Finger strength, individuation, and their interaction: Relationship to hand function and corticospinal tract injury after stroke

Wolbrecht, Eric T.; Rowe, Justin B.; Chan, Vicky; Ingemanson, Morgan L.; Cramer, Steven C.; Reinkensmeyer, David J.

doi:10.1016/j.clinph.2018.01.057

Cited by 45 publications

(72 citation statements)

References 52 publications

(86 reference statements)

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“…[23][24][25][26][27][28] The degree of lesion to the CST was a key predictor of precision grip force control at 6 months after stroke, reflecting the essential role of CST for fine motor control, especially for precision grip performance and finger individuation. 9,12,29 CST lesion load was the only significant predictor of positive change in precision grip control from 3 weeks to 6 months post-stroke. 30,31 This suggests that neurobiological processes involving residual CST integrity are critical for recovery of fine motor control of fingers after stroke.…”

Section: Mechanism Underlying Impaired Precision Grip Force Controlmentioning

confidence: 90%

“…The present study's second aim was to identify best predictors of both 6-month status and longitudinal recovery in precision grip force control after stroke. Based on previous reports, we hypothesized the strongest predictor would be the degree of lesion to the STROKE/2019/026205 R3 corticospinal tract (CST) 9,11,12 , but also that the best prediction model would additionally include measures of hand sensory 12,13 and motor impairment 14 .…”

Section: Introductionmentioning

confidence: 99%

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Recovery and Prediction of Dynamic Precision Grip Force Control After Stroke

Pennati

Plantin

Carment

et al. 2020

Stroke

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Background and Purpose— Dexterous object manipulation, requiring generation and control of finger forces, is often impaired after stroke. This study aimed to describe recovery of precision grip force control after stroke and to determine clinical and imaging predictors of 6-month performance. Methods— Eighty first-ever stroke patients with varying degrees of upper limb weakness were evaluated at 3 weeks, 3 months, and 6 months after stroke. Twenty-three healthy individuals of comparable age were also studied. The Strength-Dexterity test was used to quantify index finger and thumb forces during compression of springs of varying length in a precision grip. The coordination between finger forces (CorrForce), along with Dexterity-score and Repeatability-score, was calculated. Anatomical magnetic resonance imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL). Results— CorrForce, Dexterity-score, and Repeatability-score in the affected hand were dramatically lower at each time point compared with the less-affected hand and the control group, even in patients with mild motor impairment according to Fugl-Meyer assessment. Improved performance over time occurred in CorrForce and Dexterity-score but not in Repeatability-score. The Fugl-Meyer assessment hand subscale, sensory function, and wCST-LL best predicted CorrForce and Dexterity-score status at 6 months (R 2 =0.56 and 0.87, respectively). wCST-LL explained substantial variance in CorrForce (R 2 =0.34) and Dexterity-score (R 2 =0.50) at 6 months; two-point discrimination and Fugl-Meyer score accounted for considerable additional variance. Absence of recovery in CorrForce was predicted by wCST-LL >4 cc and in Dexterity-score by wCST-LL >6 cc. Conclusions— Findings highlight persisting deficits in the ability to grasp and control finger forces after stroke. wCST-LL was the strongest predictor of performance at 6 months, but early two-point discrimination and Fugl-Meyer score had substantial additional predictive value. Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02878304.

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Section: Mechanism Underlying Impaired Precision Grip Force Controlmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Recovery and Prediction of Dynamic Precision Grip Force Control After Stroke

Pennati

Plantin

Carment

et al. 2020

Stroke

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“…This hand function abnormality is thought to be a direct result of lesions to the motor cortex and corticospinal tract, 5,6,7,8,9 as these are known to be critical for the control of independent finger movements (i.e., finger individuation). 5,[10][11][12][13] Previously, we have shown that stroke patients recover both finger individuation and strength relying on separable recovery processes. 5 Recovery asymptotes after the first 3 to 6 months, although typically remains far from the level of performance of healthy individuals, especially for the individuation component.…”

Section: Introductionmentioning

confidence: 99%

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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“…Therapeutic effect of the device has been demonstrated in the post-stroke rehabilitation training. To reflect the improvement of hand function, angle and torque of MCP and PIP joints are measured across each individual finger for examining the finger individuation (Wolbrecht et al, 2018), which is an important and comprehensive target for rehabilitative hand training. One major limitation of these robotic hands is shown in the bulkiness of mechanical linkages that translate finger movement to linear actuators, making them unsuitable for patients wearing them to perform activities of daily living (ADL).…”

Section: Introductionmentioning

confidence: 99%

Soft Rehabilitation Actuator With Integrated Post-stroke Finger Spasticity Evaluation

Heung

Tang

Shi

et al. 2020

Front. Bioeng. Biotechnol.

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Strokes cause severe impairment of hand function because of the spasticity in the affected upper extremities. Proper spasticity evaluation is critical to facilitate neural plasticity for rehabilitation after stroke. However, existing methods for measuring spasticity, e.g. Modified Ashworth Scale (MAS), highly depends on clinicians' experiences, which are subjective and lacks quantitative details. Here, we introduce the first rehabilitation actuator that objectively reflects the condition of post-stroke finger spasticity. The actuator is 3D printed with soft materials. By considering the finger and the actuator together, the spasticity, i.e. stiffness, in finger is obtained from the pressureangle relationship. The method is validated by simulations using finite element analysis (FEA) and experiments on mannequin fingers. Furthermore, it is examined on four stroke subjects and four healthy subjects. Results show the finger stiffness increases significantly from healthy subjects to stroke subjects, particularly those with high MAS score. For patients with the same MAS score, stiffness variation can be a few times. With this soft actuator, a hand rehabilitation robot that may tell the therapeutic progress during the rehabilitation training is readily available.

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Finger strength, individuation, and their interaction: Relationship to hand function and corticospinal tract injury after stroke

Abstract: Multi-finger capacity may be an important target for rehabilitative hand training.

Cited by 45 publications

References 52 publications

Recovery and Prediction of Dynamic Precision Grip Force Control After Stroke

Recovery and Prediction of Dynamic Precision Grip Force Control After Stroke

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

Soft Rehabilitation Actuator With Integrated Post-stroke Finger Spasticity Evaluation

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