Transcranial Direct Current Stimulation has been increasing in popularity in the last few years. Despite vast amounts of articles on the use of tDCS on stroke patients, very little has been done ...during the acute phase.
Measure the effects of tDCS on functional and sensory outcomes throughout the first year post onset of stroke.
50 acute stroke patients were randomized and placed into either the treatment or sham group. Anodal tDCS was applied (2 mA, 20 min) 5 times a week during the first month post stroke. Patients were evaluated with the Wolf Motor Function Test, the Semmes Weinstein Monofilament Test, the Upper Extremity section (UEFM), the Lower Extremity section (LEFM) and the Somatosensory section of the Fugl Meyer Test, the Tardieu Spasticity Scale, the Stroke Impact Scale (SIS), the Hospital Anxiety and Depression Scale (HADS) and the Barthel Index. Evaluations were held at 48 h post stroke, week 1, 2, 3, 4, 3 months, 6 months and 1 year.
There were statistically and clinically significant improvements after tDCS in all functional motor outcomes, and somatosensory functions. Differences between both groups for the main outcome (WMFT time) were 51% (p = 0.04) at one month, and 57% (p = 0.02) at one year.
tDCS seems to be an effective adjuvant to conventional rehabilitation techniques. If applied in the acute stages of stroke, functional recovery is not only accelerated, but improved, and results are maintained up to one-year post stroke.
•Despite being popular in stroke research, tDCS has rarely been used for acute strokes.•50 patients received 20 sessions of tDCS during the first month post onset.•Functional outcomes were measured through the first year post stroke.•Significant improvements in dexterity, strength, sensitivity, anxiety and depression.•These improvements were seen from the third week to the end of the first year.
•A novel scoring approach was first proposed for the motor function assessment of stroke survivors based on the WMFT-FAS scale.•The proposed approach mainly contained one Microsoft Kinect v2, one ...customized motion tracking system, and one customized intelligent scoring system.•The proposed approach can perform the whole WMFT-FAS scale with an accuracy of 0.924 ± 0.027.•The proposed multi-ReliefF method can dynamically select suitable features and increase the accuracy by around 2.9 %.
Human-administered clinical scales, such as the Functional Ability Scale of the Wolf Motor Function Test (WMFT-FAS), are widely utilized to evaluate upper-limb motor function in stroke survivors. However, these scales are generally subjective and labor-intensive. To end this, we proposed a novel scoring approach for the motor function assessment.
The proposed novel scoring approach mainly contained one Microsoft Kinect v2, one customized motion tracking system, and one customized intelligent scoring system. Specifically, the Kinect v2 was used to capture stroke survivors’ functional movements, the motion tracking system was developed for recording the gathered movement data, and the intelligent scoring system (kernel: feed-forward neural network, FFNN) was developed to evaluate movement quality and provide corresponding WMFT-FAS scores. Several methods have been applied to enhance the approach's usability, such as singular spectrum analysis and multi-ReliefF method.
Sixteen stroke survivors and ten healthy subjects were recruited for validation. Inspiring results of the proposed approach were achieved when compared with the clinical scores provided by a physiotherapist: 0.924 ± 0.027 for accuracy, 0.875 ± 0.063 for F1-score, 0.915 ± 0.051 for sensitivity, 0.969 ± 0.013 for specificity, 0.952 ± 0.038 for AUC, 0.098 ± 0.037 for mean absolute error, and 0.214 ± 0.078 for root mean squared error.
The results indicate that the proposed novel scoring approach can provide objective and accurate assessment scores, which can help physiotherapists make individualized treatment decisions.
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Background Several predictors have been associated with upper extremity (UE) recovery after stroke, but characteristics that predict shoulder function after constraint-induced movement therapy (CIMT) ...have not yet been identified.
Objectives To identify predictors associated with satisfactory shoulder function in patients with reduced shoulder function at admission to CIMT.
Methods One hundred and seventy five patients were treated using CIMT while in a specialized inpatient hospital. Satisfactory shoulder function was defined according to the functional ability scale of the Wolf Motor Function test. Predictors of satisfactory shoulder function after CIMT were identified using multivariable logistic regression.
Results Better distal arm function and good proximal shoulder function on admission to CIMT were strong predictors of satisfactory shoulder function, while age and time of admission to CIMT since stroke were not. Seventeen percent of all CIMT-participants with reduced shoulder function pre-CIMT reached a level of satisfactory shoulder function after CIMT.
Discussion A substantial part of patients with reduced shoulder function reached a level of satisfactory shoulder function after CIMT. Intensive CIMT training, comprising tasks that require both distal and proximal UE function, may increase shoulder function in patients with a potential functional reserve.
Spastic impaired limb function is a frequent result of brain lesions. Although its assessment is important for clinical and therapeutical management, it still lacks an objective measure to quantify ...the functionality of the affected limb. The present paper reports a procedure based on the muscular activation recorded by Surface Electromyography (sEMG), which enables the assessment of the degree of spastic impairment.
15 healthy subjects and 7 patients with impaired upper limb function due to spasticity were included in the study. SEMG was recorded from the biceps and brachioradialis during active elbow extension at different movement velocities. The spastic impairment was clinically assessed by the Tardieu-Test and the Wolf Motor Function Test.
Results of the clinical assessment and parameter values quantifying the muscular activation at different joint positions and movement velocities have been set in relation to one another.
The results show that spastic impairment leads to a changed correlation between the muscular activation and movement velocity as well as to a changed inter-muscular co-ordination of biceps and brachioradialis. These changes, reflected in the sEMG, can be quantified by 5 newly introduced parameters. This way could allow the assessment of spastic impairment in the context of functional everyday tasks, for the first-time.
Strokes have recently become a leading cause of disability among Thai people. Non-invasive brain stimulation (NIBS) seems to give promising results in stroke recovery when combined with standard ...rehabilitation programs.
To evaluate the combined effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) and cathodal transcranial direct current stimulation (tDCS) over the non-lesional primary motor cortex on upper limb motor recovery in patients with subacute stroke. No reports of a combination of these two techniques of NIBS were found in the relevant literature.
This pilot study was a double-blinded, randomized controlled trial of ten patients with subacute stroke admitted to the Rehabilitation Medicine Inpatient Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. They were randomized into two groups: five in an active and five in a sham intervention group. Fugl-Meyer's upper extremity motor score (FMA-UE) and Wolf Motor Function Test (WMFT) were used to assess motor recovery at baseline, immediately, and 1 week after stimulation.
A two-way repeated ANOVA (mixed design) showed a significant improvement in FMA-UE scores in the active intervention group both immediately and 1 week after stimulation in comparison to the baseline, time, F (2, 16) = 27.44, p < 0.001, time x group interaction, F (2, 16) = 13.29, p < 0.001. Despite no statistical significance, a trend toward higher WMFT scores was shown in the active intervention group.
A single session of low-frequency rTMS and cathodal tDCS over the non-lesional primary motor cortex may enhance upper limb motor recovery in patients with subacute stroke.
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