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Sehle A, Salzmann C, Liepert J. Effects of flexor reflex stimulation on gait aspects in stroke patients: randomized clinical trial. J Neuroeng Rehabil 2024; 21:83. [PMID: 38802939 PMCID: PMC11131186 DOI: 10.1186/s12984-024-01377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study was to investigate the effect of FR stimulation on gait performance and gait parameters in participants with stroke within a single session of flexor reflex stimulation using Incedo™. METHODS Twenty-five participants with subacute (n = 14) and chronic (n = 11) stroke were enrolled in the study. Motor functions were tested with a 10-m walk test (10mWT), a 2-min walk test (2minWT), and a gait analysis. These tests were performed with and without Incedo™ within a single session in randomized order. RESULTS In the 10mWT, a significant difference was found between walking with Incedo™ (15.0 ± 8.5 s) versus without Incedo™ (17.0 ± 11.4 s, p = 0.01). Similarly, the 2minWT showed a significant improvement with Incedo™ use (90.0 ± 36.4 m) compared to without Incedo™ (86.3 ± 36.8 m, p = 0.03). These results indicate that while the improvements are statistically significant, they are modest and should be considered in the context of their clinical relevance. The gait parameters remained unchanged except for the step length. A subgroup analysis indicated that participants with subacute and chronic stroke responded similarly to the stimulation. There was a correlation between the degree of response to electrostimulation while walking and degree of improvement in 2minWT (r = 0.50, p = 0.01). CONCLUSIONS This study is the first to examine FR activation effects in chronic stroke patients and suggests that stimulation effects are independent of the time since stroke. A larger controlled clinical trial is warranted that addresses issues as the necessary number of therapeutical sessions and for how long stimulation-induced improvements outlast the treatment period. TRIAL REGISTRATION The trial was retrospectively registered in German Clinical Trials Register. CLINICAL TRIAL REGISTRATION NUMBER DRKS00021457. Date of registration: 29 June 2020.
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Affiliation(s)
- Aida Sehle
- Kliniken Schmieder, Allensbach, Germany
- Lurija Institute, Allensbach, Germany
| | - Christian Salzmann
- Kliniken Schmieder, Allensbach, Germany
- Lurija Institute, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder, Allensbach, Germany.
- Lurija Institute, Allensbach, Germany.
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2
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Hamzaid NA, Manaf H, Azmi NL, Milosevic M, Spaich EG, Yoshida K, Gorgey AS, Ferrante S. The International Functional Electrical Stimulation Society (IFESS): Highlights from the IFESS conference at Rehabweek 2023. Artif Organs 2024; 48:421-425. [PMID: 38339848 DOI: 10.1111/aor.14720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
The annual conference of the International Functional Electrical Stimulation Society (IFESS) was held in conjunction with the 7th RehabWeek Congress, from September 24 to 28, 2023 at the Resorts World Convention Centre on Sentosa Island, in Singapore. The Congress was a joint meeting of the International Consortium on Rehabilitation Technology (ICRT) together with 10 other societies in the field of assistive technology and rehabilitation engineering. The conference features comprehensive blend of technical and clinical context of FES, a sustained value the society has offered over many years. The cross- and inter- disciplinary approach of medicine, engineering, and science practiced in the FES community had enabled vibrant interaction, creation, and development of impactful and novel contributions to the field of FES, translating FES directly into highly relevant and sustainable solutions for the users.
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Affiliation(s)
- Nur Azah Hamzaid
- Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Haidzir Manaf
- Centre for Physiotherapy Study, Faculty of Health Sciences, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Nur Liyana Azmi
- Department of Mechatronics Engineering, Kulliyyah of Engineering, International Islamic University Malaysia, Kuala Lumpur, Malaysia
| | - Matija Milosevic
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida, USA
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
- Department of Biomedical Engineering, University of Miami, Miami, Florida, USA
| | - Erika G Spaich
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Ken Yoshida
- Department of Biomedical Engineering, Indiana University - Purdue University Indianapolis, Indianapolis, Indiana, USA
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ashraf S Gorgey
- Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- School of Medicine, Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Simona Ferrante
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy
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3
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Kitamura G, Nankaku M, Kikuchi T, Nishi H, Tanaka H, Nishikawa T, Yonezawa H, Kajimoto T, Kawano T, Ohtagaki A, Mashimoto E, Miyamoto S, Ikeguchi R, Matsuda S. Effect of gait distance during robot training on walking independence after acute brain injury. Assist Technol 2023:1-6. [PMID: 36441850 DOI: 10.1080/10400435.2022.2151664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to determine whether the distance of gait training using a hybrid assistive limb (HAL) is related to the improvement of walking independence in patients with acute brain injury. This was an exploratory, observational study. Thirty patients having hemiplegia (functional ambulation category, FAC score ≤2) with acute stroke or after brain tumor surgery were included. Patients performed 4 sessions of gait training using HAL (60 min/session), 1-3 sessions/week, combined with conventional physical therapy. The gait distance achieved in the four training sessions using HAL was measured. FAC score was measured before and after intervention. Patients were divided into groups A, B, and C, for FAC score improvements of 0, 1, and ≥2, respectively. Gait distance was compared among groups using one-way analysis of variance. Gait distance in group C was significantly longer than that ingroup A [mean (standard deviation): 2527 (1725) m vs. 608 (542) m]. This study suggested that the gait distance achieved during training using the HAL may be a clinical indicator of the effectiveness of the HAL on gait training in patients with acute brain injury.Clinical trial registration number: UMIN000012764 R000014756.
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Affiliation(s)
- Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroki Tanaka
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Toru Nishikawa
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Honami Yonezawa
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Taishi Kajimoto
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takumi Kawano
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ayumi Ohtagaki
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Eriko Mashimoto
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Bakalkin G. The left-right side-specific endocrine signaling in the effects of brain lesions: questioning of the neurological dogma. Cell Mol Life Sci 2022; 79:545. [PMID: 36219330 PMCID: PMC9553812 DOI: 10.1007/s00018-022-04576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022]
Abstract
Each cerebral hemisphere is functionally connected to the contralateral side of the body through the decussating neural tracts. The crossed neural pathways set a basis for contralateral effects of brain injury such hemiparesis and hemiplegia as it has been already noted by Hippocrates. Recent studies demonstrated that, in addition to neural mechanisms, the contralateral effects of brain lesions are mediated through the humoral pathway by neurohormones that produce either the left or right side-specific effects. The side-specific humoral signaling defines whether the left or right limbs are affected after a unilateral brain injury. The hormonal signals are released by the pituitary gland and may operate through their receptors that are lateralized in the spinal cord and involved in the side-specific control of symmetric neurocircuits innervating the left and right limbs. Identification of features and a proportion of neurological deficits transmitted by neurohormonal signals vs. those mediated by neural pathways is essential for better understanding of mechanisms of brain trauma and stroke and development of new therapies. In a biological context, the left-right side-specific neuroendocrine signaling may be fundamental for the control of the left- and right-sided processes in bilaterally symmetric animals.
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Affiliation(s)
- Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, Box 591, SE-751 24, Uppsala, Sweden.
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5
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Longitudinal Changes in Temporospatial Gait Characteristics during the First Year Post-Stroke. Brain Sci 2021; 11:brainsci11121648. [PMID: 34942950 PMCID: PMC8699066 DOI: 10.3390/brainsci11121648] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Given the paucity of longitudinal data in gait recovery after stroke, we compared temporospatial gait characteristics of stroke patients during subacute (<2 months post-onset, T0) and at approximately 6 and 12 months post-onset (T1 and T2, respectively) and explored the relationship between gait characteristics at T0 and the changes in gait speed from T0 to T1. Forty-six participants were assessed at T0 and a subsample of twenty-four participants were assessed at T2. Outcome measures included Fugl-Meyer lower-extremity motor score, 14 temporospatial gait parameters, and symmetry indices of 5 step parameters. Except for step width, all temporospatial parameters improved from T0 to T1 (p ≤ 0.0001). Additionally, significant improvements in symmetry were found for the initial double-support time and single-support time (p ≤ 0.0001). As a group, no significant differences were found between T1 and T2 in any of the temporospatial measures. However, the individual analysis revealed that 42% (10/24) of the subsample showed a significant increase in gait speed (Welch’s t-test, p ≤ 0.002). Yet, only 5/24 (21%) of the participants improved speed from T1 to T2 according to speed-based minimum detectable change criteria. The increase in gait speed from T0 to T1 was negatively correlated with gait speed and stride length and positively correlated with the symmetry indices of stance and single-support times at T0 (p ≤ 0.002). Temporospatial gait parameters and stance time symmetry improved over the first 6 months after stroke with an apparent plateau thereafter. A greater increase in gait speed during the first 6 months post-stroke is associated with initially slower walking, shorter stride length, and more pronounced asymmetry in stance and single-support times. The improvement in lower-extremity motor function and bilateral improvements in step parameters collectively suggest that gait changes over the first 6 months after stroke are likely due to a combination of neurological recovery, compensatory strategies, and physical therapy received during that time.
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Tabernig CB, Carrere LC, Manresa JB, Spaich EG. Does feedback based on FES-evoked nociceptive withdrawal reflex condition event-related desynchronization? An exploratory study with brain-computer interfaces. Biomed Phys Eng Express 2021; 7. [PMID: 34431480 DOI: 10.1088/2057-1976/ac2077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/24/2021] [Indexed: 11/11/2022]
Abstract
Introduction.Event-related desynchronization (ERD) is used in brain-computer interfaces (BCI) to detect the user's motor intention (MI) and convert it into a command for an actuator to provide sensory feedback or mobility, for example by means of functional electrical stimulation (FES). Recent studies have proposed to evoke the nociceptive withdrawal reflex (NWR) using FES, in order to evoke synergistic movements of the lower limb and to facilitate the gait rehabilitation of stroke patients. The use of NWR to provide sensorimotor feedback in ERD-based BCI is novel; thererfore, the conditioning effect that nociceptive stimuli might have on MI is still unknown.Objetive.To assess the ERD produced during the MI after FES-evoked NWR, in order to evaluate if nociceptive stimuli condition subsequent ERDs.Methods. Data from 528 electroencephalography trials of 8 healthy volunteers were recorded and analyzed. Volunteers used an ERD-based BCI, which provided two types of feedback: intrisic by the FES-evoked NWR and extrinsic by virtual reality. The electromyogram of the tibialis anterior muscle was also recorded. The main outcome variables were the normalized root mean square of the evoked electromyogram (RMSnorm), the average electroencephalogram amplitude at the ERD frequency during MI (A¯MI) and the percentage decrease ofA¯MIrelative to rest (ERD%) at the first MI subsequent to the activation of the BCI.Results.No evidence of changes of theRMSnormon both theA¯MI(p = 0.663) and theERD%(p = 0.252) of the subsequent MI was detected. A main effect of the type of feedback was found in the subsequentA¯MI(p < 0.001), with intrinsic feedback resulting in a largerA¯MI.Conclusions.No evidence of ERD conditioning was observed using BCI feedback based on FES-evoked NWR .Significance.FES-evoked NWR could constitute a potential feedback modality in an ERD-based BCI to facilitate motor recovery of stroke people.
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Affiliation(s)
- Carolina B Tabernig
- Laboratory of Rehabilitation Engineering and Neuromuscular and Sensory Research (LIRINS), Faculty of Engineering, National University of Entre Ríos, Oro Verde, Argentina
| | - L Carolina Carrere
- Laboratory of Rehabilitation Engineering and Neuromuscular and Sensory Research (LIRINS), Faculty of Engineering, National University of Entre Ríos, Oro Verde, Argentina
| | - José Biurrun Manresa
- Laboratory of Rehabilitation Engineering and Neuromuscular and Sensory Research (LIRINS), Faculty of Engineering, National University of Entre Ríos, Oro Verde, Argentina.,Institute for Research and Development in Bioengineering and Bioinformatics (IBB), CONICET-UNER, Oro Verde, Argentina
| | - Erika G Spaich
- Neurorehabilitation Systems Group, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2, 9220 Aalborg, Denmark
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7
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Salzmann C, Sehle A, Liepert J. Using the Flexor Reflex in a Chronic Stroke Patient for Gait Improvement: A Case Report. Front Neurol 2021; 12:691214. [PMID: 34220693 PMCID: PMC8250132 DOI: 10.3389/fneur.2021.691214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/17/2021] [Indexed: 01/19/2023] Open
Abstract
The flexor reflex or withdrawal reflex can be elicited by electrical stimulation of the sole of the foot, which serves as a reflex to protect the stimulated limb against tissue damage and consists of flexion movements in the hip, knee, and ankle joint. Triggering this reflex might improve walking abilities in hemiparetic patients. We report the first case of a chronic stroke patient with the most severe impairment of walking. She was examined with and without flexor reflex activation by the Incedo® system. Tests included a 10-m walk and a 2-min walk at baseline, after 3 weeks of training with the Incedo® system and after a follow-up 3 weeks later. Moreover, a kinematic gait analysis was done before and after the training period. At baseline, activation of the flexor reflex induced an improved gait velocity. After the training period, the patient walked twice as fast compared with baseline. Her gait velocity without Incedo® was faster than the gait velocity with Incedo® at baseline. Examination at follow-up indicated that the improvements remained almost unchanged. The kinematic analysis showed an improved stride length and gait velocity during flexor reflex activation. Initially, the foot was elevated higher above the ground during flexor reflex activation. In conclusion, this first case report of a chronic stroke patient demonstrates that flexor reflex activation is feasible and improves gait parameters despite severe impairment of walking abilities.
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Affiliation(s)
- Christian Salzmann
- Kliniken Schmieder, Allensbach, Germany.,Lurija Institute, Allensbach, Germany
| | - Aida Sehle
- Kliniken Schmieder, Allensbach, Germany.,Lurija Institute, Allensbach, Germany
| | - Joachim Liepert
- Kliniken Schmieder, Allensbach, Germany.,Lurija Institute, Allensbach, Germany
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8
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Watanabe H, Nosova O, Sarkisyan D, Storm Andersen M, Carvalho L, Galatenko V, Bazov I, Lukoyanov N, Maia GH, Hallberg M, Zhang M, Schouenborg J, Bakalkin G. Left-Right Side-Specific Neuropeptide Mechanism Mediates Contralateral Responses to a Unilateral Brain Injury. eNeuro 2021; 8:ENEURO.0548-20.2021. [PMID: 33903183 PMCID: PMC8152370 DOI: 10.1523/eneuro.0548-20.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/14/2021] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Neuropeptides are implicated in control of lateralized processes in the brain. A unilateral brain injury (UBI) causes the contralesional sensorimotor deficits. To examine whether opioid neuropeptides mediate UBI induced asymmetric processes we compared effects of opioid antagonists on the contralesional and ipsilesional hindlimb responses to the left-sided and right-sided injury in rats. UBI induced hindlimb postural asymmetry (HL-PA) with the contralesional hindlimb flexion, and activated contralesional withdrawal reflex of extensor digitorum longus (EDL) evoked by electrical stimulation and recorded with EMG technique. No effects on the interossei (Int) and peroneaus longus (PL) were evident. The general opioid antagonist naloxone blocked postural effects, did not change EDL asymmetry while uncovered cryptic asymmetry in the PL and Int reflexes induced by UBI. Thus, the spinal opioid system may either mediate or counteract the injury effects. Strikingly, effects of selective opioid antagonists were the injury side-specific. The μ-antagonist β-funaltrexamine (FNA) and κ-antagonist nor-binaltorphimine (BNI) reduced postural asymmetry after the right but not left UBI. In contrast, the δ-antagonist naltrindole (NTI) inhibited HL-PA after the left but not right-side brain injury. The opioid gene expression and opioid peptides were lateralized in the lumbar spinal cord, and coordination between expression of the opioid and neuroplasticity-related genes was impaired by UBI that together may underlie the side-specific effects of the antagonists. We suggest that mirror-symmetric neural circuits that mediate effects of left and right brain injury on the contralesional hindlimbs are differentially controlled by the lateralized opioid system.
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Affiliation(s)
- Hiroyuki Watanabe
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Olga Nosova
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Daniil Sarkisyan
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | | | - Liliana Carvalho
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, Porto, Portugal, 4200-135
| | - Vladimir Galatenko
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, Moscow, Russia, 119991
| | - Igor Bazov
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Nikolay Lukoyanov
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, Porto, Portugal, 4200-135
- Medibrain, Vila do Conde, Porto, Portugal, 4480-807
- Brain Research Institute, Porto, Portugal, 4200-135
| | - Gisela H Maia
- Medibrain, Vila do Conde, Porto, Portugal, 4480-807
- Brain Research Institute, Porto, Portugal, 4200-135
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, Porto, Portugal, 4200-135
| | - Mathias Hallberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
| | - Mengliang Zhang
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark, 5230
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden, 223 81
| | - Jens Schouenborg
- Neuronano Research Center, Department of Experimental Medical Science, Lund University, Lund, Sweden, 223 81
| | - Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden, 751 24
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9
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Watanabe H, Nosova O, Sarkisyan D, Andersen MS, Zhang M, Rorick-Kehn L, Clausen F, Gawel K, Kehr J, Hallberg M, Schouenborg J, Marklund N, Bakalkin G. Ipsilesional versus contralesional postural deficits induced by unilateral brain trauma: a side reversal by opioid mechanism. Brain Commun 2020; 2:fcaa208. [PMID: 33364602 PMCID: PMC7749794 DOI: 10.1093/braincomms/fcaa208] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 01/09/2023] Open
Abstract
Unilateral traumatic brain injury and stroke result in asymmetric postural and motor deficits including contralateral hemiplegia and hemiparesis. In animals, a localized unilateral brain injury recapitulates the human upper motor neuron syndrome in the formation of hindlimb postural asymmetry with contralesional limb flexion and the asymmetry of hindlimb nociceptive withdrawal reflexes. The current view is that these effects are developed due to aberrant activity of motor pathways that descend from the brain into the spinal cord. These pathways and their target spinal circuits may be regulated by local neurohormonal systems that may also mediate effects of brain injury. Here, we evaluate if a unilateral traumatic brain injury induces hindlimb postural asymmetry, a model of postural deficits, and if this asymmetry is spinally encoded and mediated by the endogenous opioid system in rats. A unilateral right-sided controlled cortical impact, a model of clinical focal traumatic brain injury was centred over the sensorimotor cortex and was observed to induce hindlimb postural asymmetry with contralateral limb flexion. The asymmetry persisted after complete spinal cord transection, implicating local neurocircuitry in the development of the deficits. Administration of the general opioid antagonist naloxone and μ-antagonist β-funaltrexamine blocked the formation of postural asymmetry. Surprisingly, κ-antagonists nor-binaltorphimine and LY2444296 did not affect the asymmetry magnitude but reversed the flexion side; instead of contralesional (left) hindlimb flexion the ipsilesional (right) limb was flexed. The postural effects of the right-side cortical injury were mimicked in animals with intact brain via intrathecal administration of the opioid κ-agonist (2)-(trans)-3,4-Dichloro-N-methyl-N-[2-(1-pyrrolidiny)-cyclohexyl]benzeneacetamide that induced hindlimb postural asymmetry with left limb flexion. The δ-antagonist naltrindole produced no effect on the contralesional (left) flexion but inhibited the formation of the ipsilesional (right) limb flexion in brain-injured rats that were treated with κ-antagonist. The effects of the antagonists were evident before and after spinal cord transection. We concluded that the focal traumatic brain injury-induced postural asymmetry was encoded at the spinal level, and was blocked or its side was reversed by administration of opioid antagonists. The findings suggest that the balance in activity of the mirror symmetric spinal neural circuits regulating contraction of the left and right hindlimb muscles is controlled by different subtypes of opioid receptors; and that this equilibrium is impaired after unilateral brain trauma through side-specific opioid mechanism.
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Affiliation(s)
- Hiroyuki Watanabe
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Olga Nosova
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Daniil Sarkisyan
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | | | - Mengliang Zhang
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Linda Rorick-Kehn
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN 46285, USA
| | - Fredrik Clausen
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Kinga Gawel
- Department of Experimental and Clinical Pharmacology, Medical University of Lublin, Lublin, Poland
| | - Jan Kehr
- Department of Physiology, Karolinska Institutet, Stockholm, Sweden
| | - Mathias Hallberg
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Jens Schouenborg
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, Lund, Sweden
| | - Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
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10
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Zhang M, Watanabe H, Sarkisyan D, Andersen MS, Nosova O, Galatenko V, Carvalho L, Lukoyanov N, Thelin J, Schouenborg J, Bakalkin G. Hindlimb motor responses to unilateral brain injury: spinal cord encoding and left-right asymmetry. Brain Commun 2020; 2:fcaa055. [PMID: 32954305 PMCID: PMC7425521 DOI: 10.1093/braincomms/fcaa055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 12/26/2022] Open
Abstract
Mechanisms of motor deficits (e.g. hemiparesis and hemiplegia) secondary to stroke and traumatic brain injury remain poorly understood. In early animal studies, a unilateral lesion to the cerebellum produced postural asymmetry with ipsilateral hindlimb flexion that was retained after complete spinal cord transection. Here we demonstrate that hindlimb postural asymmetry in rats is induced by a unilateral injury of the hindlimb sensorimotor cortex, and characterize this phenomenon as a model of spinal neuroplasticity underlying asymmetric motor deficits. After cortical lesion, the asymmetry was developed due to the contralesional hindlimb flexion and persisted after decerebration and complete spinal cord transection. The asymmetry induced by the left-side brain injury was eliminated by bilateral lumbar dorsal rhizotomy, but surprisingly, the asymmetry after the right-side brain lesion was resistant to deafferentation. Pancuronium, a curare-mimetic muscle relaxant, abolished the asymmetry after the right-side lesion suggesting its dependence on the efferent drive. The contra- and ipsilesional hindlimbs displayed different musculo-articular resistance to stretch after the left but not right-side injury. The nociceptive withdrawal reflexes evoked by electrical stimulation and recorded with EMG technique were different between the left and right hindlimbs in the spinalized decerebrate rats. On this asymmetric background, a brain injury resulted in greater reflex activation on the contra- versus ipsilesional side; the difference between the limbs was higher after the right-side brain lesion. The unilateral brain injury modified expression of neuroplasticity genes analysed as readout of plastic changes, as well as robustly impaired coordination of their expression within and between the ipsi- and contralesional halves of lumbar spinal cord; the effects were more pronounced after the left side compared to the right-side injury. Our data suggest that changes in the hindlimb posture, resistance to stretch and nociceptive withdrawal reflexes are encoded by neuroplastic processes in lumbar spinal circuits induced by a unilateral brain injury. Two mechanisms, one dependent on and one independent of afferent input may mediate asymmetric hindlimb motor responses. The latter, deafferentation resistant mechanism may be based on sustained muscle contractions which often occur in patients with central lesions and which are not evoked by afferent stimulation. The unusual feature of these mechanisms is their lateralization in the spinal cord.
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Affiliation(s)
- Mengliang Zhang
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, 221 00 Lund, Sweden
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Hiroyuki Watanabe
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
| | - Daniil Sarkisyan
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
| | - Marlene Storm Andersen
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Olga Nosova
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
| | - Vladimir Galatenko
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, 119234 Moscow, Russia
| | - Liliana Carvalho
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, 4200-319 Porto, Portugal
| | - Nikolay Lukoyanov
- Departamento de Biomedicina da Faculdade de Medicina da Universidade do Porto, Instituto de Investigação e Inovação em Saúde, Instituto de Biologia Molecular e Celular, 4200-319 Porto, Portugal
| | - Jonas Thelin
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, 221 00 Lund, Sweden
| | - Jens Schouenborg
- Department of Experimental Medical Science, Neuronano Research Center, Lund University, 221 00 Lund, Sweden
| | - Georgy Bakalkin
- Department of Pharmaceutical Biosciences, Uppsala University, 751 24 Uppsala, Sweden
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11
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Chow JW, Stokic DS. Gait Impairments in Patients Without Lower Limb Hypertonia Early Poststroke Are Related to Weakness of Paretic Knee Flexors. Arch Phys Med Rehabil 2018; 100:1091-1101. [PMID: 30447195 DOI: 10.1016/j.apmr.2018.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To describe gait characteristics of patients without clinical evidence of lower limb hypertonia within 2 months of stroke and explore the relationship between gait and residual motor function. DESIGN Cohort study. SETTING Motion analysis laboratory in a tertiary-care free-standing rehabilitation hospital. PARTICIPANTS Consecutive sample of 73 eligible inpatients (first-known stroke <2 months postonset, walking independently, modified Ashworth score of 0 in the paretic lower limb) and 27 healthy controls (N=100). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Gait speed, stride and step lengths and cadences, stance time, single-support and double-support times, and associated symmetry measures in patients at self-selected normal speed and controls at very slow speed (51.1±32.6 cm/s and 61.9±21.8 cm/s, respectively, P=.115); Fugl-Meyer lower extremity motor score (FM-LE) and isometric knee flexion and extension strength in patients. RESULTS Except the stride/step cadence, all temporospatial parameters significantly differed between the stroke and control participants. Furthermore, significantly greater asymmetries were found in the patients for the overall stance time, initial double-support and single-support times, and step cadence, reflecting smaller values in the paretic than nonparetic limb. Most temporospatial parameters moderately to strongly correlated with the gait speed (|r|: .72-.94, P<.0001), FM-LE (|r|: .42-.62, P≤.0005), and paretic knee flexor strength (|r|: .47-.57, P≤.0004). CONCLUSIONS Gait of patients without clinical evidence of lower limb hypertonia within 2 months of stroke is characterized by many temporospatial deviations and asymmetries. The self-selected normal gait speed, FM-LE, and paretic knee flexor strength can discriminate gait impairments in these patients shortly before inpatient discharge. It remains to be determined whether the observed relationships between paretic knee flexor strength and gait measures warrant the development of interventions for strengthening of the paretic knee flexors in order to improve gait early poststroke.
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Affiliation(s)
- John W Chow
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS.
| | - Dobrivoje S Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS
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12
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Alvisi E, Serrao M, Conte C, Alfonsi E, Tassorelli C, Prunetti P, Cristina S, Perrotta A, Pierelli F, Sandrini G. Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients. Brain Behav 2018; 8:e01069. [PMID: 30141250 PMCID: PMC6160647 DOI: 10.1002/brb3.1069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The aims of this study were to evaluate the pattern of the nociceptive withdrawal reflex (NWR) of the upper limb at rest and after injection of Botulinum toxin type A (BoNT-A) in poststroke subacute hemiparetic patients. METHODS Fourteen patients with poststroke subacute hemiparesis underwent clinical and instrumental evaluation and BoNT-A injection. Painful electrical stimulation was applied to induce the NWR. Baseline EMG activity and NWR recordings (EMG and kinematic response) were performed at T0, one month (T1), and three months (T2) after the BoNT-A injection, as were Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM) scores. RESULTS Comparison of results at T0, T1, and T2 revealed significant changes in the MAS score for the elbow (p < 0.001) and wrist joints (p < 0.001) and in the FIM score at T0 and T2. BoNT-A injection had a significant effect on both NWR amplitude and baseline EMG activity in the posterior deltoid (PD) and flexor carpi radialis (FCR) muscles as well as in all averaged muscles. Analysis of elbow kinematics before and after treatment revealed that the reflex probability rates were significantly higher at T1 and T2 than at T0. CONCLUSION Injection of BoNT-A in the subacute phase of stroke can modify both the baseline EMG activity and the NWR-related EMG responses in the upper limb muscles irrespective of the site of injection; furthermore, the reflex-mediated defensive mechanical responses, that is, shoulder extension and abduction and elbow flexion, increased after treatment. BoNT-A injection may be a useful treatment in poststroke spasticity with a potential indirect effect on spinal neurons.
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Affiliation(s)
- Elena Alvisi
- Department of Neurophysiopathology, IRCCS Casimiro Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Department of Brain Injury and Parkinson's Disease Rehabilitation, Moriggia Pelascini Hospital, Gravedona (Como), Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, Latina, Italy.,Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Rome, Italy
| | | | - Enrico Alfonsi
- Department of Neurophysiopathology, IRCCS Casimiro Mondino National Neurological Institute, Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Department of Neurorehabilitation, Casimiro Mondino National Neurological Institute, Pavia, Italy
| | - Paolo Prunetti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Silvano Cristina
- Department of Neurorehabilitation, Casimiro Mondino National Neurological Institute, Pavia, Italy
| | | | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, Latina, Italy.,IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Giorgio Sandrini
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy.,Department of Neurorehabilitation, Casimiro Mondino National Neurological Institute, Pavia, Italy
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13
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Gervasio S, Laursen CB, Andersen OK, Hennings K, Spaich EG. A Novel Stimulation Paradigm to Limit the Habituation of the Nociceptive Withdrawal Reflex. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1100-1107. [PMID: 29752246 DOI: 10.1109/tnsre.2018.2828221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In gait rehabilitation, combining gait therapy with functional electrical stimulation based on the nociceptive withdrawal reflex (NWR) improves walking velocity and gait symmetry of hemiparetic patients. However, habituation of the NWR can affect the efficacy of training. The current study aimed at identifying the stimulation parameters that would limit, in healthy participants, the habituation of the NWR. The NWR was elicited at every heel-off while the participants walked on a treadmill. Three stimulation paradigms were tested: deterministic paradigm (fixed parameters), stochastic pulse duration paradigm (varying the pulse duration of the stimuli), and stochastic frequency paradigm (varying the frequency of the stimuli). The charge delivered for the three paradigms was identical. The reflex response was quantified by the EMG activity of the tibialis anterior (TA) muscle and as ankle and hip joints angle changes. The ankle dorsiflexion and TA EMG responses were not significantly reduced with the stochastic pulse duration paradigm, in contrast to the two other paradigms. Hence, using a stochastic pulse duration stimulation paradigm seemed to be effective in limiting the habituation of the NWR in heathy individuals. This might be highly relevant for effective gait rehabilitation.
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14
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Sijobert B, Azevedo C, Andreu D, Verna C, Geny C. Effects of Sensitive Electrical Stimulation-Based Somatosensory Cueing in Parkinson's Disease Gait and Freezing of Gait Assessment. Artif Organs 2018; 41:E222-E232. [PMID: 29148136 DOI: 10.1111/aor.13059] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study aims to investigate the effect of a somatosensory cueing on gait disorders in subjects with Parkinson's disease (PD). After having performed stepping in place and timed up and go assessing tasks, 13 participants with PD were equipped with an electrical stimulator and an inertial measurement unit (IMU) located under the lateral malleolus on the sagittal plane. Electrodes were positioned under the arch of the foot and electrical stimulation (ES) parameters (five 500 µs/phase charge-balanced biphasic pulses delivered at 200 Hz, repeated four times at 10 Hz) adjusted to deliver a sensitive signal. Online IMU signal was processed in order to trigger ES at heel off detection. Starting from a quiet standing posture, subjects were asked to walk at their preferred speed on a path including 5 m straight line, u-turn, and walk around tasks. Three situations were considered: no stimulation baseline precondition (C0), ES condition (C1), and no stimulation baseline post-condition (C0bis), for eliminating a learning effect possibility. In ES condition (C1) the time to execute the different tasks was globally decreased in all the subjects (n = 13). Participants' results were then grouped regarding whether they experienced freezing of gait (FOG) or not during C0 no stimulation baseline precondition. In "freezer" subjects (n = 9), the time to complete the entire path was reduced by 19%. FOG episodes occurrence was decreased by 12% compared to baseline conditions. This preliminary work showed a positive global effect on gait and FOG in PD by a somatosensory cueing based on sensitive electrical stimulation.
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Affiliation(s)
| | | | - David Andreu
- Inria - Université de Montpellier, Montpellier, France
| | - Claudia Verna
- Service de Neurologie, CHU Montpellier Hospital, Montpellier, France
| | - Christian Geny
- Service de Neurologie, CHU Montpellier Hospital, Montpellier, France
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15
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Chen L, Chen J, Peng Q, Chen J, Zou Y, Liu G. Effect of Sling Exercise Training on Balance in Patients with Stroke: A Meta-Analysis. PLoS One 2016; 11:e0163351. [PMID: 27727288 PMCID: PMC5058486 DOI: 10.1371/journal.pone.0163351] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 09/07/2016] [Indexed: 11/18/2022] Open
Abstract
Objective This study aims to evaluate the effect of sling exercise training (SET) on balance in patients with stroke. Methods PubMed, Cochrane Library, Ovid LWW, CBM, CNKI, WanFang, and VIP databases were searched for randomized controlled trials of the effect of SET on balance in patients with stroke. The study design and participants were subjected to metrological analysis. Berg balance Scale (BBS), Barthel index score (BI), and Fugl-Meyer Assessment (FMA) were used as independent parameters for evaluating balance function, activities of daily living(ADL) and motor function after stroke respectively, and were subjected to meta-analysis by RevMan5.3 software. Results Nine studies with 460 participants were analyzed. Results of meta-analysis showed that the SET treatment combined with conventional rehabilitation was superior to conventional rehabilitation treatments, with increased degrees of BBS (WMD = 3.81, 95% CI [0.15, 7.48], P = 0.04), BI (WMD = 12.98, 95% CI [8.39, 17.56], P < 0.00001), and FMA (SMD = 0.76, 95% CI [0.41, 1.11], P < 0.0001). Conclusion Based on limited evidence from 9 trials, the SET treatment combined with conventional rehabilitation was superior to conventional rehabilitation treatments, with increased degrees of BBS, BI and FMA, So the SET treatment can improvement of balance function after stroke, but the interpretation of our findings is required to be made with caution due to limitations in included trials such as small sample sizes and the risk of bias. Therefore, more multi-center and large-sampled randomized controlled trials are needed to confirm its clinical applications.
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Affiliation(s)
- Lianghua Chen
- Department of Rehabilitation medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Junqi Chen
- Department of Rehabilitation medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Qiyuan Peng
- Department of Rehabilitation medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Jingjie Chen
- Department of Rehabilitation medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yucong Zou
- Department of Rehabilitation medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Gang Liu
- Department of Rehabilitation medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- * E-mail:
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16
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Dohle C, Tholen R, Wittenberg H, Quintern J, Saal S, Stephan KM. [Evidence-based rehabilitation of mobility after stroke]. DER NERVENARZT 2016; 87:1062-1067. [PMID: 27531212 DOI: 10.1007/s00115-016-0188-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Approximately two thirds of stroke patients initially suffer from at least impaired mobility. Various rehabilitation concepts have been proposed. OBJECTIVE Based on the current literature, which rehabilitation methods can be recommended for improvement of gait, gait velocity, gait distance and balance? METHODS A systematic literature search was carried out for randomized clinical studies and reviews with clinically relevant outcome variables. Formulation of recommendations, separated for target variables and time after stroke. RESULTS Restoration and improvement of gait function relies on a high number of repetitions of gait movements, which for more severely affected patients is preferentially machine-based. For improvement of gait velocity for less severely affected patients intensive gait training does not necessarily rely on mechanical support. Gait distance can be improved by aerobic endurance exercises with a cardiovascular effect, which have to be performed in a functional context. Improvement of balance should be achieved by intensive functional gait training. Additional stimulation techniques are only effective when included in a functionally relevant training program. DISCUSSION These guidelines not only provide recommendations for action but also provide pathophysiological insights into functional restoration of stance and gait after stroke.
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Affiliation(s)
- C Dohle
- MEDIAN Klinik Berlin-Kladow, Kladower Damm 223, 14089, Berlin, Deutschland. .,Centrum für Schlaganfallforschung, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - R Tholen
- Physio Deutschland - Deutscher Verband für Physiotherapie (ZVK), Köln, Deutschland
| | - H Wittenberg
- St. Mauritius Therapieklinik, Meerbusch, Deutschland
| | - J Quintern
- Medical Park Loipl, Bischofswiesen, Deutschland
| | - S Saal
- Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - K M Stephan
- St. Mauritius Therapieklinik, Meerbusch, Deutschland.,SRH Gesundheitszentrum Bad Wimpfen, Bad Wimpfen, Deutschland
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17
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Sijobert B, Azevedo-Coste C, Andreu D, Verna C, Geny C. Effects of Sensitive Electrical Stimulation Based Cueing in Parkinson's Disease: A Preliminary Study. Eur J Transl Myol 2016; 26:6018. [PMID: 27478565 PMCID: PMC4942708 DOI: 10.4081/ejtm.2016.6018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study aims to investigate the effect of a sensitive cueing on Freezing of Gait (FOG) and gait disorders in subjects suffering from Parkinson's disease (PD). 13 participants with Parkinson's disease were equipped with an electrical stimulator and a foot mounted inertial measurement unit (IMU). An IMU based algorithm triggered in real time an electrical stimulus applied on the arch of foot at heel off detection. Starting from standing, subjects were asked to walk at their preferred speed on a path comprising 5m straight, u-turn and walk around tasks. Cueing globally decreased the time to achieve the different tasks in all the subjects. In "freezer" subjects, the time to complete the entire path was reduced by 19%. FOG events occurrence was lowered by 12% compared to baseline before and after cueing. This preliminary work showed a positive global effect of an electrical stimulation based cueing on gait and FOG in PD.
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Affiliation(s)
- Benoît Sijobert
- INRIA - LIRMM Université de Montpellier , Montpellier, France
| | | | - David Andreu
- INRIA - LIRMM Université de Montpellier , Montpellier, France
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