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Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke.

ABSTRACT: Posture and movement planning, preparation, and execution of a goal-directed reaching movement are impaired in individuals with stroke. No studies have shown whether the deficits are generally impaired or are specific to the lesioned hemisphere/paretic arm. This study utilized StartReact (SR) responses elicited by loud acoustic stimuli (LAS) to investigate the preparation and execution of anticipatory postural adjustments (APAs) and reach movement response during both paretic and nonparetic arm reaching in individuals with stroke and in age-matched healthy controls. Subjects were asked to get ready after receiving a warning cue and to reach at a "go" cue. An LAS was delivered at -500, -200, and 0 ms relative to the go cue. Kinetic, kinematic, and electromyographic data were recorded to characterize APA-reach movement responses. Individuals with stroke demonstrated systemwide deficits in posture and in movement planning, preparation, and execution of APA-reach sequence as shown by significant reduction in the incidence of SR response and impaired APA-reach performance, with greater deficits during paretic arm reaching. Use of trunk compensation strategy as characterized by greater involvement of trunk and pelvic rotation was utilized by individuals with stroke during paretic arm reaching compared with nonparetic arm reaching and healthy controls. Our findings have implications for upper extremity and postural control, suggesting that intervention should include training not only for the paretic arm but also for the nonparetic arm with simultaneous postural control requirements to improve the coordination of the APA-reach performance and subsequently reduce instability while functional tasks are performed during standing. NEW & NOTEWORTHY Our study is the first to show that nonparetic arm reaching also demonstrates impairment in posture and movement planning, preparation, and execution when performed during standing by individuals with stroke. In addition, we found compensatory trunk and pelvic rotations were used during a standing reach task for the paretic arms. The findings have clinical implications for upper extremity and postural rehabilitation, suggesting that training should include the nonparetic arms and incorporate simultaneous postural control demands.

SUBMITTER: Yang CL

PROVIDER: S-EPMC6734070 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke.

Yang Chieh-Ling CL Creath Robert A RA Magder Laurence L Rogers Mark W MW McCombe Waller Sandy S

Journal of neurophysiology 20190220 4

Posture and movement planning, preparation, and execution of a goal-directed reaching movement are impaired in individuals with stroke. No studies have shown whether the deficits are generally impaired or are specific to the lesioned hemisphere/paretic arm. This study utilized StartReact (SR) responses elicited by loud acoustic stimuli (LAS) to investigate the preparation and execution of anticipatory postural adjustments (APAs) and reach movement response during both paretic and nonparetic arm ...[more]

PMID: 30785824

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Project description:Background:A better understanding of the neural changes associated with paresis in stroke patients could have important implications for therapeutic approaches. Dynamic Causal Modeling (DCM) for functional magnetic resonance imaging (fMRI) is commonly used for analyzing effective connectivity patterns of brain networks due to its significant property of modeling neural states behind fMRI signals. We applied this technique to analyze the differences between motor networks (MNW) activated by continuous passive movement (CPM) of paretic and non-paretic ankles in subacute stroke patients. This study aimed to identify CPM induced connectivity characteristics of the primary sensory area (S1) and the differences in extrinsic directed connections of the MNW and to explain the hemodynamic differences of brain regions of MNW. Methods:For the network analysis, we used ten stroke patients' task fMRI data collected under CPMs of both ankles. Regions for the MNW, the primary motor cortex (M1), the premotor cortex (PM), the supplementary motor area (SMA) and the S1 were defined in a data-driven way, by independent component analysis. For the network analysis of both CPMs, we compared twelve models organized into two model-families, depending on the S1 connections and input stimulus modeling. Using DCM, we evaluated the extrinsic connectivity strengths and hemodynamic parameters of both stimulations of all patients. Results:After a statistical comparison of the extrinsic connections and their modulations of the "best model", we concluded that three contralateral self-inhibitions (cM1, cS1 and cSMA), one contralateral inter-regional connection (cSMA?cM1), and one interhemispheric connection (cM1?iM1) were significantly different. Our research shows that hemodynamic parameters can be estimated with the Balloon model using DCM but the parameters do not change with stroke. Conclusions:Our results confirm that the DCM-based connectivity analyses combined with Bayesian model selection may be a useful technique for quantifying the alteration or differences in the characteristics of the motor network in subacute stage stroke patients and in determining the degree of MNW changes.

Project description:This study applied a comprehensive electroencephalography (EEG) analysis for movement-related cortical potentials (MRCPs) and event-related desynchronization (ERD) in order to understand movement-related brain activity changes during movement preparation and execution stage of unilateral wrist extension. Thirty-four healthy subjects completed two event-related potential tests in the same sequence. Unilateral wrist extension was involved in both tests as the movement task. Instruction Response Movement (IRM) was a brisk movement response task with visual "go" signal, while Cued Instruction Response Movement (CIRM) added a visual cue contenting the direction information to create a prolonged motor preparation stage. Recorded EEG data were segmented and averaged to show time domain changes and then transformed into time-frequency mapping to show the time-frequency changes. All components were calculated and compared among C3, Cz, and C4 locations. The motor potential appeared bilaterally in both tests' movement execution stages, and Cz had the largest peak value among the investigated locations (p < 0.01). In CIRM, a contingent negative variation (CNV) component presented bilaterally during the movement preparation stage with the largest amplitude at Cz. ERD of the mu rhythm (mu ERD) presented bilateral sensorimotor cortices during movement execution stages in both tests and was the smallest at Cz among the investigated locations. In the movement preparation stage of CIRM, mu ERD presented mainly in the contralateral sensory motor cortex area (C3 and C4 for right and left wrist movements, respectively) and showed significant differences between different locations. EEG changes in the time and time-frequency domains showed different topographical features. Movement execution was controlled bilaterally, while movement preparation was controlled mainly by contralateral sensorimotor cortices. Mu ERD was found to have stronger contra-lateralization features in the movement preparation stage and might be a better indicator for detecting movement intentions. This information could be helpful and might provide comprehensive information for studying movement disorders (such as those in post-stroke hemiplegic patients) or for facilitating the development of neuro-rehabilitation engineering technology such as brain computer interface.

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Project description:Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions. The so called "mirror neuron system" has been proposed to be responsible for this phenomenon. We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control. In our new neurorehabilitative schema (videotherapy) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs. Following a pilot study in chronic patients in an ambulatory setting, we currently designed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training. Within our protocol we assess 1) the capability of action observation to elicit rehabilitational effects in the motor system, and 2) the capacity of this schema to be performed by patients without assistance from a physiotherapist. The results of this study would be of high health and economical relevance.A controlled, randomized, multicenter, paralleled, 6?month follow-up study will be conducted on three groups of patients: one group will be given the experimental treatment whereas the other two will participate in control treatments. All patients will undergo their usual rehabilitative treatment beside participation in the study. The experimental condition consists in the observation and immediate imitation of common daily hand and arm actions. The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment. Trial randomization is provided via external data management. The primary efficacy endpoint is the improvement of the experimental group in a standardized motor function test (Wolf Motor Function Test) relative to control groups. Further assessments refer to subjective and qualitative rehabilitational scores. This study has been reviewed and approved by the ethics committee of Aachen University.This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice, for example as an ad on and individualized therapy.

Dataset Information

Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke.

Publications

Impaired posture, movement preparation, and execution during both paretic and nonparetic reaching following stroke.

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