Neurorehabilitation and Neural Repair最新文献

{"title":"Grasp Analysis in the Home Environment as a Measure of Hand Function After Cervical Spinal Cord Injury.","authors":"Mehdy Dousty,&nbsp;Andrea Bandini,&nbsp;Parvin Eftekhar,&nbsp;David J Fleet,&nbsp;José Zariffa","doi":"10.1177/15459683231177601","DOIUrl":"https://doi.org/10.1177/15459683231177601","url":null,"abstract":"<p><strong>Background: </strong>Following a spinal cord injury, regaining hand function is a top priority. Current hand assessments are conducted in clinics, which may not fully represent real-world hand function. Grasp strategies used in the home environment are an important consideration when examining the impact of rehabilitation interventions.</p><p><strong>Objective: </strong>The main objective of this study is to investigate the relationship between grasp use at home and clinical scores.</p><p><strong>Method: </strong>We used a previously collected dataset in which 21 individuals with spinal cord injuries (SCI) recorded egocentric video while performing activities of daily living in their homes. We manually annotated 4432 hand-object interactions into power, precision, intermediate, and non-prehensile grasps. We examined the distributions of grasp types used and their relationships with clinical assessments.</p><p><strong>Results: </strong>Moderate to strong correlations were obtained between reliance on power grasp and the Spinal Cord Independence Measure III (SCIM; <i>P</i> < .05), the upper extremity motor score (UEMS; <i>P</i> < .01), and the Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) Prehension (<i>P</i> < .01) and Strength (<i>P</i> < .01). Negative correlations were observed between the proportion of non-prehensile grasping and SCIM (<i>P</i> < .05), UEMS (<i>P</i> < .05), and GRASSP Prehension (<i>P</i> < .01) and Strength (<i>P</i> < .01).</p><p><strong>Conclusion: </strong>The types of grasp types used in naturalistic activities at home are related to upper limb impairment after cervical SCI. This study provides the first direct demonstration of the importance of hand grasp analysis in the home environment.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 7","pages":"466-474"},"PeriodicalIF":4.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/01/10.1177_15459683231177601.PMC10350692.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9885208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Dynamic Resting State Functional Connectivity Associated With Somatosensory Impairments in the Upper Limb in the Early Sub-Acute Phase Post-Stroke.","authors":"Nele De Bruyn,&nbsp;Anna K Bonkhoff,&nbsp;Leen Saenen,&nbsp;Liselot Thijs,&nbsp;Bea Essers,&nbsp;Kaat Alaerts,&nbsp;Geert Verheyden","doi":"10.1177/15459683231179172","DOIUrl":"https://doi.org/10.1177/15459683231179172","url":null,"abstract":"<p><strong>Background.: </strong>Altered dynamic functional connectivity has been associated with motor impairments in the acute phase post-stroke. Its association with somatosensory impairments in the early sub-acute phase remains unexplored.</p><p><strong>Objective.: </strong>To investigate altered dynamic functional connectivity associated with somatosensory impairments in the early sub-acute phase post-stroke.</p><p><strong>Methods.: </strong>We collected resting state magnetic resonance imaging and clinical somatosensory function of the upper limb of 20 subacute stroke patients and 16 healthy controls (HC). A sliding-window approach was used to identify 3 connectivity states based on the estimated dynamic functional connectivity of sensorimotor related networks. Network components were subdivided into 3 domains: cortical and subcortical sensorimotor, as well as cognitive control network. Between-group differences were investigated using independent <i>t</i>-tests and Mann-Whitney-<i>U</i> tests. Analyzes were performed with correction for age, head motion and time post-stroke and corrected for multiple comparisons.</p><p><strong>Results.: </strong>Stroke patients spent significantly less time in a weakly connected network state (state 3; dwell time: <i>p</i>_state3 = 0.003, mean_stroke = 53.02, SD_stroke = 53.13; mean_HC = 118.92, SD_HC = 72.84), and stayed shorter but more time intervals in a highly connected intra-domain network state (state 1; fraction time: <i>p</i>_{state 1} < 0.001, mean_stroke = 0.46, SD_stroke = 0.26; mean_HC = 0.26, SD_HC = 0.21) compared to HC. After 8 weeks of therapy, improvements in wrist proprioception were moderately associated with decreases in dwell and fraction times toward a more normalized pattern.</p><p><strong>Conclusion.: </strong>Changes in temporal properties of large-scale network interactions are present in the early rehabilitation phase post-stroke and could indicate enhanced neural plasticity. These findings could augment the understanding of cerebral reorganization after loss of neural tissue specialized in somatosensory functions.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 7","pages":"423-433"},"PeriodicalIF":4.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does a Cognitive Network Contribute to Motor Recovery After Ischemic Stroke?","authors":"Jungsoo Lee,&nbsp;Yun-Hee Kim","doi":"10.1177/15459683231177604","DOIUrl":"https://doi.org/10.1177/15459683231177604","url":null,"abstract":"<p><strong>Background: </strong>In stroke patients, preserved cognitive function plays a role in motor recovery, but there is insufficient evidence on the involved mechanisms. These mechanisms require investigation in the human brain, which is composed of large-scale functionally specialized networks.</p><p><strong>Objective: </strong>In this study, we investigated the role of cognition-related networks on upper extremity motor recovery using neuroimaging data of subacute stroke patients.</p><p><strong>Methods: </strong>This study retrospectively analyzed cohort data of 108 subacute ischemic stroke patients. All patients underwent resting-state functional MRI and motor function assessments using the Fugl-Meyer assessment (FMA) at 2 weeks after stroke onset. The FMA upper extremity (FMA-UE) score was obtained again at three months after stroke onset to assess motor recovery. To construct a resting-state network, cortical surface parcellation was performed using the Gordon atlas, which included 333 regions of interest, and 12 resting-state networks were extracted. Linear regression was used to identify the relationships between the FMA-UE recovery score and resting-state networks.</p><p><strong>Results: </strong>Cognition-related networks were correlated with the FMA-UE recovery score, as were motor-related networks. Interaction effects between motor- and cognition-related network states existed in motor recovery. Specifically, cognition-related networks were associated with motor recovery in patients with a lower strength of motor-related networks.</p><p><strong>Conclusions: </strong>These results suggested that the greater the damage to the motor network caused by stroke is, the more important the cognition-related networks are in motor recovery.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 7","pages":"458-465"},"PeriodicalIF":4.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9786492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Dual-Task Gait Cost and White Matter Hyperintensity Burden Poststroke: Results From the ONDRI.","authors":"Frederico Pieruccini-Faria,&nbsp;Benjamin Cornish,&nbsp;Malcolm Binns,&nbsp;Julia Fraser,&nbsp;Seyyed M H Haddad,&nbsp;Kelly Sunderland,&nbsp;Joel Ramirez,&nbsp;Derek Beaton,&nbsp;Donna Kwan,&nbsp;Allison A Dilliott,&nbsp;Christopher Scott,&nbsp;Yanina Sarquis-Adamson,&nbsp;Alanna Black,&nbsp;Karen Van Ooteghem,&nbsp;Leanne Casaubon,&nbsp;Dar Dowlatshahi,&nbsp;Ayman Hassan,&nbsp;Jennifer Mandzia,&nbsp;Demetrios Sahlas,&nbsp;Gustavo Saposnik,&nbsp;Brian Tan,&nbsp;Robert Hegele,&nbsp;Dennis Bulman,&nbsp;Mahdi Ghani,&nbsp;John Robinson,&nbsp;Ekaterina Rogaeva,&nbsp;Sali Farhan,&nbsp;Sean Symons,&nbsp;Nuwan Nanayakkara,&nbsp;Stephen R Arnott,&nbsp;Courtney Berezuk,&nbsp;Melissa Holmes,&nbsp;Sabrina Adamo,&nbsp;Miracle Ozzoude,&nbsp;Mojdeh Zamyadi,&nbsp;Wendy Lou,&nbsp;Sujeevini Sujanthan,&nbsp;Robert Bartha,&nbsp;Sandra E Black,&nbsp;Richard H Swartz,&nbsp;William McIlroy,&nbsp;Manuel Montero-Odasso","doi":"10.1177/15459683231177606","DOIUrl":"https://doi.org/10.1177/15459683231177606","url":null,"abstract":"<p><strong>Background: </strong>Acute change in gait speed while performing a mental task [dual-task gait cost (DTC)], and hyperintensity magnetic resonance imaging signals in white matter are both important disability predictors in older individuals with history of stroke (poststroke). It is still unclear, however, whether DTC is associated with overall hyperintensity volume from specific major brain regions in poststroke.</p><p><strong>Methods: </strong>This is a cohort study with a total of 123 older (69 ± 7 years of age) participants with history of stroke were included from the Ontario Neurodegenerative Disease Research Initiative. Participants were clinically assessed and had gait performance assessed under single- and dual-task conditions. Structural neuroimaging data were analyzed to measure both, white matter hyperintensity (WMH) and normal appearing volumes. Percentage of WMH volume in frontal, parietal, occipital, and temporal lobes as well as subcortical hyperintensities in basal ganglia + thalamus were the main outcomes. Multivariate models investigated associations between DTC and hyperintensity volumes, adjusted for age, sex, years of education, global cognition, vascular risk factors, APOE4 genotype, residual sensorimotor symptoms from previous stroke and brain volume.</p><p><strong>Results: </strong>There was a significant positive global linear association between DTC and hyperintensity burden (adjusted Wilks' λ = .87, <i>P</i> = .01). Amongst all WMH volumes, hyperintensity burden from basal ganglia + thalamus provided the most significant contribution to the global association (adjusted β = .008, η² = .03; <i>P</i> = .04), independently of brain atrophy.</p><p><strong>Conclusions: </strong>In poststroke, increased DTC may be an indicator of larger white matter damages, specifically in subcortical regions, which can potentially affect the overall cognitive processing and decrease gait automaticity by increasing the cortical control over patients' locomotion.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 7","pages":"434-443"},"PeriodicalIF":4.2,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10350733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10188472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motor Activated Auricular Vagus Nerve Stimulation as a Potential Neuromodulation Approach for Post-Stroke Motor Rehabilitation: A Pilot Study.","authors":"Bashar W Badran, Xiaolong Peng, Brenna Baker-Vogel, Scott Hutchison, Patricia Finetto, Kelly Rishe, Andrew Fortune, Ellen Kitchens, Georgia H O'Leary, Abigail Short, Christian Finetto, Michelle L Woodbury, Steve Kautz","doi":"10.1177/15459683231173357","DOIUrl":"10.1177/15459683231173357","url":null,"abstract":"<p><strong>Background: </strong>Implanted vagus nerve stimulation (VNS), when synchronized with post-stroke motor rehabilitation improves conventional motor rehabilitation training. A non-invasive VNS method known as transcutaneous auricular vagus nerves stimulation (taVNS) has emerged, which may mimic the effects of implanted VNS.</p><p><strong>Objective: </strong>To determine whether taVNS paired with motor rehabilitation improves post-stroke motor function, and whether synchronization with movement and amount of stimulation is critical to outcomes.</p><p><strong>Methods: </strong>We developed a closed-loop taVNS system for motor rehabilitation called motor activated auricular vagus nerve stimulation (MAAVNS) and conducted a randomized, double-blind, pilot trial investigating the use of MAAVNS to improve upper limb function in 20 stroke survivors. Participants attended 12 rehabilitation sessions over 4-weeks, and were assigned to a group that received either MAAVNS or active unpaired taVNS concurrently with task-specific training. Motor assessments were conducted at baseline, and weekly during rehabilitation training. Stimulation pulses were counted for both groups.</p><p><strong>Results: </strong>A total of 16 individuals completed the trial, and both MAAVNS (n = 9) and unpaired taVNS (n = 7) demonstrated improved Fugl-Meyer Assessment upper extremity scores (Mean ± SEM, MAAVNS: 5.00 ± 1.02, unpaired taVNS: 3.14 ± 0.63). MAAVNS demonstrated greater effect size (Cohen's <i>d</i> = 0.63) compared to unpaired taVNS (Cohen's <i>d</i> = 0.30). Furthermore, MAAVNS participants received significantly fewer stimulation pulses (Mean ± SEM, MAAVNS: 36 070 ± 3205) than the fixed 45 000 pulses unpaired taVNS participants received (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>This trial suggests stimulation timing likely matters, and that pairing taVNS with movements may be superior to an unpaired approach. Additionally, MAAVNS effect size is comparable to that of the implanted VNS approach.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 6","pages":"374-383"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10363288/pdf/nihms-1893293.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9845131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurotechnology's Prospects for Bringing About Meaningful Reductions in Neurological Impairment.","authors":"David Putrino,&nbsp;John W Krakauer","doi":"10.1177/15459683221137341","DOIUrl":"https://doi.org/10.1177/15459683221137341","url":null,"abstract":"<p><p>Here we report and comment on the magnitudes of post-stroke impairment reduction currently observed using new neurotechnologies. We argue that neurotechnology's best use case is impairment reduction as this is neither the primary strength nor main goal of conventional rehabilitation, which is better at targeting the activity and participation levels of the ICF. The neurotechnologies discussed here can be divided into those that seek to be adjuncts for enhancing conventional rehabilitation, and those that seek to introduce a novel behavioral intervention altogether. Examples of the former include invasive and non-invasive brain stimulation. Examples of the latter include robotics and some forms of serious gaming. We argue that motor learning and training-related recovery are conceptually and mechanistically distinct. Based on our survey of recent results, we conclude that large reductions in impairment will need to begin with novel forms of high dose and high intensity behavioral intervention that are qualitatively different to conventional rehabilitation. Adjunct forms of neurotechnology, if they are going to be effective, will need to piggyback on these new behavioral interventions.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 6","pages":"356-366"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9731174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Special Issue: Novel Technologies for Recovery after Neurological Injuries.","authors":"Steven Zeiler,&nbsp;Randolph J Nudo","doi":"10.1177/15459683231186235","DOIUrl":"https://doi.org/10.1177/15459683231186235","url":null,"abstract":"This Special Issue provides a glimpse into the burgeoning and exciting field that pairs technology with neurorehabilitation. We wanted to provide an overview of the novel measurements, interventions, and future that such a pairing is meant to accomplish. In the first paper in this special issue, Putrino and Krakauer survey technology-based approaches and their efficacy in reducing impairment in neurological conditions. They argue that neurotechnology is uniquely suited for impairment reduction as compared to conventional rehabilitation, which focuses primarily on activity and participation. They also argue that technology will best accomplish this goal when it is used to develop new behavioral interventions and not just adjuvants for regular rehabilitation. For this project to succeed, they maintain that neuroscience must be in the driver’s seat, not engineering. Two of the papers focus on vagus nerve stimulation (VNS), a rapidly emerging modality that targets neuroplasticity mechanisms and is typically paired with rehabilitation interventions. Dawson and colleagues explore why participants in clinical stroke trials might differ in their response to VNS therapy. They found that outcomes were similar across subgroups varying by age, sex, impairment level, severity, time after stroke, stroke location and paretic side. This suggests that VNS effects are consistent across a wide range of stroke survivors. In the next paper, in an attempt to provide a less-invasive form of VNS, Badran and colleagues tested the effects of transcutaneous auricular VNS in a cohort of participants after stroke. The unique aspect of their approach is that stimulation was synchronized with movement during motor rehabilitation using an approach called motor activated auricular vagus nerve stimulation. They found that synchronized stimulation resulted in greater improvement on the Fugl-Meyer Assessment compared with unpaired stimulation despite the reduced number of stimulation pulses required. Thus, while VNS is an important new adjuvant to rehabilitation, stimulation timing matters. In an invasive approach in a rat model of focal traumatic brain injury, Guggenmos and colleagues explore the therapeutic window of activity-dependent stimulation (ADS). ADS utilizes the timing of action potentials in one cortical area to trigger stimulation pulses in another cortical area, driving greater efficacy in cortico-cortical communication. They found persistent improvement in motor skill when ADS was introduced up to 3 weeks post-injury. This study demonstrates that while this approach is still restricted to laboratory animals, it might be implemented in a clinically relevant time frame, and does not require pairing with specific rehabilitative training. Finally, Ganguly and colleagues explore new ways to characterize hand and arm kinematics using electromagnetic orientation sensors implemented in a custom glove, a significant improvement on optical approaches particularly for object in","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 6","pages":"355"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Broad Therapeutic Time Window for Driving Motor Recovery After TBI Using Activity-Dependent Stimulation.","authors":"Heather M Hudson, David J Guggenmos, Meysam Azin, Nicholas Vitale, Katelyn A McKenzie, Jonathan D Mahnken, Pedram Mohseni, Randolph J Nudo","doi":"10.1177/15459683221145144","DOIUrl":"10.1177/15459683221145144","url":null,"abstract":"<p><strong>Background: </strong>After an acquired injury to the motor cortex, the ability to generate skilled movements is impaired, leading to long-term motor impairment and disability. While rehabilitative therapy can improve outcomes in some individuals, there are no treatments currently available that are able to fully restore lost function.</p><p><strong>Objective: </strong>We previously used activity-dependent stimulation (ADS), initiated immediately after an injury, to drive motor recovery. The objective of this study was to determine if delayed application of ADS would still lead to recovery and if the recovery would persist after treatment was stopped.</p><p><strong>Methods: </strong>Rats received a controlled cortical impact over primary motor cortex, microelectrode arrays were implanted in ipsilesional premotor and somatosensory areas, and a custom brain-machine interface was attached to perform the ADS. Stimulation was initiated either 1, 2, or 3 weeks after injury and delivered constantly over a 4-week period. An additional group was monitored for 8 weeks after terminating ADS to assess persistence of effect. Results were compared to rats receiving no stimulation.</p><p><strong>Results: </strong>ADS was delayed up to 3 weeks from injury onset and still resulted in significant motor recovery, with maximal recovery occurring in the 1-week delay group. The improvements in motor performance persisted for at least 8 weeks following the end of treatment.</p><p><strong>Conclusions: </strong>ADS is an effective method to treat motor impairments following acquired brain injury in rats. This study demonstrates the clinical relevance of this technique as it could be initiated in the post-acute period and could be explanted/ceased once recovery has occurred.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 6","pages":"384-393"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9787814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vagus Nerve Stimulation Paired With Rehabilitation for Upper Limb Motor Impairment and Function After Chronic Ischemic Stroke: Subgroup Analysis of the Randomized, Blinded, Pivotal, VNS-REHAB Device Trial.","authors":"Jesse Dawson,&nbsp;Navzer D Engineer,&nbsp;Steven C Cramer,&nbsp;Steven L Wolf,&nbsp;Rushna Ali,&nbsp;Michael W O'Dell,&nbsp;David Pierce,&nbsp;Cecília N Prudente,&nbsp;Jessica Redgrave,&nbsp;Wuwei Feng,&nbsp;Charles Y Liu,&nbsp;Gerard E Francisco,&nbsp;Benjamin L Brown,&nbsp;Anand Dixit,&nbsp;Jen Alexander,&nbsp;Louis DeMark,&nbsp;Vibor Krishna,&nbsp;Steven A Kautz,&nbsp;Arshad Majid,&nbsp;Brent Tarver,&nbsp;Duncan L Turner,&nbsp;Teresa J Kimberley","doi":"10.1177/15459683221129274","DOIUrl":"https://doi.org/10.1177/15459683221129274","url":null,"abstract":"<p><strong>Background: </strong>Vagus Nerve Stimulation (VNS) paired with rehabilitation improved upper extremity impairment and function in a recent pivotal, randomized, triple-blind, sham-controlled trial in people with chronic arm weakness after stroke.</p><p><strong>Objective: </strong>We aimed to determine whether treatment effects varied across candidate subgroups, such as younger age or less injury.</p><p><strong>Methods: </strong>Participants were randomized to receive rehabilitation paired with active VNS or rehabilitation paired with sham stimulation (Control). The primary outcome was the change in impairment measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE) score on the first day after completion of 6-weeks in-clinic therapy. We explored the effect of VNS treatment by sex, age (≥62 years), time from stroke (>2 years), severity (baseline FMA-UE score >34), paretic side of body, country of enrollment (USA vs UK) and presence of cortical involvement of the index infarction. We assessed whether there was any interaction with treatment.</p><p><strong>Findings: </strong>The primary outcome increased by 5.0 points (SD 4.4) in the VNS group and by 2.4 points (SD 3.8) in the Control group (<i>P</i> = .001, between group difference 2.6, 95% CI 1.03-4.2). The between group difference was similar across all subgroups and there were no significant treatment interactions. There was no important difference in rates of adverse events across subgroups.</p><p><strong>Conclusion: </strong>The response was similar across subgroups examined. The findings suggest that the effects of paired VNS observed in the VNS-REHAB trial are likely to be consistent in wide range of stroke survivors with moderate to severe upper extremity impairment.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 6","pages":"367-373"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10097830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9750616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Arm and Hand Joint Kinematics to Estimate Impairment During a Functional Reach and Grasp Task after Stroke.","authors":"Preeya Khanna, Tomas Oppenheim, Adelyn Tu-Chan, Gary Abrams, Karunesh Ganguly","doi":"10.1177/15459683231179173","DOIUrl":"10.1177/15459683231179173","url":null,"abstract":"<p><strong>Background: </strong>Current approaches to characterizing deficits in upper limb movements after stroke typically focus either on changes in a functional measure, for example, how well a patient can complete a task, or changes in impairment, for example, isolated measurements of joint range of motion. However, there can be notable dissociations between static measures of impairment versus those of function.</p><p><strong>Objective: </strong>We develop a method to measure upper limb joint angles during performance of a functional task and use measurements to characterize joint impairment in the context of a functional task.</p><p><strong>Methods: </strong>We developed a sensorized glove that can precisely measure select finger, hand, and arm joints while participants complete a functional reach-to-grasp task involving manipulation of a sensorized object.</p><p><strong>Results: </strong>We first characterized the accuracy and precision of the glove's joint angle measurements. We then measured joint angles in neurologically intact participants (n = 4 participants, 8 limbs) to define the expected distribution of joint angle variation during task execution. These distributions were used to normalize finger, hand, and arm joint angles in stroke participants (n = 6) as they performed the task. We present a participant-specific visualization of functional joint angle variance which illustrated that stroke participants with nearly identical clinical scores exhibited unique patterns of joint angle variation.</p><p><strong>Conclusions: </strong>Overall, measuring individual joint angles in the context of a functional task may inform whether changes in functional scores over recovery or rehabilitation are driven by changes in impairment or the development of compensatory strategies, and provide a quantified path toward personalized rehabilitative therapy.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 6","pages":"409-417"},"PeriodicalIF":4.2,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10330436/pdf/nihms-1901349.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9769254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}