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Sensorimotor training and neural reorganization after stroke: a case series.

ABSTRACT: Impaired hand function decreases quality of life after stroke. The purpose of this study was to pilot a novel 2-week upper extremity sensorimotor training program. This case series describes the training program and highlights outcome measures used for documenting behavioral change and neural reorganization.Behavioral/performance changes were identified via sensorimotor evaluation. Activity-induced neural reorganization was examined using sensory functional magnetic resonance imaging, diffusion tensor tractography, and brain volume measurement. Participant 1 was a 75-year-old right-handed man 1 year post-right hemisphere stroke, with severe sensory impairment across domains in his left hand; he reported limited left-hand/arm use. Participant 2 was a 63-year-old right-handed woman who had experienced a left hemisphere stroke 9 months earlier, resulting in mild sensory impairment across domains in her right hand, as well as mild motor deficit.Participants were trained 4 hours per day, 5 days per week for 2 weeks. Training tasks required sensory discrimination of temperature, weights, textures, shapes, and objects in the context of active exploration with the involved hand. Random multimodal feedback was used.Both participants had improved scores on the Wolf Motor Function Test after training. Participant 1 had no measurable change in sensory function, while participant 2 improved in touch perception, proprioception, and haptic performance. Sensory functional magnetic resonance imaging suggested neural reorganization in both participants; participant 1 had a small increase in brain volume, while superior thalamic radiation white matter connectivity was unchanged in either participant.Participating in sensorimotor training focused on sensory discrimination during manual manipulation was feasible for both participants. Future research to determine efficacy and identify optimal measures of sensory function and neural reorganization is recommended.(see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A38) for more insights from the authors.

SUBMITTER: Borstad AL

PROVIDER: S-EPMC3726277 | biostudies-literature | 2013 Mar

REPOSITORIES: biostudies-literature

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Sensorimotor training and neural reorganization after stroke: a case series.

Borstad Alexandra L AL Bird Travis T Choi Seongjin S Goodman Lindsay L Schmalbrock Petra P Nichols-Larsen Deborah S DS

Journal of neurologic physical therapy : JNPT 20130301 1

<h4>Background and purpose</h4>Impaired hand function decreases quality of life after stroke. The purpose of this study was to pilot a novel 2-week upper extremity sensorimotor training program. This case series describes the training program and highlights outcome measures used for documenting behavioral change and neural reorganization.<h4>Case description</h4>Behavioral/performance changes were identified via sensorimotor evaluation. Activity-induced neural reorganization was examined using s ...[more]

PMID: 23399924

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Project description:The quality of arm movements typically improves in the sub-acute phase of stroke affecting the upper extremity. Here, we used whole arm kinematic analysis during reaching movements to distinguish whether these improvements are due to true recovery or to compensation. Fifty-three participants with post-acute stroke performed ∼80 reaching movement tests during 4 weeks of training with the ArmeoSpring exoskeleton. All participants showed improvements in end-effector performance, as measured by movement smoothness. Four ArmeoSpring angles, shoulder horizontal (SH) rotation, shoulder elevation (SE), elbow rotation, and forearm rotation, were recorded and analyzed. We first characterized healthy joint coordination patterns by performing a sparse principal component analysis on these four joint velocities recorded during reaching tests performed by young control participants. We found that two dominant joint correlations [SH with elbow rotation and SE with forearm rotation] explained over 95% of variance of joint velocity data. We identified two clusters of stroke participants by comparing the evolution of these two correlations in all tests. In the "Recoverer" cluster (N = 19), both joint correlations converged toward the respective correlations for control participants. Thus, Recoverers relearned how to generate smooth end-effector movements while developing joint movement patterns similar to those of control participants. In the "Compensator" cluster (N = 34), at least one of the two joint correlations diverged from the corresponding correlation of control participants. Compensators relearned how to generate smooth end-effector movements by discovering various new compensatory movement patterns dissimilar to those of control participants. New compensatory patterns included atypical decoupling of the SE and forearm joints, and atypical coupling of the SH rotation and elbow joints. There was no difference in clinical impairment level between the two groups either at the onset or at the end of training as assessed with the Upper Extremity Fugl-Meyer scale. However, at the start of training, the Recoverers showed significantly faster improvements in end-effector movement smoothness than the Compensators. Our analysis can be used to inform neurorehabilitation clinicians on how to provide movement feedback during practice and suggest avenues for refining exoskeleton robot therapy to reduce compensatory patterns.

Project description:BackgroundMotor dysfunction in the upper extremities after stroke prohibits people with stroke from being independent in daily living. The application of fNIRS to explore brain activity under rehabilitation intervention is a research focus on neurorehabilitation.ObjectiveThe purpose of this study was to explore, using a grip-release ring motor task, the activated changes of regions of interest and changes in motor function utilizing fNIRS technology and test scales on persons with stroke who received unilateral task-oriented therapy with a hand orthosis in the early subacute stroke period before and after intervention. The study aimed to find a sensitive motor task and region of interest first, then to evaluate the feasibility and mechanism of this rehabilitation method by utilizing fNIRS technology in the next randomized controlled trial.MethodsIn this case series, eight right-handed, right hemiplegia subacute stroke persons (6 males,2 females from age 47 to 72) were enrolled. They received 30 min of unilateral task-oriented therapy without orthosis and 30 min of unilateral task-oriented therapy with orthosis (5 days/week) for 4 weeks. Activated channel numbers and beta values based on oxygenated hemoglobin concentration change using a grip-release ring motor task were estimated with fNIRS. Clinical outcome measures, including grip strength evaluation, action research arm test, and Fugl-Meyer assessment of the arm, were evaluated at the same time.ResultsIndividual activation analysis showed that, after intervention, Subjects 1, 2, 6, 7, and 8 had the maximum mean beta value located in the left premotor cortex, while Subjects 4 and 5 had the maximum mean beta value located in the left sensorimotor cortex. The activation analysis of Subject 3 showed the maximum mean beta value located in the right premotor cortex. Deactivations of left sensorimotor cortex, left premotor cortex, and bilateral prefrontal cortex were observed after intervention which were different from other cases. Group activation analysis showed that bilateral cerebral hemispheres were activated in all eight participants, with right hemisphere and right supplementary motor cortex activated dominantly. After the intervention, the activation of bilateral hemispheres decreased but in different brain regions; there was a trend that the activation intensity of left sensorimotor cortex, right premotor cortex, and right prefrontal cortex decreased while activation intensity of left premotor cortex and left prefrontal cortex increased. Each participant demonstrated improvements in all the clinical test scales after intervention.ConclusionsLeft premotor cortex, left sensorimotor cortex, and right supplementary motor cortex may be the primary regions of interest. Grasp-release ring task was not appropriate to achieve our fNIRS research objective and a more sensitive motor task or more sensitive evaluating indicator should be used in further studies.

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Sensorimotor training and neural reorganization after stroke: a case series.

Publications

Sensorimotor training and neural reorganization after stroke: a case series.

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