Clinimetric properties of the Fugl-Meyer assessment with adapted guidelines for the assessment of arm function in hemiparetic patients after stroke

Background: Against the background of linguistic and cultural differences, there is a need for translation and adaptation from the English version of the Fugl-Meyer Assessment (FMA) to Japanese. In addition, there is no study of inter-rater reliability of FMA all domains for affected upper extremities with appropriate sample size based on the intraclass correlation coefficient (ICC) focusing on non-simultaneous assessment.

Objective: This study aimed (1) to translate the English version of the FMA and its administration/scoring manual; and (2) to investigate the psychometric properties of the Japanese version of the FMA in patients with stroke.

Methods: A prospective single-center study involving 30 patients was conducted. The FMA and the Action Research Arm Test, the Box-and-Block Test, and the Motor Activity Log were employed. The inter-rater/intra-rater reliability, the internal consistency, the validity, and the floor/ceiling effects were assessed.

Results: Regarding the non-simultaneous and simultaneous inter-rater reliability, ICC ranged from 0.809–0.983 (P<0.001) and 0.991–0.999 (P<0.001), respectively. Regarding the simultaneous intra-rater reliability, ICC ranged from 0.994–0.999 (P<0.001). The Cronbach’s alpha was 0.973 in the non-simultaneous evaluation and 0.981 in the simultaneous evaluation. Regarding the validity, Spearman’s rhos were higher than 0.92 for the FMA all domains and motor domain. The patients who showed the highest score and the lowest score of the FMA (all domains and motor domain) were 10% and 0%, respectively.

Conclusions: The Japanese version of the FMA motor domain and all domains can reliably assess the affected upper extremities in patients with mild-to-severe hemiparesis after stroke for both non-simultaneous and simultaneous assessment.     

Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.

Design: A randomised, controlled, assessor-blinded trial.

Setting: Rehabilitation institute.

Participants: Thirty-six chronic poststroke (15.89?±?9.01 months) hemiparetic subjects (age: 46.44?±?7.89 years, 30 men and functional ambulation classification of median level 3).

Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.

Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).

Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference?=?3.29, 95% CI?=?1.23–5.35, p?=?.003) and RVGA (mean difference?=?5.41, 95% CI?=?1.12–9.71, p?=?.015) in comparison to the control group. No considerable changes were observed on 10-MWT.

Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.     

Effect of intensive motor training with repetitive transcranial magnetic stimulation on upper limb motor function in chronic post-stroke patients with severe upper limb motor impairment

Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment.

Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment.

Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl–Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention.

Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6–18.0; WMFT: 3.6–3.3, p < 0.001).

Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.     

Effects of action observation therapy on hand dexterity and EEG-based cortical activation patterns in patients with post-stroke hemiparesis

Background: Previous reports have suggested that action observation training (AOT) is beneficial in enhancing the early learning of new motor tasks; however, EEG-based investigation has received little attention for AOT.

Objective: The purpose of this study was to illustrate the effects of AOT on hand dexterity and cortical activation in patients with post-stroke hemiparesis.Method: Twenty patients with post-stroke hemiparesis were randomly divided into either the experimental group (EG) or control group (CG), with 10 patients in each group. Prior to the execution of motor tasks (carrying wooden blocks from one box to another), subjects in the EG and CG observed a video clip displaying the execution of the same motor task and pictures showing landscapes, respectively. Outcome measures included the box and block test (BBT) to evaluate hand dexterity and EEG-based brain mapping to detect changes in cortical activation.

Results: The BBT scores (EG: 20.50 ± 6.62 at pre-test and 24.40 ± 5.42 at post-test; CG: 20.20 ± 6.12 at pre-test and 20.60 ± 7.17 at post-test) revealed significant main effects for the time and group and significant time-by-group interactions (p < 0.05). For the subjects in the EG, topographical representations obtained with the EEG-based brain mapping system were different in each session of the AOT and remarkable changes occurred from the 2nd session of AOT. Furthermore, the middle frontal gyrus was less active at post-test than at pre-test.

Conclusions: These findings support that AOT may be beneficial in altering cortical activation patterns and hand dexterity.     

表面肌电信号对脑卒中患者远程居家康复指导的效果研究

目的探讨表面肌电信号对指导脑卒中患者居家远程康复的效果。方法筛选2014年7月至2015年6月在上海市第五人民医院神经内科住院治疗的脑卒中患者78例,78例患者通过SPSS统计软件按1:1的比例分成两组,分别为表面肌电信号指导进行居家康复的治疗组(39例)与无表面肌电信号指导居家康复的常规组(39例)。采用简化FuglMeyer运动功能量表(FMA)评定上肢功能,通过均方根值(RMS)测定肌肉收缩时的收缩强度。结果康复治疗前,两组患者上肢FMA评分与RMS评分比较,差异无统计学意义(P0.001)。康复治疗后,两组患者上肢FMA评分与RMS评分均较康复治疗前增加,差异具有统计学意义(P0.001)。康复治疗后,治疗组上肢FMA评分与RMS评分均较常规组增加,差异具有统计学意义(FMA:P=0.02;RMS:P=0.018)。结论康复过程中进行表面肌电信号调整康复方案可增强运动功能康复的效果。     

Cognitive function is largely intact in methadone maintenance treatment patients

Objectives: To confirm our previous findings of less cognitive impairments (based on cognitive screening tools) among methadone maintenance treatment (MMT) patients who achieved take-home dose (THD) privileges.

Methods: a random sample of 65 Israeli MMT patients were studied using computerised, age and education standardised, cognitive domains (attention, executive function, memory, motor skills), and non-computerised phonetic and semantic verbal fluency.

Results: Cognitive scores were within?±1 standard deviation (SD) of average for most domains, including non-verbal IQ, attention and motor skills. Verbal fluency and memory were?>1 SD below average (mean?=?84; z?=?–1.1 for both). Females were younger than the males and had poorer motor skills (P?=?0.005) but better verbal memory (P?P?=?0.05) and inversely with verbal memory (P?=?0.01). Overall cognitive function was poorest among 25 (38.5%) current drug users, and 6 (9.2%) lifetime schizophrenia patients. Cognitive domains were comparable between THD privileges subgroups.

Conclusions: Despite heterogeneity in MMT duration, abuse duration, substance use and psychiatric comorbidity, all performed within?±1 SD of average for age and education in most cognitive domains. Our findings challenge the notion of MMT as being synonymous with compromised cognition and may lead to reduced bias regarding cognitive function of MMT patients.     

Mirror Illusion for Sensori-Motor Training in Stroke: A Randomized Controlled Trial

Background

Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects.

Improving motor imagery practice with synchronous action observation in stroke patients

Background: Action observation (AO) has the potential to improve motor imagery (MI) practice in stroke patients. However, currently only a few results are available on how to use AO effectively.

Objective: The aim of this study is to investigate whether MI practice can be improved more effectively by synchronous AO than by asynchronous AO.

Methods: Ten patients with upper limb motor dysfunction following stroke were selected as the participants. They were divided into two groups to perform MI practice combined with a daily conventional rehabilitation for four consecutive weeks. The control group was asked to perform MI guided by asynchronous AO (MIAAO), and the experimental group was asked to perform the same MI but guided by synchronous AO (MISAO). The event-related power decrease (ERD) in sensorimotor rhythms of electroencephalograph was calculated to reflect the sensorimotor cortex activation and to assess the cortex excitability during MI. Fugl-Meyer assessment (FMA) and pinch strength test (PST) were used to assess the limb motor recovery.

Results: The ERD pattern of the experimental group not only had greater amplitude and longer duration, but also included more frequency components. Furthermore, the effect sizes of ERD values between the two groups continuously increased (d_ES > 0.8) during the course of treatment. Moreover, the FMA and PST scores achieved with MISAO were also significantly higher than those achieved with MIAAO (p < 0.05).

Conclusions: Compared with MIAAO, MISAO can enhance the excitation of sensorimotor cortex more effectively and lead to a more rapid neurorehabilitation of stroke patients.     

Association of ideomotor apraxia with lesion site,etiology, neglect,and functional independence in patients with first ever stroke

Abstract

Background:

Ideomotor apraxia (IMA) is characterized by the inability to correctly imitate hand gestures and voluntarily pantomime tool use. The relationship between IMA and characteristics of stroke has not been totally elucidated.

Objective:

This study aimed to find out associations between presence of IMA and stroke etiology, site of the lesions, neglect, and temporal and functional parameters of stroke in patients with first ever stroke.

Methods:

Thirty-nine patients with first ever stroke were included. Patients with severe cognitive deficits were excluded. Assessment tools included Ideomotor Apraxia Test, Functional Independence Measure (FIM), Brunnstrom recovery stages, Mini Mental Test (MMT), and star cancellation test. Etiology (hemorrhagic or ischemic) and site of stroke was assessed through brain imaging methods. Location and size of ischemic lesion was determined by using the Oxfordshire Community Stroke Project system.

Results:

IMA was identified in 35.9% of the patients. Patients with IMA had significantly lower FIM scores both on admission and discharge (P?=?0.001, P?=?0.001). Presence of IMA was significantly associated with the presence of neglect (P?=?0.004), total anterior circulation ischemia (TACI) (P?<?0.001), and lower MMT scores (P?<?0.001). Lesion site, patient age, time since onset, and stroke etiology had no impact on the presence of IMA.

Conclusion:

IMA was in concordance with poor cognitive and functional state and was not limited to left hemisphere lesions. The study revealed strong associations between IMA, neglect, and TACI. Every patient with stroke should be evaluated for the presence of IMA on admission to rehabilitation unit.     

Motor and sensory effects of ipsilesional upper extremity hypothermia and contralesional sensory training for chronic stroke patients

Abstract

As hypothermia by immersion can reduce the sensory nerve conduction velocity, this study hypothesized that the reduction of sensory input to the ipsilesional upper extremity (UE) using cryotherapy would reduce the inhibitory activity of the contralesional hemisphere in chronic stroke subjects.

Objective:

In this study, hypothermia was applied by immersing the ipsilesional UE in association with sensory training of the contralesional UE of stroke patients to assess the immediate (e.g. sensorimotor function, hemodynamics, and levels of comfort) and long-term (sensory and motor performances of the UEs) effects.

Methods:

The sample included 27 stroke patients allocated into group 1 (n?=?14), which received conventional physiotherapy for the affected UE, and group 2 (n?=?13), which underwent 10 sessions of immersion hypothermia of the ipsilesional wrist and hand. Assessments were performed pre- and post-treatment and at follow-up using esthesiometry, the Fugl–Meyer Assessment (FMA), the Nottingham Sensory Assessment, functional tests, tactile and weight discrimination, motor sequence, level of comfort, and hemodynamic parameters.

Results:

The immediate effects of hypothermia using immersion of the ipsilesional UE in association with sensory training of the contralesional UE were hemodynamic stability during and after hypothermia, the absence of sensory abnormalities in the contralesional UE, hypoesthesia in the ipsilesional extremity (dermatomes C6 and C8) (P?<?0.05), the maintenance of acceptable levels of comfort, and good patient compliance to the technique. The long-term effects included significant increases in scores on tests performed without functional vision, in scores on blindfolded functional tests, and in tactile localization and joint position sense for the contralesional hand in group 2 as well as the maintenance of these gains at long-term follow-up (5?weeks). Improvement was also found in the tactile function of the C6 and C7 dermatomes of the contralesional hand (P?<?0.05).

Conclusions:

The use of immersion hypothermia on the ipsilesional UE in association with sensory training of the contralesional UE improved motor function and sensitivity in the contralesional UE of individuals with chronic stroke. Immersion hypothermia of the ipsilesional UE in chronic stroke patients is a safe, practical, inexpensive, and easily applied technique.     

Mental practice for upper limb motor restoration after stroke: an updated meta-analysis of randomized controlled trials

Objectives: Stroke is a common refractory disease that may cause dysfunctions in the motor system. The study aimed to evaluate the effects of mental practice (MP) compared with other methods on upper limb motor restoration after stroke.

Methods: Eligible studies were identified from Pubmed, Embase, and The Cochrane Library. The study quality was assessed with the Cochrane risk assessment tool and heterogeneity test was performed using I² statistic and Q test. Random- and fixed-effects models were used and data were reported as weighted mean difference (WMD) and 95% confidence intervals (CIs). The publication bias was examined by Egger’s test and the sensitivity analysis was conducted by ignoring one literature at a time to observe whether this document could reverse the merged results.

Results: Total of 12 randomized controlled trials were identified. No evidence of publication bias was found. In a fixed-effect model, MP (experimental group) resulted in a significantly larger increase in Fugl-Meyer assessment (FMA) compared with other exercise methods (control group) (WMD = 2.0702, 95% CI: 1.2354–2.905, Z = 4.8606, P < 0.001). In a random-effect model, a significant pooled outcome was obtained for action research arm test (ARAT) (WMD = 4.0936, 95% CI: 1.9900–6.1971, Z = 3.8141, P < 0.001). Sensitivity analysis revealed that the merged WMDs of FMA and ARAT were not reversed.

Conclusions: Mental practice is effective on upper limb motor restoration after stroke. It is recommended to treat with MP to improve the outcome of stroke.     

Cortical disconnection of the ipsilesional primary motor cortex is associated with gait speed and upper extremity motor impairment in chronic left hemispheric stroke

Advances in neuroimaging have enabled the mapping of white matter connections across the entire brain, allowing for a more thorough examination of the extent of white matter disconnection after stroke. To assess how cortical disconnection contributes to motor impairments, we examined the relationship between structural brain connectivity and upper and lower extremity motor function in individuals with chronic stroke. Forty‐three participants [mean age: 59.7 (±11.2) years; time poststroke: 64.4 (±58.8) months] underwent clinical motor assessments and MRI scanning. Nonparametric correlation analyses were performed to examine the relationship between structural connectivity amid a subsection of the motor network and upper/lower extremity motor function. Standard multiple linear regression analyses were performed to examine the relationship between cortical necrosis and disconnection of three main cortical areas of motor control [primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA)] and motor function. Anatomical connectivity between ipsilesional M1/SMA and the (1) cerebral peduncle, (2) thalamus, and (3) red nucleus were significantly correlated with upper and lower extremity motor performance (P ≤ 0.003). M1–M1 interhemispheric connectivity was also significantly correlated with gross manual dexterity of the affected upper extremity (P = 0.001). Regression models with M1 lesion load and M1 disconnection (adjusted for time poststroke) explained a significant amount of variance in upper extremity motor performance (R² = 0.36–0.46) and gait speed (R² = 0.46), with M1 disconnection an independent predictor of motor performance. Cortical disconnection, especially of ipsilesional M1, could significantly contribute to variability seen in locomotor and upper extremity motor function and recovery in chronic stroke. Hum Brain Mapp 39:120–132, 2018. © 2017 Wiley Periodicals, Inc.     

Prospective 12-Month Study of Intrathecal Baclofen Therapy for Poststroke Spastic Upper and Lower Extremity Motor Control and Functional Improvement

Objectives: To assess the effects of intrathecal baclofen (ITB) therapy for the treatment of poststroke spastic hemiparesis on quality of life, functional independence, and upper, lower extremity (UE, LE) motor functions. Materials and Methods: Prospective observational study of adult men and women with a minimum 6‐month stroke‐related spastic hemiparesis graded as ≥2 in UE and LE on Modified Ashworth Scale (MAS). Patients served as their own controls with measures compared pre‐implant with 12 months post ITB including: MAS, manual muscle test (MMT), gait distance/velocity, Functional Independence Measures (FIM), stroke‐specific quality of life scale (SSQL), and upper extremity manual activity log. Results: After 12‐month ITB therapy, 26 patients (poststroke = 6.4 ± 9 years) demonstrated 1) reduced MAS/increased MMT for most LE muscle groups (p≤ 0.0001); 2) reduced MAS/increased MMT most UE muscle groups (p≤ 0.01); 3) FIM scores improved (p≤ 0.05) except bed mobility and lower body dressing; 4) gait distance and velocity improved (p≤ 0.05); 5) SSQL domains of family roles, mobility, personality, self‐care, social roles, thinking, UE function, and work/productivity improved (p≤ 0.05); 6) amount of use and quality of movement of the spastic UE in performing common activities of daily living increased (p < 0.0001). Conclusions: Regardless of duration of spastic hemiparesis, a reduction in tone with ITB therapy facilitates motor strength improvement and is associated with clinically significant improvements in functional independence and quality of life.     

Poststroke dementia: influence of hippocampal atrophy

BACKGROUND: The prevalence of dementia is increased after stroke. Medial temporal lobe atrophy (MTLA) is associated with Alzheimer disease, and with prestroke dementia in patients who have had a stroke. OBJECTIVE: To determine the influence of MTLA on the long-term risk of dementia after stroke, after excluding the patients who had prestroke dementia. METHODS: The study was conducted in 144 consecutive patients who had a stroke, who were aged 40 years or older (66 women and 78 men; median age, 72 years), and who had an Informant Questionnaire on Cognitive Decline in the Elderly score lower than 104. On admission to the hospital all patients underwent a noncontrast computed tomographic scan including temporal lobe-positioned slices. A cut-off of 11.5 mm was used to differentiate patients with MTLA from those without MTLA. Patients were followed up with clinical and cognitive assessments over a 3-year period. RESULTS: Three years after stroke, 34 patients (23.6%) had developed new-onset dementia. The cumulative proportion of survivors without dementia was 57.6% in patients with MTLA and 80.8% in patients without MTLA (P =.02). The unadjusted relative risk of poststroke dementia associated with MTLA was 2.3 (95% confidence interval, 1.1-4.7). However, using the Cox proportional hazards model, MTLA did not seem to be an independent predictor of poststroke dementia. Independent predictors of poststroke dementia were increasing age, diabetes mellitus, severity of the clinical deficit at admission, and severity of leukoaraiosis on computed tomography. CONCLUSIONS: Patients who had a stroke and MTLA more frequently develop dementia than patients without MTLA, but our study does not suggest that MTLA independently contributes to dementia. A longer follow-up may be necessary to reevaluate the influence of MTLA.     

Does training sitting balance on a platform tilted 10° to the weak side improve trunk control in the acute phase after stroke? A randomized,controlled trial

Background: Trunk performance and sitting balance, especially lateral sitting control, are important predictors of functional outcome after stroke. However, no studies have focused only on trunk function in the frontal plane for persons with acute-phase stroke.

Objective: To investigate the effects of lateral sitting training on a tilting platform in persons with stroke.

Methods: An assessor-blinded, randomized, controlled trial was carried out involving inpatients at a stroke rehabilitation center. Patients were allocated to either an experimental group (n?=?15) or a control group (n?=?15). The experimental group sat without leg support on a platform tilted 10° to the paretic side in the frontal plane, while the controls sat on a horizontal platform. Both groups were asked to move their trunk laterally from the paretic side to the nonparetic side. In addition to conventional therapy, this training was performed 60 times/session, with 6 sessions/week. Trunk function was assessed using the Trunk Control Test (TCT), and the ability to move the trunk laterally was evaluated kinematically. Measurements were performed at baseline and after training. Two-way repeated measures analysis of variance was used to test the significance between and within treatments for each dependent variable.

Results: None of the demographic data differed between the groups. After training, a significant improvement was noted in the experimental group compared to the controls in the TCT and the ability for lateral trunk transference (P?<?0.05, 1???β?=?0.98, effect size?=?0.4).

Conclusion: Lateral sitting training on the tilting platform improved the impaired trunk function of persons with stroke.     

Neural Reorganization Accompanying Upper Limb Motor Rehabilitation from Stroke with Virtual Reality-Based Gesture Therapy

Abstract

Background: Gesture Therapy is an upper limb virtual reality rehabilitation-based therapy for stroke survivors. It promotes motor rehabilitation by challenging patients with simple computer games representative of daily activities for self-support. This therapy has demonstrated clinical value, but the underlying functional neural reorganization changes associated with this therapy that are responsible for the behavioral improvements are not yet known. Objective: We sought to quantify the occurrence of neural reorganization strategies that underlie motor improvements as they occur during the practice of Gesture Therapy and to identify those strategies linked to a better prognosis. Methods: Functional magnetic resonance imaging (fMRI) neuroscans were longitudinally collected at 4 time points during Gesture Therapy administration to 8 patients. Behavioral improvements were monitored using the Fugl-Meyer scale and Motricity Index. Activation loci were anatomically labelled and translated to reorganization strategies. Strategies are quantified by counting the number of active clusters in brain regions tied to them. Results: All patients demonstrated significant behavioral improvements (P < .05). Contralesional activation of the unaffected motor cortex, cerebellar recruitment, and compensatory prefrontal cortex activation were the most prominent strategies evoked. A strong and significant correlation between motor dexterity upon commencing therapy and total recruited activity was found (r² = 0.80; P < .05), and overall brain activity during therapy was inversely related to normalized behavioral improvements (r² = 0.64; P < .05). Conclusions: Prefrontal cortex and cerebellar activity are the driving forces of the recovery associated with Gesture Therapy. The relation between behavioral and brain changes suggests that those with stronger impairment benefit the most from this paradigm.     

Muscle weakness and cocontraction in upper limb hemiparesis: relationship to motor impairment and physical disability

The purpose of this article is to describe the relationship between poststroke upper limb muscle weakness and cocontraction, and clinical measures of upper limb motor impairment and physical disability. Electrormyographic (EMG) activity of the paretic and nonparetic wrist flexors and extensors of 26 chronic stroke survivors were recorded during isometric wrist flexion and extension. The root mean square (RMS) of the EMG signal was used as a measure of strength of contraction. A ratio of RMS of antagonist and agonist muscles was used as a measure of cocontraction. Upper limb motor impairment and physical disability were assessed with the Fugl-Meyer motor assessment (FMA) and the arm motor ability test (AMAT), respectively. The strength of muscle contraction was significantly stronger in the nonparetic limb (P < 0.001). The degree of cocontraction was significantly greater in the paretic limb (P < 0.001). The strength of muscle contraction in the paretic limb correlated significantly with FMA (r = 0.62 to 0.87, P < or = 0.001) and AMAT (r = 0.66 to 0.80, P < or = 0.001) scores. Similarly, the degree of cocontraction correlated significantly with FMA (r = -0. 70 to -0.64, P < or = 0.001) and AMAT (r = -0. 72 to -0.62, P < or = 0.001) scores. Muscle weakness and degree of cocontraction correlate significantly with motor impairment and physical disability in upper limb hemiplegia. This relationship may provide insights toward development of specific interventions. However, additional studies are needed to demonstrate a cause and effect relationship.     

Motor-cognitive effects of a computerized game-based training method in people with dementia: a randomized controlled trial

ABSTRACT

Objectives: To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia.

Method: Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled trial with three-month follow-up. The intervention group (IG) received a motor-cognitive training on (Physiomat®) including concurrent dual-tasks of balance control with cognitive demands (Physiomat®-Trail Making Tasks (PTMTs)). The control group (CG) performed non-specific, low-intensity exercises. Duration and accuracy at different complexity levels of trained and untrained PTMTs and the number of successfully performed tasks (PTMT score) were assessed.

Results: Physiomat® training significantly improved the duration and accuracy at almost all complexity levels of trained (P ≤ 0.001–0.047, η_p² = 0.065–0.589) and untrained PTMTs (P < 0.001–0.005, η_p² = 0.073–0.459). Significant effects were also found for the PTMT score of trained (P < 0.001, η_p² = 0.211) and untrained PTMTs (P < 0.001, η_p² = 0.184). Training gains were partly sustained at follow-up.

Conclusion: Physiomat® is feasible and has the potential to sustainably improve motor-cognitive performances in people with dementia.     

Home-based telesurveillance and rehabilitation after stroke: a real-life study

Background: After discharge from in-hospital rehabilitation, post-stroke patients should have the opportunity to continue the rehabilitation through structured programs to maintain the benefits acquired during intensive rehabilitation treatment.

Objective: The primary objective was to evaluate the feasibility of implementing an home-based telesurveillance and rehabilitation (HBTR) program to optimize the patient's recovery by reducing dependency degree.

Method: Post-stroke patients were consecutively screened. Data were expressed as mean ± standard deviation (SD). 26 patients enrolled: 15 were sub-acute (time since stroke: 112?±?39?days) and 11 were chronic (time since stroke: 470?±?145?days). For 3?months patients were followed at home by a nurse-tutor, who provided structured phone support and vital signs telemonitoring, and by a physiotherapist (PT) who monitored rehabilitation sessions by videoconferencing.

Results: 23 patients completed the program; 16.7?±?5.2 phone contacts/patient were initiated by the nurse and 0.9?±?1.8 by the patients. Eight episodes of atrial fibrillation that required a change in therapy were recorded in two patients. Physiotherapists performed 1.2?±?0.4 home visits, 1.6?±?0.9 phone calls and 4.5?±?2.8 videoconference-sessions per patient. At least three sessions/week of home exercises were performed by 31% of patients, two sessions by 54%. At the end of the program, global functional capacity improved significantly (P?<?0.001), in particular, static (P?<?0.001) and dynamic (P?=?0.0004) postural balance, upper limb dexterity of the paretic side (P?=?0.01), and physical performance (P?=?0.002). Symptoms of depression and caregiver strain also improved.

Conclusion: The home-based program was feasible and effective in both sub-acute and chronic post-stroke patients, improving their recovery, and maintaining the benefits reached during inpatient rehabilitation     

Motor outcome of deep intracerebral haemorrhage in diffusion tensor imaging: comparison of data from different locations along the corticospinal tract

Abstract

Objectives:

Although diffusion tensor imaging (DTI) is widely studied to assess the motor outcome after ischaemic stroke, there is paucity of data regarding outcomes of intracerebral haemorrhage (ICH). The aim of this study was to determine the DTI data from different locations along the corticospinal tract (CST) and association to motor outcome.

Methods:

We prospectively recruited patients with deep ICH admitted to our hospital from November 2010 to July 2012.Diffusion tensor imaging was performed within 14?days after the onset of ICH. Fractional anisotropy (FA) was measured along the CST at corona radiata, perihaematomal oedema, cerebral peduncle and pons. Corticospinal tract integrity was classified into three types by diffusion tensor tractography (DTT): type A with preserved CST, type B with partially interrupted CST and type C with completely interrupted CST. Motor outcome was assessed by Motricity index (MI) at admission, after 1 and 3?months.

Results:

Forty-eight patients were enrolled with a mean age of 62?years. The median time interval from onset of ICH to DTI study was 7?days. The patients in type C had significantly worse MI at admission (P?<?0.001), after 1?month (P?<?0.001) and after 3?months (P?<?0.001) as compared to those with type A and type B. Lower rFA at the corona radiata was significantly correlated with poorer motor outcome at admission, after 1?month and after 3?months.

Discussion:

Clinical motor outcome of ICH within 2?weeks can be identified with a statistically significant decrease in rFA at the corona radiata.