Background
Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.

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Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

Brain-machine interfaces (BMI) have recently been integrated within motor rehabilitation therapies by actively involving the central nervous system (CNS) within the exercises. For instance, the online decoding of intention of motion of a limb from pre-movement EEG correlates is being used to convert passive rehabilitation strategies into active ones mediated by robotics. As early stages of upper limb motor rehabilitation usually focus on analytic single-joint mobilizations, this paper investigates the feasibility of building BMI decoders for these specific types of movements. Two different experiments were performed within this study. For the first one, six healthy subjects performed seven self-initiated upper-limb analytic movements, involving from proximal to distal articulations. For the second experiment, three spinal cord injury patients performed two of the previously studied movements with their healthy elbow and paralyzed wrist. In both cases EEG neural correlates such as the event-related desynchronization (ERD) and movement related cortical potentials (MRCP) were analyzed, as well as the accuracies of continuous decoders built using the pre-movement features of these correlates (i.e., the intention of motion was decoded before movement onset). The studied movements could be decoded in both healthy subjects and patients. For healthy subjects there were significant differences in the EEG correlates and decoding accuracies, dependent on the moving joint. Percentages of correctly anticipated trials ranged from 75% to 40% (with chance level being around 20%), with better performances for proximal than for distal movements. For the movements studied for the SCI patients the accuracies were similar to the ones of the healthy subjects. This paper shows how it is possible to build continuous decoders to detect movement intention from EEG correlates for seven different upper-limb analytic movements. Furthermore we report differences in accuracies among movements, which might have an impact on the design of the rehabilitation technologies that will integrate this new type of information. The applicability of the decoders was shown in a clinical population, with similar performances between healthy subjects and patients.

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Continuous decoding of movement intention of upper limb self-initiated analytic movements from pre-movement EEG correlates.

Introduction: The proprioceptive neuromuscular facilitation-concept (PNF-concept) is a widely used rehabilitation concept, and is in many countries part of the undergraduate curriculum of physiotherapy education. It is also offered in postgraduate training worldwide. The modern physiotherapist is confronted with the application of evidence-based practice; therefore, the aim of this review is to summarize the available evidence for this rehabilitation concept.Method: A search was completed using Pubmed, ScienceDirect, PEDro, Cochrane library and the International PNF Association website. An evidence-based practice approach has been promoted in the field of physiotherapy since the early 1990s, hence we limited the search from 1990 until 2014.Major findings: Seventy-four sources that were found were categorized in: (A) PNF philosophy, (B) PNF basic principles and procedures, (C) PNF techniques in rehabilitation. In the reviewed publications, a variety of indications and subject populations were identified in...

The proprioceptive neuromuscular facilitation-concept; the state of the evidence, a narrative review

Upper extremity interventions account for 15 % of all symptomatic, extracranial cerebrovascular disease. Brachiocephalic/innominate and subclavian artery lesions account for the majority of upper extremity endovascular procedures with atherosclerotic occlusive disease as the principle etiology. Subclavian stenosis most frequently involves the ostial and/or proximal segment of the subclavian artery. The left subclavian artery is more frequently involved than the right. With technological advances in endovascular therapies providing a safe alternative to traditional surgery, a paradigm shift has developed in the way these lesions are treated.

Upper Extremity Interventions

Objectives
To evaluate effects of somatosensory stimulation in the form of repetitive peripheral nerve sensory stimulation (RPSS) in combination with transcranial direct current stimulation (tDCS), tDCS alone, RPSS alone, or sham RPSS + tDCS as add-on interventions to training of wrist extension with functional electrical stimulation (FES), in chronic stroke patients with moderate to severe upper limb impairments in a crossover design. We hypothesized that the combination of RPSS and tDCS would enhance the effects of FES on active range of movement (ROM) of the paretic wrist to a greater extent than RPSS alone, tDCS alone or sham RPSS + tDCS.

Materials and Methods
The primary outcome was the active ROM of extension of the paretic wrist. Secondary outcomes were ROM of wrist flexion, grasp, and pinch strength of the paretic and nonparetic upper limbs, and ROM of wrist extension of the nonparetic wrist. Outcomes were blindly evaluated before and after each intervention. Analysis of variance with repeated measures with factors “session” and “time” was performed.

Results
After screening 2499 subjects, 22 were included. Data from 20 subjects were analyzed. There were significant effects of “time” for grasp force of the paretic limb and for ROM of wrist extension of the nonparetic limb, but no effects of “session” or interaction “session x time.” There were no significant effects of “session,” “time,” or interaction “session x time” regarding other outcomes.

Conclusions
Single sessions of PSS + tDCS, tDCS alone, or RPSS alone did not improve training effects in chronic stroke patients with moderate to severe impairment.

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Combined brain and peripheral nerve stimulation in chronic stroke patients with moderate to severe motor impairment

Manual mobilization of the wrist: a pilot study in rehabilitation of patients with a chronic hemiplegic hand post-stroke.

Scapula motor control training with Proprioceptive Neuromuscular Facilitation in chronic subacromial impingement syndrome: A case report.

Motor learning with the PNF-concept, an alternative to constrained induced movement therapy in a patient after a stroke; a case report

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Incorrect use of proprioceptive neuromuscular facilitation-techniques and principles, a response to: Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial.

Introduction Congenital dysplasia of the pelvis often occurs in isolation, however, it can also involve other pelvic components, and anomalies of the digestive system. Pelvic malformations have effects on the pelvic girdle and pelvic stability influencing the quality of gait. The condition can be treated with a total hip arthroplasty (THA). The concept of Proprioceptive Neuromuscular Facilitation (PNF) has been described as a comprehensive rehabilitation approach with a focus on motor learning. This case report seeks to illustrate the clinical reasoning and feasibility of applying the PNF-concept in a patient after a THA with multiple congenital pelvis malformations. Case description A male, 44 years of age, physically active laborer was treated with THA after hip dysplasia, with comorbid missing pubic symphysis. The patient presented with complaints in gait speed, gait distance, hip joint mobility and stability. Patient management PNF-based motor-control training, including specified PNF-pattern exercises with specific PNF-facilitation principles and techniques was provided over a period of eighteen weeks. Results showed improvements beyond the minimal detectable change and/or the minimal clinically important difference for physical functioning in gait, strength, range of motion, and personal required activities. Discussion and conclusion Gait rehabilitation training, restoring altered movement patterns in the patient's activities of daily living was provided with PNF. Besides targeting structural impairments, this approach elicited motor learning effects. PNF-patterns have been described as: "mimicking functional activities" from daily life and sports. A specified PNF-based therapy including motor learning components, was a feasible approach in this case of complex pelvic skeletal malformations.

Fred Smedes

Papers

Manual mobilization of the wrist: a pilot study in rehabilitation of patients with a chronic hemiplegic hand post-stroke.

Scapula motor control training with Proprioceptive Neuromuscular Facilitation in chronic subacromial impingement syndrome: A case report.

Motor learning with the PNF-concept, an alternative to constrained induced movement therapy in a patient after a stroke; a case report

Incorrect use of proprioceptive neuromuscular facilitation-techniques and principles, a response to: Proprioceptive neuromuscular facilitation training improves pain-related and balance outcomes in working-age patients with chronic low back pain: a randomized controlled trial.

PNF- based Gait Rehabilitation-training after a Total Hip Arthroplasty in congenital pelvic malformation; A case report.