Choosing the Optimal Trigger Point for Analysis of Movements after Stroke Based on Magnetoencephalographic Recordings

The aim of this study was to select the optimal procedure for analysing motor fields (MF) and motor evoked fields (MEF) measured from brain injured patients. Behavioural pretests with patients have shown that most of them cannot stand measurements longer than 30 minutes and they also prefer to move the hand with rather short breaks between movements. Therefore, we were unable to measure the motor field (MF) optimally. Furthermore, we planned to use MEF to monitor cortical plasticity in a motor rehabilitation procedure. Classically, the MF analysis refers to rather long epochs around the movement onset (M-onset). We shortened the analysis epoch down to a range from 1000 milliseconds before until 500 milliseconds after M-onset to fulfil the needs of the patients. Additionally, we recorded the muscular activity (EMG) by surface electrodes on the extensor carpi ulnaris and flexor carpi ulnaris muscles. Magnetoencephalographic (MEG) data were recorded from 9 healthy subjects, who executed horizontally brisk extension and flexion in the right wrist. Significantly higher MF dipole strength was found in data based on EMG-onset than in M-onset based data. There was no difference in MEF I dipole strength between the two trigger latencies. In conclusion, we recommend averaging in respect to the EMG-onset for the analysis of both components MF as well as MEF

Rapidly induced changes in neuromagnetic fields following repetitive hand movements

Sensory feedback plays a major role in movement execution and motor learning, particularly in motor rehabilitation. Whilst elaborating therapeutic strategies, it is of interest to visualize the effect of a therapeutic intervention at the moment of its application. We analyzed the effect of repeated execution of a simple extension and flexion movement of the wrist on the sensorimotor cortex of seven healthy subjects using magnetoencephalography. Spatial filtering based on current dipoles was used to quantify the strength of cortical activation. Our results showed an increase of cortical activation reflecting activity of efferent neurons, whereas the activity of proprioceptive afferent neurons was not affected. Since only efferent activity increased, it is suggested that this reflects phenomena of long-term potentiation

Patients' use of a home-based virtual reality system to provide rehabilitation of the upper limb following stroke

Background: A low cost, virtual reality system that translates movements of the hand, fingers and thumb into game play was designed to provide a flexible and motivating approach to increasing adherence to home based rehabilitation. Objective: Effectiveness depends on adherence, so did patients use the intervention to the recommended level. If not, what reasons did they give? Design: Prospective cohort study plus qualitative analysis of interviews. Methods: 17 patients recovering from stroke recruited to the intervention arm of a feasibility trial had the equipment left in their homes for eight weeks and were advised to use it three times a day for periods of no more than 20 minutes. Frequency and duration of use were automatically recorded. At the end of the intervention, participants were interviewed to determine barriers to using it in the recommended way. Results: Duration of use and how many days they used the equipment are presented for the 13 participants who successfully started the intervention. These figures were highly variable and could fall far short of our recommendations. There was a weak (p=0.053) positive correlation between duration and baseline reported activities of daily living. Participants reported familiarity with technology and competing commitments as barriers to use although appreciated the flexibility of the intervention and found it motivating

Effect of interstimulus interval on cortical proprioceptive responses to passive finger movements

Accepted manuscript online: 28 October 2016Shortening of the interstimulus interval (ISI) generally leads to attenuation of cortical sensory responses. For proprioception, however, this ISI effect is still poorly known. Our aim was to characterize the ISI dependence of movement-evoked proprioceptive cortical responses and to find the optimum ISI for proprioceptive stimulation. We measured, from 15 healthy adults, magnetoencephalographic responses to passive flexion and extension movements of the right index finger. The movements were generated by a movement actuator at fixed ISIs of 0.5, 1, 2, 4, 8, and 16 s, in separate blocks. The responses peaked at ~ 70 ms (extension) and ~ 90 ms (flexion) in the contralateral primary somatosensory cortex. The strength of the cortical source increased with the ISI, plateauing at the 8-s ISI. Modeling the ISI dependence with an exponential saturation function revealed response lifetimes of 1.3 s (extension) and 2.2 s (flexion), implying that the maximum signal-to-noise ratio (SNR) in a given measurement time is achieved with ISIs of 1.7 s and 2.8 s respectively. We conclude that ISIs of 1.5–3 s should be used to maximize SNR in recordings of proprioceptive cortical responses to passive finger movements. Our findings can benefit the assessment of proprioceptive afference in both clinical and research settings.This work was supported by the Academy of Finland (Grants #131483 and #263800 to Riitta Hari and Grants #266133 and #296240 to Harri Piitulainen), Tekes – the Finnish Funding Agency for Technology and Innovation (Grant 1104/10), the European Research Council (Advanced Grant #232946 to Riitta Hari), the Emil Aaltonen Foundation (Eero Smeds), and the Research Programs Unit of the University of Helsinki (Eero Smeds)

a Função de Orientador Argumentativo dos Rotulos em Artigo de Opinião: uma Questão de Entonação de Valores Sociais

À luz de uma perspectiva sociointeracionista, este trabalho tem como objetivo pesquisar o processo referenciação através dos rótulos (expressões nominais que sumarizam porções de texto), evidenciando a função de orientador argumentativo desempenhada por essas expressões. Assumida a perspectiva teórica, entendemos que o real é fabricado através de nossas práticas sociais e discursivas. Assim, ao contrário de concebermos que a relação entre linguagem e mundo se dá de forma direta e especular, defendemos as versões públicas do mundo (MONDADA e DUBOIS 2003[1995]). A fim de buscar o objetivo proposto, trazemos para o nosso texto a concepção filosófica bakthiniana de valoração (BAKTHIN, 1993[1920-24]), com o intuito de mostrar que, ao construir o objeto de discurso, o sujeito seleciona as formas linguísticas que melhor se adaptem ao seu projeto de dizer. No entanto, essas escolhas não emanam de um sujeito solitário; pelo contrário, são usadas por um sujeito que é singular e social, simultaneamente, que rejeita e assume diversos valores sociais, os quais determinam a forma e o conteúdo de seu enunciado e com os quais convive. Os textos utilizados exemplificar o que é discutido nessa pesquisa são três artigos de opinião publicados no jornal A Gazeta, selecionados no período de agosto a dezembro de 2009. Para a análise dos textos tomamos uma postura dialógica a fim de explicitar que o posicionamento assumido pelo articulista na construção do objeto de discurso é dialógico, pois responde a outros enunciados e entoa uma avaliação que não emana de um sujeito isolado, mas social. Desse modo, acreditamos que a função de orientador argumentativo dos rótulos é mais bem compreendida se levarmos em consideração a corrente dialógica na qual se insere o uso dessas expressões. Palavras-chave: Referenciação; Objeto de discurso; Rotulação; Dialogia; Valoração

Comparison of embedded and added motor imagery training in patients after stroke: Study protocol of a randomised controlled pilot trial using a mixed methods approach

Copyright @ 2009 Schuster et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Two different approaches have been adopted when applying motor imagery (MI) to stroke patients. MI can be conducted either added to conventional physiotherapy or integrated within therapy sessions. The proposed study aims to compare the efficacy of embedded MI to an added MI intervention. Evidence from pilot studies reported in the literature suggests that both approaches can improve performance of a complex motor skill involving whole body movements, however, it remains to be demonstrated, which is the more effective one.Methods/Design: A single blinded, randomised controlled trial (RCT) with a pre-post intervention design will be carried out. The study design includes two experimental groups and a control group (CG). Both experimental groups (EG1, EG2) will receive physical practice of a clinical relevant motor task ('Going down, laying on the floor, and getting up again') over a two week intervention period: EG1 with embedded MI training, EG2 with MI training added after physiotherapy. The CG will receive standard physiotherapy intervention and an additional control intervention not related to MI.The primary study outcome is the time difference to perform the task from pre to post-intervention. Secondary outcomes include level of help needed, stages of motor task completion, degree of motor impairment, balance ability, fear of falling measure, motivation score, and motor imagery ability score. Four data collection points are proposed: twice during baseline phase, once following the intervention period, and once after a two week follow up. A nested qualitative part should add an important insight into patients' experience and attitudes towards MI. Semi-structured interviews of six to ten patients, who participate in the RCT, will be conducted to investigate patients' previous experience with MI and their expectations towards the MI intervention in the study. Patients will be interviewed prior and after the intervention period.Discussion: Results will determine whether embedded MI is superior to added MI. Findings of the semi-structured interviews will help to integrate patient's expectations of MI interventions in the design of research studies to improve practical applicability using MI as an adjunct therapy technique

Aberrant crossed corticospinal facilitation in muscles distant from a spinal cord injury.

Crossed facilitatory interactions in the corticospinal pathway are impaired in humans with chronic incomplete spinal cord injury (SCI). The extent to which crossed facilitation is affected in muscles above and below the injury remains unknown. To address this question we tested 51 patients with neurological injuries between C2-T12 and 17 age-matched healthy controls. Using transcranial magnetic stimulation we elicited motor evoked potentials (MEPs) in the resting first dorsal interosseous, biceps brachii, and tibialis anterior muscles when the contralateral side remained at rest or performed 70% of maximal voluntary contraction (MVC) into index finger abduction, elbow flexion, and ankle dorsiflexion, respectively. By testing MEPs in muscles with motoneurons located at different spinal cord segments we were able to relate the neurological level of injury to be above, at, or below the location of the motoneurons of the muscle tested. We demonstrate that in patients the size of MEPs was increased to a similar extent as in controls in muscles above the injury during 70% of MVC compared to rest. MEPs remained unchanged in muscles at and within 5 segments below the injury during 70% of MVC compared to rest. However, in muscles beyond 5 segments below the injury the size of MEPs increased similar to controls and was aberrantly high, 2-fold above controls, in muscles distant (>15 segments) from the injury. These aberrantly large MEPs were accompanied by larger F-wave amplitudes compared to controls. Thus, our findings support the view that corticospinal degeneration does not spread rostral to the lesion, and highlights the potential of caudal regions distant from an injury to facilitate residual corticospinal output after SCI

Technology-assisted training of arm-hand skills in stroke: concepts on reacquisition of motor control and therapist guidelines for rehabilitation technology design

<p>Abstract</p> <p>Background</p> <p>It is the purpose of this article to identify and review criteria that rehabilitation technology should meet in order to offer arm-hand training to stroke patients, based on recent principles of motor learning.</p> <p>Methods</p> <p>A literature search was conducted in PubMed, MEDLINE, CINAHL, and EMBASE (1997–2007).</p> <p>Results</p> <p>One hundred and eighty seven scientific papers/book references were identified as being relevant. Rehabilitation approaches for upper limb training after stroke show to have shifted in the last decade from being analytical towards being focussed on environmentally contextual skill training (task-oriented training). Training programmes for enhancing motor skills use patient and goal-tailored exercise schedules and individual feedback on exercise performance. Therapist criteria for upper limb rehabilitation technology are suggested which are used to evaluate the strengths and weaknesses of a number of current technological systems.</p> <p>Conclusion</p> <p>This review shows that technology for supporting upper limb training after stroke needs to align with the evolution in rehabilitation training approaches of the last decade. A major challenge for related technological developments is to provide engaging patient-tailored task oriented arm-hand training in natural environments with patient-tailored feedback to support (re) learning of motor skills.</p