented and not-goaloriented tasks, while no response was noticed in the control location (prefrontal cortex position). Conclusions This study provides a basis for canonical upper limb motor cortex activations that can be potentially compared to pathological cerebral responses in patients. It also highlights the potential use of TD-fNIRS to study goal-oriented versus non-goaloriented motor tasks. Impact: the findings of this study may have implications for clinical rehabilitation by providing a better understanding of the neural mechanisms underlying goal-oriented versus non-goal-oriented motor tasks. This may lead to more effective rehabilitation strategies for individuals with motor disorders and a more effective diagnosis of motor dysfunction supported by objective and quantitative neurophysiological readings.
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Affiliation(s)
- Michele Lacerenza
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
- PIONIRS s.r.l., Milano, Italy
| | | | | | - Lorenzo Spinelli
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Elisa Bassani
- Scuola Universitaria Professionale della Svizzera Italiana, Manno, Switzerland
- Centro Studi Riabilitazione Neurologica, Neuropsicologia e Neuropsicoterapia, Milano, Italy
| | - Francesco Micheloni
- Centro Studi Riabilitazione Neurologica, Neuropsicologia e Neuropsicoterapia, Milano, Italy
| | | | - Alessandro Torricelli
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
- Istituto di Fotonica e Nanotecnologie, Consiglio Nazionale delle Ricerche, Milano, Italy
| | - Davide Contini
- Dipartimento di Fisica, Politecnico di Milano, Milano, Italy
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Parnandi A, Kaku A, Venkatesan A, Pandit N, Fokas E, Yu B, Kim G, Nilsen D, Fernandez-Granda C, Schambra H. Data-Driven Quantitation of Movement Abnormality after Stroke. Bioengineering (Basel) 2023; 10:648. [PMID: 37370579 PMCID: PMC10294965 DOI: 10.3390/bioengineering10060648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Stroke commonly affects the ability of the upper extremities (UEs) to move normally. In clinical settings, identifying and measuring movement abnormality is challenging due to the imprecision and impracticality of available assessments. These challenges interfere with therapeutic tracking, communication, and treatment. We thus sought to develop an approach that blends precision and pragmatism, combining high-dimensional motion capture with out-of-distribution (OOD) detection. We used an array of wearable inertial measurement units to capture upper body motion in healthy and chronic stroke subjects performing a semi-structured, unconstrained 3D tabletop task. After data were labeled by human coders, we trained two deep learning models exclusively on healthy subject data to classify elemental movements (functional primitives). We tested these healthy subject-trained models on previously unseen healthy and stroke motion data. We found that model confidence, indexed by prediction probabilities, was generally high for healthy test data but significantly dropped when encountering OOD stroke data. Prediction probabilities worsened with more severe motor impairment categories and were directly correlated with individual impairment scores. Data inputs from the paretic UE, rather than trunk, most strongly influenced model confidence. We demonstrate for the first time that using OOD detection with high-dimensional motion data can reveal clinically meaningful movement abnormality in subjects with chronic stroke.
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Affiliation(s)
- Avinash Parnandi
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Aakash Kaku
- NYU Center for Data Science, New York, NY 10011, USA; (A.K.)
| | - Anita Venkatesan
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Natasha Pandit
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Emily Fokas
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
| | - Boyang Yu
- NYU Center for Data Science, New York, NY 10011, USA; (A.K.)
| | - Grace Kim
- Department of Occupational Therapy, NYU Steinhardt, New York, NY 10011, USA
| | - Dawn Nilsen
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY 10032, USA
| | - Carlos Fernandez-Granda
- NYU Center for Data Science, New York, NY 10011, USA; (A.K.)
- Courant Institute of Mathematical Sciences, New York, NY 10011, USA
| | - Heidi Schambra
- Department of Neurology, NYU Grossman School of Medicine, New York, NY 10017, USA; (A.P.)
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, NY 10017, USA
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Kim H, Kim J, Jo S, Lee K, Kim J, Song C. Video augmented mirror therapy for upper extremity rehabilitation after stroke: a randomized controlled trial. J Neurol 2023; 270:831-842. [PMID: 36210358 DOI: 10.1007/s00415-022-11410-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effects of mirror therapy using a newly developed video augmented wearable reflection device on reach-to-grasp motor control and upper extremity motor function. METHODS Participants were randomly allocated to one of three groups: mirror therapy using a video augmented wearable reflection device group (MTVADG), n = 12; traditional mirror therapy group (TMTG), n = 12; and control group (CG), n = 12. Participants in the MTVADG and TMTG received conventional rehabilitation in addition to mirror therapy. Motor control during the reach-to-grasp movement was assessed using kinematic analysis. Each participant's upper extremity motor function was assessed using the Fugl-Meyer Assessment, Manual Function Test, and Box and Block Test. RESULTS While both the MTVADG and TMTG showed significantly improved reach-to-grasp movement. The MTVADG showed greater efficiency in kinematic performance than the TMTG. Moreover, while both the MTVADG and TMTG showed improved upper extremity motor function, the MTVADG showed significantly greater improvement in proximal upper limb function compared to the TMTG. CONCLUSION Our results suggested that mirror therapy using a video augmented wearable reflection device is more efficient compared to traditional mirror therapy for patients with stroke. CLINICAL TRIAL REGISTRATION UNIQUE IDENTIFIER KCT0003047.
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Affiliation(s)
- Hyunjin Kim
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, 01795, Republic of Korea
| | - Junghyun Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Sungbae Jo
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, 01795, Republic of Korea
| | - Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Kyungdong University, Wonju-si, Gangwon-Do, 26495, Republic of Korea
| | - Junesun Kim
- Department of Physical Therapy, College of Health Science, Korea University, 145, Anam-Ro, Sungbuk-Gu, Seoul, 02841, Republic of Korea.
- Department of Health Science, Rehabilitation Science Program, Korea University Graduate School, Seoul, 02841, Republic of Korea.
- BK21FOUR Program in Learning Health Systems Korea University, Seoul, 02841, Republic of Korea.
| | - Changho Song
- Department of Physical Therapy, College of Health Science, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, 01795, Republic of Korea.
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. The effect of time spent in rehabilitation on activity limitation and impairment after stroke. Cochrane Database Syst Rev 2021; 10:CD012612. [PMID: 34695300 PMCID: PMC8545241 DOI: 10.1002/14651858.cd012612.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Stroke affects millions of people every year and is a leading cause of disability, resulting in significant financial cost and reduction in quality of life. Rehabilitation after stroke aims to reduce disability by facilitating recovery of impairment, activity, or participation. One aspect of stroke rehabilitation that may affect outcomes is the amount of time spent in rehabilitation, including minutes provided, frequency (i.e. days per week of rehabilitation), and duration (i.e. time period over which rehabilitation is provided). Effect of time spent in rehabilitation after stroke has been explored extensively in the literature, but findings are inconsistent. Previous systematic reviews with meta-analyses have included studies that differ not only in the amount provided, but also type of rehabilitation. OBJECTIVES To assess the effect of 1. more time spent in the same type of rehabilitation on activity measures in people with stroke; 2. difference in total rehabilitation time (in minutes) on recovery of activity in people with stroke; and 3. rehabilitation schedule on activity in terms of: a. average time (minutes) per week undergoing rehabilitation, b. frequency (number of sessions per week) of rehabilitation, and c. total duration of rehabilitation. SEARCH METHODS We searched the Cochrane Stroke Group trials register, CENTRAL, MEDLINE, Embase, eight other databases, and five trials registers to June 2021. We searched reference lists of identified studies, contacted key authors, and undertook reference searching using Web of Science Cited Reference Search. SELECTION CRITERIA We included randomised controlled trials (RCTs) of adults with stroke that compared different amounts of time spent, greater than zero, in rehabilitation (any non-pharmacological, non-surgical intervention aimed to improve activity after stroke). Studies varied only in the amount of time in rehabilitation between experimental and control conditions. Primary outcome was activities of daily living (ADLs); secondary outcomes were activity measures of upper and lower limbs, motor impairment measures of upper and lower limbs, and serious adverse events (SAE)/death. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies, extracted data, assessed methodological quality using the Cochrane RoB 2 tool, and assessed certainty of the evidence using GRADE. For continuous outcomes using different scales, we calculated pooled standardised mean difference (SMDs) and 95% confidence intervals (CIs). We expressed dichotomous outcomes as risk ratios (RR) with 95% CIs. MAIN RESULTS The quantitative synthesis of this review comprised 21 parallel RCTs, involving analysed data from 1412 participants. Time in rehabilitation varied between studies. Minutes provided per week were 90 to 1288. Days per week of rehabilitation were three to seven. Duration of rehabilitation was two weeks to six months. Thirteen studies provided upper limb rehabilitation, five general rehabilitation, two mobilisation training, and one lower limb training. Sixteen studies examined participants in the first six months following stroke; the remaining five included participants more than six months poststroke. Comparison of stroke severity or level of impairment was limited due to variations in measurement. The risk of bias assessment suggests there were issues with the methodological quality of the included studies. There were 76 outcome-level risk of bias assessments: 15 low risk, 37 some concerns, and 24 high risk. When comparing groups that spent more time versus less time in rehabilitation immediately after intervention, we found no difference in rehabilitation for ADL outcomes (SMD 0.13, 95% CI -0.02 to 0.28; P = 0.09; I2 = 7%; 14 studies, 864 participants; very low-certainty evidence), activity measures of the upper limb (SMD 0.09, 95% CI -0.11 to 0.29; P = 0.36; I2 = 0%; 12 studies, 426 participants; very low-certainty evidence), and activity measures of the lower limb (SMD 0.25, 95% CI -0.03 to 0.53; P = 0.08; I2 = 48%; 5 studies, 425 participants; very low-certainty evidence). We found an effect in favour of more time in rehabilitation for motor impairment measures of the upper limb (SMD 0.32, 95% CI 0.06 to 0.58; P = 0.01; I2 = 10%; 9 studies, 287 participants; low-certainty evidence) and of the lower limb (SMD 0.71, 95% CI 0.15 to 1.28; P = 0.01; 1 study, 51 participants; very low-certainty evidence). There were no intervention-related SAEs. More time in rehabilitation did not affect the risk of SAEs/death (RR 1.20, 95% CI 0.51 to 2.85; P = 0.68; I2 = 0%; 2 studies, 379 participants; low-certainty evidence), but few studies measured these outcomes. Predefined subgroup analyses comparing studies with a larger difference of total time spent in rehabilitation between intervention groups to studies with a smaller difference found greater improvements for studies with a larger difference. This was statistically significant for ADL outcomes (P = 0.02) and activity measures of the upper limb (P = 0.04), but not for activity measures of the lower limb (P = 0.41) or motor impairment measures of the upper limb (P = 0.06). AUTHORS' CONCLUSIONS An increase in time spent in the same type of rehabilitation after stroke results in little to no difference in meaningful activities such as activities of daily living and activities of the upper and lower limb but a small benefit in measures of motor impairment (low- to very low-certainty evidence for all findings). If the increase in time spent in rehabilitation exceeds a threshold, this may lead to improved outcomes. There is currently insufficient evidence to recommend a minimum beneficial daily amount in clinical practice. The findings of this study are limited by a lack of studies with a significant contrast in amount of additional rehabilitation provided between control and intervention groups. Large, well-designed, high-quality RCTs that measure time spent in all rehabilitation activities (not just interventional) and provide a large contrast (minimum of 1000 minutes) in amount of rehabilitation between groups would provide further evidence for effect of time spent in rehabilitation.
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Affiliation(s)
- Beth Clark
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, Maryland, USA
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences and Amsterdam, Amsterdam Neurosciences, VU University Medical Center, Amsterdam, Netherlands
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Sean Ewings
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Jane Burridge
- Research Group, Faculty of Health Sciences, University of Southampton, Southampton, UK
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10
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Ferrari F, Shell CE, Thumser ZC, Clemente F, Plow EB, Cipriani C, Marasco PD. Proprioceptive Augmentation With Illusory Kinaesthetic Sensation in Stroke Patients Improves Movement Quality in an Active Upper Limb Reach-and-Point Task. Front Neurorobot 2021; 15:610673. [PMID: 33732129 PMCID: PMC7956990 DOI: 10.3389/fnbot.2021.610673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Stroke patients often have difficulty completing motor tasks even after substantive rehabilitation. Poor recovery of motor function can often be linked to stroke-induced damage to motor pathways. However, stroke damage in pathways that impact effective integration of sensory feedback with motor control may represent an unappreciated obstacle to smooth motor coordination. In this study we investigated the effects of augmenting movement proprioception during a reaching task in six stroke patients as a proof of concept. We used a wearable neurorobotic proprioceptive feedback system to induce illusory kinaesthetic sensation by vibrating participants' upper arm muscles over active limb movements. Participants were instructed to extend their elbow to reach-and-point to targets of differing sizes at various distances, while illusion-inducing vibration (90 Hz), sham vibration (25 Hz), or no vibration was applied to the distal tendons of either their biceps brachii or their triceps brachii. To assess the impact of augmented kinaesthetic feedback on motor function we compared the results of vibrating the biceps or triceps during arm extension in the affected arm of stroke patients and able-bodied participants. We quantified performance across conditions and participants by tracking limb/hand kinematics with motion capture, and through Fitts' law analysis of reaching target acquisition. Kinematic analyses revealed that injecting 90 Hz illusory kinaesthetic sensation into the actively contracting (agonist) triceps muscle during reaching increased movement smoothness, movement directness, and elbow extension. Conversely, injecting 90 Hz illusory kinaesthetic sensation into the antagonistic biceps during reaching negatively impacted those same parameters. The Fitts' law analyses reflected similar effects with a trend toward increased throughput with triceps vibration during reaching. Across all analyses, able-bodied participants were largely unresponsive to illusory vibrational augmentation. These findings provide evidence that vibration-induced movement illusions delivered to the primary agonist muscle involved in active movement may be integrated into rehabilitative approaches to help promote functional motor recovery in stroke patients.
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Affiliation(s)
- Francesca Ferrari
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Courtney E Shell
- Laboratory for Bionic Integration, Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Zachary C Thumser
- Laboratory for Bionic Integration, Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Francesco Clemente
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Christian Cipriani
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Excellence in Robotics & A.I., Scuola Superiore Sant'Anna, Pisa, Italy
| | - Paul D Marasco
- Laboratory for Bionic Integration, Department of Biomedical Engineering, Lerner Research Institute-Cleveland Clinic, Cleveland, OH, United States.,Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
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11
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Stewart JC, Handlery K, Baird JF, Blanck EL, Pathak G, Fritz SL. Targeted Engagement of the Action Selection Network during Task-Oriented Arm Training after Stroke. Neural Plast 2020; 2020:8814158. [PMID: 33029117 PMCID: PMC7530513 DOI: 10.1155/2020/8814158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Action selection (AS), or selection of an action from a set of alternatives, is an important movement preparation process that engages a frontal-parietal network. The addition of AS demands to arm training after stroke could be used to engage this motor planning process and the neural network that supports it. The purpose of this case series is to describe the feasibility and outcomes associated with task-oriented arm training aimed at engaging the AS behavioral process and the related neural network in three individuals with chronic stroke. Three participants with mild to moderate motor deficits completed 13 to 15 sessions of task-oriented arm training that included AS cues for each movement repetition; cues dictated movement direction, height, or distance. Before and after training, individuals completed an AS brain-behavior probe during functional MRI. AS behavioral performance improved after training (increased accuracy, decreased reaction time) in all participants while brain activation in the AS network (dorsal premotor, parietal, dorsolateral prefrontal cortices) decreased in two participants. Gains in motor function were also found in all three participants, especially on patient-reported measures of perceived difficulty and confidence to complete upper extremity functional tasks. It was feasible to target the AS behavioral process and the related neural network through the addition of AS demands to functional, task-oriented arm training in three individuals with mild to moderate motor dysfunction poststroke.
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Affiliation(s)
- Jill Campbell Stewart
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
| | - Jessica F. Baird
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Erika L. Blanck
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29208, USA
| | - Geetanjali Pathak
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Stacy L. Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
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12
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Baccinelli W, Bulgheroni M, Frigo CA. Using UHF RFID Properties to Develop and Optimize an Upper-Limb Rehabilitation System. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3224. [PMID: 32517139 PMCID: PMC7309084 DOI: 10.3390/s20113224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/16/2022]
Abstract
Rehabilitation of the upper limb is an important aspect of the therapy for people affected by neuromotor diseases for the recovery of the capability to perform activities of daily living (ADLs). Nonetheless, the costs associated with the administration of rehabilitation therapy and the increasing number of patients highlight the need for new solutions. Technology-based solutions and, in particular, telerehabilitation could strongly impact in this field. In this paper, a new system based on radiofrequency (RF) technology is presented which is able to effectively provide home-based telerehabilitation and extract meaningful information on the therapy execution performance. The technology has been tuned to the needs of the rehabilitation system, optimizing the hardware, the communication protocol and the software control. A methodology for extracting the execution time of the rehabilitation tasks, the distance covered by the patient's hand in each subtask and the velocity profile is presented. The results show that a highly usable system for the rehabilitation of the upper limb has been developed using the RF technology and that performance metrics can be reliably extracted by the acquired signals.
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Affiliation(s)
- Walter Baccinelli
- R&D Department, Ab.Acus Srl, via F. Caracciolo 77, 20155 Milano, Italy;
- Movement Biomechanics and Motor Control Lab, DEIB, Politecnico di Milano, 20133 Milano, Italy;
| | - Maria Bulgheroni
- R&D Department, Ab.Acus Srl, via F. Caracciolo 77, 20155 Milano, Italy;
| | - Carlo Albino Frigo
- Movement Biomechanics and Motor Control Lab, DEIB, Politecnico di Milano, 20133 Milano, Italy;
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13
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Paolucci T, Bernetti A, Bai AV, Capobianco SV, Bonifacino A, Maggi G, Ippolitoni G, Tinelli L, Santilli V, Agostini F, Paoloni M, Mangone M. The recovery of reaching movement in breast cancer survivors: two different rehabilitative protocols in comparison. Eur J Phys Rehabil Med 2020; 57:137-147. [PMID: 32406224 DOI: 10.23736/s1973-9087.20.06138-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in women in the developed world. The about the sequelae of surgery, especially in case of mastectomy or modified radical mastectomy is grown. Nowadays it is important choose appropriate exercise programs to allow recovery in "quantity" but also in "quality" of the movement of the operated upper limb. AIM The aim of this study was to verify whether specific exercises for the scapula may induce changes in fluidity of the reaching movement. DESIGN Randomized control-trial double-blind study. SETTING Exercise training laboratory and gait analysis laboratory. POPULATION Sixty-three breast cancer survivors were enrolled. METHODS Participants randomized to single rehabilitative treatment (ST), or to group rehabilitative treatment (GT). VAS, DASH and a biomechanical evaluation of upper limb were performed for each group before treatment (T0=baseline), at the end rehabilitative treatment (T1) and after three months of follow-up (T2). RESULTS Respect within group analysis, in the ST and in the GT, for VAS an improvement along evaluation times were observed, respectively at T0 to T1 and at T0 to T2 (P<0.001) without a statistically significant difference between groups. At the same, for the DASH, the results showed the same trend without a statistically significant difference between groups. For biomechanical parameters, at T2 velocity was statistically significantly greater in the ST than in the GT (P=0.029) in contrast with the duration, that was statistically significantly greater in the GT than in the ST (P=0.010). CONCLUSIONS Both protocols are effective in reducing pain and for functional recovery of the upper limb. The adoption of a non-intensive rehabilitation program should be implemented at least in the first year after the operation, with the adoption of specific myofascial exercises on the scapulo-thoracic joint with better results in the "qualitative" recovery of the achievement. CLINICAL REHABILITATION IMPACT Our study emphasizes the importance of rehabilitation in BC survivors after mastectomy, even during the course of radiotherapy and chemotherapy and the adoption of specific myofascial exercises on the scapulo-thoracic joint and specific exercises of muscular stretching on the pectoral muscle. Therefore, the proposed rehabilitation protocol must be "clipped" and "integrated" according to the specific objectives for each individual patient.
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Affiliation(s)
- Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University of Chieti-Pescara, Pescara, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Serena V Capobianco
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | | | | | | | | | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy -
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, Rome, Italy
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14
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Maier M, Ballester BR, Verschure PFMJ. Principles of Neurorehabilitation After Stroke Based on Motor Learning and Brain Plasticity Mechanisms. Front Syst Neurosci 2019; 13:74. [PMID: 31920570 PMCID: PMC6928101 DOI: 10.3389/fnsys.2019.00074] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 11/19/2019] [Indexed: 01/19/2023] Open
Abstract
What are the principles underlying effective neurorehabilitation? The aim of neurorehabilitation is to exploit interventions based on human and animal studies about learning and adaptation, as well as to show that the activation of experience-dependent neuronal plasticity augments functional recovery after stroke. Instead of teaching compensatory strategies that do not reduce impairment but allow the patient to return home as soon as possible, functional recovery might be more sustainable as it ensures a long-term reduction in impairment and an improvement in quality of life. At the same time, neurorehabilitation permits the scientific community to collect valuable data, which allows inferring about the principles of brain organization. Hence neuroscience sheds light on the mechanisms of learning new functions or relearning lost ones. However, current rehabilitation methods lack the exact operationalization of evidence gained from skill learning literature, leading to an urgent need to bridge motor learning theory and present clinical work in order to identify a set of ingredients and practical applications that could guide future interventions. This work aims to unify the neuroscientific literature relevant to the recovery process and rehabilitation practice in order to provide a synthesis of the principles that constitute an effective neurorehabilitation approach. Previous attempts to achieve this goal either focused on a subset of principles or did not link clinical application to the principles of motor learning and recovery. We identified 15 principles of motor learning based on existing literature: massed practice, spaced practice, dosage, task-specific practice, goal-oriented practice, variable practice, increasing difficulty, multisensory stimulation, rhythmic cueing, explicit feedback/knowledge of results, implicit feedback/knowledge of performance, modulate effector selection, action observation/embodied practice, motor imagery, and social interaction. We comment on trials that successfully implemented these principles and report evidence from experiments with healthy individuals as well as clinical work.
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Affiliation(s)
- Martina Maier
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Belén Rubio Ballester
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Paul F. M. J. Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia, The Barcelona Institute of Science and Technology, Barcelona, Spain
- Institucio Catalana de Recerca I Estudis Avançats, Barcelona, Spain
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15
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Abd El Rhm A, El Sayed S K, Mosaad Abd G, Hassan Abo M. Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.3923/jms.2019.63.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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16
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Levin MF, Hiengkaew V, Nilanont Y, Cheung D, Dai D, Shaw J, Bayley M, Saposnik G. Relationship Between Clinical Measures of Upper Limb Movement Quality and Activity Poststroke. Neurorehabil Neural Repair 2019; 33:432-441. [PMID: 31072222 DOI: 10.1177/1545968319847969] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Understanding the relationship between movement quality (impairment) and performance (activity) in poststroke patients is important for rehabilitation intervention studies. This has led to an interest in kinematic characterization of upper limb motor impairment. Since instrumented motion analysis is not readily clinically available, observational kinematics may be a viable alternative. Objective. To determine if upper limb movement quality during a reach-to-grasp task identified by observation could be used to describe the relationship between motor impairments and the time to perform functional tasks. Methods. Cross-sectional, secondary analysis of baseline data from 141 participants with stroke, age 18 to 85 years, who participated in a multicenter randomized controlled trial. Clinical assessment of movement quality using the Reaching Performance Scale for Stroke (RPSS-Close and Far targets) and of performance (activity) from the Wolf Motor Function Test (WMFT-7 items) was assessed. The degree to which RPSS component scores explained scores on WMFT items was determined by multivariable regression. Results. Clinically significant decreases (>2 seconds) in performance time for some of the more complex WMFT tasks involving prehension were predicted from RPSS-Close and Far target components. Trunk compensatory movements did not predict either increases or decreases in performance time for the WMFT tasks evaluated. Overall, the strength of the regression models was low. Conclusions. In lieu of kinematic analysis, observational clinical movement analysis may be a valid and accessible method to determine relationships between motor impairment, compensations and upper limb function in poststroke patients. Specific relationships are unlikely to generalize to all tasks due to kinematic redundancy and task specificity.
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Affiliation(s)
- Mindy F Levin
- 1 McGill University and Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | | | | | - Donna Cheung
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Dai
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Shaw
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Bayley
- 5 Toronto Rehabilitation Institute and University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- 4 St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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17
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Annino G, Alashram AR, Alghwiri AA, Romagnoli C, Messina G, Tancredi V, Padua E, Mercuri NB. Effect of segmental muscle vibration on upper extremity functional ability poststroke: A randomized controlled trial. Medicine (Baltimore) 2019; 98:e14444. [PMID: 30762754 PMCID: PMC6408108 DOI: 10.1097/md.0000000000014444] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Upper extremity functional impairments are common consequences of stroke. Therefore, continuous investigation of effective interventions for upper extremity functions after stroke is a necessity. Segmental muscle vibration (SMV) is one of the interventions that incorporate sensory stimulation to improve motor cortical excitability. The aim of this study was to investigate the influence of 5-minute SMV application along with supervised physical therapy (SPT) on improving activities of daily living and motor recovery on the hemiparetic upper extremity in patients with stroke. METHODS A sample of 37 patients poststroke (29 males) was randomly allocated to either SPT control group (n = 18) or SPT and SMV (SPT-SMV) experimental group (n = 19). All patients received 3 sessions per week of SPT for 8 weeks. The SPT-SMV experimental group received SMV at the end of each SPT session. Outcome measures used were Barthel index (BI), modified Ashworth scale, manual muscle testing, and goniometry for range of motion (ROM) assessment. RESULTS Thirty-four patients completed the study. Patients in both groups improved significantly after treatment in BI, elbow ROM, and elbow muscles strength. However, muscle tone in elbow joint of the hemiplegic upper extremity improved significantly after SMV only in the experimental group (SPT-SMV). CONCLUSION The SPT intervention can improve functional outcomes of upper extremity in people after stroke. However, using SMV may have superior effect on improving muscle tone after stroke.
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Affiliation(s)
- Giuseppe Annino
- Department of Medicine Systems, University of Rome, “Tor Vergata”
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome
| | - Anas R. Alashram
- Faculty of Medicine and Surgery, University of Rome, “Tor Vergata,” Italy
| | - Alia A. Alghwiri
- Department of Physical Therapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | | | - Giuseppe Messina
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Virginia Tancredi
- Department of Medicine Systems, University of Rome, “Tor Vergata”
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome
| | | | - Nicola Biagio Mercuri
- Department of Medicine Systems, University of Rome, “Tor Vergata”
- Faculty of Medicine and Surgery, University of Rome, “Tor Vergata,” Italy
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18
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Collins KC, Kennedy NC, Clark A, Pomeroy VM. Kinematic Components of the Reach-to-Target Movement After Stroke for Focused Rehabilitation Interventions: Systematic Review and Meta-Analysis. Front Neurol 2018; 9:472. [PMID: 29988530 PMCID: PMC6026634 DOI: 10.3389/fneur.2018.00472] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/31/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Better upper limb recovery after stroke could be achieved through tailoring rehabilitation interventions directly at movement deficits. Aim: To identify potential; targets for therapy by synthesizing findings of differences in kinematics and muscle activity between stroke survivors and healthy adults performing reach-to-target tasks. Methods: A systematic review with identification of studies, data extraction, and potential risk of bias was completed independently by two reviewers. Online databases were searched from their inception to November 2017 to find studies of reach-to-target in people-with-stroke and healthy adults. Potential risk-of-bias was assessed using the Down's and Black Tool. Synthesis was undertaken via: (a) meta-analysis of kinematic characteristics utilizing the standardized mean difference (SMD) [95% confidence intervals]; and (b), narrative synthesis of muscle activation. Results: Forty-six studies met the review criteria but 14 had insufficient data for extraction. Consequently, 32 studies were included in the meta-analysis. Potential risk-of-bias was low for one study, unclear for 30, and high for one. Reach-to-target was investigated with 618 people-with-stroke and 429 healthy adults. The meta-analysis found, in all areas of workspace, that people-with-stroke had: greater movement times (seconds) e.g., SMD 2.57 [0.89, 4.25]; lower peak velocity (millimeters/second) e.g., SMD -1.76 [-2.29, -1.24]; greater trunk displacement (millimeters) e.g. SMD 1.42 [0.90, 1.93]; a more curved reach-path-ratio e.g., SMD 0.77 [0.32, 1.22] and reduced movement smoothness e.g., SMD 0.92 [0.32, 1.52]. In the ipsilateral and contralateral workspace, people-with-stroke exhibited: larger errors in target accuracy e.g., SMD 0.70 [0.39, 1.01]. In contralateral workspace, stroke survivors had: reduced elbow extension and shoulder flexion (degrees) e.g., elbow extension SMD -1.10 [-1.62, -0.58] and reduced shoulder flexion SMD -1.91 [-1.96, -0.42]. Narrative synthesis of muscle activation found that people-with-stroke, compared with healthy adults, exhibited: delayed muscle activation; reduced coherence between muscle pairs; and use of a greater percentage of muscle power. Conclusions: This first-ever meta-analysis of the kinematic differences between people with stroke and healthy adults performing reach-to-target found statistically significant differences for 21 of the 26 comparisons. The differences identified and values provided are potential foci for tailored rehabilitation interventions to improve upper limb recovery after stroke.
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Affiliation(s)
- Kathryn C. Collins
- Faculty of Human Science and Public Health, School of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom
| | - Niamh C. Kennedy
- School of Psychology, Ulster University, Coleraine, United Kingdom
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Valerie M. Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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19
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Collins KC, Kennedy NC, Clark A, Pomeroy VM. Getting a kinematic handle on reach-to-grasp: a meta-analysis. Physiotherapy 2017; 104:153-166. [PMID: 29402446 DOI: 10.1016/j.physio.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 10/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Reach-to-grasp is an essential everyday activity that is often impaired after stroke. The objectives of this review are: (1) identify differences in the kinematic characteristics of reach-to-grasp between individuals with and without stroke, and (2) determine the influence of object location on kinematics. DATA SOURCES MEDLINE, AMED, and Embase databases. ELIGIBILITY CRITERIA Studies investigating individuals with stroke and neurologically intact control participants completing reach-to-grasp (paretic upper limb) of an object assessed via kinematic assessment (motion analysis). REVIEW METHODS Following Cochrane Collaboration guidelines a meta-analysis comparing kinematic characteristics of reach-to-grasp between individuals with and without stroke. Potential risk of bias was assessed using the Down's and Black Tool. Data were synthesised by calculating the standardised mean difference (SMD) in kinematic characteristics between adults with and without stroke. RESULTS Twenty-nine studies met the review criteria, mainly of observational design; 460 individuals with stroke and 324 control participants. Kinematic differences in reach-to-grasp were identified in the central and ipsilateral workspace for example, individuals with stroke exhibited significantly lower peak velocity SMD -1.48 (95% CI -1.94, -1.02), and greater trunk displacement SMD 1.55 (95% CI 0.85, 2.25) than control participants. Included studies were assessed as demonstrating unclear or high potential risk-of-bias. CONCLUSIONS Differences in kinematic characteristics between individuals with and without stroke were identified which may be different reaching in the ipsilateral and central workspace. Suggesting, that object location may influence some kinematic characteristics and not others which may be pertinent when re-training reach-to-grasp. PROSPERO CRD42014009479.
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Affiliation(s)
- Kathryn C Collins
- Acquired Brain Injury Rehabilitation Alliance, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Niamh C Kennedy
- Acquired Brain Injury Rehabilitation Alliance, University of East Anglia, Norwich NR4 7TJ, UK; School of Psychology, Ulster University, BT52 1SA, UK.
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Valerie M Pomeroy
- Acquired Brain Injury Rehabilitation Alliance, University of East Anglia, Norwich NR4 7TJ, UK.
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Totty MS, Wade E. Muscle Activation and Inertial Motion Data for Noninvasive Classification of Activities of Daily Living. IEEE Trans Biomed Eng 2017; 65:1069-1076. [PMID: 28809669 DOI: 10.1109/tbme.2017.2738440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Remote monitoring of physical activity using body-worn sensors provides an objective alternative to current functional assessment tools. The purpose of this study was to assess the feasibility of classifying categories of activities of daily living from the functional arm activity behavioral observation system (FAABOS) using muscle activation and motion data. METHODS Ten nondisabled, healthy adults were fitted with a Myo armband on the upper forearm. This multimodal commercial sensor device features surface electromyography (sEMG) sensors, an accelerometer, and a rate gyroscope. Participants performed 17 different activities of daily living, which belonged to one of four functional groups according to the FAABOS. Signal magnitude area (SMA) and mean values were extracted from the acceleration and angular rate of change data; root mean square (RMS) was computed for the sEMG data. A nearest neighbors machine learning algorithm was then applied to predict the FAABOS task category using these raw data as inputs. RESULTS Mean acceleration, SMA of acceleration, mean angular rate of change, and RMS of sEMG were significantly different across the four FAABOS categories ( in all cases). A classifier using mean acceleration, mean angular rate of change, and sEMG data was able to predict task category with 89.2% accuracy. CONCLUSION The results demonstrate the feasibility of using a combination of sEMG and motion data to noninvasively classify types of activities of daily living. SIGNIFICANCE This approach may be useful for quantifying daily activity performance in ambient settings as a more ecologically valid measure of function in healthy and disease-affected individuals.
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Clark B, Whitall J, Kwakkel G, Mehrholz J, Ewings S, Burridge J. Time spent in rehabilitation and effect on measures of activity after stroke. Hippokratia 2017. [DOI: 10.1002/14651858.cd012612] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Beth Clark
- Poole Hospital NHS Foundation Trust; Stroke Care Unit; Poole Dorset UK BH15 2JB
| | - Jill Whitall
- University of Maryland; Department of Physical Therapy and Rehabilitation Science; Baltimore MD USA 21403
| | - Gert Kwakkel
- VU University Medical Center; Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, Amsterdam Neurosciences; De Boelelaan 1118 Amsterdam Netherlands 1007 MB
| | - Jan Mehrholz
- Technical University Dresden; Department of Public Health, Dresden Medical School; Fetscherstr. 74 Dresden Germany 01307
| | - Sean Ewings
- University of Southampton; Southampton Statistical Sciences Research Institute; Southampton Hampshire UK SO17 1BJ
| | - Jane Burridge
- University of Southampton; Research Group, Faculty of Health Sciences; Building 45, University of Southampton Southampton UK SO17 1BJ
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Vaz DV, Silva PL, Mancini MC, Carello C, Kinsella-Shaw J. Towards an ecologically grounded functional practice in rehabilitation. Hum Mov Sci 2017; 52:117-132. [PMID: 28187353 DOI: 10.1016/j.humov.2017.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 01/20/2017] [Accepted: 01/21/2017] [Indexed: 01/28/2023]
Abstract
According to the International Classification of Functioning, Disability and Health, effective rehabilitation requires interventions that go beyond minimizing pathological conditions and associated symptoms. The scope of practice must include promoting an individual's activity within relevant contexts. We argue that best practice requires decisions that are not only evidence-based but also theory-based. Perception and action theories are essential for interpreting evidence and clinical phenomena as well as for developing new interventions. It is our contention that rehabilitation goals can best be achieved if inspired by the ecological approach to perception and action, an approach that focuses on the dynamics of interacting constraints of performer, task and environment. This contrasts with organism-limited motor control theories that have important influence in clinical practice. Parallels between such theories and the medical model of care highlight their fundamental inconsistency with the current understanding of functioning. We contend that incorporating ecological principles into rehabilitation research and practice can help advance our understanding of the complexity of action and provide better grounding for the development of effective functional practice. Implications and initial suggestions for an ecologically grounded functional practice are outlined.
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Affiliation(s)
- Daniela Virgínia Vaz
- Departament of Physical Therapy, EEFFTO, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 Campus - Pampulha, Belo Horizonte, MG CEP 31270-901, Brazil.
| | - Paula Lanna Silva
- Department of Psychology, McMicken College of Arts & Sciences, University of Cincinnati, P.O. Box 210376, 4150M Edwards 1 Bldg, Cincinnati, OH 45221-0376, United States.
| | - Marisa Cotta Mancini
- Department of Occupational Therapy, EEFFTO, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627 Campus - Pampulha, Belo Horizonte, MG CEP 31270-901, Brazil.
| | - Claudia Carello
- Department of Psychology and Center for the Ecological Study of Perception and Action, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1020, United States.
| | - Jeffrey Kinsella-Shaw
- Center for the Ecological Study of Perception and Action, University of Connecticut, Doctor of Physical Therapy Program, Dept. of Kinesiology, Neag School of Education, 358 Mansfield Road, Unit 2101, Storrs, CT 06269-2101, United States.
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Sainburg RL, Liew SL, Frey SH, Clark F. Promoting Translational Research Among Movement Science, Occupational Science, and Occupational Therapy. J Mot Behav 2017; 49:1-7. [PMID: 28166469 DOI: 10.1080/00222895.2016.1271299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Integration of research in the fields of neural control of movement and biomechanics (collectively referred to as movement science) with the field of human occupation directly benefits both areas of study. Specifically, incorporating many of the quantitative scientific methods and analyses employed in movement science can help accelerate the development of rehabilitation-relevant research in occupational therapy (OT) and occupational science (OS). Reciprocally, OT and OS, which focus on the performance of everyday activities (occupations) to promote health and well-being, provide theoretical frameworks to guide research on the performance of actions in the context of social, psychological, and environmental factors. Given both fields' mutual interest in the study of movement as it relates to health and disease, the authors posit that combining OS and OT theories and principles with the theories and methods in movement science may lead to new, impactful, and clinically relevant knowledge. The first step is to ensure that individuals with OS or OT backgrounds are academically prepared to pursue advanced study in movement science. In this article, the authors propose 2 strategies to address this need.
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Affiliation(s)
- Robert L Sainburg
- a Department of Kinesiology , The Pennsylvania State University , University Park , PA.,b Department of Neurology , Penn State College of Medicine , Hershey , PA
| | - Sook-Lei Liew
- c Chan Division of Occupational Science and Occupational Therapy, University of Southern California , Los Angeles , CA.,d Division of Physical Therapy and Biokinesiology, University of Southern California , Los Angeles , CA.,e Keck Department of Neurology , University of Southern California , Los Angeles , CA
| | - Scott H Frey
- f Department of Psychological Sciences , University of Missouri , Columbia , MO
| | - Florence Clark
- c Chan Division of Occupational Science and Occupational Therapy, University of Southern California , Los Angeles , CA
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Sarcher A, Raison M, Leboeuf F, Perrouin-Verbe B, Brochard S, Gross R. Pathological and physiological muscle co-activation during active elbow extension in children with unilateral cerebral palsy. Clin Neurophysiol 2017; 128:4-13. [DOI: 10.1016/j.clinph.2016.10.086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 09/19/2016] [Accepted: 10/09/2016] [Indexed: 02/07/2023]
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Sackley CM, Atkinson JC, Walker MF. Occupational Therapy in Nursing and Residential Care Settings: A Description of a Randomised Controlled Trial Intervention. Br J Occup Ther 2016. [DOI: 10.1177/030802260406700302] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article describes an occupational therapy intervention for stroke that was provided as part of a randomised controlled trial in order to evaluate the effects of the intervention of an occupational therapist in a nursing and residential home setting. The intervention was developed and described to enable it to be reproduced in further evaluations, as recommended by the Medical Research Council's guidelines for clinical trials. Initially, the published evidence was reviewed and advice was sought to identify the process, content and recording methods needed to treat clients in a care home setting. This resulted in a clearly defined, evidence-based treatment package and a predetermined recording system. Sixty residents received occupational therapy: the mean number of visits was 8.5 and the mean total time per participant was 4.7 hours. During 508 visits, the majority of time was spent on activities of daily living training and mobility practice (40%), followed by assessment and goal setting (31%), communication with residents, staff, relatives and other agencies (15%), adaptive equipment (10%) and the treatment of impairments (4%). It is possible to develop evidence-based targeted occupational therapy interventions to be used in the context of a controlled clinical trial. Further work is required to examine the validity of the recording methods and the reproducibility of the intervention.
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Sullivan JE, Hedman LD. Effects of home-based sensory and motor amplitude electrical stimulation on arm dysfunction in chronic stroke. Clin Rehabil 2016; 21:142-50. [PMID: 17264108 DOI: 10.1177/0269215506071252] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To examine the effects of a home-based arm exercise programme of sensory and motor amplitude electrical stimulation. Design: Non-concurrent, multiple-baseline, single-subject design. Subjects: Ten adults with chronic arm hemiparesis following stroke. Subjects ranged in age from 38 to 74 years and were 2-16 years post stroke. Three subjects had right-sided involvement; seven had left. Intervention: Subjects completed an eight-week, individualized, home programme of neuromuscular and sensory amplitude electrical stimulation. All subjects engaged in stimulation-assisted task-specific exercises for 15 minutes 2 -3 times daily. Participants with sensory deficits received an additional 15 minutes of sensory amplitude stimulation twice daily. The Action Research Arm Test was used to examine arm function; the Stroke Rehabilitation Assessment of Movement was used to examine movement quality; and the Modified Ashworth Assessment of Spasticity was used to examine muscle tone. Results: A statistically significant improvement was demonstrated by six of the 10 subjects on the Action Research Arm Test, and five subjects on the Stroke Rehabilitation Assessment of Movement. Four subjects had ≥ 10% improvement on the Modified Ashworth Assessment of Spasticity. Two subjects demonstrated significant improvement on all three outcome measures; six subjects improved on two or more measures; and seven subjects improved on one or more measure. Subjects who improved on two or more measures tended to have had more recent onset of stroke, were older and had higher baseline motor and functional capacity. Conclusion: Subjects with chronic stroke can experience impairment and functional improvements following a home-based programme of motor and sensory amplitude electrical stimulation.
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Affiliation(s)
- Jane E Sullivan
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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27
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Fasoli SE, Trombly CA, Tickle-Degnen L, Verfaellie MH. Context and Goal-Directed Movement: The Effect of Materials-Based Occupation. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016. [DOI: 10.1177/153944920202200305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This exploratory study investigated whether materials-based occupation elicited significantly better movement organization in the ipsilateral arm following left hemisphere stroke than imagery-based occupation. Five persons with left cerebrovascular accident (CVA) and 5 control participants performed functional tasks (e.g., slicing bread) under four conditions. During the materials-based condition, needed tools and objects were available for task completion. In the three imagery-based conditions, either the tool or object of the tool's action was present, or the participant was asked to simulate the task without objects. For all tasks, motor performance of persons with and without CVA was significantly more direct and less forceful during materials-based occupation. Movement time was significantly faster under this condition in three of the four tasks. The relationship between motor performance and context was reinforced. Persons with and without CVA adjusted their motor actions according to the affordances offered during materials-based occupation.
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28
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Chen HL, Lin KC, Liing RJ, Wu CY, Chen CL. Kinematic measures of Arm-trunk movements during unilateral and bilateral reaching predict clinically important change in perceived arm use in daily activities after intensive stroke rehabilitation. J Neuroeng Rehabil 2015; 12:84. [PMID: 26392271 PMCID: PMC4578333 DOI: 10.1186/s12984-015-0075-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 09/11/2015] [Indexed: 11/16/2022] Open
Abstract
Background Kinematic analysis has been used to objectively evaluate movement patterns, quality, and strategies during reaching tasks. However, no study has investigated whether kinematic variables during unilateral and bilateral reaching tasks predict a patient’s perceived arm use during activities of daily living (ADL) after an intensive intervention. Therefore, this study investigated whether kinematic measures during unilateral and bilateral reaching tasks before an intervention can predict clinically meaningful improvement in perceived arm use during ADL after intensive poststroke rehabilitation. Methods The study was a secondary analysis of 120 subjects with chronic stroke who received 90–120 min of intensive intervention every weekday for 3–4 weeks. Reaching kinematics during unilateral and bilateral tasks and the Motor Activity Log (MAL) were evaluated before and after the intervention. Results Kinematic variables explained 22 and 11 % of the variance in actual amount of use (AOU) and quality of movement (QOM), respectively, of MAL improvement during unilateral reaching tasks. Kinematic variables also explained 21 and 31 % of the variance in MAL-AOU and MAL-QOM, respectively, during bilateral reaching tasks. Selected kinematic variables, including endpoint variables, trunk involvement, and joint recruitment and interjoint coordination, were significant predictors for improvement in perceived arm use during ADL (P < 0.05). Conclusions Arm–trunk kinematics may be used to predict clinically meaningful improvement in perceived arm use during ADL after intensive rehabilitation. Involvement of interjoint coordination and trunk control variables as predictors in bilateral reaching models indicates that a high level of motor control (i.e., multijoint coordination) and trunk stability may be important in obtaining treatment gains in arm use, especially for bilateral daily activities, in intensive rehabilitation after stroke.
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Affiliation(s)
- Hao-ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Rong-jiuan Liing
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Healthy Ageing Research Center, Chang Gung University, Taoyuan, Taiwan.
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Postacchini R, Paoloni M, Carbone S, Fini M, Santilli V, Postacchini F, Mangone M. Kinematic analysis of reaching movements of the upper limb after total or reverse shoulder arthroplasty. J Biomech 2015. [PMID: 26194874 DOI: 10.1016/j.jbiomech.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.
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Affiliation(s)
- Roberto Postacchini
- Department of Orthopedic Surgery, Israelitic Hospital, Italian University Sport and Movement, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy.
| | - Stefano Carbone
- Department of Orthopedic Surgery, Sapienza University, Rome, Italy
| | | | - Valter Santilli
- Department of Physical Medicine and Rehabilitation, Sapienza University, Rome, Italy
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Yang HC, Lee IC, Lee IC. Visual feedback and target size effects on reach-to-grasp tasks in children with autism. J Autism Dev Disord 2015; 44:3129-39. [PMID: 24974254 DOI: 10.1007/s10803-014-2165-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This study explores the effects of visual condition and target size during four reach-to-grasp tasks between autistic children and healthy controls. Twenty children with autism and 20 healthy controls participated in the study. Qualisys motion capture system and kinematic measures were used to record movement. Autistic group showed significantly longer movement time, larger normalized jerk score, more movement unit than controls, especially in non-visual feedback and small target blocks. Autistic group also showed significantly larger maximal grip aperture and normalized maximal grip aperture in visual feedback condition than controls. Autistic children demonstrate motor coordination problems and also depend on more visual cuing in high accuracy tasks. Autistic children develop other compensatory skills while performing tasks.
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Affiliation(s)
- Hsiu-Ching Yang
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan
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Song GB. The effects of task-oriented versus repetitive bilateral arm training on upper limb function and activities of daily living in stroke patients. J Phys Ther Sci 2015; 27:1353-5. [PMID: 26157217 PMCID: PMC4483395 DOI: 10.1589/jpts.27.1353] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/11/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of task-oriented
bilateral arm training and repetitive bilateral arm training on upper limb function and
activities of daily living in stroke patients. [Subjects] Forty patients with hemiplegia
resulting from stroke were divided into a task orientied bilateral arm training group
(n=20) and a repetitive bilateral arm training group (n=20). [Methods] The task-oriented
group underwent bilateral arm training with 5 functional tasks, and the repetitive group
underwent bilateral arm training with rhythmin auditory cueing for 30 minutes/day, 5
times/week, for 12 weeks. [Results] The upper limb function and the ability to perform
activities of daily living improved significantly in both groups. Although there were
significant differences between the groups, the task-oriented group showed greater
improvement in upper limb function and activities of daily living. [Conclusion] We
recommend bilateral arm training as well as adding functional task training as a clinical
intervention to improve upper limb function activities of daily living in patients with
hemiplegia.
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Affiliation(s)
- Gui Bin Song
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Republic of Korea
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Alt Murphy M, Häger CK. Kinematic analysis of the upper extremity after stroke – how far have we reached and what have we grasped? PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Concurrent and Predictive Validity of Arm Kinematics With and Without a Trunk Restraint During a Reaching Task in Individuals With Stroke. Arch Phys Med Rehabil 2015; 96:1666-75. [PMID: 25940684 DOI: 10.1016/j.apmr.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/18/2015] [Accepted: 04/21/2015] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine the concurrent and predictive validity of measurements of kinematic variables during reaching tasks with and without a trunk constraint in individuals with stroke. DESIGN Randomized controlled trials. SETTINGS Hospitals and a laboratory. PARTICIPANTS Individuals with stroke (N=95) enrolled in previous and ongoing clinical trials. INTERVENTIONS Upper limb training protocols were 90 to 120 minutes of intervention every weekday for 3 to 4 weeks. MAIN OUTCOME MEASURES Functional capacity was assessed using the Action Research Arm Test and motor impairment using the Fugl-Meyer Assessment for the Upper Extremity. Movement kinematics were measured during a reaching task with and without a trunk constraint. We derived 5 endpoint control variables and 3 joint recruitment variables for estimating concurrent and predictive validity. RESULTS The adjusted R(2) values for the constraint tasks ranged from .24 to .38 and for the unconstraint tasks from .29 to .40. Movement time was the most prominent kinematic variable for the Fugl-Meyer Assessment for the Upper Extremity before and after the intervention (P<.05). For the Action Research Arm Test, movement time and endpoint displacement were the most significant variables before and after the intervention, respectively (P<.05). CONCLUSIONS Measuring kinematic performance during an unconstrained task is appropriate and possibly sufficient to represent motor impairment and functional capacity of individuals with stroke. Movement time is the dominant variable associated with motor impairment and functional capacity, and endpoint displacement is unique in reflecting functional capacity of individuals with stroke.
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Park SD, Kim JY, Song HS. Effect of application of transcranial direct current stimulation during task-related training on gait ability of patients with stroke. J Phys Ther Sci 2015; 27:623-5. [PMID: 25931694 PMCID: PMC4395678 DOI: 10.1589/jpts.27.623] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/01/2014] [Indexed: 12/05/2022] Open
Abstract
[Purpose] The objective of this study was to determine the effect of transcranial direct
current stimulation (tDCS) during task-related training (TRT) on the gait ability of
patients with chronic stroke. [Subjects and Methods] The participants were 24 patients who
were diagnosed with hemiplegia due to stroke. Three groups were created: subjects who
performed TRT for general exercise therapy (TRT), subjects who received sham tDCS during
TRT for general exercise therapy (TST), and subjects who received tDCS during TRT for
general exercise therapy (TT). [Results] The stance phase symmetry profile, the swing
phase symmetry profile, and gait velocity all decreased significantly in the TT group
compared with the TRT group. However, there was no significant difference in the step
length symmetry profile among the groups. [Conclusion] A application of tDCS, that affects
the excitatory regulation in the cortical motor area, is an effective rehabilitation
method for gait improvement.
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Affiliation(s)
- Seong Doo Park
- Graduate School of Physical Therapy, Daejeon University, Republic of Korea
| | - Jin Young Kim
- Department of Occupational Therapy, Howon University, Republic of Korea
| | - Hyun Seung Song
- Graduate School of Physical Therapy, Daejeon University, Republic of Korea
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Winstein CJ, Kay DB. Translating the science into practice: shaping rehabilitation practice to enhance recovery after brain damage. PROGRESS IN BRAIN RESEARCH 2015; 218:331-60. [PMID: 25890145 DOI: 10.1016/bs.pbr.2015.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The revolution in neuroscience provided strong evidence for learning-dependent neuroplasticity and presaged the role of motor learning as essential for restorative therapies after stroke and other disabling neurological conditions. The scientific basis of motor learning has continued to evolve from a dominance of cognitive or information processing perspectives to a blend with neural science and contemporary social-cognitive-psychological science, which includes the neural and psychological underpinnings of motivation. This transformation and integration across traditionally separate domains is timely now that clinician scientists are developing novel, evidence-based therapies to maximize motor recovery in the place of suboptimal solutions. We will review recent evidence pertaining to therapeutic approaches that spring from an integrated framework of learning-dependent neuroplasticity along with the growing awareness of protocols that directly address the patient's fundamental psychological needs. Of importance, there is mounting evidence that when the individual's needs are considered in the context of instructions or expectations, the learning/rehabilitation process is accelerated.
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Affiliation(s)
- Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, Los Angeles, CA, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.
| | - Dorsa Beroukhim Kay
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, Los Angeles, CA, USA; Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, USA.
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Rachwani J, Santamaria V, Saavedra SL, Woollacott MH. The development of trunk control and its relation to reaching in infancy: a longitudinal study. Front Hum Neurosci 2015; 9:94. [PMID: 25759646 PMCID: PMC4338766 DOI: 10.3389/fnhum.2015.00094] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/29/2015] [Indexed: 01/15/2023] Open
Abstract
The development of reaching is crucially dependent on the progressive control of the trunk, yet their interrelation has not been addressed in detail. Previous studies on seated reaching evaluated infants during fully supported or unsupported conditions; however, trunk control is progressively developed, starting from the cervical/thoracic followed by the lumbar/pelvic regions for the acquisition of independent sitting. Providing external trunk support at different levels to test the effects of controlling the upper and lower regions of the trunk on reaching provides insight into the mechanisms by which trunk control impacts reaching in infants. Ten healthy infants were recruited at 2.5 months of age and tested longitudinally, until 8 months. During the reaching test, infants were placed in an upright seated position and an adjustable support device provided trunk fixation at pelvic and thoracic levels. Kinematic and electromyographic data were collected. Results showed that prior to independent sitting, postural instability was higher when infants were provided with pelvic compared to thoracic support. Associated reaches were more circuitous, less smooth and less efficient. In response to the instability, there was increased postural muscle activity and arm muscle co-activation. Differences between levels of support were not observed once infants acquired independent sitting. These results suggest that trunk control is acquired in a segmental sequence across the development of upright sitting, and it is tightly correlated with reaching performance.
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Affiliation(s)
- Jaya Rachwani
- Human Physiology and Institute of Neuroscience, University of OregonEugene, OR, USA
| | - Victor Santamaria
- Human Physiology and Institute of Neuroscience, University of OregonEugene, OR, USA
| | - Sandra L. Saavedra
- Department of Rehabilitation Sciences, University of HartfordWest Hartford, CT, USA
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Davis JZ. Task Selection and Enriched Environments: A Functional Upper Extremity Training Program for Stroke Survivors. Top Stroke Rehabil 2015; 13:1-11. [PMID: 16987787 DOI: 10.1310/d91v-2ney-6fl5-26y2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Functional tasks using real-life objects in an enriched environment provide a multidimensional approach to treatment. Functional tasks are therapeutic for stroke survivors, because they require the simultaneous use of motor control, cognition, visual perception, sensation, and motor planning. Therapists utilizing functional tasks as treatment modalities must also be multidimensional in their implementation. This article provides a systematic approach to guide therapists in developing a functional upper extremity training program for stroke survivors.
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Affiliation(s)
- Jan Z Davis
- International Clinical Educators, Inc., Port Townsend, Washington, USA
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Gosser SM, Rice MS. Efficiency of unimanual and bimanual reach in persons with and without stroke. Top Stroke Rehabil 2015; 22:56-62. [DOI: 10.1179/1074935714z.0000000002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Infusing motor learning research into neurorehabilitation practice: a historical perspective with case exemplar from the accelerated skill acquisition program. J Neurol Phys Ther 2015; 38:190-200. [PMID: 24828523 DOI: 10.1097/npt.0000000000000046] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
UNLABELLED : This special interest article provides a historical framework with a contemporary case example that traces the infusion of the science of motor learning into neurorehabilitation practice. The revolution in neuroscience provided the first evidence for learning-dependent neuroplasticity and presaged the role of motor learning as critical for restorative therapies after stroke. The scientific underpinnings of motor learning have continued to evolve from a dominance of cognitive or information processing perspectives to a blend with neural science and contemporary social-cognitive psychological science. Furthermore, advances in the science of behavior change have contributed insights into influences on sustainable and generalizable gains in motor skills and associated behaviors, including physical activity and other recovery-promoting habits. For neurorehabilitation, these insights have tremendous relevance for the therapist-patient interactions and relationships. We describe a principle-based intervention for neurorehabilitation termed the Accelerated Skill Acquisition Program that we developed. This approach emphasizes integration from a broad set of scientific lines of inquiry including the contemporary fields of motor learning, neuroscience, and the psychological science of behavior change. Three overlapping essential elements-skill acquisition, impairment mitigation, and motivational enhancements-are integrated. VIDEO ABSTRACT AVAILABLE (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A71) for more insights from the authors.
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Jeon HS, Woo YK, Yi CH, Kwon OY, Jung MY, Lee YH, Hwang S, Choi BR. Effect of Intensive Training With a pring-Assisted Hand Orthosis on Movement Smoothness in Upper Extremity Following Stroke: A Pilot Clinical Trial. Top Stroke Rehabil 2014; 19:320-8. [DOI: 10.1310/tsr1904-320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dodakian L, Campbell Stewart J, Cramer SC. Motor imagery during movement activates the brain more than movement alone after stroke: a pilot study. J Rehabil Med 2014; 46:843-8. [PMID: 25182189 DOI: 10.2340/16501977-1844] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the neural correlates of motor imagery performed in conjunction with movement of the paretic arm after stroke. DESIGN Cross-sectional, cohort study. SUBJECTS Seven individuals in the chronic phase of stroke recovery (median (range): age: 58 years (37-73); time post-stroke: 9 months (4-42); upper extremity Fugl-Meyer motor score: 48 (36-64)). METHODS Participants actively moved the paretic/right arm under two conditions while undergoing functional magnetic resonance imaging. In the motor condition, pronation/supination movements were made in response to a visual cue. In the motor + imagery condition, the same movements were performed in response to a visual cue but the participants were instructed to imagine opening and closing a doorknob during performance of the movement. RESULTS For the motor condition, the anticipated motor network was activated and included left sensorimotor cortex and right cerebellum. For performance of the same movements during the motor + imagery condition, additional brain regions were significantly engaged including the left inferior parietal lobule and right dorsolateral prefrontal cortex. CONCLUSIONS The addition of motor imagery to movement may provide a practical, accessible way to modulate activity in both the planning and execution components of the motor network after stroke.
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Affiliation(s)
- Lucy Dodakian
- Departments of Neurology and Anatomy and Neurobiology, University of California, Irvine, USA
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Kim JY, Kim JM, Ko EY. The effect of the action observation physical training on the upper extremity function in children with cerebral palsy. J Exerc Rehabil 2014; 10:176-83. [PMID: 25061598 PMCID: PMC4106773 DOI: 10.12965/jer.140114] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/19/2014] [Indexed: 11/22/2022] Open
Abstract
The purpose this study was to investigate the effect of action observation physical training (AOPT) on the functioning of the upper extremities in children with cerebral palsy (CP), using an evaluation framework based on that of the International Classification of Functioning, Disability and Health (ICF). The subjects were divided into an AOPT group and a physical training (PT) group. AOPT group practiced repeatedly the actions they observed on video clips, in which normal child performed an action with their upper extremities. PT group performed the same actions as the AOPT group did after observing landscape photographs. The subjects participated in twelve 30-min sessions, 3 days a week, for 4 weeks. Evaluation of upper extremity function using the following: the power of grasp and Modified Ashworth Scale for body functions and structures, a Box and Block test, an ABILHAND-Kids questionnaire, and the WeeFIM scale for activity and participation. Measurements were performed before and after the training, and 2 weeks after the end of training. The results of this study showed that, in comparison with the PT group, the functioning of the upper extremities in the AOPT group was significantly improved in body functions and activity and participation according to the ICF framework. This study demonstrates that AOPT has a positive influence on the functioning of the upper extremities in children with CP. It is suggested that this alternative approach for functioning of the upper extremities could be an effective method for rehabilitation in children with CP.
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Affiliation(s)
- Jin-Young Kim
- Department of Occupational Therapy, Howon University, Gunsan, Korea
| | - Jong-Man Kim
- Department of Occupational Therapy, Jeonju University, Jeonju, Korea
| | - Eun-Young Ko
- Department of Physical Therapy, Singa Hospital, Gwangju, Korea
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Paik YR, Kim SK, Lee JS, Jeon BJ. Simple and Task-oriented Mirror Therapy for Upper Extremity Function in Stroke Patients: A Pilot Study. Hong Kong J Occup Ther 2014. [DOI: 10.1016/j.hkjot.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective/Background To compare the effects of simple and task-oriented mirror therapies on upper extremity function in stroke patients with hemiplegia. Methods A single-subject, reversal (applied behaviour analysis) research design was used, and the study included four patients and two treatments. Treatment 1 involved simple mirror therapy that was performed using simple upper limb movements. Treatment 2 involved task-oriented mirror therapy that required each patient to perform functional movements associated with the tasks of daily living. Changes in upper extremity function were assessed during 23 sessions using box and block test, cube carry, and card turning tests. The Fugl-Meyer Assessment of upper extremity function was also performed. Results The upper extremity function of all patients increased after mirror therapy. However, the improved upper extremity function of the patients undergoing simple mirror therapy was not maintained after the conclusion of the therapy. By contrast, the improved upper extremity function of the patients receiving task-oriented mirror therapy continued to improve, even after therapy cessation. Conclusion Task-oriented mirror therapy in stroke patients provided more effective improvement in the upper extremity function of the hemiplegic stroke victims.
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Affiliation(s)
- Young-Rim Paik
- Department of Occupational Therapy, The Graduate School of Public Health and Welfare, Konyang University, Daejeon, Republic of Korea
| | - Su-Kyoung Kim
- Department of Occupational Therapy, The Graduate School of Public Health and Welfare, Konyang University, Daejeon, Republic of Korea
- Department of Occupational Therapy, The Konyang University, Daejeon, Republic of Korea
| | - Jae-Shin Lee
- Department of Occupational Therapy, The Graduate School of Public Health and Welfare, Konyang University, Daejeon, Republic of Korea
- Department of Occupational Therapy, The Konyang University, Daejeon, Republic of Korea
| | - Byoung-Jin Jeon
- Department of Occupational Therapy, Kangwon National University, Kangwon, Republic of Korea
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Lemmens RJM, Timmermans AAA, Janssen-Potten YJM, Pulles SANTD, Geers RPJ, Bakx WGM, Smeets RJEM, Seelen HAM. Accelerometry measuring the outcome of robot-supported upper limb training in chronic stroke: a randomized controlled trial. PLoS One 2014; 9:e96414. [PMID: 24823925 PMCID: PMC4019639 DOI: 10.1371/journal.pone.0096414] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/05/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aims to assess the extent to which accelerometers can be used to determine the effect of robot-supported task-oriented arm-hand training, relative to task-oriented arm-hand training alone, on the actual amount of arm-hand use of chronic stroke patients in their home situation. METHODS This single-blind randomized controlled trial included 16 chronic stroke patients, randomly allocated using blocked randomization (n = 2) to receive task-oriented robot-supported arm-hand training or task-oriented (unsupported) arm-hand training. Training lasted 8 weeks, 4 times/week, 2 × 30 min/day using the (T-)TOAT ((Technology-supported)-Task-Oriented-Arm-Training) method. The actual amount of arm-hand use, was assessed at baseline, after 8 weeks training and 6 months after training cessation. Duration of use and intensity of use of the affected arm-hand during unimanual and bimanual activities were calculated. RESULTS Duration and intensity of use of the affected arm-hand did not change significantly during and after training, with or without robot-support (i.e. duration of use of unimanual use of the affected arm-hand: median difference of -0.17% in the robot-group and -0.08% in the control group between baseline and after training cessation; intensity of the affected arm-hand: median difference of 3.95% in the robot-group and 3.32% in the control group between baseline and after training cessation). No significant between-group differences were found. CONCLUSIONS Accelerometer data did not show significant changes in actual amount of arm-hand use after task-oriented training, with or without robot-support. Next to the amount of use, discrimination between activities performed and information about quality of use of the affected arm-hand are essential to determine actual arm-hand performance. TRIAL REGISTRATION Controlled-trials.com ISRCTN82787126.
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Affiliation(s)
- Ryanne J. M. Lemmens
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Annick A. A. Timmermans
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- BIOMED Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Yvonne J. M. Janssen-Potten
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | | | - Richard P. J. Geers
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
| | - Wilbert G. M. Bakx
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Adelante Rehabilitation Centre, Hoensbroek, the Netherlands
| | - Rob J. E. M. Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
- Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Henk A. M. Seelen
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands
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Wade E, Chen C, Winstein CJ. Spectral analyses of wrist motion in individuals poststroke: the development of a performance measure with promise for unsupervised settings. Neurorehabil Neural Repair 2013; 28:169-78. [PMID: 24213957 DOI: 10.1177/1545968313505911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upper extremity use in daily life is a critical ingredient of continued functional recovery after cerebral stroke. However, time-evolutions of use-dependent motion quality are poorly understood due to limitations of existing measurement tools. OBJECTIVE Proof-of-concept study to determine if spectral analyses explain the variability of known temporal kinematic movement quality (ie, movement duration, number of peaks, jerk) for uncontrolled reach-to-grasp tasks. METHODS Ten individuals with chronic stroke performed unimanual goal-directed movements using both hands, with and without task object present, wearing accelerometers on each wrist. Temporal and spectral measures were extracted for each gesture. The effects of performance condition on outcome measures were determined using 2-way, within subject, hand (nonparetic vs paretic) × object (present vs absent) analysis of variance. Regression analyses determined if spectral measures explained the variability of the temporal measures. RESULTS There were main effects of hand on all 3 temporal measures and main effects of object on movement duration and peaks. For the paretic limb, spectral measures explain 41.2% and 51.1% of the variability in movement duration and peaks, respectively. For the nonparetic limb, spectral measures explain 40.1%, 42.5%, and 27.8% of the variability of movement duration, peaks, and jerk, respectively. CONCLUSIONS Spectral measures explain the variability of motion efficiency and control in individuals with stroke. Signal power from 1.0 to 2.0 Hz is sensitive to changes in hand and object. Analyzing the evolution of this measure in ambient environments may provide as yet uncharted information useful for evaluating long-term recovery.
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Affiliation(s)
- Eric Wade
- 1University of Tennessee, Knoxville, TN, USA
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Savelsbergh GJP, Ledebt A, Smorenburg ARP, Deconinck F. Upper limb activity in children with unilateral spastic cerebral palsy: the role of vision in movement strategies. Dev Med Child Neurol 2013; 55 Suppl 4:38-42. [PMID: 24237278 DOI: 10.1111/dmcn.12305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/29/2022]
Abstract
This article reviews the capacity of children with unilateral spastic cerebral palsy (USCP) to (re)organize the available degrees of freedom and to use visual information in interceptive actions during motion with either the impaired or the less-impaired hand. Atypical reaching movements, such as increased trunk movement or slower wrist velocity, are considered adaptive coordination patterns that are the result of a change in the constraints. It is argued that manipulation of the task context facilitates children with USCP to enhance performance. For example, when reducing the time available to intercept a ball, the children are found to exceed their usual maximum walking speed and to increase range of motion of the elbow. In addition, the children appear to rely on a visual information strategy similar to typically developing children ('bearing angle'), although more variability is observed when using the impaired arm. The implications for interventions are, it should be recognized, that these children adapt to the impairment by reorganizing the movement system and that this process can be influenced by changing the task context. Attention should be paid to the importance of using correct visual cues for initiation and guidance of interceptive actions, which may be provoked by using external visual triggers.
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Affiliation(s)
- Geert J P Savelsbergh
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands; Institute for Biomedical Research into Human Movement and Health, School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
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Woo Y, Jeon H, Hwang S, Choi B, Lee J. Kinematics variations after spring-assisted orthosis training in persons with stroke. Prosthet Orthot Int 2013; 37:311-6. [PMID: 23112278 DOI: 10.1177/0309364612461050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Static wrist splinting after stroke was not effective in facilitating distal movement. However, the purpose of this study is to evaluate the efficacy of training using kinematic parameters after a SaeboFlex orthosis training on chronic stroke patients. CASE DESCRIPTION AND METHODS Five stroke patients participated in 4 weeks of training using a SaeboFlex orthosis for 1 hour per day, five times per week. Fugl-Meyer Assessment, Box and Block Test, Action Research Arm Test, and Kinematics using a three-dimensional motion analysis system were used for evaluating of training effects. FINDINGS AND OUTCOMES The upper extremity score of the Fugl-Meyer Assessment and the Box and Block Test score were increased significantly after the intervention. The jerkiness score of the shoulder and elbow joints at the sagittal plane decreased significantly during the reach-to-grasp task at acromion height, and the jerkiness scores of the wrist joint during the reach-to-grasp task decreased significantly at both elbow and acromion heights. CONCLUSION The results of this study indicate that a SaeboFlex training is effective in recovering the movement of the hemiparetic upper extremity of patients after stroke. CLINICAL RELEVANCE Using a spring-assisted dynamic hand orthosis is considered to be an effective treatment option for providing repetition, task-oriented training, and real-world activities for the hemiparetic upper extremity, which was impaired hand to perform functional training.
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Affiliation(s)
- Youngkeun Woo
- Department of Physical Therapy, College of Alternative Medicine, Jeonju University, Jeonju, Republic of Korea
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Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Blanton S, Scott C, Reiss A, Cen SY, Holley R, Azen SP. Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE): a randomized controlled trial protocol. BMC Neurol 2013; 13:5. [PMID: 23311856 PMCID: PMC3547701 DOI: 10.1186/1471-2377-13-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Residual disability after stroke is substantial; 65% of patients at 6 months are unable to incorporate the impaired upper extremity into daily activities. Task-oriented training programs are rapidly being adopted into clinical practice. In the absence of any consensus on the essential elements or dose of task-specific training, an urgent need exists for a well-designed trial to determine the effectiveness of a specific multidimensional task-based program governed by a comprehensive set of evidence-based principles. The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) Stroke Initiative is a parallel group, three-arm, single blind, superiority randomized controlled trial of a theoretically-defensible, upper extremity rehabilitation program provided in the outpatient setting.The primary objective of ICARE is to determine if there is a greater improvement in arm and hand recovery one year after randomization in participants receiving a structured training program termed Accelerated Skill Acquisition Program (ASAP), compared to participants receiving usual and customary therapy of an equivalent dose (DEUCC). Two secondary objectives are to compare ASAP to a true (active monitoring only) usual and customary (UCC) therapy group and to compare DEUCC and UCC. METHODS/DESIGN Following baseline assessment, participants are randomized by site, stratified for stroke duration and motor severity. 360 adults will be randomized, 14 to 106 days following ischemic or hemorrhagic stroke onset, with mild to moderate upper extremity impairment, recruited at sites in Atlanta, Los Angeles and Washington, D.C. The Wolf Motor Function Test (WMFT) time score is the primary outcome at 1 year post-randomization. The Stroke Impact Scale (SIS) hand domain is a secondary outcome measure.The design includes concealed allocation during recruitment, screening and baseline, blinded outcome assessment and intention to treat analyses. Our primary hypothesis is that the improvement in log-transformed WMFT time will be greater for the ASAP than the DEUCC group. This pre-planned hypothesis will be tested at a significance level of 0.05. DISCUSSION ICARE will test whether ASAP is superior to the same number of hours of usual therapy. Pre-specified secondary analyses will test whether 30 hours of usual therapy is superior to current usual and customary therapy not controlled for dose. TRIAL REGISTRATION www.ClinicalTrials.gov Identifier: NCT00871715
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Affiliation(s)
- Carolee J Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry University of Southern California, Los Angeles, California, USA
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Emory University School of Medicine Center for Rehabilitation Medicine, Atlanta, GA, USA
- Department of Cell Biology, Emory University School of Medicine Center for Rehabilitation Medicine, Atlanta, GA, USA
| | - Alexander W Dromerick
- National Rehabilitation Hospital, Washington, DC, USA
- Georgetown University, Washington, DC, USA
- Washington DC VA Medical Center, Washington, DC, USA
| | - Christianne J Lane
- Statistical Consulting Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Monica A Nelsen
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry University of Southern California, Los Angeles, California, USA
| | - Rebecca Lewthwaite
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry University of Southern California, Los Angeles, California, USA
| | - Sarah Blanton
- Department of Rehabilitation Medicine, Emory University School of Medicine Center for Rehabilitation Medicine, Atlanta, GA, USA
| | - Charro Scott
- Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Aimee Reiss
- Department of Rehabilitation Medicine, Emory University School of Medicine Center for Rehabilitation Medicine, Atlanta, GA, USA
| | - Steven Yong Cen
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry University of Southern California, Los Angeles, California, USA
- Statistical Consulting Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Stanley P Azen
- Statistical Consulting Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Barden HLH, Nott MT, Baguley IJ, Heard R, Chapparo C. Test-retest reliability of computerised hand dynamometry in adults with acquired brain injury. Aust Occup Ther J 2013; 59:319-27. [PMID: 22934905 DOI: 10.1111/j.1440-1630.2012.01016.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM The ability to objectively and reliably measure hand performance over time is critical to monitor patient performance and evaluate treatment efficacy. Current spasticity measures are subjective in nature and fail to capture the complexity of the multi-faceted upper motor neuron syndrome. This study examined the test-retest reliability of dynamic computerised hand dynamometry for simultaneously measuring multiple aspects of positive and negative features of the upper motor neuron syndrome during an active grasp and release task. METHODS Community-living adults with upper motor neuron syndrome following acquired brain injury attending metropolitan spasticity clinics for management of upper limb spasticity (N = 36; mean age 50 years ±15) and control participants (N = 27, mean age 40 years ±12) completed a computerised hand dynamometry protocol across two testing occasions 5 weeks apart. Objective measurement of Isometric Force, Cycle Duration and Isometric Grip Work, Force Velocity, was completed during a repeated grasp and release test protocol with a computerised hand dynamometer to evaluate the reliability and reproducibility of hand performance. RESULTS Kendall Coefficient of Concordance W scores ranged from W = 0.69-0.98 for motor elements of grasp and release, including Isometric Force, Cycle Duration, Isometric Grip Work and Force Velocity. CONCLUSIONS The investigated dynamic computerised hand dynamometry protocol showed fair/good to excellent levels of test-retest reliability in control participants and in subjects with upper motor neuron syndrome following acquired brain injury.
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Affiliation(s)
- Hannah L H Barden
- Brain Injury Rehabilitation Service, Westmead Hospital, Westmead, NSW, Australia.
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50
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Hétu S, Mercier C. Using Purposeful Tasks to Improve Motor Performance: Does Object Affordance Matter? Br J Occup Ther 2012. [DOI: 10.4276/030802212x13433105374314] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Purposeful activity is believed to yield better results than meaningless exercises during motor rehabilitation. The objective of this paper is to provide a narrative review of the literature regarding the influence of object affordance on motor performance, a factor that contributes to the purposefulness of a task. Method: Thirty-five reviewed articles were selected following an online search on PubMed, Cinahl and Google Scholar and an inspection of their references. Results of reviewed studies are discussed in relation to (1) the different approaches used to increase object affordance; (2) the influence of clinical conditions on the relationship between object affordance and motor performance; and (3) the influence of object affordance on immediate motor performance vs motor learning. Findings: The three main approaches used to increase object affordance relate to (a) the number of objects used during the task; (b) the functional information that these objects convey; and (c) the functional goals of the task. Reviewed results suggest that increasing object affordance can produce beneficial effects on immediate motor performance and motor learning, and especially support the effect of varying the number of objects. However, most evidence on object affordance has not come from high quality research. Conclusion: Clinicians should favour the use of tasks with high object affordance during both clinical assessment and therapy in order to promote optimal motor performance. More high quality research is needed to assess the influence of object affordance during therapy and on long-term motor learning and clinical outcomes.
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Affiliation(s)
- Sébastien Hétu
- PhD Candidate, École de psychologie, Université Laval/CIRRIS, Québec, Canada
| | - Catherine Mercier
- Associate Professor, Département de réadaptation, Université Laval/CIRRIS, Québec, Canada
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