Flexors activity of affected upper extremity in stroke patients during different standing conditions and their relationships with clinical scales: a cross-sectional study

ABSTRACT

Purpose: To explore the flexors activity of affected upper extremity in stroke patients during different standing conditions and their relationships with clinical scales.

Materials and methods: Sixteen stroke patientswere recruited, all subjects stood on balance equipment with four different standing postures. The electromyogram (EMG) simultaneously recorded the muscle activity of bilateral biceps brachii, triceps brachii, flexor carpi radialis and extensor carpi radialis and their integrated electromyogram were figured out the contraction rate of elbow flexors(biceps brachii/triceps brachii) and wrist flexors(flexor carpi radialis/extensor carpi radialis). All subjects were assessed using Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Barthel Index (BI) and Modified Ashworth Scale (MAS).

Results: The contraction rate of affected elbow flexors in the condition of feet together on soft surface was significantly higher than that in the condition of feet separatedon hard surface (P < 0.05). The contraction rate of affected elbow flexors in four standing conditions tended to increase, all the values of which were greater than numerical value1. The difference in the contraction rate of elbow flexor between the affected side and the unaffected side was statistically significant (P < 0.05). No correlation was observed between the contraction rate of the elbow flexor and the results of MAS, FMA-UE, BBS and BI regardless of the standing conditions.

Conclusions: The contraction rates of elbowflexor in the affected side increase with the difficulty in different standing postures,and it may be a good index to reflect the changes of muscle tone in postural control.     

The effect of upper limb orthotics after stroke: a systematic review

Upper limb orthotics, or splints, are widely advocated for people with stroke however opinion about whether, and how, they should be used is varied. We therefore systematically reviewed the literature on upper limb orthotics for people with stroke and other non-progressive brain lesions to establish whether an orthosis can improve function or/and impairments. Search strategy: The Cochrane library, MEDLINE, EMBASE, CINAHL, AMED, PsycINFO and RECAL were searched. We screened reference lists and contacted lead authors and other researchers in the field. Selection criteria: Randomised controlled trials of upper limb orthoses in stroke survivors and other non-progressive brain lesions. Data collection and analysis: Two reviewers independently identified trials, extracted data and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. Main results: We analysed 4 trials with 126 participants. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. Conclusions: Current evidence suggests that an upper limb orthosis does not effect upper limb function, range of movement at the wrist, fingers or thumb, nor pain.     

Neuropsychological assessment without upper limb involvement: a systematic review of oral versions of the Trail Making Test and Symbol-Digit Modalities Test

The Trail Making Test (TMT) and written version of the Symbol Digit Modalities Test (SDMT) assess attention, processing speed, and executive functions but their utility is limited in populations with upper limb dysfunction. Oral versions of the TMT and SDMT exist, but a systematic review of their psychometric properties and clinical utility has not been conducted, which was the goal of this study. Searches were conducted in PubMed and PsycINFO, test manuals, and the reference lists of included articles. Four measures were identified: the SDMT-oral, oral TMT-A, oral TMT-B, and the Mental Alternation Test (MAT). Two investigators independently reviewed abstracts to identify peer-reviewed articles that reported on these measures in adult populations. From each article, one investigator extracted information on reliability, validity, responsiveness, minimum detectable change, normative data, and demographic influences. A second investigator verified the accuracy of the data in a random selection of 10% of papers. The quality of the evidence for each psychometric property was rated on a 4-point scale (unknown, poor, adequate, excellent). Results showed excellent evidence for the SDMT-oral, adequate evidence for the oral TMT-B and MAT, and adequate to poor evidence for the oral TMT-A. These findings inform the clinical assessment of attention, processing speed, and executive functions in individuals with upper limb disability.     

虚拟现实康复技术在脑卒中后上肢运动障碍中的应用进展

虚拟现实康复技术是计算机模拟真实环境的集成技术,具有沉浸、交互和想象三大特点,广泛应用于脑卒中后上肢运动功能康复。本文简要阐述虚拟现实康复技术在脑卒中后上肢运动障碍中的应用进展。     

A型肉毒毒素治疗脑卒中后上肢肌痉挛的疗效分析

目的 探讨A型肉毒毒素(BTX-A)治疗脑卒中后肌痉挛的临床疗效.方法 选择54例脑卒中后存在上肢肌肉痉挛的患者,按随机数字表法分为研究组和对照组(各27例),两组患者均进行肢体康复训练.研究组加行注射BTX-A.分别观察比较两组治疗后2周、4周、12周的Fugl-Meyer运动功能评测、改良 Ashworth肌痉挛量表评定情况及Barthel指数.结果 治疗后2周、4周时,研究组与对照组的改良Ashworth评分评定比较差异具有统计学意义(P<0.01).治疗后4周、12周时,研究组与对照组的Fugl-Meycr评分变化、Barthel指数比较差异具有统计学意义(P<0.01).结论 BTX-A治疗脑卒中后上肢肌痉挛安全、简便、起效迅速,同时积极配合康复功能训缘,可以有效改善患者的运动功能和日常生活活动能力.     

Spin-lock magnetic resonance imaging of muscle in patients with autosomal recessive limb girdle muscular dystrophy.

Spin-lock imaging is a new magnetic resonance imaging (MRI) technique used to reflect the microstructural integrity of muscle. The purpose of this study was to characterize spin-lock contrast (SLC) of calf muscles in limb girdle muscular dystrophy (LGMD). The calf muscles of 5 patients with LGMD and 10 healthy volunteers were imaged with an off-resonance magnetic resonance (MR) spin-lock suppression pulse. Spin-lock suppression ratios were calculated for anterior tibialis, posterior tibialis, soleus, and gastrocnemius muscles. Clinical assessments of muscle strength were compared to the spin-lock suppression ratios in the LGMD group. Strong SLC was observed in healthy muscles, with mean (+/- SD) suppression ratios ranging from 51.2% (+/- 3.6%) to 56.3% (+/- 1.3%). In diseased muscle, spin-lock signal suppression was reduced by 8%-70%, demonstrating an inverse correlation between symptom duration and suppression ratios. Spin-lock contrast in the patients with LGMD, as a reflection of tissue integrity, was best preserved in posterior tibialis, anterior tibialis, soleus, and gastrocnemius muscles in descending order. Clinical assessments did a poorer job of differentiating than SLC did and were in poor agreement with spin-lock suppression ratios. Spin-lock MRI can quantify microstructural changes in LGMD and appears to provide information not obtainable from clinical evaluations. This suggests that this noninvasive technique may be useful in evaluating the extent, progression, and response to therapy of LGMD.     

Efficacy of motor imagery additional to motor-based therapy in the recovery of motor function of the upper limb in post-stroke individuals: a systematic review

Background. Motor imagery (MI) consists of the mental simulation of repetitive movements with the intention of promoting the learning of a motor skill. It seems to be an additional useful tool for motor-based therapy to potentiate the rehabilitation of the upper limb function of post-stroke individuals. Objective. To investigate whether MI combined with motor-based therapy is effective in recovering motor deficits of upper limbs from post-stroke individuals. Method. A systematic review of the literature was performed in the PEDro, LILACS, Cochrane, SCOPUS, Medline/PubMed and SciELO databases. Randomized controlled trials (RCTs) investigating the efficacy of MI associated with motor-based therapy compared with isolated motor-based therapy were included. The included outcomes were gross motor function and functional activities of the upper limb of post-stroke individuals. The physiotherapy evidence database scale was applied for evaluation of methodological quality. Results. Four RCTs were included, with a total of 104 participants, with methodological quality varying from moderate to high. There was a statistically significant improvement in upper limb motor function in all studies. Gross motor function was higher in MI associated with motor-based therapy compared to controls, but only in one study there was superiority in the results of functional activities of the upper limb. Conclusion. There is evidence showing that MI associated with motor-based therapy is an effective tool in improving the motor function of upper limbs of post-stroke individuals. However, more studies are needed to establish criteria for frequency and duration of intervention, and what better type of MI should be used.     

Reachable workspace and performance of upper limb (PUL) in duchenne muscular dystrophy

Introduction: The Kinect‐based reachable workspace relative surface area (RSA) is compared with the performance of upper limb (PUL) assessment in Duchenne muscular dystrophy (DMD). Methods: 29 individuals with DMD (ages: 7–23; Brooke: 1–5) underwent both Kinect‐based reachable workspace RSA and PUL assessments. RSAs were also collected from 24 age‐matched controls. Total and quadrant RSAs were compared with the PUL total, shoulder‐, middle‐, and distal‐dimension scores. Results: The total reachable workspace RSA correlated well with the total PUL score (Spearman ρ = ‐0.602; P < 0.001), and with each of the PUL dimensional scores: shoulder (ρ = ‐0.624; P < 0.001), middle (ρ = ‐0.564; P = 0.001), and distal (ρ = ‐0.630; P < 0.001). With quadrant RSA, reachability in a particular quadrant was closely associated with respective PUL dimensional‐level function (lateral‐upper quadrant for shoulder‐, lateral‐upper/lower quadrants for middle‐, and lateral‐lower quadrant for distal‐level function). Conclusions: This study demonstrates concurrent validity of the reachable workspace outcome measure (RSA) with the DMD‐specific upper extremity outcome measure (PUL). Muscle Nerve 53: 545–554, 2016     

Clinical observations of juvenile nonprogressive muscular atrophy localized in hand and forearm

Summary Twenty-seven patients with juvenile nonprogressive muscular atrophy localized in the hand and forearm were analyzed. The clinical characteristics were juvenile male occurrence, insidious onset, specific distribution of localized muscular atrophy and a stationary course. On electromyography, denervation voltage (or giant NMU) is found in the atrophied muscles and sometimes in contralateral nonatrophied ones. Sensory disturbance was not remarkable. Although the etiological factor was not known, strenuous exercise of arms in sports was noted frequently in the history.

---

Zusammenfassung 27 Patienten mit juveniler nonprogressiver Muskelatrophie, lokalisiert an der Hand und dem Vorderarm wurden analysiert. Klinisch charakteristische Merkmale waren Vorkommen bei jungen Männern, schleichender Beginn, lokalisierter Befall der erwähnten Muskelgruppe und stationärer Verlauf nach einer anfänglichen Progression. Elektromyographisch wurde eine Denervation in den atrophischen Muskeln und manchmal in den Muskeln der kontralateralen Seite bemerkt. Sensible Ausfälle waren nicht eindrücklich. Obgleich die Ätiologie nicht klar war, wurde häufiger Gebrauch der Hand im Sport in der Krankheitsgeschichte bemerkt.

     

Systematic review of orthoses for stroke-induced upper extremity deficits

Background: Orthoses for individuals with stroke is considered an integral part of the neurorehabilitation process. However, there are no universal guidelines to determine the initiation period, duration, or type of orthosis for stroke patients.

Objectives: For this study, we systematically reviewed the evidence surrounding the use of orthoses for stroke-related upper extremity deficits.

Methods: Medical librarians searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Health Technology Assessment Database, Physiotherapy Evidence Database, and OTSeeker using subject headings and keywords related to upper extremities, orthoses, and stroke. The resulting articles were evaluated for inclusion by the systematic review team. Articles that met the inclusion criteria were appraised for content and quality using the “Evaluation Guidelines for Rating the Quality of an Intervention Study” (EQIS).

Results: 14 studies were included, with the mean score of 31.29 (out of 48) for the EQIS using an ordinal scale with a range of 23–43.6 studies produced significant outcomes with effect sizes ranging from d = .52 (wrist flexion PROM) to d = 9.02 (patient satisfaction with orthosis).

Conclusion: Future studies should aim to utilize homogenous outcome measures while exploring variability in dosage and level of upper extremity impairment upon initiation. Additionally, universal guidelines for initiation period, duration, and type of orthosis for patients post-stroke need to be established.     

低频重复经颅磁刺激联合以任务为导向作业疗法对脑卒中患者上肢运动功能的康复作用

目的探讨低频重复经颅磁刺激联合以任务为导向作业疗法对脑卒中患者上肢运动功能的康复作用。方法共42例脑卒中后偏瘫患者随机接受常规康复训练和以任务为导向作业疗法(对照组,20例)以及在此基础上联合健侧运动皮质低频(1 Hz)重复经颅磁刺激(治疗组,22例),分别于治疗前、治疗4周时和治疗后3个月采用Fugl-Meyer上肢评价量表(FMA-UE)和Wolf运动功能测验(WMFT)评价上肢运动功能,记录并分析健侧运动皮质运动诱发电位潜伏期和中枢运动传导时间。结果与对照组相比,治疗组FMA-UE评分(P=0.006)和WMFT评分(P=0.024)均增加;两组不同时间点FMA-UE评分(P=0.000)和WMFT评分(P=0.000)差异有统计学意义,其中治疗4周时和治疗后3个月FMA-UE评分(均P=0.000)和WMFT评分(均P=0.000)均高于治疗前,治疗后3个月FMA-UE评分(均P=0.000)和WMFT评分(均P=0.000)亦高于治疗4周时。两组患者治疗前后健侧运动皮质运动诱发电位潜伏期(P=0.979)和中枢运动传导时间(P=0.807)差异无统计学意义,不同时间点(治疗前、治疗4周时和治疗后3个月)健侧运动皮质运动诱发电位潜伏期(P=0.085)和中枢运动传导时间(P=0.507)差异亦无统计学意义。结论脑卒中患者健侧运动皮质低频重复经颅磁刺激联合以任务为导向作业疗法可以有效改善脑卒中患者上肢运动功能,值得临床推广应用。     

Dysferlin aggregation in limb‐girdle muscular dystrophy type 2B/myoshi myopathy necessitates mutational screen for diagnosis

Introduction: Diagnosis of the limb‐girdle muscular dystrophies (LGMDs) has been facilitated by the use of immunofluorescence microscopy, Western blot analysis, and rapid genetic testing. Methods: We identified 7 patients with LGMD2B or Miyoshi myopathy (MM) phenotypes and performed detailed history, physical examination, and mutation analyses of genomic DNA. Results: Ten disease‐causing variants of the dysferlin gene (DYSF) were detected, 4 of which were novel and predicted to be pathogenic (IVS33+9G>T, c.1343T>C, c.4747T>G, and c.5066dupC). Two of these mutations (c.1343T>C and IVS33+9G>T) were associated with a reduction in sarcolemmal dysferlin expression, despite increased total mRNA and protein in mixed muscle homogenates, due to a pathological retention of the mutated polypeptide in the cytoplasm. Conclusions: Considering that protein‐based assays may yield false negative test results and that dysferlin aggregation may be present in other LGMDs, mutational screening is necessary for specific diagnosis in primary dysferlinopathy patients exhibiting this phenotype. Muscle Nerve 47: 740–747, 2013     

Skeletal muscle changes following stroke: a systematic review and comparison to healthy individuals

Background: Despite extensive study of the impact of stroke on muscle and functional performance, questions remain regarding the extent to which changes are due to the neurological injury vs. age-related loss of morphology and force production.

Objectives: To synthesize available evidence describing post-stroke changes in lower extremity muscle size and strength compared to healthy adults.

Methods: Scientific literature was searched up to April 2016 to identify studies that included lower extremity muscle size and strength measures in individuals with chronic stroke. Lower extremity muscle size and strength data from healthy controls were sought for comparison. Relative differences were calculated between paretic, nonparetic, and control limbs.

Results: Fifteen studies with 375 participants (61% male; age = 62 ± 5 years; time since stroke = 60 ± 42 months) were included. The paretic limb exhibited deficits of ~13% in thigh muscle size, ~5% in lower leg muscle size, and ~8% in lean leg mass compared to the nonparetic limb. Paretic plantarflexor and knee extensor strength were 52 and 36% lower, respectively, compared to the nonparetic limb. When compared to age-matched control data, both paretic and nonparetic limbs showed deficits in muscle size and strength.

Conclusions: Age-related differences support the impact of stroke-related sarcopenia as a contributor to hemiparetic muscle dysfunction. Understanding these muscular changes is necessary for designing appropriate exercise interventions aimed at restoring muscle function.     

Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression

Neurological Sciences - Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted...     

Clinical factors associated with the development of nonuse learned after stroke: a prospective study

Background: Upper extremity impairment is present in most of people with stroke. The use of the affected upper extremity can be impacted not only by physical impairment but also by abehavioral phenomenon called learned nonuse.

Objective: The aim of this study was to evaluate which clinical factors in the acute phase are associated with the development of learned nonuse in the upper extremity after stroke.

Methods: This cohort study included 38 patients with ischemic stroke. Hospital discharge data were collected for clinical aspects, scales of severity, incapacity and autonomy, as well as for neuromuscular and sensory evaluations. At 90 days after hospital discharge, the score on the Motor Activity Log scale for detecting learned nonuse was obtained, and life quality was evaluated by the EuroQol. The individuals with and without learned nonuse were compared by attest for univariate analysis, and ageneralized linear model was employed to find possible predictors, which were considered significant p <0.05.

Results: In the statistical model, age (p= .006), severity at discharge (p= .036), handgrip strength (p= .000), altered sensitivity (p= .011), incapacity at discharge (p= .009) and autonomy at discharge (p= .011) were found to be associated with learned nonuse. In relation to quality of life, mobility, personal care, usual activities, anxiety, depression and perception had lower mean values in the learned nonuse group.

Conclusion: Age, severity of stroke, incapacity and neuromuscular and sensory compromises are associated with upper extremity learned nonuse in stroke patients.