Showing papers in "Neurorehabilitation and Neural Repair in 2011"
TL;DR: This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization.
Abstract: Objective. To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. Methods. A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline—posttreatment and at 6 months—were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). Results. Posttreatment, the FMA improved more in...
354 citations
TL;DR: Bihemispheric tDCS may achieve the training-induced recovery of motor functions and foster greater functional recovery and CIMT alone appears effective in modulating local excitability but not in removing the imbalance in transcallosal inhibition.
Abstract: Background. Recovery of motor function after stroke may depend on a balance of activity in the neural network involving the affected and the unaffected motor cortices. Objective. To assess whether ...
281 citations
TL;DR: Kinematic analysis in this study identified a set of movement variables during a functional task that may serve as an objective assessment of upper-extremity motor performance in persons who can complete a task, such as reaching and drinking, after stroke.
Abstract: Background. Three-dimensional kinematic analysis provides quantitative and qualitative assessment of upper-limb motion and is used as an outcome measure to evaluate impaired movement after stroke. The number of kinematic variables used, however, is diverse, and models for upper-extremity motion analysis vary. Objective. The authors aim to identify a set of clinically useful and sensitive kinematic variables to quantify upper-extremity motor control during a purposeful daily activity, that is, drinking from a glass. Methods. For this purpose, 19 participants with chronic stroke and 19 healthy controls reached for a glass of water, took a sip, and placed it back on a table in a standardized way. An optoelectronic system captured 3-dimensional kinematics. Kinematical parameters describing movement time, velocity, strategy and smoothness, interjoint coordination, and compensatory movements were analyzed between groups. Results. The majority of kinematic variables showed significant differences between study g...
280 citations
TL;DR: A randomized trial comparing Constraint-induced movement therapy (CIMT) and a bimanual intervention that maintains the intensity of practice associated with CIMT but where children are engaged in functional bimanUAL tasks leads to similar improvements in hand function.
Abstract: Background. Constraint-induced movement therapy (CIMT) promotes hand function using intensive unimanual practice along with restraint of the less-affected hand. CIMT has not been compared with a treatment with equivalent dosing frequency and intensity in children with cerebral palsy (CP). Objectives. The authors report a randomized trial comparing CIMT and a bimanual intervention (hand-arm intensive bimanual therapy; HABIT) that maintains the intensity of practice associated with CIMT but where children are engaged in functional bimanual tasks. Methods. A total of 42 participants with hemiplegic CP between the ages of 3.5 and 10 years (matched for age and hand function) were randomized to receive 90 hours of CIMT or an equivalent dosage of functional bimanual training (HABIT) conducted in day-camp environments. A physical therapist blinded to treatment allocation tested hand function before and after treatment. The primary outcomes were changes in Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting ...
262 citations
TL;DR: Mobile health tools that enable clinicians and researchers to monitor the type, quantity, and quality of everyday activities of patients and trial participants have long been needed to improve daily care, design more clinically meaningful randomized trials of interventions, and establish cost-effective, evidence-based practices.
Abstract: Mobile health tools that enable clinicians and researchers to monitor the type, quantity, and quality of everyday activities of patients and trial participants have long been needed to improve daily care, design more clinically meaningful randomized trials of interventions, and establish cost-effective, evidence-based practices. Inexpensive, unobtrusive wireless sensors, including accelerometers, gyroscopes, and pressure-sensitive textiles, combined with Internet-based communications and machine-learning algorithms trained to recognize upper- and lower-extremity movements, have begun to fulfill this need. Continuous data from ankle triaxial accelerometers, for example, can be transmitted from the home and community via WiFi or a smartphone to a remote data analysis server. Reports can include the walking speed and duration of every bout of ambulation, spatiotemporal symmetries between the legs, and the type, duration, and energy used during exercise. For daily care, this readily accessible flow of real-world information allows clinicians to monitor the amount and quality of exercise for risk factor management and compliance in the practice of skills. Feedback may motivate better self-management as well as serve home-based rehabilitation efforts. Monitoring patients with chronic diseases and after hospitalization or the start of new medications for a decline in daily activity may help detect medical complications before rehospitalization becomes necessary. For clinical trials, repeated laboratory-quality assessments of key activities in the community, rather than by clinic testing, self-report, and ordinal scales, may reduce the cost and burden of travel, improve recruitment and retention, and capture more reliable, valid, and responsive ratio-scaled outcome measures that are not mere surrogates for changes in daily impairment, disability, and functioning.
251 citations
TL;DR: Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness.
Abstract: Background. No rehabilitation intervention has effectively improved functional use of the arm and hand in patients with severe upper limb paresis after stroke. Pilot studies suggest the potential f...
230 citations
TL;DR: Although the organization of KRWs is in flux as the system of hospitals grows, results over the past 8 years suggest that changes in national insurance policies are affecting the quantity and organization of rehabilitation interventions and improvement in patient outcomes.
Abstract: Background A new interdisciplinary postacute rehabilitation unit, the Kaifukuki (convalescent) rehabilitation ward (KRW), has been incorporated into the Japanese medical insurance system since 200
191 citations
TL;DR: Frequency-derived measures are valid and sensitive estimates of stride-to-stride variability that can be used to assess the quality and consistency of walking in patients with PD in real-life settings.
Abstract: Objective. To develop an automated and objective method to assess mobility in Parkinson disease (PD) patients in daily-life settings and to investigate whether accelerometer-derived measures discri...
171 citations
TL;DR: Anodal tDCS transiently enhanced knee extensor strength, and the modest increase was specific to the LL, which might augment the rehabilitation of stroke patients when combined with lower extremity strengthening or functional training.
Abstract: Background. Transcranial direct current stimulation (tDCS) of the motor cortex can enhance the performance of a paretic upper extremity after stroke. Reported effects on lower limb (LL) function are sparse. Objective. The authors examined whether tDCS can increase the force production of the paretic quadriceps. Methods. In this double-blind, crossover, sham-controlled experimental design, 8 participants with chronic subcortical stroke performed knee extension using their hemiparetic leg before, during, and after anodal or sham tDCS of the LL motor cortex representation in the affected hemisphere. Affected hand-grip force was also recorded. Results. The maximal knee-extension force increased by 21 N (13.2%, P < .01) during anodal tDCS compared with baseline and sham stimulation. The increase persisted less than 30 minutes. Maximal hand-grip force did not change. Conclusions. Anodal tDCS transiently enhanced knee extensor strength. The modest increase was specific to the LL. Thus, tDCS might augment the reh...
157 citations
TL;DR: BATRAC is not superior to DMTE, but both rehabilitation programs durably improve motor function for individuals with chronic UE hemiparesis and with varied deficit severity.
Abstract: Background and Purpose. This randomized controlled trial tests the efficacy of bilateral arm training with rhythmic auditory cueing (BATRAC) versus dose-matched therapeutic exercises (DMTEs) on upp...
155 citations
TL;DR: These findings provide support for introducing SENSe discrimination training in rehabilitation of sensory deficits after stroke and can achieve significant improvements in functional sensory discrimination capacity after stroke.
Abstract: Background. Sensory loss is common after stroke, with negative impact on exploration of the immediate environment, hand function, and return to daily activities. Objective. To compare the effective...
TL;DR: Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation.
Abstract: Background. Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk independently, but results have been mixed. Objective. The authors aimed to identify the c...
TL;DR: RMV with PT may be used as a nonpharmacological intervention in the neurorehabilitation of mild to moderate hemiparesis and a significant correlation was found between the degree of spasticity and the amount of intracortical inhibition.
Abstract: Background. Muscle vibration modifies corticomotor excitability in healthy subjects and reduces muscle tonus in stroke patients. Objective. This study examined whether repeated muscle vibration (rMV) applied over the flexor carpi radialis (FCR) and biceps brachii (BB) can induce long-lasting changes, using transcranial magnetic stimulation (TMS), in patients with chronic stroke. Methods. Thirty hemiparetic patients who offered at least minimal wrist and elbow isometric voluntary contractions were randomly assigned to either an experimental group, which received rMV in addition to physiotherapy (rMV + PT), or a control group that underwent PT alone. The following parameters of the FCR, BB, and extensor digitorum communis (EDC) were measured through TMS before, and 1 hour, 1 week, and 2 weeks after the end of intervention: resting motor threshold (RMT), map area, map volume, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). Muscle tonus and motor function were assessed on...
TL;DR: FET significantly reduced disability and improved voluntary grasping beyond the effects of considerable conventional upper extremity therapy in individuals with tetraplegia.
Abstract: Background. Functional electrical stimulation therapy (FET) has a potential to improve voluntary grasping among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Objective. This single-site, randomized controlled trial examined the efficacy of 40 hours of FET with conventional occupational therapy (COT) compared with COT alone to improve grasping. Methods. Twenty-four subjects with subacute traumatic incomplete SCI (C4-C7, AIS B-D) consented to participate in 40 hours of therapy over 8 weeks, beyond the conventional rehabilitation program. Subjects were randomized to receive FET + COT (n = 9) or COT (n = 12). The key outcomes were changes in Functional Independence Measure (FIM) self-care subscores, Spinal Cord Independence Measure (SCIM) self-care subscores, and Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) performed at baseline and follow-up. Results. At the end of the treatments, the change in mean FIM self-care subscore for the FET + COT group was 20.1 versu...
TL;DR: Accurate prediction of independent gait performance can be made soon after stroke, using 2 simple bedside tests: “sitting balance” and “strength of the hemiparetic leg”, useful for making early clinical decisions regarding treatment goals and discharge planning at hospital stroke units.
Abstract: Background. Early prognosis, adequate goal setting, and referral are important for stroke management. Objective. To investigate if independent gait 6 months poststroke can be accurately predicted within the first 72 hours poststroke, based on simple clinical bedside tests. Reassessment on days 5 and 9 was used to check whether accuracy changed over time. Methods. In 154 first-ever ischemic stroke patients unable to walk independently, 19 demographic and clinical variables were assessed within 72 hours and again on days 5 and 9 poststroke. Multivariable logistic modeling was applied to identify early prognostic factors for regaining independent gait, defined as ≥4 points on the Functional Ambulation Categories. Results. Multivariable modeling showed that patients with an independent sitting balance (Trunk Control Test–sitting; 30 seconds) and strength of the hemiparetic leg (Motricity Index leg; eg, visible contraction for all 3 items, or movement against resistance but weaker for 1 item) on day 2 poststro...
TL;DR: Data suggest that there is a critical threshold of rehabilitation, below which recovery will not occur, and that BDNF mediates functional recovery, and the use of intensive rehabilitation therapies for stroke patients is strongly supported.
Abstract: Background. Enriched rehabilitation (ER; environmental enrichment plus skilled reaching) improves recovery after middle cerebral artery occlusion (MCAo) in rats. Fundamental issues such as whether ER is effective in other models, optimal rehabilitation intensity, and underlying recovery mechanisms have not been fully assessed. Objective. The authors tested whether the efficacy of ER varies with ischemia model and assessed the importance of rehabilitation intensity and brain-derived neurotrophic factor (BDNF) in recovery. Methods. Rats in experiment 1 received 8 weeks of ER or remained in standard housing. Functional outcome was assessed with the staircase and cylinder tasks. Surprisingly, ER provided no functional benefit in any model. In this experiment, ER was delivered during the light phase, whereas other studies delivered ER in the dark phase of the light cycle. It was hypothesized that in the light, rats engaged in less rehabilitation or alternatively that BDNF was lower. Experiment 2 tested these h...
TL;DR: In mild USN patients, there was significantly greater improvement of BIT and FIM in the prism group, and PA therapy can significantly improve ADL in patients with subacute stroke.
Abstract: Background and objective. Unilateral spatial neglect (USN) can interfere with rehabilitation processes and lead to poor functional outcome. The purpose of this study was to determine whether prism adaptation (PA) therapy improves USN and functional outcomes in stroke patients in the subacute stage. Methods. A multicenter, double-masked, randomized, controlled trial was conducted to evaluate the effects of a 2-week PA therapy on USN assessed with the Behavioral Inattention Test (BIT), the Catherine Bergego Scale (CBS), and activities of daily living (ADL) as evaluated with the Functional Independence Measure (FIM). A total of 38 USN patients with right-brain damage were divided into prism (n = 20) and control (n = 18) groups. Patients were divided into mild and severe USN groups according to BIT behavioral test (mild ≥ 55 and severe<55). The prism group performed repetitive pointing with prism glasses that induce rightward optical shift twice daily, 5 days per week, for 2 weeks, whereas the control group p...
TL;DR: The authors’ findings suggest that the effectiveness of explicit-memory training in patients with MCI is associated with training-specific increases in activation and connectivity in a distributed neural system that includes areas involved in explicit memory.
Abstract: Background. Mild cognitive impairment (MCI) is often a precursor to Alzheimer disease. Little research has examined the efficacy of cognitive rehabilitation in patients with MCI, and the relevant neural mechanisms have not been explored. The authors previously showed the behavioral efficacy of cognitive rehabilitation using mnemonic strategies for face–name associations in patients with MCI. Here, the authors used functional magnetic resonance imaging (fMRI) to test whether there were training-specific changes in activation and connectivity within memory-related areas. Methods. A total of 6 patients with amnestic, multidomain MCI underwent pretraining and posttraining fMRI scans, during which they encoded 90 novel face–name pairs and completed a 4-choice recognition memory test immediately after scanning. Patients were taught mnemonic strategies for half the face–name pairs during 3 intervening training sessions. Results. Training-specific effects comprised significantly increased activation within a wide...
TL;DR: The skeletal muscle atrophy, increased fat around and within muscle, and ensuing muscular weakness observed in chronic stroke patients relates to diabetes risk and may impair functional mobility and independence.
Abstract: Purpose. Sarcopenia and increased fat infiltration in muscle may play a role in the functional impairment and high risk for diabetes in stroke. Our purpose was to compare muscle volume and muscle attenuation across 6 muscles of the paretic and nonparetic thigh and examine the relationships between intramuscular fat and insulin resistance and between muscle volume and strength in stroke patients. Methods. Stroke participants (70; 39 men, 31 women) aged 40 to 84 years, BMI = 16 to 45 kg/m2 underwent multiple thigh CT scans, total body scan by DXA (dual-energy X-ray absorptiometry), peak oxygen intake (VO2peak) graded treadmill test, 6-minute walk, fasting blood draws, and isokinetic strength testing. Results. Muscle volume is 24% lower and subcutaneous fat volume is 5% higher in the paretic versus nonparetic thigh. Muscle attenuation (index of amount of fat infiltration in muscle) is 17% higher in the nonparetic midthigh than the paretic. The semitendinosis/semimembranosis, biceps femoris, sartorius, vastus...
TL;DR: BAT is a better option if improvement of force generation is the treatment goal, and dCIT is more appropriate for improving functional ability and use of the affected arm in daily life, according to findings.
Abstract: Background and Objective. This study compared the efficacy of distributed constraint-induced therapy (dCIT), bilateral arm training (BAT), and control treatment (CT) on motor control and functional performance of the upper limb in stroke patients. Methods. A total of 66 patients with mean stroke onset of 16.20 months and mild to moderate motor impairment were randomized to dCIT, BAT, or CT groups. Each group received treatment for 2 h/d and 5 d/wk for 3 weeks. Pretreatment and posttreatment measures included reaching kinematic variables in unilateral and bilateral tasks, the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). Results. The dCIT and BAT groups had smoother reaching trajectories in the unilateral and bilateral tasks than the CT group. The BAT group, but not the dCIT group, generated greater force at movement initiation than the CT group during the unilateral and bilateral tasks. The dCIT patients had decreased WMFT time and higher functional ability scores than the CT patients...
TL;DR: This third chapter discusses the evidence for the rehabilitation of the most common movement disorders of the upper extremity and presents a framework, building on the computation, anatomy, and physiology (CAP) model, for incorporating some of the principles discussed in the 2 previous chapters.
Abstract: This third chapter discusses the evidence for the rehabilitation of the most common movement disorders of the upper extremity. The authors also present a framework, building on the computation, anatomy, and physiology (CAP) model, for incorporating some of the principles discussed in the 2 previous chapters by Frey et al and Sathian et al in the practice of rehabilitation and for discussing potentially helpful interventions based on emergent neuroscience principles.
TL;DR: Passive stretching combined with engaging in active movement training was of benefit in this pilot study for children with CP and demonstrated improvements in joint biomechanical properties, motor control performance, and functional capability in balance and mobility.
Abstract: Background. Ankle impairments are closely associated with functional limitations in children with cerebral palsy (CP). Passive stretching is often used to increase the range of motion (ROM) of the impaired ankle. Improving motor control is also a focus of physical therapy. However, convenient and effective ways to control passive stretching and motivate active movement training with quantitative outcomes are lacking. Objective. To investigate the efficacy of combined passive stretching and active movement training with motivating games using a portable rehabilitation robot. Methods. Twelve children with mild to moderate spastic CP participated in robotic rehabilitation 3 times per week for 6 weeks. Each session consisted of 20 minutes of passive stretching followed by 30 minutes of active movement training and ended with 10 minutes of passive stretching. Passive ROM (PROM), active ROM (AROM), dorsiflexor and plantarflexor muscle strength, Selective Control Assessment of the Lower Extremity, and functional...
TL;DR: Robotic feedback training improved paretic ankle motor control with improvements in floor walking, and increased walking speeds were comparable with reports from other task-oriented, locomotor training approaches used in stroke, suggesting that a focus on ankleMotor control may provide a valuable adjunct to locomotor therapies.
Abstract: Background. Task-oriented therapies such as treadmill exercise can improve gait velocity after stroke, but slow velocities and abnormal gait patterns often persist, suggesting a need for additional...
TL;DR: An association between impaired conflict resolution and FOG is shown, important in understanding the interplay between cognitive and motor problems, which can lead to specific rehabilitation strategies.
Abstract: Background. Freezing of gait (FOG) in Parkinson disease (PD) may involve executive dysfunction. This study examined whether executive functioning and attention are more affected in patients with FOG compared with those without and determined whether these processes are influenced by anti-Parkinson medication. Methods. A total of 11 PD patients with FOG, 11 without FOG, and 10 healthy control subjects, matched for age, gender, and education, participated. General motor, mental and cognitive screening tests, as well as specific neuropsychological assessment of executive functions and the Attention Network Test (ANT) were administered. The ANT was conducted in both ON and OFF phases in a counterbalanced design to determine medication-specific effects. Results. FOG showed a clear association with impairment in the executive control network for conflict resolution (inhibition of unwanted responses and impaired response selection), compared with nonfreezers and healthy controls, F(2, 28) = 5.41, P = .01. Orienting and alerting function did not differ between groups, F .10). Anti-Parkinson medication did not ameliorate conflict resolution (P > .10), although orienting attention improved with medication, F(1, 17) = 9.81, P < .01. Conclusions. This study shows an association between impaired conflict resolution and FOG, important in understanding the interplay between cognitive and motor problems, which can lead to specific rehabilitation strategies.
TL;DR: FES-ET on a workstation, supervised over the Internet, is feasible and may be effective for patients who can meet the residual motor function requirements of the study.
Abstract: Background. Spinal cord injury (SCI) survivors with tetraplegia have great difficulty performing activities of daily living (ADLs). Functional electrical stimulation (FES) combined with exercise therapy (ET) can improve hand function, but delivering the treatment is problematic. Objective. To compare 2 ET treatments delivered by in-home tele-therapy (IHT). Methods. Each treatment involved ET, tele-supervised 1 h/d, 5 d/wk for 6 weeks. Treatment 1: “conventional ET” comprised strength training, computer games played with a trackball, and therapeutic electrical stimulation (TES). Treatment 2: “ReJoyce ET” comprised FES-ET on a workstation, the Rehabilitation Joystick for Computerized Exercise (ReJoyce) with which participants played computer games associated with ADLs. Participants were block-randomized into group 1 receiving conventional ET first, followed by 1-month washout, and then ReJoyce ET and group 2 in reverse order. In all, 13 participants took part, 5 completing the study with both hands, such that both groups had a sample size of 9. Primary outcome measure: Action Research Arm Test (ARAT). Secondary outcome measures: grasp and pinch forces and the ReJoyce automated hand function test (RAHFT). Results. ARAT scores improved more after ReJoyce ET (13.0% ± 9.8%) than after conventional ET (4.0% ± 9.6%; F = 10.6, P < .01). RAHFT scores also improved more after ReJoyce ET (16.9% ± 8.6%) than conventional ET (3.3% ± 10.2%; F = 20.4, P < .01). Conclusions. FES-ET on a workstation, supervised over the Internet, is feasible and may be effective for patients who can meet the residual motor function requirements of our study.
TL;DR: Improved gait coordination and function were produced by the multimodal Gait Training Protocol, with or without functional electrical stimulation (FES), to improve volitional walking in patients with persistent (>6 months) dyscoordinated gait.
Abstract: Background. No single intervention restores the coordinated components of gait after stroke. Objective. The authors tested the multimodal Gait Training Protocol, with or without functional electric...
TL;DR: Individuals with PD can generalize motor improvements achieved during multidirectional step training to contexts of functional gait and balance and maintain improvements over 8 weeks.
Abstract: Background. Rhythmic auditory stimulation (RAS) can influence movement during straight line walking and direction transition in individuals with Parkinson disease (PD). Objective. The authors studi...
TL;DR: The results suggest that the model allows valid measurement of spasticity in the upper extremity of chronic stroke patients and that it can be used to separate the neural component induced by the stretch reflex from resistance caused by altered muscle properties.
Abstract: Background. There is no easy and reliable method to measure spasticity, although it is a common and important symptom after a brain injury. Objective. The aim of this study was to develop and validate a new method to measure spasticity that can be easily used in clinical practice. Methods. A biomechanical model was created to estimate the components of the force resisting passive hand extension, namely (a) inertia (IC), (b) elasticity (EC), (c) viscosity (VC), and (d) neural components (NC). The model was validated in chronic stroke patients with varying degree of hand spasticity. Electromyography (EMG) was recorded to measure the muscle activity induced by the passive stretch. Results. The model was validated in 3 ways: (a) NC was reduced after an ischemic nerve block, (b) NC correlated with the integrated EMG across subjects and in the same subject during the ischemic nerve block, and (c) NC was velocity dependent. In addition, the total resisting force and NC correlated with the modified Ashworth score...
TL;DR: Higher intensity of RT that assists forearm and wrist movements may lead to greater improvement in motor ability and functional performance in stroke patients.
Abstract: Background and Objectives. Robot-assisted therapy (RT) is a current promising intervention in stroke rehabilitation, but more research is warranted for examining its efficacy and the dose–benefit r...
TL;DR: Sensory stimulation via TENS may be beneficial to enhance aspects of motor recovery following a stroke, particularly when used in combination with active training, as well as providing guidelines about strategies and efficacy.
Abstract: Background. Somatosensory input may lead to long-lasting cortical plasticity enhanced by motor recovery in patients with neurological impairments. Sensory transcutaneous electrical stimulation (TEN...