Deans' stroke musings: Direction-Specific Instability Poststroke Is Associated With Deficient Motor Modules for Balance Control

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.

Tuesday, July 3, 2018

Direction-Specific Instability Poststroke Is Associated With Deficient Motor Modules for Balance Control

Useless crap. Nothing here will help survivors recover. Yes, most strokes have postural instability but what the hell is the protocol to address that? All these Ph.Ds and we still get useless crapola like this. Have none of them ever talked to a survivor about their needs?
http://journals.sagepub.com/doi/abs/10.1177/1545968318783884

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Digna de Kam, PhD¹² , Alexander C. Geurts, PhD¹³ , Vivian Weerdesteyn, PhD¹³

1Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands3Sint Maartenskliniek Research, Nijmegen, The Netherlands
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, , ,

Gelsy Torres-Oviedo, PhD²

2University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, PA, United States
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, Digna de Kam, PhD¹²

1Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands2University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, PA, United States
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, Alexander C. Geurts, PhD¹³

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, Vivian Weerdesteyn, PhD¹³

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, Gelsy Torres-Oviedo, PhD²

2University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, PA, United States
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...

First Published June 29, 2018 Research Article

https://doi.org/10.1177/1545968318783884

Article Information

Article first published online: June 29, 2018

https://doi.org/10.1177/1545968318783884

Digna de Kam, PhD¹^,², Alexander C. Geurts, PhD¹^,³, Vivian Weerdesteyn, PhD¹^,³, Gelsy Torres-Oviedo, PhD²

¹Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands

²University of Pittsburgh, Swanson School of Engineering, Department of Bioengineering, Pittsburgh, PA, United States

³Sint Maartenskliniek Research, Nijmegen, The Netherlands

Corresponding Author: Gelsy Torres-Oviedo, PhD, Department of Bioengineering, University of Pittsburgh, 4420 Bayard St, Suite 110, Pittsburgh, PA 15213, USA. Email: gelsyto@pitt.edu

Abstract

Abstract

Defective muscle coordination for balance recovery may contribute to stroke survivors’ propensity for falling. Thus, we investigated deficits in muscle coordination for postural control and their association to body sway following balance perturbations in people with stroke. Specifically, we compared the automatic postural responses of 8 leg and trunk muscles recorded bilaterally in unimpaired individuals and those with mild to moderate impairments after unilateral supratentorial lesions (>6 months). These responses were elicited by unexpected floor translations in 12 directions. We extracted motor modules (ie, muscle synergies) for each leg using nonnegative matrix factorization. We also determined the magnitude of perturbation-induced body sway using a single-link inverted pendulum model. Whereas the number of motor modules for balance was not affected by stroke, those formed by muscles with long latency responses were replaced by atypically structured paretic motor modules (atypical muscle groupings), which hints at direct cerebral involvement in long-latency feedback responses. Other paretic motor modules had intact structure but were poorly recruited, which is indicative of indirect cerebral control of balance. Importantly, these paretic deficits were strongly associated with postural instability in the preferred activation direction of the impaired motor modules. Finally, these deficiencies were heterogeneously distributed across stroke survivors with lesions in distinct locations, suggesting that different cerebral substrates may contribute to balance control. In conclusion, muscle coordination deficits in the paretic limb of stroke survivors result in direction-specific postural instability, which highlights the importance of targeted interventions to address patient-specific balance impairments.