Functional synergy recruitment index as a reliable biomarker of motor function and recovery in chronic stroke patients

Objective. Stroke affects the expression of muscle synergies underlying motor control, most notably in patients with poorer motor function. The majority of studies on muscle synergies have conventionally approached this analysis by assuming alterations in the inner structures of synergies after stroke. Although different synergy-based features based on this assumption have to some extent described pathological mechanisms in post-stroke neuromuscular control, a biomarker that reliably reflects motor function and recovery is still missing. Approach. Based on the theory of muscle synergies, we alternatively hypothesize that functional synergy structures are physically preserved and measure the temporal correlation between the recruitment profiles of healthy modules by paretic and healthy muscles, a feature hereafter reported as the FSRI. We measured clinical scores and extracted the muscle synergies of both ULs of 18 chronic stroke survivors from the electromyographic activity of 8 muscles during bilateral movements before and after 4 weeks of non-invasive BMI controlled robot therapy and physiotherapy. We computed the FSRI as well as features quantifying inter-limb structural differences and evaluated the correlation of these synergy-based measures with clinical scores. Main results. Correlation analysis revealed weak relationships between conventional features describing inter-limb synergy structural differences and motor function. In contrast, FSRI values during specific or combined movement data significantly correlated with UL motor function and recovery scores. Additionally, we observed that BMI-based training with contingent positive proprioceptive feedback led to improved FSRI values during the specific trained finger extension movement. Significance. We demonstrated that FSRI can be used as a reliable physiological biomarker of motor function and recovery in stroke, which can be targeted via BMI-based proprioceptive therapies and adjuvant physiotherapy to boost effective rehabilitation.This study was funded by the Fortüne-Program of the University of Tübingen (2452-0-0/2), the Bundesministerium für Bildung und Forschung (AMORSA (FKZ-16SV7754), REHOME (V5GR2001M1007-01)), EUROSTARS (SubliminalHomeRehab (FKZ: 01QE2023C E! 113928)) and the Basque Government Science Program (SINICTUS (2018222036), MODULA (KK-2019/00018), Elkartek-EXOTEK (KK-2016/00083)). N Irastorza-Landa's work was funded by the Basque Government's scholarship for predoctoral students

Diagnostik und Therapie bei Bandscheibenschäden. Neurologie und Physiotherapie

Bandscheibenschäden stellen den Betroffenen vor ein großes Problem: Die Lebensqualität leidet enorm, wenn jede Bewegung schmerzt. Umso wichtiger ist es als Physiotherapeut die richtigen Gegenmaßnahmen zu kennen. Doris Brötz, Physiotherapeutin aus Tübingen, und Michael Weller, Professor für Neurologie und Direktor der neurologischen Klinik und Poliklinik des Universitäts- Spitals Zürich, stellen in diesem Buch ihre klinische und wissenschaftliche Arbeit zur spezifischen Therapie bei Bandscheibenschädigungen unter anderem nach dem McKenzie-Konzept vor. In der völlig überarbeiteten und aktualisierten Auflage lernen Sie die Physiotherapie bei Patienten mit Bandscheibenschäden kennen und erfahren alle

A Brain-Robot Interface for Studying Motor Learning after Stroke

Despite intensive efforts, no significant benefit of rehabilitation robotics in post-stroke motor-recovery has yet been demonstrated in large-scale clinical trials. The present work is based on the premise that future advances in rehabilitation robotics require an enhanced understanding of the neural processes involved in motor learning after stroke. We present a system that combines a Barret WAM TM seven degreeof-freedom robot arm with neurophysiological recordings for the purpose of studying post-stroke motor learning. We used this system to conduct a pilot study on motor learning during reaching movements with two stroke patients. Preliminary results indicate that pre-trial brain activity in ipsilesional sensorimotor areas may be a neural correlate of the current state of motor learning. These results are discussed in terms of their relevance for future rehabilitation strategies that combine rehabilitation robotics with real-time analyses of neurophysiological recordings

Chronic stroke recovery after combined BCI training and physiotherapy: A case report

A case of partial recovery after stroke and its associated brain reorganization in a chronic patient after combined brain computer interface (BCI) training and physiotherapy is presented. A multimodal neuroimaging approach based on fMRI and diffusion tensor imaging was used to investigate plasticity of the brain motor system in parallel with longitudinal clinical assessments. A convergent association between functional and structural data in the ipsilesional premotor areas was observed. As a proof of concept investigation, these results encourage further research on a specific role of BCI on brain plasticity and recovery after stroke

Lower Limb Movement Preparation in Chronic Stroke: A Pilot Study Toward an fNIRS-BCI for Gait Rehabilitation

Background: Thus far, most of the brain–computer interfaces (BCIs) developed for motor rehabilitation used electroencephalographic signals to drive prostheses that support upper limb movement. Only few BCIs used hemodynamic signals or were designed to control lower extremity prostheses. Recent technological developments indicate that functional near-infrared spectroscopy (fNIRS)-BCI can be exploited in rehabilitation of lower limb movement due to its great usability and reduced sensitivity to head motion artifacts. Objective: The aim of this proof of concept study was to assess whether hemodynamic signals underlying lower limb motor preparation in stroke patients can be reliably measured and classified. Methods: fNIRS data were acquired during preparation of left and right hip movement in 7 chronic stroke patients. Results: Single-trial analysis indicated that specific hemodynamic changes associated with left and right hip movement preparation can be measured with fNIRS. Linear discriminant analysis classification of totHB signal changes in the premotor cortex and/or posterior parietal cortex indicated above chance accuracy in discriminating paretic from nonparetic movement preparation trials in most of the tested patients. Conclusion: The results provide first evidence that fNIRS can detect brain activity associated with single-trial lower limb motor preparation in stroke patients. These findings encourage further investigation of fNIRS suitability for BCI applications in rehabilitation of patients with lower limb motor impairment after stroke.peerReviewe

Is there a role for benzodiazepines in the management of lumbar disc prolapse with acute sciatica?

Patients with acute lumbar disc prolapse with sciatica who are not considered candidates for surgery are usually treated with physiotherapy and non-steroidal anti-inflammatory agents. Moreover, the treatment with benzodiazepines is common practice in the absence of class I or II level of evidence. Here we assessed the role of benzodiazepines in the conservative management of acute lumbar disc prolapse. Using a placebo-controlled, double-blinded design, 60 patients were randomized to receive placebo or diazepam in addition to mechanical physiotherapy and analgesics for the first 7 days of conservative treatment of clinically and radiologically confirmed lumbar disc prolapse. The primary objective was to evaluate if physiotherapy plus analgesics, but without benzodiazepines, is equivalent to the same therapy plus benzodiazepines. The primary endpoint was centralization of referred pain at day 7. Twenty-six female and 34 male patients were enrolled. The median age was 42 years (range 22-68 years). Analysis of the primary endpoint demonstrated equivalence between placebo and diazepam (median 60% vs. 50% reduction of distance of referred pain at day 7) within the predefined equivalence tolerance of 20% at a significance level of p<0.05. Regarding the secondary endpoints, the median duration of the stay in hospital was shorter in the placebo arm (8 vs. 10 days, p=0.008), and the probability of pain reduction on a visual analog scale by more than 50% was twice as high in placebo patients (p<0.0015). Benzodiazepines should not be used routinely in patients treated with mechanical physiotherapy for lumbar disc prolapse