Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials

Schambra, Heidi M.; Xu, Jing; Branscheidt, Meret; Lindquist, Martin A.; Uddin, Jasim; Steiner, Levke; Hertler, Benjamin; Kim, Nathan; Berard, Jessica; Harran, Michelle D.; Cortes, Juan C.; Kitago, Tomoko; Luft, Andreas R.; Krakauer, John W.; Celnik, Pablo

doi:10.1177/1545968319850138

Cited by 39 publications

(54 citation statements)

References 63 publications

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“…This study was more recently followed by another investigation demonstrating the reliance of finger individuation recovery on the presence of motorevoked potentials in the hand. 56 Based on these observations, we speculate that the residual CST of the ipsilesional side was most likely involved in the finger individuation recovery observed in our study. The multifinger motor action during the chord/pianolike training task resembles to some extent the action performed during music playing on a piano.…”

Section: Discussionsupporting

confidence: 60%

Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

Mawase

Cherry‐Allen

et al. 2020

Neurorehabil Neural Repair

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Background. Stroke is one of the most common causes of physical disability worldwide. The majority of survivors experience impairment of movement, often with lasting deficits affecting hand dexterity. To date, conventional rehabilitation primarily focuses on training compensatory maneuvers emphasizing goal completion rather than targeting reduction of motor impairment. Objective. We aim to determine whether finger dexterity impairment can be reduced in chronic stroke when training on a task focused on moving fingers against abnormal synergies without allowing for compensatory maneuvers. Methods. We recruited 18 chronic stroke patients with significant hand motor impairment. First, participants underwent baseline assessments of hand function, impairment, and finger individuation. Then, participants trained for 5 consecutive days, 3 to 4 h/d, on a multifinger piano-chord-like task that cannot be performed by compensatory actions of other body parts (e.g., arm). Participants had to learn to simultaneously coordinate and synchronize multiple fingers to break unwanted flexor synergies. To test generalization, we assessed performance in trained and nontrained chords and clinical measures in both the paretic and the nonparetic hands. To evaluate retention, we repeated the assessments 1 day, 1 week, and 6 months post-training. Results. Our results showed that finger impairment assessed by the individuation task was reduced after training. The reduction of impairment was accompanied by improvements in clinical hand function, including precision pinch. Notably, the effects were maintained for 6 months following training. Conclusion. Our findings provide preliminary evidence that chronic stroke patient can reduce hand impairment when training against abnormal flexor synergies, a change that was associated with meaningful clinical benefits.

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Section: Discussionsupporting

confidence: 60%

Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

Mawase

Cherry‐Allen

et al. 2020

Neurorehabil Neural Repair

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“…These findings are in line with results from other studies that described recovery of proximal joint movements preceding recovery of distal movements, suggesting differences in neural substrates for paretic upper limb recovery. 22 , 34 , 35 In our study, the relative infarct size in rats was within the range of relative infarct sizes in stroke patients. Hemispheric infarct volume was about 3% in rats and ranged between 0.1% and 26% in humans.…”

Section: Discussionsupporting

confidence: 71%

Translational Value of Skilled Reaching Assessment in Clinical and Preclinical Studies on Motor Recovery After Stroke

Lieshout

Boonzaier

Pel

et al. 2021

Neurorehabil Neural Repair

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Background Assessment of skilled reaching enables extensive analysis of upper limb function in clinical and preclinical studies on poststroke outcome. However, translational research if often limited by lack of correspondence between tests of human and rodent motor function. Objectives To determine (1) the translational value of skilled reaching performance for preclinical research by comparing the behavioral recovery profiles of skilled reaching characteristics between humans and rats recovering from stroke and (2) the relationship between skilled reaching performance and commonly used clinical outcome measures after stroke. Methods Twelve patients with ischemic or hemorrhagic stroke and 17 rats with photothrombotic stroke underwent an equivalent skilled reaching test at different time points, representing early to late subacute stages poststroke. Success scores and a movement element rating scale were used to measure the skilled reaching performance. The Fugl-Meyer Upper Extremity (FM-UE) assessment and the Action Research Arm Test (ARAT) were used as clinical outcome measures. Results Both species had muscle flaccidity at the early subacute stage after stroke and showed motor recovery following a proximal-distal principle toward the early subacute stage, albeit for rats within a shorter time course. Human skilled reaching scores and FM-UE and ARAT scores in the first 3 months poststroke were significantly correlated ( P < .05). Conclusions Our study demonstrates that poststroke changes in skilled reaching performance are highly similar between rats and humans and correspond with standard clinical outcome measures. Skilled reaching testing therefore offers an effective and highly translational means for assessment of motor recovery in experimental and clinical stroke settings.

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“…It is considered that the rTMS treatment improved the FMA score, and the patients with more severe motor paralysis had improved proximal upper limb movements. Schambra et al reported that there was no difference in FME-UE score recovery with or without MEP in patients in the acute phase, but there was less improvement in patients with high FMA scores than in those with low FMA scores, and FMA recovery curves plateaued below the reported normal levels for both the arm and hand (51). The lower response of patients with high motor function compared to moderately paretic patients in our study might be because the treatment-recovery values were low in patients with high motor function.…”

Section: Discussionmentioning

confidence: 97%

Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data

et al. 2020

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Recovery from motor paralysis is facilitated by affected patients' recognition of the need for and practice of their own exercise goals. Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified. If an expected score for the neurorehabilitation effect can be calculated using the Fugl-Meyer Motor Assessment (FMA), a global assessment index, before neurorehabilitation, such a score will be useful for optimizing the treatment application criteria and for setting a goal to enhance the treatment effect. Therefore, this study verified whether the responsiveness to a treatment method, the NovEl intervention using repetitive transcranial magnetic stimulation and occupational therapy (NEURO), in patients with post-stroke upper extremity (UE) motor paralysis could be predicted by the pretreatment FMA score. No control group was established in this study for NEURO treatment. To analyze the recovery of the motor function in the UE, delta-FMA was calculated from the pre-and post-FMA scores obtained during NEURO treatment. The probability of three levels of treatment responsiveness was evaluated in association with delta-FMA score (<5, 5≤ delta-FMA <10, and ≥10 as non-responders; responders; and hyper-responders, respectively) according to the reported minimal clinically important difference (MCID). The association of the initial FMA scores with post-FMA scores, from the status of the treatment responsiveness, was determined by multinomial logistic regression analysis. Finally, 1,254 patients with stroke, stratified by FMA scores were analyzed. About 45% of the patients who had FMA scores ranging from 30 to 40 before treatment showed improvement over the MCID by NEURO treatment (odds ratio = 0.93, 95% CI = 0.92-0.95). Furthermore, more than 25% of the patients with more severe initial values, ranging from 26 to 30, improved beyond the MCID calculated in the acute phase Hamaguchi et al. Motor Recovery Predictions in Stroke (odds ratio = 0.87, 95% CI = 0.85-0.89). These results suggest that the evaluated motor function score of the UE before NEURO treatment can be used to estimate the possibility of a patient recovering beyond MCID in the chronic phase. This study provided clinical data to estimate the effect of NEURO treatment by the pretreatment FMA-UE score.

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Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials

Cited by 39 publications

References 63 publications

Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

Pushing the Rehabilitation Boundaries: Hand Motor Impairment Can Be Reduced in Chronic Stroke

Translational Value of Skilled Reaching Assessment in Clinical and Preclinical Studies on Motor Recovery After Stroke

Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data

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