BOLD fMRI signal in stroke patients and its importance for prognosis in the subacute disease period – Preliminary report

Functional magnetic resonance imaging (fMRI) allows for the assessment of neuronal activity through the blood-level-dependent signal. The purpose of study was to evaluate the pattern of brain activity in fMRI in patients with ischemic stroke and to assess the potential relationship between the activity pattern and the neurological/functional status. Methods The fMRI was performed in patients up to 4th day of stroke. All the patients were analyzed according to NIHSS on 1st day and mRankin scale on 14th day of stroke, followed by analyzing of fMRI signal. Results The study enrolled 13 patients at a mean age of 64.3years. Eight (61.5%) showed cerebellar activation and 2 (15.38%)- insular activation. In those who scored 0–2 on mRankin scale, the most frequently observed activity was located in the regions: the M1, SMA and PMC in the stroke hemisphere and the cerebellum. In those cases, the non-stroke hemisphere was more frequently involved in the areas: the M1 and PMC. There was a tendency for a better prognosis in relation to age <65years and activation of the SMA in the stroke hemisphere. Conclusion There are differences observed in the activation areas of the cerebral cortex both in the stroke and non-stroke hemispheres. More than half of the patients with hemispheric stroke but all with good outcome showed cerebellar activation. There is probable positive correlation between the BOLD-signal size, young age, activation of supplementary motor area in stroke hemisphere and good functional status of patients in the subacute period of stroke

Analysis of Ankle sEMG on Both Stable and Unstable Surfaces for Elderly and Young Women—A Pilot Study

Body aging is frequently accompanied with numerous consequences such as increased tendency to falls, which may be connected not only with the impaired ability of keeping balance, but also with some limitations of the system responsible for the maintenance of balance. The aim of this study was defining the importance of muscle activity in the ankle joint when standing on stable and unstable surfaces with eyes open and closed as well as examining indications of the influence of body aging on the activity of the selected muscles. The study was carried out on a group of 20 healthy women divided into two age groups (aged 24 ± 3.6 years and aged 64 ± 4.2 years). The activity of muscles stabilizing the ankle joint while standing on different types of surfaces was tested with an EMG (surface electromyography) on both elderly and young women during trials with open and closed eyes. The tests showed higher activation in the evaluated muscles of the anterior group (tibialis anterior (TA), peroneus longus (PL)) of elderly women. For the posterior shin muscles of both groups, a higher activation was observed in the gastrocnemius lateralis muscle (GL) of elderly women, whereas gastrocnemius medialis muscle (GM) showed highly comparable activity. The results obtained in this work confirm the importance of proprioception training and muscle strength in the rehabilitation of older people as well as in prophylactic exercise aimed toward the prevention of ankle injuries

Kontynuacja rehabilitacji po udarze mózgu w domu według modelu EHSD

The growing costs of health care have enforced managers to look for new solutions of services which could enable them to reduce the costs of treatment. During recent years a promising alternative to conventional institutional post-stroke rehabilitation has appeared. Early Home Supported Discharge (EHSD) consists of many elements of the modern strategy of rehabilitation. It realizes the idea of early rehabilitation, its continuation after discharge from hospital, and for the first: social integration – participation. Many authors have published extended studies demonstrating the significant effect on poor final outcomes and the length of hospitalization. In 2006 these results were elaborated in a HTA of EHSD where the extra ‘H’ specifies that this intervention has to be delivered at the domicile of the patient. The HTA concludes that EHSD is a dominant intervention in comparison with conventional stroke unit rehabilitation. The biggest benefits of this model have been noticed in those survivals who displayed a middle-moderate level of disability. In this review article the contemporary state of art with regard to the post-stroke model of Early Home Supported Discharge is presented

Analysis of Ankle sEMG on Both Stable and Unstable Surfaces for Elderly and Young Women—A Pilot Study

Body aging is frequently accompanied with numerous consequences such as increased tendency to falls, which may be connected not only with the impaired ability of keeping balance, but also with some limitations of the system responsible for the maintenance of balance. The aim of this study was defining the importance of muscle activity in the ankle joint when standing on stable and unstable surfaces with eyes open and closed as well as examining indications of the influence of body aging on the activity of the selected muscles. The study was carried out on a group of 20 healthy women divided into two age groups (aged 24 ± 3.6 years and aged 64 ± 4.2 years). The activity of muscles stabilizing the ankle joint while standing on different types of surfaces was tested with an EMG (surface electromyography) on both elderly and young women during trials with open and closed eyes. The tests showed higher activation in the evaluated muscles of the anterior group (tibialis anterior (TA), peroneus longus (PL)) of elderly women. For the posterior shin muscles of both groups, a higher activation was observed in the gastrocnemius lateralis muscle (GL) of elderly women, whereas gastrocnemius medialis muscle (GM) showed highly comparable activity. The results obtained in this work confirm the importance of proprioception training and muscle strength in the rehabilitation of older people as well as in prophylactic exercise aimed toward the prevention of ankle injuries

sEMG Activation of the Flexor Muscles in the Foot during Balance Tasks by Young and Older Women: A Pilot Study

Objective: In this publication, we suggest that young adults and seniors use various defense mechanisms to counteract loss of balance. One of the hypotheses is the change in the coordination of antagonistic muscle groups, especially within the ankles. In this study, we tried to determine if there is a relationship between the condition from resilient, to pre-frail, to frail and the ability to maintain balance during free standing and balance tasks. The aim of the study was to define the importance of muscle activity in the ankle joint, dorsal flexor of the foot for the following: tibialis anterior (TA), plantar flexor of the foot gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and peroneus longus (PER), during balance tasks with eyes open (EO) and closed (EC). We hypothesized that there are differences in the activity and co-activation of the tested muscles in young and older women, which may indicate an increased risk of falls and walking disorders. Materials and methods: A group of 20 women qualified for the study. The group was divided into two subgroups, young (G1) and elderly women (G2). The aim of the study was to define the importance of muscle activity in the ankle joint, dorsal flexor of the foot for the following: tibialis anterior (TA), plantar flexor of the foot gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and peroneus longus (PER), during balance tasks with eyes open (EO) and closed (EC). Results: In this study, we observed significant differences between groups in the maximum and mean values of electromyography activity (EMG) activation of the examined muscles on different types of surfaces and with open and closed eyes. Older women generated higher values of EMG activation in all muscles except the gastrocnemius medialis muscle. The results were significant for co-activation at rest for muscles as follows: tibialis anterior and gastrocnemius medialis with eyes closed (p = 0.01) and peroneus and gastrocnemius lateralis at rest with eyes open (p = 0.03), eyes closed (p = 0.04), and on a foam (p = 0.02). The sEMG amplitude of the tested muscles means that agonist muscle activity changed relative to antagonistic muscle activity. Conclusions: Activation of sEMG and coordination of ankle muscles during balance tasks change with age. It can be hypothesized that assessment of balance during free standing and equivalent tasks can predict the state of frailty, after taking into account other physiological variables that are believed to affect balance control

Neuromuscular, Perceptual, and Temporal Determinants of Movement Patterns in Wheelchair Fencing: Preliminary Study

The objective of the present study was to determine the structure of the movement pattern performed during a wheelchair fencing lunge that is executed in response to visual and sensory stimuli. In addition, a comparison was made between fencers in the categories A and B of disability. In addition, the analysis involved the correlation between the duration of the sensorimotor response and the value of the bioelectric signal recorded in selected muscles. Seven Paralympic team athletes specializing in wheelchair fencing (3 in category A and 4 in category B) participated in the research. The fencers perform at international level competitions and are multiple medalists of the Paralympic Games. In the study, a wireless system for sEMG and accelerometer signal measurement was employed to test the intervals between the initiation of the lunge attack and its termination defined by the touch of the weapon on the coach’s torso. The electrodes were placed on 9 key muscles responsible for the effectiveness of the executed attack: DEL, TRI, BC, ECR FCR, LD, and EAO. The significant intergroup difference in the muscle activation was found to be 0.333 s for category A fencers and 0.522 s for category A fencers at p=0.039 applies to the latissimus dorsi (LD LT) muscle, which demonstrates its significance as a postural muscle in the structure of the examined movement pattern. In terms of the values of EMG, a tendency for higher MVC (%) values in most muscles for category A competitors was recorded. The latissimus dorsi (DL RT) muscle with an intergroup difference of MVC-114.63 for cat. A and 67.50 for cat. B at p=0.039 turned out to play a significant role. The results prove the role of postural muscles: external abdominal oblique and latissimus dorsi on the effectiveness of the attacks executed in wheelchair fencing

Rozwój modelu EHSD w rehabilitacji po udarze mózgu

At the beginning of the twenty first century there appeared a promising alternative to stationary rehabilitation for post-stroke patients. This is the organizational model for rehabilitation continuation after a stroke at home referred to as the Early Supported Discharge Home (EHSD). This model is an organizational solution allowing for a shortening of hospital stay and a reduction in the costs of treatment and rehabilitation. This comprises many elements of modern rehabilitation strategies. In 2009 we presented in Medical Rehabilitation ESD model assumptions. Since then there have been numerous reports that have continued to demonstrate that the EHSD model, despite shortening stays in the hospital, provides the patient with a real chance for successful rehabilitation. The biggest benefit of this type of practice is experienced by patients with an average level of disability. In this review article we present the latest reports on the further development of the concept of home-based post-stroke rehabilitation according to the EHSD model.W pierwszych latach XXI wieku pojawiła się obiecująca alternatywa dla rehabilitacji stacjonarnej osób po udarze mózgu – jest nią model organizacyjny polegający na kontynuacji rehabilitacji po przebytym udarze w warunkach domowych nazwany Early Home Supported Discharge (EHSD). Model kontynuacji rehabilitacji po udarze mózgu w domu jest rozwiązaniem organizacyjnym, które pozwala na skrócenie pobytu w szpitalu i zmniejszenie kosztów leczenia i rehabilitacji - zawiera on wiele elementów nowoczesnej strategii postępowania rehabilitacyjnego. W roku 2009 przedstawiliśmy w Rehabilitacji Medycznej załoŜenia modelu ESD. Od tego czasu pojawiły się dalsze liczne doniesienia wykazujące, Ŝe model EHSD, mimo skrócenia pobytu w szpitalu zapewnia choremu realne szanse na skuteczną rehabilitację. Największe korzyści z tego typu postępowania odnoszą pacjenci ze średnim poziomem niepełnosprawności. W artykule poglądowym przedstawiamy najnowsze doniesienia na temat rozwoju koncepcji rehabilitacji po udarze mózgu według modelu EHSD

Electromyography, Wavelet Analysis and Muscle Co-Activation as Comprehensive Tools of Movement Pattern Assessment for Injury Prevention in Wheelchair Fencing

The aim of the study was to determine the correct movement patterns of fencing techniques in wheelchair fencers. Through a comprehensive analysis, the key muscles in the kinematic chain exposed to potential injuries were identified. The study participants were 16 wheelchair fencers, divided into two groups representing two categories of disability: Group A (N = 7) comprising fencers with mild paraplegia, having freedom of movement of the trunk and arms; and Group B (N = 9) comprising fencers with a spinal cord injury and partial paresis of the arms. EMG and an accelerometer were used as the main research tools. The EMG electrodes were placed on the muscles of the sword arm as well as on the left and right sides of the abdomen and torso. The EMG signal was transformed using wavelet analysis, and the muscle activation time and co-activation index (CI) were determined. In Group A fencers, first the back and abdominal muscles were activated, while in Group B, it was the deltoid muscle. The wavelet coherence analysis revealed intermuscular synchronization at 8–20 Hz for Group A fencers and at 5–15 Hz for Group B fencers. In Group A fencers, the co-activation index was 50.94 for the right-side back and abdominal muscles, 50.75 for the ECR-FCR, and 47.99 for the TRI-BC pairs of upper limb muscles. In contrast, Group B fencers demonstrated higher CI values (50.54) only for the postural left-side muscle pairs. Many overload injuries of the shoulder girdle, elbow, postural muscles, spine, and neck have been found to be preventable through modification of current training programs dominated by specialist exercises. Modern wheelchair fencing training should involve neuromuscular coordination and psychomotor exercises. This will facilitate the individualization of training depending on the fencer’s degree of disability and training experience

Aktualny stan wiedzy o wybranych metodach rehabilitacji chorych po udarach mózgu

In 2009 and in 2012 we published two articles in “Medical Rehabilitation” regarding the development of idea of Early Home Supported Discharge in stroke rehabilitation. Today, omitting the word “Home”, the abbreviation ESD is more popular. The aim of this article is to present the latest developments around the idea of continuing rehabilitation after early discharge from the hospital in a home setting. We primarily focus on the most recent reports, particularly systematic reviews. Each country has its own eligibility criteria which are different for early hospital discharge and follow-up rehabilitation in the place of residence, and sometimes the rehabilitation team staff also differs. So far, studies have shown that the optimal role of the rehabilitation team is coordination and delivery of rehabilitation in a home setting. It is also clear that the ESD model brings tangible economic benefits, mainly by shortening hospital stays. Specific organizational solutions used in different countries depend on cultural traditions, capabilities and financial sources.W roku 2009 i w roku 2012 opublikowaliśmy w „Rehabilitacji Medycznej” dwa artykuły przedstawiające rozwój idei Early Home Supported Discharge w rehabilitacji poudarowej. Obecnie coraz częściej używa się skrótu ESD, pomijając słowo „Home”. Celem niniejszego artykułu jest przedstawienie najnowszych kierunków rozwoju idei kontynuacji rehabilitacji po udarze mózgu po wczesnym wypisie ze szpitala. Skoncentrujemy się przede wszystkim na najnowszych doniesieniach, zwłaszcza systematycznych przeglądach. W każdym kraju stosuje się własne kryteria kwalifikacji do wczesnego wypisu ze szpitala i kontynuacji rehabilitacji w miejscu zamieszkania, różny też bywa skład rehabilitacyjnego zespołu wyjazdowego. Dotychczas przeprowadzone badania wykazały, że optymalną rolą zespołu rehabilitacyjnego jest koordynacja i realizacja rehabilitacji w miejscu zamieszkania. Nie ulega również wątpliwości, że model ESD przynosi konkretne korzyści ekonomiczne, głównie poprzez skrócenie pobytu chorego w szpitalu. Szczegółowe rozwiązania organizacyjne, stosowane w poszczególnych krajach, zależą od tradycji kulturowych, możliwości i zasobności finansowej