Mirror Symmetric Bimanual Movement Priming Can Increase Corticomotor Excitability and Enhance Motor Learning

Repetitive mirror symmetric bilateral upper limb may be a suitable priming technique for upper limb rehabilitation after stroke. Here we demonstrate neurophysiological and behavioural after-effects in healthy participants after priming with 20 minutes of repetitive active-passive bimanual wrist flexion and extension in a mirror symmetric pattern with respect to the body midline (MIR) compared to an control priming condition with alternating flexion-extension (ALT). Transcranial magnetic stimulation (TMS) indicated that corticomotor excitability (CME) of the passive hemisphere remained elevated compared to baseline for at least 30 minutes after MIR but not ALT, evidenced by an increase in the size of motor evoked potentials in ECR and FCR. Short and long-latency intracortical inhibition (SICI, LICI), short afferent inhibition (SAI) and interhemispheric inhibition (IHI) were also examined using pairs of stimuli. LICI differed between patterns, with less LICI after MIR compared with ALT, and an effect of pattern on IHI, with reduced IHI in passive FCR 15 minutes after MIR compared with ALT and baseline. There was no effect of pattern on SAI or FCR H-reflex. Similarly, SICI remained unchanged after 20 minutes of MIR. We then had participants complete a timed manual dexterity motor learning task with the passive hand during, immediately after, and 24 hours after MIR or control priming. The rate of task completion was faster with MIR priming compared to control conditions. Finally, ECR and FCR MEPs were examined within a pre-movement facilitation paradigm of wrist extension before and after MIR. ECR, but not FCR, MEPs were consistently facilitated before and after MIR, demonstrating no degradation of selective muscle activation. In summary, mirror symmetric active-passive bimanual movement increases CME and can enhance motor learning without degradation of muscle selectivity. These findings rationalise the use of mirror symmetric bimanual movement as a priming modality in post-stroke upper limb rehabilitation

User profile of people contacting a stroke helpline (StrokeLine) in Australia: a retrospective cohort study

Background: StrokeLine is a specialised telephone helpline led by health professionals in Australia. Aims: (i) To describe the profile of StrokeLine callers; (ii) to understand the reasons people engage with the service and (iii) how StrokeLine responded to the caller\u27s needs. Methods: Routine call data were obtained from the StrokeLine between November 2019 and November 2020. Data were extracted and descriptive analyses performed. De-identified free-text data were obtained separately for November 2019 and June 2020 and analysed using qualitative content analysis. Results: Of the 1429 calls most were from carers, family and friends (38%) or the stroke survivor themselves (34%). Most calls were made by women (64%) and the average age of the stroke survivor was ≥65 years (33%) with the time since the stroke occurred \u3c1 year. The main reason for calling was to manage stroke-related impairments (40%). Providing information, support and advice was the most common action provided by StrokeLine staff (25%). Content analysis of 225 calls revealed most stroke survivors called for emotional support, while carers sought more practical guidance. StrokeLine provided information for referral to relevant services and guidance on what to do next. Conclusions: Most calls were received from family and carers, as well as stroke survivors. They contacted StrokeLine for information and advice, practical solutions, emotional support, and referral advice to other services

Bridging the gap between goal intentions and actions: a systematic review in patient populations

Purpose: To evaluate the evidence for the effectiveness of if-then implementation intentions (if-then plans) in adult patient populations. Outcomes of interest included adherence, goal pursuit and physical health outcomes. Methods: Keywords were used to search electronic databases without date or language restrictions (up to 30 April 2014). Studies were included if they (1) concerned a patient population; (2) used if-then plans as a sole intervention or as part of treatment, therapy or rehabilitation; (3) if they were randomised controlled trials. The PEDro scale was used to evaluate study quality. Guidance as set out by the Cochrane Collaboration was used. Two reviewers independently extracted data, discrepancies were discussed and if required referred to a third reviewer. Results: In total, 18 of the 2141 articles were identified as potentially relevant and four studies of people with epilepsy, chronic back pain, stroke and obesity met the inclusion criteria. People who form if-then plans achieved better outcomes on epilepsy and stroke medication adherence and physical capacity than controls. Conclusions: Of the four studies that used an if-then plan, only one (people with epilepsy) looked at the intervention as a stand-alone strategy. Further research needs to explore if this simple approach improves rehabilitation outcomes and is a helpful and feasible strategy for people experiencing disabilities. Implications for Rehabilitation Steps involved in achieving goals, such as doing exercises or completing other goal related tasks, can be compromised for people with chronic health conditions particularly resulting from difficulties in self-regulating behaviour. If-then plans are implementation intention tools aimed at supporting people to deal more effectively with self-regulatory problems that might undermine goal striving and goal attainment, and have been found to be effective in health promotion and health behaviour change. This systematic literature review identified four studies completed with patient populations, with three demonstrating effectiveness. If-then plans provide an opportunity for clinicians to develop better ways of implementing rehabilitation. Bridging the gap between goal intentions and actions

Neurophysiological effects after active-passive movement priming.

<p>Black bars are group averages from the mirror symmetric (MIR) session; white bars are group averages from the alternating (ALT) session. <b>A.</b> Corticomotor excitability increased after MIR but not ALT. There was a main effect of Pattern for non-conditioned ECR and FCR MEP area (Exp 1). Bars represent average ECR and FCR MEP area from 13 participants collapsed across all three post time points expressed as a percentage of baseline (100%). One-sample t-tests indicated significant MEP facilitation in both muscles after mirror symmetric but not parallel movement. <b>B.</b> Long interval intracortical inhibition (LICI) was modulated by Pattern (Exp 1). There was a main effect of Pattern for ΔLICI. Bars represent average change in LICI from ECR and FCR MEPs of 8 participants at each Post time point relative to baseline (0%). Relative to baseline, there was a non-significant trend for reduced LICI after the mirror session (<i>P</i>&lt;0.1) and a trend for increased LICI in the alternating session (<i>P</i>&lt;0.06). <b>C.</b> Interhemispheric inhibition (IHI) was modulated by Pattern and Time reduced after the MIR, but not PAR, session (Exp 2) indicated by a Pattern×Time interaction for ΔIHI. Bars represent average change in IHI from FCR MEPs of 13 participants at each Post time point relative to baseline (0%). At Post₁₅, ΔIHI was less in the MIR session compared to the ALT session, but did not differ at other time points. One-sample t-tests indicated a significant reduction of IHI at Post₁₅ relative to baseline after MIR only.</p