Deans' stroke musings: Movement goals encoded within the cortex and muscle synergies to reduce redundancy pre and post-stroke. The relevance for gait rehabilitation and the prescription of walking-aids. A literature review and scholarly discussion

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, February 10, 2018

Movement goals encoded within the cortex and muscle synergies to reduce redundancy pre and post-stroke. The relevance for gait rehabilitation and the prescription of walking-aids. A literature review and scholarly discussion

Stop with the fuckingly lazy scholarly discussion and write up protocols that get survivors recovered. Are you that fucking lazy and stupid about what needs to be done to help survivors? Or do you like hearing yourself talk and do nothing?
Movement goals encoded within the cortex and muscle synergies to reduce redundancy pre and post-stroke. The relevance for gait rehabilitation and the prescription of walking-aids. A literature review and scholarly discussion

ABSTRACT

ABSTRACT

Current knowledge of neural and neuromuscular processes controlling gait and movement as well as an understanding of how these mechanisms change following stroke is an important basis for the development of effective rehabilitation interventions. To support the translation of findings from basic research into useful treatments in clinical practice, up-to-date neuroscience should be presented in forms accessible to all members of the multidisciplinary team. In this review we discuss aspects of cortical control of gait and movement, muscle synergies as a way of translating cortical commands into specific muscle activity and as an efficient means of reducing neural and musculoskeletal redundancy. We discuss how these mechanisms change following stroke, potential consequences for gait rehabilitation, and the prescription and use of walking-aids as well as areas requiring further research.

KEYWORDS: Cerebral cortex, neuronal networks, muscle synergies, cerebrovascular stroke, gait rehabilitation, walking aids

Introduction

An up-to-date knowledge of neural and neuromuscular processes controlling movement as well as an understanding of how these mechanisms change following stroke is an important basis for developing effective rehabilitation interventions. This approach has been advocated and implemented by many physiotherapy researchers over the past three decades leading to the routine implementation of science based interventions such as high repetition, task-oriented training, constraint-induced movement therapy, and biofeedback (Carr and Shepherd, 1987 Carr JH, Shepherd RB 1987 A Motor Relearning Programme for Stroke, Aspen Publishers, UK. [Google Scholar]; Clark and Patten, 2013 Clark DJ, Patten C 2013 Eccentric versus concentric resistance training to enhance neuromuscular activation and walking speed following stroke. Neurorehabilitation and Neural Repair 27: 335–344.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Dean and Shepherd, 1997 Dean CM, Shepherd RB 1997 Task-related training improves performance of seated reaching tasks after stroke. a randomized controlled trial. Stroke 28: 722–728.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Lee, Kilbreath, and Refshauge, 2005 Lee MJ, Kilbreath SL, Refshauge KM 2005 Movement detection at the ankle following stroke is poor. Australian Journal of Physiotherapy 51: 19–24.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Lord, Wade, and Halligan, 1998 Lord SE, Wade DT, Halligan PW 1998 A comparison of two physiotherapy treatment approaches to improve walking in multiple sclerosis: A pilot randomized controlled study. Clinical Rehabilitation 12: 477–486.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Shepherd and Carr, 1994 Shepherd RB, Carr J 1994 Reflections on physiotherapy and the emerging science of movement rehabilitation. Australian Journal of Physiotherapy 40: 39–47.[Crossref], [Google Scholar]; Shumway-Cook and Woollacott, 1995 Shumway-Cook A, Woollacott MH 1995 Motor Control: theory and Practical Applications, Lippincott Williams and Wilkins, Philadelphia, Baltimore, New York, London. [Google Scholar]; Veerbeek et al., 2014 Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G 2014 What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 9: e87987.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]). Despite these developments, numerous aspects of clinical practice remain based on low level evidence or expert opinion (Kollen et al., 2009 Kollen BJ, Lennon S, Lyons B, Wheatley-Smith L, Scheper M, Buurke JH, Halfens J, Geurts AC, Kwakkel G 2009 The effectiveness of the Bobath concept in stroke rehabilitation: what is the evidence? Stroke 40: e89–e97.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Lennon, 2003 Lennon S 2003 Physiotherapy practice in stroke rehabilitation: a survey. Disability and Rehabilitation 25: 455–461.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]; States, Pappas, and Salem, 2009 States RA, Pappas E, Salem Y 2009 Overground physical therapy gait training for chronic stroke patients with mobility deficits. Cochrane Database of Systematic Reviews 3: CD006075.[PubMed], [Google Scholar]; Veerbeek et al., 2014 Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, Kwakkel G 2014 What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One 9: e87987.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]). Walking aids for example, including canes and rollators, although often widely used for long periods, have been only sparsely investigated regarding long-term impact on neural and neuromuscular mechanisms. Information from basic science and the potential relevance for walking aid prescription is not routinely considered. To date, research has mainly studied the immediate effects on kinetic, kinematic, or physiological outcomes in cross-sectional studies (Jeong, Jeong, Myong, and Koo, 2015 Jeong YG, Jeong YJ, Myong JP, Koo JW 2015 Which type of cane is the most efficient, based on oxygen consumption and balance capacity. In Chronic Stroke Patients? Gait and Posture 41: 493–498.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]; Polese et al., 2012 Polese JC, Teixeira-Salmela LF, Nascimento LR, Faria CD, Kirkwood RN, Laurentino GC, Ada L 2012 The effects of walking sticks on gait kinematics and kinetics with chronic stroke survivors. Clinical Biomechanics 27: 131–137.[Crossref], [PubMed], [Web of Science ®], [Google Scholar]).
Movement has been described as the result of interactions between: the person (with their individual physical and mental characteristics); and the task or movement goal the person is attempting to achieve and the environment (including the perpetual force of gravity) within which the movement is occurring (Shumway-Cook and Woollacott, 2007 Shumway-Cook A, Woollacott MH 2007 Motor Control. Translating Research into Clinical Practice, Lippincott Williams & Wilkins, Philadelphia, Baltimore, New York, London. [Google Scholar]). In this article we discuss research finding related to the neuromuscular control of movement which illustrate these points on a neuroscientific basis.
We examine research findings regarding: 1) cortical involvement in movement and gait control; 2) “muscle synergies” which according to a large body of evidence are the means by which cortical commands are converted into muscle actions; and 3) We discuss how these mechanisms change post stroke and possible consequences for rehabilitation and the use of walking-aids.