Genetic Factors, Brain Atrophy, and Response to Rehabilitation Therapy After Stroke

 I got nothing out of this.

Another superstar stroke researcher(Steven C. Cramer) and we still don't get anything that helps us recover.

• Dr. Steven Cramer (16 posts to October 2011)

Genetic Factors, Brain Atrophy, and Response to Rehabilitation Therapy After Stroke

Show all authors

Steven C. Cramer, MD, Jill See, MPT, Brent Liu, PhD, ...

First Published December 21, 2021 Research Article Find in PubMed 

https://doi.org/10.1177/15459683211062899

Article information

Abstract

Objective

Patients show substantial differences in response to rehabilitation therapy after stroke. We hypothesized that specific genetic profiles might explain some of this variance and, secondarily, that genetic factors are related to cerebral atrophy post-stroke.

Methods

The phase 3 ICARE study examined response to motor rehabilitation therapies. In 216 ICARE enrollees, DNA was analyzed for presence of the BDNF val⁶⁶met and the ApoE ε4 polymorphism. The relationship of polymorphism status to 12-month change in motor status (Wolf Motor Function Test, WMFT) was examined. Neuroimaging data were also evaluated (n=127).

Results

Subjects were 61±13 years old (mean±SD) and enrolled 43±22 days post-stroke; 19.7% were BDNF val⁶⁶met carriers and 29.8% ApoE ε4 carriers. Carrier status for each polymorphism was not associated with WMFT, either at baseline or over 12 months of follow-up. Neuroimaging, acquired 5±11 days post-stroke, showed that BDNF val⁶⁶met polymorphism carriers had a 1.34-greater degree of cerebral atrophy compared to non-carriers (P=.01). Post hoc analysis found that age of stroke onset was 4.6 years younger in subjects with the ApoE ε4 polymorphism (P=.02).

Conclusion

Neither the val⁶⁶met BDNF nor ApoE ε4 polymorphism explained inter-subject differences in response to rehabilitation therapy. The BDNF val⁶⁶met polymorphism was associated with cerebral atrophy at baseline, echoing findings in healthy subjects, and suggesting an endophenotype. The ApoE ε4 polymorphism was associated with younger age at stroke onset, echoing findings in Alzheimer’s disease and suggesting a common biology. Genetic associations provide insights useful to understanding the biology of outcomes after stroke.

Keywords

stroke, rehabilitation, imaging, genetics, biomarker, endophenotype

Access Options

 

Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures

I got nothing out of this.

Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures

Daniel Fernando Arias Betancur^1,2, Maria da Graça Lopes Tarragó³, Iraci Lucena da Silva Torres^1,4, Felipe Fregni⁵ and Wolnei Caumo^1,2,6,7*

• ¹Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
• ²Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
• ³Physical Medicine and Rehabilitation Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
• ⁴Pharmacology of Pain and Neuromodulation: Pre-clinical Investigations Research Group, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
• ⁵Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics, and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, United States
• ⁶Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
• ⁷Department of Surgery, School of Medicine, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil

Introduction: The physiopathology of central post-stroke pain (CPSP) is poorly understood, which may contribute to the limitations of diagnostic and therapeutic advancements. Thus, the current systematic review was conducted to examine, from an integrated perspective, the cortical neurophysiological changes observed via transcranial magnetic stimulation (TMS), focusing on the structural damage, and clinical symptoms in patients with CPSP.

Methods: The literature review included the databases EMBASE, PubMed, and ScienceDirect using the following search terms by MeSH or Entree descriptors: [(“Cerebral Stroke”) AND (“Pain” OR “Transcranial Magnetic Stimulation”) AND (“Transcranial Magnetic Stimulation”)] (through September 29, 2020). A total of 297 articles related to CPSP were identified. Of these, only four quantitatively recorded cortical measurements.

Results: We found four studies with different methodologies and results of the TMS measures. According to the National Institutes of Health (NIH) guidelines, two studies had low methodological quality and the other two studies had satisfactory methodological quality. The four studies compared the motor threshold (MT) of the stroke-affected hemisphere with the unaffected hemisphere or with healthy controls. Two studies assessed other cortical excitability measures, such as cortical silent period (CSP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). The main limitations in the interpretation of the results were the heterogeneity in parameter measurements, unknown cortical excitability measures as potential prognostic markers, the lack of a control group without pain, and the absence of consistent and validated diagnosis criteria.

Conclusion: Despite the limited number of studies that prevented us from conducting a meta-analysis, the dataset of this systematic review provides evidence to improve the understanding of CPSP physiopathology. Additionally, these studies support the construction of a framework for diagnosis and will help improve the methodological quality of future research in somatosensory sequelae following stroke. Furthermore, they offer a way to integrate dysfunctional neuroplasticity markers that are indirectly assessed by neurophysiological measures with their correlated clinical symptoms.

Introduction

Stroke is the second leading cause of death in the world (1, 2). Among those who survive, motor and somatosensory sequelae compromise the functional capacity and quality of life in many individuals (3–5). In general, one can define two types of pain after stroke: pain associated with peripheral mechanisms (e.g., musculoskeletal, spastic pain, headache, and shoulder pain) and neuropathic central post-stroke pain (CPSP) (6). Although, CPSP is one of the primary sequelae following stroke, there is a gap in understanding its pathophysiology and a diagnostic definition (7). Dejerine and Roussy (8) performed the first description of CPSP in 1906. They described the clinical–anatomical correlation of patients diagnosed with a thalamic stroke who presented a syndrome characterized by intense pain, changes in superficial and deep sensorial perception, mild hemiplegia, choreoathetoid movements, astereognosis, and hemiataxia. Initial studies have linked CPSP to stroke in the thalamus, specifically the pulvinar, the ventral posteromedial, and posterolateral nuclei (9, 10). However, later studies described CPSP in lesions located in the lateral medulla (11), lenticulo-capsular area (12), pons, and in cortical areas (insula and operculum) (13, 14).

Although, there has been enormous progress in stroke treatment in recent decades, the rehabilitation of those who survive a stroke remains a challenge, specifically the recovery of disability, and well-being. Among these sequelae is CPSP, which has been shown to be slightly improved by pharmacological treatments. There is limited literature concerning this neuropathic pain category, primarily focusing on diagnosis and treatment. Thus, a better understanding of the neuroplasticity process might help progress in this field. In this regard, there is an urgent need to conduct studies investigating markers with diagnostic and prognostic potential to assist in the treatment of CPSP. This systematic review aimed to gather data from the literature concerning the physiopathology of CPSP and to critically examine these data to assist in planning future studies that may be able to help in the neurorehabilitation and optimization of functional recovery in individuals affected by CPSP. Specifically, the current review explored, from an integrative perspective, the relationships of the anatomical areas, clinical symptoms, and the cortical excitability (CE) parameters indexed by transcranial magnetic stimulation (TMS) measures. The TMS measures included motor threshold (MT), motor evoked potential (MEP), short intracortical inhibition (SICI), intracortical facilitation (ICF), and cortical silent period (CSP). From this dataset, we hope to offer additional information to advance this field of knowledge and open a new avenue for the treatment and rehabilitation of individuals affected by CPSP.

 

High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia

 Did your hospital create a protocol to find and treat this issue when this research from 2013 came out? Or are they still fuckingly incompetent and have nothing?

Stroke-Associated Pneumonia: Major Advances and Obstacles June 2013

The latest here:

High Monocyte-To-Lymphocyte Ratio Is Associated With Stroke-Associated Pneumonia

Hao-Ran Cheng^1†, Jia-Ying Song^2†, Yi-Nuo Zhang¹, Yun-Bin Chen¹, Gang-Qiang Lin¹, Gui-Qian Huang^1*, Jin-Cai He^1* and Zhen Wang^1*

• ¹Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
• ²School of Mental Health, Wenzhou Medical University, Wenzhou, China

Purpose: Stroke-associated pneumonia (SAP), a common complication in acute ischemic stroke (AIS) patients, is associated with poor prognosis after AIS. Inflammation plays an important role in the development of SAP. In this study, we aimed to explore the association between the monocyte-to-lymphocyte ratio (MLR) and SAP in AIS patients.

Methods: We continuously enrolled 972 AIS patients. SAP was diagnosed by two trained neurologists and confirmed by radiography, meeting the modified Centers for Disease Control and Prevention criteria. MLR values were measured for all participants, and all patients were evenly classified into three tertiles according to the MLR levels. We used the values that Youden's index max points corresponded to represent the optimal cutoffs, which represented the balance in sensitivity and specificity.

Results: 104 (10.7%) patients were diagnosed with SAP. SAP patients showed a significant increased (P < 0.001) MLR when compared with non-SAP. The optimal cutoff points of MLR were (T1) <0.2513, (T2) 0.2513–0.3843, and (T3) > 0.3843. The incidence of SAP was significantly higher in the third MLR tertile than the first and second MLR tertiles (21.7 vs. 4 vs. 6.5%, respectively, P < 0.001). After adjusting for confounding and risk factors, multivariate regression analysis showed that the third MLR tertile was an independent variable predicting the occurrence of SAP (odds ratio = 3.503, 95%CI = 1.066–11.515, P = 0.039).

Conclusions: Our study showed that higher MLR was significantly associated with SAP in AIS patients. MLR is beneficial for clinicians to recognize patients with a high risk of SAP at an early stage and is an effective way to improve clinical care of SAP patients. Higher MLR could be a helpful and valid biomarker for predicting SAP in clinical practice.

Introduction

Stroke-associated pneumonia (SAP) is one of the most common complications after acute ischemic stroke (AIS), with an incidence of 6.7–36.98% (1–3), and may lead to lengthy hospitalization, poor functional outcome, and high morbidity and mortality (2, 4–7). It has been previously confirmed that the use of prophylactic antibiotics does not prevent SAP (8, 9). Due to the extra clinical and financial burden associated with SAP, it is necessary to explore underlying risk factors to aid with early recognition and prevention.

The SAP-related poor prognosis and several risk factors have been recognized in previous studies, creating several predictive models of SAP (5, 10–14). Hoffmann et al. developed and validated the A²DS², a 10-point clinical model with high sensitivity and specificity for predicting SAP (3, 14, 15). This model assesses risk factors, including age, atrial fibrillation, dysphagia, sex, and previous stroke severity. In a total of 3,160 Chinese AIS patients, Li et al. (16) used machine learning methods to develop a model with high sensitivity and specificity to predict SAP. Interestingly, a study found that reduced vitamin D was a potential risk factor of SAP (17). In 2019, Zapata-Arriaza et al. (18) found that soluble urokinase plasminogen activator receptor and serum amyloid A, which were determined by immunoassays, were promising tools in early diagnosis of SAP. Advanced age, male, stroke severity, dysphagia, and low estimated glomerular filtration rate (eGFR) are predictive factors for SAP (5, 12, 13). In an animal experiment, C57BL/6 mice treated with an anti-CD147 antibody could decrease the lung damages, bacterial load, and pulmonary edema after receiving middle cerebral artery occlusion (19).

Evidence has found that inflammation is important in the development of SAP, and the associations between SAP and inflammatory biomarkers, such as interleukin 6, neutrophil-to-lymphocyte ratio, and C-reactive protein, have been explored (20, 21). Monocyte-to-lymphocyte ratio (MLR) is the absolute monocyte count divided by the absolute lymphocyte count and has been demonstrated to be a novel hematological and inflammatory parameter. MLR is associated with various diseases, such as community-acquired pneumonia, axial spondylarthritis, and coronary angiography, as well as the systemic inflammatory response, which reflects the abnormal immune status of diseases (22–24); however, the relationship between SAP and MLR remains unclear. In 2017, a study found that lymphocyte-to-monocyte ratios (LMRs) at admission were lower in AIS patients with pneumonia or urinary tract infection compared with patients without infections (25). Alternatively, the platelet-to-lymphocyte ratio (PLR) is the absolute platelet count divided by the absolute lymphocyte count, is a biomarker of systemic inflammation, and is related to the prognosis of hepatocellular carcinoma and the cognitive functions of breast cancer survivors (26, 27). Furthermore, leukocytes, monocytes, and lymphocytes have different roles in the inflammatory process, and their counts could directly reflect the inflammatory process. Meanwhile, the relationship between plasma biomarkers and AIS has been studied in many areas of stroke researches and found that biomarkers may help a lot in the early stage of AIS. Tu et al. (28) found that copeptin, as a plasma neuroendocrine biomarker, showed great ability in predicting a 3 month functional outcome and mortality after AIS.

To date, researches concerning the relationships between SAP and easy obtained blood biomarkers and comparing the predictive values of different biomarkers were insufficient. Our study could fill these gaps in previous studies and find the economical, objective, simple blood biomarkers. Thus, these biomarkers could help clinicians recognize AIS patients with a high risk of SAP at an early stage as well as reduce the financial and caring burden of patients. The purpose of the present study was to investigate the association between MLR and SAP in AIS patients, as well as find a helpful and valid biomarker for predicting and evaluating SAP in clinical practice.

More at link.

 

Time course of wrist hyper-resistance in relation to upper limb motor recovery early post stroke

I got nothing out of this.

 Time course of wrist hyper-resistance in relation to upper limb motor recovery early post stroke

 Neurorehabilitation and Neural Repair (NNR) , Volume 34(8) , Pgs. 690-701.

NARIC Accession Number: J84638.  What's this?
ISSN: 1545-9683.
Author(s): Andringa, Aukje ; Meskers, Carel ; van de Port, Ingrid ; van Wegen, Erwin ; Kwakkel, Gert.
Publication Year: 2020.
Number of Pages: 12.
Abstract: Study investigated the time course of neural and biomechanical components of wrist hyper-resistance in relation to upper-limb motor recovery in the first 6 months post stroke. Neural (NC), biomechanical elastic (EC), and viscous (VC) components of wrist hyper-resistance (NeuroFlexor device), and upper-limb motor recovery (Fugl-Meyer upper extremity scale [FM-UE]), were assessed in 17 patients within 3 weeks and at 5, 12, and 26 weeks post stroke. Patients were stratified according to the presence of voluntary finger extension (VFE) at baseline. Time course of wrist hyper-resistance components and assumed interaction effects were analyzed using linear mixed models. On average, patients without VFE at baseline showed a significant increase in NC, EC, and VC, and an increase in FM-UE from 13 to 26 points within the first 6 months post stroke. A significant increase in NC within 5 weeks preceded a significant increase in EC between weeks 12 and 26. Patients with VFE at baseline showed, on average, no significant increase in components from baseline to 6 months whereas FM-UE scores improved from 38 to 60 points. Findings suggest that the development of neural and biomechanical wrist hyper-resistance components in patients with severe baseline motor deficits is determined by lack of spontaneous neurobiological recovery early post stroke.
Descriptor Terms: JOINTS, LIMBS, MOBILITY IMPAIRMENTS, MOTOR SKILLS, SPASTICITY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://journals.sagepub.com/doi/full/10.1177/1545968320932135.

Citation: Andringa, Aukje , Meskers, Carel , van de Port, Ingrid , van Wegen, Erwin , Kwakkel, Gert. (2020). Time course of wrist hyper-resistance in relation to upper limb motor recovery early post stroke.  Neurorehabilitation and Neural Repair (NNR) , 34(8), Pgs. 690-701. Retrieved 10/14/2020, from REHABDATA database.

Aminov et al. (2018). What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta- analysis of upper-limb and cognitive outcomes

I got nothing out of this, numbers not meaning a thing and with no protocol produced, USELESS.

Aminov et al. (2018). What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta- analysis of upper-limb and cognitive outcomes

 Anna Aminov 1, 

Jeffrey M. Rogers 2, 

Sandy Middleton 1, 

Karen Caeyenberghs 3,4
and Peter H. Wilson 1,3,4*

Abstract

Background:
 Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects.
Methods:
 Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge’s g) were estimated using a random effects model, with motor andfunctional outcomes between different protocols compared at the
 Body Structure/Function, Activity, and Participation levels of the International Classification of Functioning.
Results:
 Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced
 small to medium overall effects (g = 0.46; 95% CI: 0.33–0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function
 (g = 0.41; 95% CI: 0.28–0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34–0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38;95% CI: -0.29-1.04, p
 = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g =0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28–
0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury.
Conclusion:
 VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.
Keywords:
 Cognition, Meta-analysis, Motor performance, Rehabilitation, Stroke, Virtual reality
* Correspondence: peterh.wilson@acu.edu.au
1 School of Psychology, Faculty of Health Sciences, Australian CatholicUniversity, Sydney, NSW, Australia
3 School of Psychology, Australian Catholic University, Melbourne, VIC,AustraliaFull list of author information is available at the end of the article
© The Author(s). 2018
 Open Access
 This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.
Aminov
 et al. Journal of NeuroEngineering and Rehabilitation
 (2018) 15:29
https://doi.org/10.1186/s12984-018-0370-2

The association between reorganization of bilateral M1 topography and function in response to early intensive hand focused upper limb rehabilitation following stroke is dependent on ipsilesional corticospinal tract integrity

I got nothing out of this, Motor Evoked Potentials means squat to survivors. Useless. But those wonderful abbreviations, hope you can translate research jargon.  I couldn't. Did it work? Because if virtual reality works then lots of patients could use it.  Even me with lots of dead brain.

The association between reorganization of bilateral M1 topography and function in response to early intensive hand focused upper limb rehabilitation following stroke is dependent on ipsilesional corticospinal tract integrity

Frontiers in Neurology , Volume 10(258)

NARIC Accession Number: J83228.  What's this?
ISSN: 1664-2295.
Author(s): Yarossi, Mathew ; Patel, Jigna ; Qiu, Qinyin ; Massood, Supriya ; Fluet, Gerard ; Merians, Alma ; Adamovich, Sergei Tunik, Eugene.
Project Number: 90RE5021.
Publication Year: 2019.
Number of Pages: 13.
Abstract: Study examined the relationship between changes in function/motor recovery and cortical motor topography in patients undergoing early (<3 months) and intensive hand focused upper-limb rehabilitation. Seventeen individuals received 8 one hour-sessions of training with virtual reality/robotic simulations. Participants were divided into two groups (MEP+, MEP-) based on whether motor evoked potentials (MEPs) were present in the affected first dorsal interosseous (FDI) at any time point. Clinical tests were performed prior to (PRE), directly following (POST), and 1 month following (1M) training. Measures included the Box and Blocks Test (BBT), Wolf Motor Function Test (WMFT), Upper Extremity Fugl-Meyer (UEFMA); kinematic and kinetic assessments including finger active range of motion (finger AROM) and maximum pinch force (MPF); and bilateral TMS mapping of 5 hand muscles. MEP+ individuals improved significantly more than MEP- individuals from PRE to 1M on the WMFT, BBT, and finger AROM scores. Ipsilesional hemisphere FDI area increased significantly with time in the MEP+ group. FDI area of the contralesional hemisphere was not significantly different across time points or groups. In the MEP+ group, significant correlations were observed between PRE and 1M changes in ipsilesional FDI area and WMFT, BBT, and finger AROM, and contralesional FDI area and UEFMA and MPF. In the MEP- group, no significant correlations were found between changes in contralesional FDI area and functional outcomes.
Descriptor Terms: BIOENGINEERING, BODY MOVEMENT, BRAIN, COMPUTER APPLICATIONS, ELECTRICAL STIMULATION, ELECTROPHYSIOLOGY, EXERCISE, IMAGING, LIMBS, MOTOR SKILLS, REHABILITATION TECHNOLOGY, ROBOTICS, STROKE, THERAPEUTIC TRAINING.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://www.frontiersin.org/articles/10.3389/fneur.2019.00258/full.

Citation: Yarossi, Mathew , Patel, Jigna , Qiu, Qinyin , Massood, Supriya , Fluet, Gerard , Merians, Alma , Adamovich, Sergei Tunik, Eugene. (2019). The association between reorganization of bilateral M1 topography and function in response to early intensive hand focused upper limb rehabilitation following stroke is dependent on ipsilesional corticospinal tract integrity.  Frontiers in Neurology , 10(258) Retrieved 4/17/2020, from REHABDATA database.

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

I got nothing out of the abstract because the robotic used was not mentioned. Without that I can't even tell my therapists and doctor what to bring in.  Useless. Hope you know what intraclass correlation coefficient means and the number associated with it.

Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke

 Journal of NeuroEngineering and Rehabilitation , Volume 17(1)

NARIC Accession Number: J83131.  What's this?
ISSN: 1743-0003.
Author(s): Germanotta, Marco ; Gower, Valerio ; Papadopoulou, Dionysia ; Cruciani, Arianna ; Pecchioli, Cristiano ; Mosca, Rita ; Speranza, Gabriele ; Falsini, Catuscia ; Cecchi, Francesca ; Vannetti, Federica ; Montesano, Angelo ; Galeri, Silvia ; Gramatica, Furio ; Aprile, Irene.
Publication Year: 2020.
Number of Pages: 10.
Abstract: Study assessed the reliability, validity, and discriminant ability of the indices provided by a robotic device for hand rehabilitation in 120 patients with stroke and 40 control subjects. Clinical evaluation included finger flexion and extension strength using the Medical Research Council (MRC), finger spasticity using the Modified Ashworth Scale (MAS), and motor control and dexterity during activities of daily living using the Frenchay Arm Test (FAT). Robotic evaluations included finger flexion and extension strength, muscle tone at rest, and instrumented MAS and Modified Tardieu Scale. Subjects were evaluated twice, one day apart, to assess the test-retest reliability of the robotic measures, using the intraclass correlation coefficient (ICC). To estimate the response stability, the standard errors of measurement and the minimum detectable change (MDC) were also calculated. Validity was assessed by analyzing the correlations between the robotic metrics and the clinical scales, using Spearman’s correlation coefficient (r). Finally, the ability of the robotic measures to distinguish between patients with stroke and healthy subjects was investigated by means of Mann-Whitney U tests. All the investigated measures were able to discriminate patients with stroke from healthy subjects. Test-retest reliability was found to be excellent for finger strength (in both flexion and extension) and muscle tone, with ICCs higher than 0.9. MDCs were equal to 10.6 N for finger flexion, 3.4 N for finger extension, and 14.3 N for muscle tone(Don't use the word tone, it sounds too benign, spasticity sounds like it needs to be solved.). Conversely, test-retest reliability of the spasticity measures was poor. Finally, finger strength (in both flexion and extension) was correlated with the clinical scales (r of about 0.7 with MRC, and about 0.5 with FAT). Findings indicate that finger strength and muscle tone, as provided by a robotic device for hand rehabilitation, are reliable and sensitive measures. Moreover, finger strength is strongly correlated with clinical scales.
Descriptor Terms: DEXTERITY, EVALUATION TECHNIQUES, LIMBS, MOTOR SKILLS, MUSCLES, PERFORMANCE STANDARDS, REHABILITATION TECHNOLOGY, ROBOTICS, SPASTICITY, STROKE.


Can this document be ordered through NARIC's document delivery service*?: Y.
Get this Document: https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-019-0634-5.

Citation: Germanotta, Marco , Gower, Valerio , Papadopoulou, Dionysia , Cruciani, Arianna , Pecchioli, Cristiano , Mosca, Rita , Speranza, Gabriele , Falsini, Catuscia , Cecchi, Francesca , Vannetti, Federica , Montesano, Angelo , Galeri, Silvia , Gramatica, Furio , Aprile, Irene. (2020). Reliability, validity and discriminant ability of a robotic device for finger training in patients with subacute stroke.  Journal of NeuroEngineering and Rehabilitation , 17(1) Retrieved 4/17/2020, from REHABDATA database.

Poststroke postural sway improved by botulinum toxin: A multicenter randomized double-blind controlled trial

I got nothing out of this. What does improving sway do for functional recovery?  The only goal in stroke is 100% recovery, not some intermediate stage improvement.  Tell us how this got us closer to 100% recovery or go home.

Poststroke postural sway improved by botulinum toxin: A multicenter randomized double-blind controlled trial

Archives of Physical Medicine and Rehabilitation , Volume 101(2) , Pgs. 242-248.

NARIC Accession Number: J83116.  What's this?
ISSN: 0003-9993.
Author(s): Kerzoncuf, Marjorie; Viton, Jean-Michel; Pellas, Frederic; Cotinat, Maeva; Calmels, Paul; Milhe de Bovis, Virginie; Delarque, Alain; Benssoussan, Laurent.
Publication Year: 2020.
Number of Pages: 7.
Abstract: Study assessed the effects of injecting botulinum toxin into the lower-limb muscles of people with hemiparesis post stroke in terms of their sway areas. Forty people with hemiparesis with chronic post-stroke lower-limb spasticity were randomized to treatment and control groups. Intramuscular injection of a placebo (physiological serum) was performed on the control group, and botulinum toxin injections were performed on the treatment group. Participants and physical and rehabilitation medicine specialists were given no information as to which of the 2 treatments was applied. The sway area of the center of pressure was recorded for 30 seconds in 3 conditions: eyes open, eyes open in a dual task (a postural control task combined with an arithmetic task), and eyes closed. Spasticity was measured using the Modified Ashworth Scale. Clinical examinations and postural sway assessments were performed before botulinum toxin injection and again 4-6 weeks after the injection. Spasticity decreased significantly in the treatment group. The sway area did not differ significantly between the 2 groups before treatment. The most conspicuous effect was observed in the case of the dual task, where a significant decrease in the sway area occurred in the treatment group in comparison with the placebo group. Treating spasticity by injecting botulinum toxin into people's lower-limb muscles post stroke seems to improve their postural sway. The dual task used in this study to assess sway seems to be a useful, sensitive test for this purpose.
Descriptor Terms: DRUGS, EQUILIBRIUM, INTERVENTION, LIMBS, MEDICAL TREATMENT, MOBILITY IMPAIRMENTS, PHARMACOLOGY, POSTURE, SPASTICITY, STROKE, TASK ANALYSIS.


Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Kerzoncuf, Marjorie, Viton, Jean-Michel, Pellas, Frederic, Cotinat, Maeva, Calmels, Paul, Milhe de Bovis, Virginie, Delarque, Alain, Benssoussan, Laurent. (2020). Poststroke postural sway improved by botulinum toxin: A multicenter randomized double-blind controlled trial.  Archives of Physical Medicine and Rehabilitation , 101(2), Pgs. 242-248. Retrieved 4/17/2020, from REHABDATA database.

The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

 I got nothing out of this, hopefully your doctor can explain how this is going to get you 100% recovered.  If you get my upper arm and hand spasticity cured this problem would cease to exist. Solve the correct problem, spasticity, not this secondary effect of spasticity. THIS is why we need a stroke strategy, we wouldn't be wasting time on secondary issues, we would solve the primary problem.

The nature and extent of upper limb associated reactions during walking in people with acquired brain injury

• Michelle B. Kahn,
• Ross A. Clark,
• Gavin Williams,
• Kelly J. Bower,
• Megan Banky,
• John Olver &
• Benjamin F. Mentiplay 

Journal of NeuroEngineering and Rehabilitation volume 16, Article number: 160 (2019) Cite this article

Abstract

Background

Upper limb associated reactions (ARs) are common in people with acquired brain injury (ABI). Despite this, there is no gold-standard outcome measure and no kinematic description of this movement disorder. The aim of this study was to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort at matched walking speed intention.

Methods

A convenience sample of 36 healthy control adults (HCs) and 42 people with ABI who had upper limb ARs during walking were recruited and underwent assessment of their self-selected walking speed using the criterion-reference three dimensional motion analysis (3DMA) at Epworth Hospital, Melbourne. Shoulder flexion, abduction and rotation, elbow flexion, forearm rotation and wrist flexion were assessed. The mean angle, standard deviation (SD), peak joint angles and total joint angle range of motion (ROM) were calculated for each axis across the gait cycle. On a group level, ANCOVA was used to assess the between-group differences for each upper limb kinematic outcome variable. To quantify abnormality prevalence on an individual participant level, the percentage of ABI participants that were outside of the 95% confidence interval of the HC sample for each variable were calculated.

Results

There were significant between-group differences for all elbow and shoulder abduction outcome variables (p < 0.01), most shoulder flexion variables (except for shoulder extension peak), forearm rotation SD and ROM and for wrist flexion ROM. Elbow flexion and shoulder abduction were the axes most frequently affected by ARs. Despite the elbow being the most prevalently affected (38/42, 90%), a large proportion of participants had abnormality, defined as ±1.96 SD of the HC mean, present at the shoulder (32/42, 76%), forearm (20/42, 48%) and wrist joints (10/42, 24%).

Conclusion

This study provides valuable information on ARs, and highlights the need for clinical assessment of ARs to include all of the major joints of the upper limb. This may inform the development of a criterion-reference outcome measure or classification system specific to ARs.

Background

People with acquired brain injury (ABI) often present with movement abnormalities including upper limb associated reactions (ARs) during walking [1, 2]. Associated reactions are prevalent, recently being reported as a key goal area in 43% of people in a large stroke cohort (n = 964) [3]. Associated reactions are an effort-dependent phenomenon causing an involuntary increase in upper limb muscle tone, with awkward and uncomfortable postures [4]. Normal arm swing in walking is important to reduce energy expenditure [5], enhance gait stability and balance [6] and facilitate leg swing for faster walking speeds [7,8,9]. Abnormal upper limb kinematics resulting from ARs may negatively impact gait [10], balance [11], dynamic upper limb function [12, 13] and activities of daily living [10] for people with ABI. The treatment of ARs is therefore commonly a focus for physical and pharmacological management [3, 14].
Despite the prevalence and significance of ARs, there are many issues that exist in this field, such as, inconsistent terminology, no gold-standard assessment, unconfirmed contributing factors and varied treatment without supporting evidence [15]. In regards to assessment, there is currently no gold-standard outcome measure, with most having poor ecological validity for walking, involving stationary tests performed in a seated position [4]. The elbow joint is frequently the focus of assessment [4], despite literature suggesting that ARs affect all joints of the upper limb [16, 17]. Therefore, investigation into the upper limb movement abnormalities caused by ARs during walking is required.
Instrumented three-dimensional motion analysis (3DMA) is the criterion-reference for objective evaluation of joint kinematics during walking [18]. Despite the potential for 3DMA to fulfil the requirements of detailed dynamic upper limb assessment, it is not yet widely integrated into research or clinical practice. To date there have only been a few studies that have developed upper limb marker sets. These have been used for evaluation of arm posture during walking in healthy controls (HCs) [19, 20], paediatric cerebral palsy [21,22,23] and adults with stroke [2, 24]. While these studies have refined the use of upper body marker sets in gait analysis there has been no research to date in applying 3DMA specifically for the evaluation of ARs. Given that clinically, people with ARs and their therapists often describe ARs in terms of the visual impact, 3DMA is an appropriate methodology to quantify ARs.
A comprehensive assessment of the kinematics of upper limb ARs during walking in ABI may provide insight into the key abnormalities, facilitate the development of a criterion-reference outcome measure, help guide assessment, and clinical decision-making regarding therapeutic interventions. The aim of this study was therefore to determine the upper limb kinematic variables most frequently affected by ARs in people with ABI compared with a healthy cohort.

Role of Interhemispheric Cortical Interactions in Poststroke Motor Function

I got nothing out of this. Nothing that is going to get survivors 100% recovered. Not even a suggestion on what to use this for for future research that will lead to 100% recovery.  I blame the mentors and senior researchers for not elucidating that all stroke research leads to 100% recovery or it is not done.

Role of Interhemispheric Cortical Interactions in Poststroke Motor Function 

Show all authors

Jacqueline A. Palmer, DPT, PhD*, Lewis A. Wheaton, PhD*, Whitney A. Gray, DPT, ...

First Published July 22, 2019 Research Article

https://doi.org/10.1177/1545968319862552

Article information

Abstract

Background/Objective. We investigated interhemispheric interactions in stroke survivors by measuring transcranial magnetic stimulation (TMS)–evoked cortical coherence. We tested the effect of TMS on interhemispheric coherence during rest and active muscle contraction and compared coherence in stroke and older adults. We evaluated the relationships between interhemispheric coherence, paretic motor function, and the ipsilateral cortical silent period (iSP).  
Methods. Participants with (n = 19) and without (n = 14) chronic stroke either rested or maintained a contraction of the ipsilateral hand muscle during simultaneous recordings of evoked responses to TMS of the ipsilesional/nondominant (i/ndM1) and contralesional/dominant (c/dM1) primary motor cortex with EEG and in the hand muscle with EMG. We calculated pre- and post-TMS interhemispheric beta coherence (15-30 Hz) between motor areas in both conditions and the iSP duration during the active condition.  
Results. During active i/ndM1 TMS, interhemispheric coherence increased immediately following TMS in controls but not in stroke. Coherence during active cM1 TMS was greater than iM1 TMS in the stroke group. Coherence during active iM1 TMS was less in stroke participants and was negatively associated with measures of paretic arm motor function. Paretic iSP was longer compared with controls and negatively associated with clinical measures of manual dexterity. There was no relationship between coherence and. iSP for either group. No within- or between-group differences in coherence were observed at rest.  
Conclusions. TMS-evoked cortical coherence during hand muscle activation can index interhemispheric interactions associated with poststroke motor function and potentially offer new insights into neural mechanisms influencing functional recovery.

Keywords Interhemispheric inhibition, transcallosal inhibition, transcranial magnetic stimulation, electroencephalography, stroke, GABA

Access Options

The Effect of a Cognitive Dual Task on the Control of Minimum Toe Clearance While Walking

I got nothing out of this, but maybe our stroke leaders could inform us if this testing needs to be followed up with stroke patients.  Do our stroke leaders have any way for stroke survivors to contact them?

The Effect of a Cognitive Dual Task on the Control of Minimum Toe Clearance While Walking 

Daniel Hamacher ,^*1 , Dennis Hamacher ,^*2 , Roy Müller ,^*1,3 , Lutz Schega ,^*2 , Show all authors

Affiliations

Volume: 23 Issue: 3 Pages: 344-353

https://doi.org/10.1123/mc.2018-0006

• ABSTRACT
• FULL TEXT
• REFERENCES
• PDF

The aim of the current study was to evaluate the effect of a cognitive dual task on minimum toe clearance (MTC) variability while walking. In a randomized cross-over design, gait kinematics of 25 older (70 ± 6 years) and 45 younger adults (25 ± 2 years) were captured during normal walking and dual-task walking. Variability of stride time, stride length, and MTC were calculated. Differences between normal versus dual-task walking were assessed using Wilcoxon tests. Compared with normal walking, dual-task walking caused an increase in stride time variability (older adults: p < .001 and younger adults: p < .001), while the variability of MTC decreased (older adults: p = .032 and younger adults: p = .012). MTC seems to be a task-relevant gait parameter that is controlled with high priority to preserve its variability under challenging conditions.