Predicting Training Gain for a 3 Week Period of Arm Ability Training in the Subacute Stage After Stroke

Background: Biomarkers for gains of evidence based interventions for upper limb motor training in the subacute stage following stroke have rarely been described. Information about these parameters might help to identify patients who benefit from specific interventions and to determine individually expected behavioral gains for a certain period of therapy.Objective: To evaluate predictors for hand motor outcome after arm ability training in the subacute stage after stroke selected from known potentially relevant parameters (initial motor strength, structural integrity of the pyramidal tract and functional motor cortex integrity).Methods: We applied the arm ability training (AAT) over 3 weeks to a subpopulation of stroke patients with mild arm paresis, i.e., in 14 patients on average 4 weeks after stroke. The following biomarkers were measured before therapy onset: grip strength on the affected hand, transcranial magnetic stimulation recruitment curve steepness over the primary motor hand area [slope ratio between the ipsilesional hemisphere (IH) and contralesional hemisphere (CH)], and diffusion weighted MRI fractional anisotropy (FA) in the posterior limb of the internal capsule (PLIC; determined as a lateralization index between IH and CH). Outcome was assessed as the AATgain (percentage improvement over training). The “Test d'Evaluation des Membres Supérieurs de Personnes Âgées” (TEMPA) was assessed before and after training to test for possible associations of AAT with activity of daily living.Results: A stepwise linear regression identified the lateralization index of PLIC FA as the only significant predictor for AAT-gain (R2 = 0.519; P = 0.029). AAT-gain was positively associated (r = 0.59; P = 0.028) with improvement in arm function during daily activities (TEMPA).Conclusions: While all mildly affected patients achieved a clinically relevant therapeutic effect, pyramidal tract integrity nevertheless had a modifying role for clinical benefit

Do stroke survivors with upper extremity spasticity benefit from botulinum toxin? An observational study exploring daily activities

PURPOSE: To explore the benefit of routine botulinum toxin A (BoNT-A) treatment for the daily activities of stroke survivors with upper extremity spasticity and to facilitate 'patient-centred' and daily life-oriented spasticity management. METHODS: A quantitative observational study over one injection cycle performed in a German spasticity outpatient clinic. Participants (n=27) were assessed at baseline (T0), 4-6 (Tmax1) and 12-14 weeks (T2) after injection. Primary outcome measures were Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS) and Arm Activity Measure (ArmA). Secondary measures included Resistance to Passive Movement Scale (REPAS), Motricity Index (MI), SF-12v2 Health Survey, Global Clinical Impression (GCI) and importance and satisfaction. RESULTS: Significant improvements were observed from T0 to Tmax1 and T0 to T2, but not from Tmax1 to T2 for COPM, ArmA part A and REPAS. Goals were attained by 33.3% of participants. Importance and satisfaction with the treatment was high. GCI was rated "good" to "very good" by 45.8% to 75%. ArmA part B, MI and SF-12v2 showed no change. CONCLUSIONS: Routine BoNT-A treatment with outpatient therapy improved daily activities, being clinically significant for up to 50% of participants. ArmA and COPM are suitable measures to facilitate 'patient-centred' and daily life-focused routine spasticity management

Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction

Objective. Results of a device-training for nonambulatory individuals with thoracic and lumbar spinal cord injury (SCI) using a powered exoskeleton for technically assisted mobility with regard to the achieved level of control of the system after training, user satisfaction, and effects on quality of life (QoL). Methods. Observational single centre study with a 4-week to 5-week intensive inpatient device-training using a powered exoskeleton (ReWalk™). Results. All 7 individuals with SCI who commenced the device-training completed the course of training and achieved basic competences to use the system, that is, the ability to stand up, sit down, keep balance while standing, and walk indoors, at least with a close contact guard. User satisfaction with the system and device-training was documented for several aspects. The quality of life evaluation (SF-12v2™) indicated that the use of the powered exoskeleton can have positive effects on the perception of individuals with SCI regarding what they can achieve physically. Few adverse events were observed: minor skin lesions and irritations were observed; no falls occurred. Conclusions. The device-training for individuals with thoracic and lumbar SCI was effective and safe. All trained individuals achieved technically assisted mobility with the exoskeleton while still needing a close contact guard

Secondary use of health care data and left-over biosamples within the ‘Medical Informatics Initiative’ (MII): a quasi-randomized controlled evaluation of patient perceptions and preferences regarding the consent process

Background Data collected during routine health care and ensuing analytical results bear the potential to provide valuable information to improve the overall health care of patients. However, little is known about how patients prefer to be informed about the possible usage of their routine data and/or biosamples for research purposes before reaching a consent decision. Specifically, we investigated the setting, the timing and the responsible staff for the information and consent process. Methods We performed a quasi-randomized controlled trial and compared the method by which patients were informed either in the patient admission area following patient admission by the same staff member (Group A) or in a separate room by another staff member (Group B). The consent decision was hypothetical in nature. Additionally, we evaluated if there was the need for additional time after the information session and before taking the consent decision. Data were collected during a structured interview based on questionnaires where participants reflected on the information and consent process they went through. Results Questionnaire data were obtained from 157 participants in Group A and 106 participants in Group B. Overall, participants in both groups were satisfied with their experienced process and with the way information was provided. They reported that their (hypothetical) consent decision was freely made. Approximately half of the interested participants in Group B did not show up in the separate room, while all interested participants in Group A could be informed about the secondary use of their routine data and left-over samples. No participants, except for one in Group B, wanted to take extra time for their consent decision. The hypothetical consent rate for both routine data and left-over samples was very high in both groups. Conclusions The willingness to support medical research by allowing the use of routine data and left-over samples seems to be widespread among patients. Information concerning this secondary data use may be given by trained administrative staff immediately following patient admission. Patients mainly prefer making a consent decision directly after information is provided and discussed. Furthermore, less patients are informed when the process is organized in a separate room

Effects of combining 2 weeks of passive sensory stimulation with active hand motor training in healthy adults.

The gold standard to acquire motor skills is through intensive training and practicing. Recent studies have demonstrated that behavioral gains can also be acquired by mere exposure to repetitive sensory stimulation to drive the plasticity processes. Single application of repetitive electric stimulation (rES) of the fingers has been shown to improve tactile perception in young adults as well as sensorimotor performance in healthy elderly individuals. The combination of repetitive motor training with a preceding rES has not been reported yet. In addition, the impact of such a training on somatosensory tactile and spatial sensitivity as well as on somatosensory cortical activation remains elusive. Therefore, we tested 15 right-handed participants who underwent repetitive electric stimulation of all finger tips of the left hand for 20 minutes prior to one hour of motor training of the left hand over the period of two weeks. Overall, participants substantially improved the motor performance of the left trained hand by 34%, but also showed a relevant transfer to the untrained right hand by 24%. Baseline ipsilateral activation fMRI-magnitude in BA 1 to sensory index finger stimulation predicted training outcome for somatosensory guided movements: those who showed higher ipsilateral activation were those who did profit less from training. Improvement of spatial tactile discrimination was positively associated with gains in pinch grip velocity. Overall, a combination of priming rES and repetitive motor training is capable to induce motor and somatosensory performance increase and representation changes in BA1 in healthy young subjects

Overview on the performance changes over training time.

<p>Left: Average percentual improvement in the AAT-tasks plotted for the trained left and the untrained right hand. Means are provided with standard errors. Right: Detailed absolute increase of performance of the AAT tasks over ten consecutive days for each type of movement trained.</p

Somatosensory findings on changes over time.

<p>A. Visualization of the fMRI-map of the BA 1 activation (ROI indicated with a white line) of the index finger stimulation before (left) and after (right) 2 weeks of intervention (combination of rES and active training). The representational map is decreased in size after two weeks of training although spatial acuity increase was positively associated with increase of pinch grip performance as indicated below. B. The correlation of spatial resolution and motor performance of the AAT task placing small objects was r = 0.67; <i>P</i><0.01.</p

Parameters of the clusters found in the contralateral (right hemispheric) BA1 for the pre- and the post-examination.

<p>Parameters of the clusters found in the contralateral (right hemispheric) BA1 for the pre- and the post-examination.</p