Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design

Kwakkel, Gert; Meskers, Carel G.M.; Wegen, Erwin E. H. van; Lankhorst, Gustaaf J.; Geurts, Alexander C. H.; Kuijk, Annette A. van; Lindeman, Eline; Visser‐Meily, Anne; Vlugt, Erwin de; Arendzen, J. Hans

doi:10.1186/1471-2377-8-49

Cited by 56 publications

(65 citation statements)

References 63 publications

(79 reference statements)

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“…To improve our understanding of mechanisms that may underlie recovery, future prospective studies should longitudinally combine clinical and noninvasive neurophysiologic assessments such as transcranial magnetic stimulation and functional MRI in an intensive, early, repeatedmeasurement design after stroke. 30 For clinical practice, the findings of the present study might improve early stroke management decisions like discharge and multidisciplinary intervention planning at (sub)acute stroke units. As a consequence, subsequent multidisciplinary rehabilitation services may be optimized in line with the probability for regaining some dexterity, particularly acknowledging that many evidence-based therapies for the upper paretic limb, including Constrained Induced Movement Therapy and may require some return of voluntary wrist and finger extension.…”

Section: Discussionmentioning

confidence: 99%

“…28 The present study suggests that transcranial magnetic stimulation measurements should investigate the predictive validity of motor-evoked potentials of finger extensors rather than finger flexors or the abductor digiti minimi alone. 30 The presence of shoulder abduction as a determinant for upper limb function may reflect the intralimb neural coupling between proximal and distal segments in motor control. As early as 1916, Souques 31 observed that elevation of the affected arm frequently caused the paralyzed finger to extend.…”

Section: Discussionmentioning

confidence: 99%

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Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery

Nijland

Wegen

Wel

et al. 2010

Stroke

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351

317

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on behalf of the EPOS InvestigatorsBackground and Purpose-The aim of the present study was to determine if outcome in terms of upper limb function at 6 months after stroke can be predicted in hospital stroke units using clinical parameters measured within 72 hours after stroke. In addition, the effect of the timing of assessment after stroke on the accuracy of prediction was investigated by measurements on days 5 and 9. Methods-Candidate determinants were measured in 188 stroke patients within 72 hours and at 5 and 9 days after stroke.Logistic regression analysis was used for model development to predict upper limb function at 6 months measured with the action research arm test (ARAT). Results-Patients with an upper limb motor deficit who exhibit some voluntary extension of the fingers and some abduction of the hemiplegic shoulder on day 2 have a probability of 0.98 to regain some dexterity at 6 months, whereas the probability was 0.25 for those without this voluntary motor activity. Sixty percent of patients with some early finger extension achieved full recovery at 6 months in terms of action research arm test score. Retesting the model on days 5 and 9 resulted in a gradual decline in probability from 0.25 to 0.14 for those without voluntary motor activity of shoulder abduction and finger extension, whereas the probability remained 0.98 for those with this motor activity. Conclusions-Based on 2 simple bedside tests, finger extension and shoulder abduction, functional recovery of the hemiplegic arm at 6 months can be predicted early in a hospital stroke unit within 72 hours after stroke onset. (Stroke. 2010;41:745-750.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery

Nijland

Wegen

Wel

et al. 2010

Stroke

Self Cite

351

317

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“…EXPLICIT-stroke is a multicenter translational research program, which aims to investigate the mechanisms of recovery and the effects of early applied intensive intervention on regaining dexterity after stroke (Kwakkel et al 2008). …”

Section: Methodsmentioning

confidence: 99%

Unraveling the interaction between pathological upper limb synergies and compensatory trunk movements during reach-to-grasp after stroke: a cross-sectional study

2012

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The aim of the present study was to identify how pathological limb synergies between shoulder and elbow movements interact with compensatory trunk movements during a functional movement with the paretic upper limb after stroke. 3D kinematic joint and trunk angles were measured during a reach-to-grasp movement in 46 patients with stroke and 12 healthy individuals. We used principal component analyses (PCA) to identify components representing linear relations between the degrees of freedom of the upper limb and trunk across patients with stroke and healthy participants. Using multivariate logistic regression analysis, we investigated whether component scores were related to the presence or absence of basic limb synergies as indicated by the arm section of the Fugl-Meyer motor assessment (FMA). Four and three principal components were extracted in patients with stroke and healthy individuals, respectively. Visual inspection revealed that the contribution of joint and trunk angles to each component differed substantially between groups. The presence of the flexion synergy (Shoulder Abduction and Elbow Flexion) was reflected by component 1, whereas the compensatory role of trunk movements for lack of shoulder and elbow movements was reflected by components 2 and 3 respectively. The presence or absence of basic limb synergies as determined by means of the FMA was significantly related to components 2 (p = 0.014) and 3 (p = 0.003) in patients with stroke. These significant relations indicate that PCA is a useful tool to identify clinically meaningful interactions between compensatory trunk movements and pathological synergies in the elbow and shoulder during reach-to-grasp after stroke.

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“…Nested imaging and transcranial magnetic simulation (TMS) studies to examine brain recovery characteristics in 30 patients from each of the prognostic groups are planned (25).…”

Section: Early Upper Limb Rehabilitationmentioning

confidence: 99%

Early rehabilitation after stroke

Bernhardt

Godecke

Johnson

et al. 2017

Current Opinion in Neurology

128

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Impact of early applied upper limb stimulation: The EXPLICIT-stroke programme design

Cited by 56 publications

References 63 publications

Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery

Presence of Finger Extension and Shoulder Abduction Within 72 Hours After Stroke Predicts Functional Recovery

Unraveling the interaction between pathological upper limb synergies and compensatory trunk movements during reach-to-grasp after stroke: a cross-sectional study

Early rehabilitation after stroke

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