The role of the ipsilesional side in the rehabilitation of post-stroke subjects

Pereira

Somatosensory & Motor Research

et al. 2018

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After a stroke in middle cerebral artery territory, there is a high probability of dysfunction of the ventromedial pathways, mainly related with postural control mechanisms such as the anticipatory postural adjustments (APAs). According to neuroanatomical knowledge, these pathways have a predominant ipsilesional disposition, which justifies a bilateral postural control dysfunction, often neglected in rehabilitation. In order to assess this bilateral postural control dysfunction, electromyography activity was assessed in eight post-stroke and 10 healthy individuals in the anterior deltoids, the superior and lower trapezius, and the latissimus dorsi as they reached for a bottle with both upper limbs separately at a self-selected velocity and fast velocity while standing associated with trunk kinematics analysis. Through this analysis it was possible to compare the timing of APAs in scapular muscles between sides in post-stroke and with healthy individuals, and to verify if there is a relation between the timing and the displacement of the trunk in the temporal window of the APAs. Indeed, post-stroke individuals show a delayed activation of APAs on scapular girdle muscles on both ipsilesional and contralesional sides, which were not reflected in the trunk displacement.

Section: Discussionmentioning

confidence: 99%

Anticipatory postural adjustments in the shoulder girdle in the reach movement performed in standing by post-stroke subjects

Pereira

Somatosensory & Motor Research

et al. 2018

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“…Therefore, the incorporation and adaptation of FES technology for enhancing postural activity during reaching would increase its potential for improving UL movement quality and function. The evidence demonstrates that post-stroke subjects with lesions in the middle cerebral territory also present impairments in the ipsilesional side, mainly related to postural control, which are even more important to this adaptation [ 7 ]. Since shoulder and elbow training only improves motor impairment in the shoulder and elbow [ 62 ], and that training of the wrist and finger extensors only improves hand function [ 63 ], FES systems should have the capacity of stimulating postural control muscles involving other anatomic regions, linking the trunk and ipsilesional side to improve UL function.…”

Section: Ul Post Stroke Rehabilitation Factors That Should Be Conside...mentioning

confidence: 99%

“…It was estimated that after stroke, 70% of the patients present upper limb (UL) dysfunction, more than half present moderate to severe dysfunction, 40% are left with a non-functional arm with implications in quality of life [ 3 , 4 ] and only 5–20% recover UL function completely [ 5 , 6 ]. Although the main deficits were described for the contralesional limb (limb contralateral to the lesioned hemisphere), more recent studies have described postural control deficits also in the ipsilesional limb (limb ipsilateral to the lesioned hemisphere) [ 7 , 8 , 9 ], which were demonstrated to interfere in the rehabilitation of contralesional UL function [ 7 ]. Considering the determinant role of UL during activities of daily living (ADL) [ 10 , 11 , 12 , 13 ], the rehabilitation of UL function, namely to improve the ability to reach and grasp, required in over 50% of ADLs [ 14 ], is a primary aim in stroke rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review

Sousa

Moreira

et al. 2022

Sensors

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Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.

“…However, evidence suggests that lesions affecting solely the cortico-spinal system do not strongly interfere with functionality (Lemon, Landau et al 2012) when compared to lesions affecting network connections between the cerebral cortex and reticular formation (Rothwell 2009). Although, there is a growing body of knowledge with respect to bilateral postural control impairment in persons post-stroke (Sousa, Silva et al 2012;Kitsos et al 2013;Silva, Silva et al 2014;Silva, Sousa et al 2017), the current evidence is limited to biomechanical data within the research environment. Despite physiotherapist s observational skills being considered a valuable tool, especially when referring to expert professionals (McGinley et al 2003), there is a profound lack of objective measures to allow valid and reliable quantification of postural control variables within the clinical setting.…”

Section: Measuring Post-stroke Deficits and Effectiveness Of Stroke Rehabilitation Interventionsmentioning

confidence: 99%

“…This is made even more difficult due to our evolving understanding that even localized lesions will influence remote linked neural areas due to the process of secondary denervation known as diaschisis (Silasi and Murphy 2014). In fact, both cortico-spinal and reticulospinal pathways maybe affected, with contra-lesional motor impairments primarily due to cortico-spinal involvement, as well as ipsi-and contra-lesional postural control impairments due to the involvement of bilateral reticulospinal pathways (Lemon 2008;Sousa, Silva et al 2012;Silva, Sousa et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Stroke rehabilitation and research: consideration of the role of the cortico-reticulospinal system

Somatosensory & Motor Research

Vaughan-Graham

Sousa

et al. 2018

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A cerebrovascular accident, otherwise known as stroke, has the potential to damage multiple areas within the brain affecting descending motor control via a multitude of pathways resulting in a wide variety of movement problems. The cortico-reticulospinal system, one of the largest motor systems, is frequently affected, compromising its output, resulting in postural control deficits. The identification of clinically relevant instruments and scales to document and evaluate recovery in post-stroke patients is vital. However, the availability of such measures and scales which take into consideration the role of postural control as an integral component of functional movement performance are scarce. This paper will critically discuss the importance of integrating current neuroscience and motor control knowledge in order to better understand and describe the clinical presentation of persons post-stroke such that the effectiveness of stroke rehabilitation can be appropriately measured.