Mental chronometry and mental rotation abilities in stroke patients with different degrees of sensory deficit.
Restor Neurol Neurosci. 2016 Nov 22;34(6):907-914
Authors: Liepert J, Büsching I, Sehle A, Schoenfeld MA
BACKGROUND: Motor imagery is used for treatment of motor deficits after stroke. Clinical observations suggested that motor imagery abilities might be reduced in patients with severe sensory deficits. This study investigated the influence of somatosensory deficits on temporal (mental chronometry, MC) and spatial aspects of motor imagery abilities.
METHODS: Stroke patients (n = 70; <6 months after stroke) were subdivided into 3 groups according to their somatosensory functions. Group 1 (n = 31) had no sensory deficits, group 2 (n = 27) had a mild to moderate sensory impairment and group 3 (n = 12) had severe sensory deficits. Patients and a healthy age-matched control group (n = 23) participated in a mental chronometry task (Box and Block Test, BBT) and a mental rotation task (Hand Identification Test, HIT). MC abilities were expressed as a ratio (motor execution time-motor imagery time/motor execution time).
RESULTS: MC for the affected hand was significantly impaired in group 3 in comparison to stroke patients of group 1 (p = 0.006), group 2 (p = 0.005) and healthy controls (p < 0.001). For the non-affected hand MC was similar across all groups. Stroke patients had a slower BBT motor execution than healthy controls (p < 0.001), and group 1 executed the task faster than group 3 (p = 0.002). The percentage of correct responses in the HIT was similar for all groups.
CONCLUSION: Severe sensory deficits impair mental chronometry abilities but have no impact on mental rotation abilities. Future studies should explore whether the presence of severe sensory deficits in stroke patients reduces the benefit from motor imagery therapy.
PMID: 27689548 [PubMed - indexed for MEDLINE]
A new therapeutic application of brain-machine interface (BMI) training followed by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy for patients with severe hemiparetic stroke: A proof of concept study.
Restor Neurol Neurosci. 2016 Sep 21;34(5):789-97
Authors: Kawakami M, Fujiwara T, Ushiba J, Nishimoto A, Abe K, Honaga K, Nishimura A, Mizuno K, Kodama M, Masakado Y, Liu M
BACKGROUND: Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy improved paretic upper extremity motor function in patients with severe to moderate hemiparesis. We hypothesized that brain machine interface (BMI) training would be able to increase paretic finger muscle activity enough to apply HANDS therapy in patients with severe hemiparesis, whose finger extensor was absent.
OBJECTIVE: The aim of this study was to assess the efficacy of BMI training followed by HANDS therapy in patients with severe hemiparesis.
METHODS: Twenty-nine patients with chronic stroke who could not extend their paretic fingers were participated this study. We applied BMI training for 10 days at 40 min per day. The BMI detected the patients' motor imagery of paretic finger extension with event-related desynchronization (ERD) over the affected primary sensorimotor cortex, recorded with electroencephalography. Patients wore a motor-driven orthosis, which extended their paretic fingers and was triggered with ERD. When muscle activity in their paretic fingers was detected with surface electrodes after 10 days of BMI training, we applied HANDS therapy for the following 3 weeks. In HANDS therapy, participants received closed-loop, electromyogram-controlled, neuromuscular electrical stimulation (NMES) combined with a wrist-hand splint for 3 weeks at 8 hours a day. Before BMI training, after BMI training, after HANDS therapy and 3month after HANDS therapy, we assessed Fugl-Meyer Assessment upper extremity motor score (FMA) and the Motor Activity Log14-Amount of Use (MAL-AOU) score.
RESULTS: After 10 days of BMI training, finger extensor activity had appeared in 21 patients. Eighteen of 21 patients then participated in 3 weeks of HANDS therapy. We found a statistically significant improvement in the FMA and the MAL-AOU scores after the BMI training, and further improvement was seen after the HANDS therapy.
CONCLUSION: Combining BMI training with HANDS therapy could be an effective therapeutic strategy for severe UE paralysis after stroke.
PMID: 27589505 [PubMed - indexed for MEDLINE]
The effects of graded motor imagery and its components on phantom limb pain and disability in upper and lower limb amputees: a systematic review protocol.
Syst Rev. 2016 Sep 01;5(1):145
Authors: Limakatso K, Corten L, Parker R
BACKGROUND: Phantom limb pain (PLP) is characterized by the anatomical shifting of neighbouring somatosensory and motor areas into a deafferented cortical area of the brain contralateral to the amputated limb. It has been shown that maladaptive neuroplasticity is positively correlated to the perception of PLP in amputees. Recent studies support the use of graded motor imagery (GMI) and its component to alleviate the severity of PLP and disability. However, there is insufficient collective empirical evidence exploring the effectiveness of these treatment modalities in amputees with PLP. This systematic review will therefore explore the effects of GMI and its individual components on PLP and disability in upper and lower limb amputees.
METHODS: We will utilize a customized search strategy to search PubMed, Cochrane Central register of Controlled Trials, MEDLINE, Embase, PsycINFO, PEDro, Scopus, CINAHL, LILACS, DARE, Africa-Wide Information and Web of Science. We will also look at clinicaltrials.gov ( http://www.clinicaltrials.gov/ ), Pactr.gov ( http://www.pactr.org/ ) and EU Clinical trials register ( https://www.clinicaltrialsregister.eu/ ) for ongoing research. Two independent reviewers will screen articles for methodological validity. Thereafter, data from included studies will be extracted by two independent reviewers through a customized pre-set data extraction sheet. Studies with a comparable intervention and outcome measure will be pooled for meta-analysis. Studies with high heterogeneity will be analysed through random effects model. A narrative data analysis will be considered where there is insufficient data to perform a meta-analysis.
DISCUSSION: Several studies investigating the effectiveness of GMI and its different components on PLP have drawn contrasting conclusions regarding the efficacy and applicability of GMI in clinical practice. This systematic review will therefore gather and critically appraise all relevant data, to generate a substantial conclusion and recommendations for clinical practice and research on this subject.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016036471.
PMID: 27582042 [PubMed - indexed for MEDLINE]