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1.
J Integr Complement Med ; 28(5): 391-398, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35100035

RESUMEN

Objective: This pilot study evaluated the effects of Citrus depressa Hayata fruit extract (CFEx) on thigh muscle cross-sectional area (CSA) and composition in subacute stroke patients with hemiparesis who were undergoing rehabilitation. Design and Intervention: This double-blinded, placebo-controlled, randomized pilot trial included 40 subacute stroke patients with moderate-to-severe hemiparesis, and they were randomly assigned to receive CFEx or placebo supplements for 12 weeks. The thigh muscle CSA was measured by computed tomography as total muscle area defined by Hounsfield units (HU) values of -29 to 150 HU. The total muscle area was divided into muscle area with fat infiltration and normal muscle area to evaluate muscle composition (-29 to 29 and 30 to 150 HU, respectively). Results: At baseline, the total muscle area and normal muscle area in the paretic thigh were lower than those in the nonparetic thigh. The nonparetic normal muscle area was significantly higher in the CFEx group than in the placebo group at 12 weeks, whereas the total muscle area was not different. Conclusions: The thigh muscle CSA and composition in the paretic side have already deteriorated in patients with moderate-to-severe hemiparesis at the subacute stroke stage. CFEx supplementation during rehabilitation might improve the nonparetic thigh muscle composition in subacute stroke patients. Findings of this study are needed to be verified by a large-scale randomized trial since this study was a pilot study with a small sample size. Trial registration: UMIN Clinical Trial Registry (UMIN ID: UMIN000012902).


Asunto(s)
Citrus , Accidente Cerebrovascular , Frutas , Humanos , Músculo Esquelético/diagnóstico por imagen , Paresia/tratamiento farmacológico , Proyectos Piloto , Extractos Vegetales/uso terapéutico , Accidente Cerebrovascular/diagnóstico por imagen , Muslo
2.
Behav Brain Res ; 335: 185-190, 2017 09 29.
Artículo en Inglés | MEDLINE | ID: mdl-28827129

RESUMEN

OBJECTIVE: To investigate real-time excitability changes in corticospinal pathways related to motor imagery in a changing force control task, using transcranial magnetic stimulation (TMS). METHODS: Ten healthy volunteers learnt to control the contractile force of isometric right wrist dorsiflexion in order to track an on-screen sine wave form. Participants performed the trained task 40 times with actual muscle contraction in order to construct the motor image. They were then instructed to execute the task without actual muscle contraction, but by imagining contraction of the right wrist in dorsiflexion. Motor evoked potentials (MEPs), induced by TMS in the right extensor carpi radialis muscle (ECR) and flexor carpi radialis muscle (FCR), were measured during motor imagery. MEPs were induced at five time points: prior to imagery, during the gradual generation of the imaged wrist dorsiflexion (Increasing phase), the peak value of the sine wave, during the gradual reduction (Decreasing phase), and after completion of the task. The MEP ratio, as the ratio of imaged MEPs to resting-state, was compared between pre- and post-training at each time point. RESULTS: In the ECR muscle, the MEP ratio significantly increased during the Increasing phase and at the peak force of dorsiflexion imagery after training. Moreover, the MEP ratio was significantly greater in the Increasing phase than in the Decreasing phase. In the FCR, there were no significant consistent changes. CONCLUSION: Corticospinal excitability during motor imagery in an isometric contraction task was modulated in relation to the phase of force control after image construction.


Asunto(s)
Excitabilidad Cortical/fisiología , Potenciales Evocados Motores/fisiología , Imaginación/fisiología , Adulto , Electromiografía/métodos , Femenino , Voluntarios Sanos , Humanos , Masculino , Corteza Motora/fisiología , Movimiento/fisiología , Contracción Muscular/fisiología , Músculo Esquelético/fisiología , Neurorretroalimentación/métodos , Tractos Piramidales/fisiología , Estimulación Magnética Transcraneal/métodos , Muñeca/fisiología
4.
J Neuroeng Rehabil ; 10: 55, 2013 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-23764012

RESUMEN

BACKGROUND: Sensory disturbance is common following stroke and can exacerbate functional deficits, even in patients with relatively good motor function. In particular, loss of appropriate sensory feedback in severe sensory loss impairs manipulation capability. We hypothesized that task-oriented training with sensory feedback assistance would improve manipulation capability even without sensory pathway recovery. METHODS: We developed a system that provides sensory feedback by transcutaneous electrical nerve stimulation (SENS) for patients with sensory loss, and investigated the feasibility of the system in a stroke patient with severe sensory impairment and mild motor deficit. The electrical current was modulated by the force exerted by the fingertips so as to allow the patient to identify the intensity. The patient had severe sensory loss due to a right thalamic hemorrhage suffered 27 months prior to participation in the study. The patient first practiced a cylindrical grasp task with SENS for 1 hour daily over 29 days. Pressure information from the affected thumb was fed back to the unaffected shoulder. The same patient practiced a tip pinch task with SENS for 1 hour daily over 4 days. Pressure information from the affected thumb and index finger was fed back to the unaffected and affected shoulders, respectively. We assessed the feasibility of SENS and examined the improvement of manipulation capability after training with SENS. RESULTS: The fluctuation in fingertip force during the cylindrical grasp task gradually decreased as the training progressed. The patient was able to maintain a stable grip force after training, even without SENS. Pressure exerted by the tip pinch of the affected hand was unstable before intervention with SENS compared with that of the unaffected hand. However, they were similar to each other immediately after SENS was initiated, suggesting that the somatosensory information improved tip pinch performance. The patient's manipulation capability assessed by the Box and Block Test score improved through SENS intervention and was partly maintained after SENS was removed, until at least 7 months after the intervention. The sensory test score, however, showed no recovery after intervention. CONCLUSIONS: We conclude that the proposed system would be useful in the rehabilitation of patients with sensory loss.


Asunto(s)
Retroalimentación Sensorial , Trastornos de la Sensación/rehabilitación , Rehabilitación de Accidente Cerebrovascular , Estimulación Eléctrica Transcutánea del Nervio/métodos , Anciano , Femenino , Dedos/inervación , Dedos/fisiopatología , Fuerza de la Mano , Humanos , Hemorragias Intracraneales/complicaciones , Paresia/fisiopatología , Paresia/rehabilitación , Proyectos Piloto , Desempeño Psicomotor , Trastornos de la Sensación/etiología , Trastornos de la Sensación/fisiopatología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Percepción del Tacto
5.
J Neuroeng Rehabil ; 9: 56, 2012 Aug 16.
Artículo en Inglés | MEDLINE | ID: mdl-22897888

RESUMEN

BACKGROUND: We developed an electroencephalogram-based brain computer interface system to modulate functional electrical stimulation (FES) to the affected tibialis anterior muscle in a stroke patient. The intensity of FES current increased in a stepwise manner when the event-related desynchronization (ERD) reflecting motor intent was continuously detected from the primary cortical motor area. METHODS: We tested the feasibility of the ERD-modulated FES system in comparison with FES without ERD modulation. The stroke patient who presented with severe hemiparesis attempted to perform dorsiflexion of the paralyzed ankle during which FES was applied either with or without ERD modulation. RESULTS: After 20 minutes of training, the range of movement at the ankle joint and the electromyography amplitude of the affected tibialis anterior muscle were significantly increased following the ERD-modulated FES compared with the FES alone. CONCLUSIONS: The proposed rehabilitation technique using ERD-modulated FES for stroke patients was feasible. The system holds potentials to improve the limb function and to benefit stroke patients.


Asunto(s)
Interfaces Cerebro-Computador , Sincronización Cortical/fisiología , Terapia por Estimulación Eléctrica/instrumentación , Electroencefalografía , Rehabilitación de Accidente Cerebrovascular , Tobillo/fisiología , Fenómenos Biomecánicos , Terapia por Estimulación Eléctrica/métodos , Electrodos , Electromiografía , Diseño de Equipo , Estudios de Factibilidad , Retroalimentación Fisiológica , Femenino , Humanos , Intención , Masculino , Persona de Mediana Edad , Músculo Esquelético/fisiología , Paresia/etiología , Paresia/rehabilitación , Educación y Entrenamiento Físico , Rango del Movimiento Articular , Accidente Cerebrovascular/complicaciones , Resultado del Tratamiento
6.
Brain Inj ; 26(9): 1105-12, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22571491

RESUMEN

OBJECTIVE: For the recovery of hemiparetic hand function, a therapy was developed called contralateral homonymous muscle activity stimulated electrical stimulation (CHASE), which combines electrical stimulation and bilateral movements, and its feasibility was studied in three chronic stroke patients with severe hand hemiparesis. METHODS: Patients with a subcortical lesion were asked to extend their wrist and fingers bilaterally while an electromyogram (EMG) was recorded from the extensor carpi radialis (ECR) muscle in the unaffected hand. Electric stimulation was applied to the homonymous wrist and finger extensors of the affected side. The intensity of the electrical stimulation was computed based on the EMG and scaled so that the movements of the paretic hand looked similar to those of the unaffected side. The patients received 30-minutes of therapy per day for 2 weeks. RESULTS: Improvement in the active range of motion of wrist extension was observed for all patients. There was a decrease in the scores of modified Ashworth scale in the flexors. Fugl-Meyer assessment scores of motor function of the upper extremities improved in two of the patients. CONCLUSIONS: The results suggest a positive outcome can be obtained using the CHASE system for upper extremity rehabilitation of patients with severe hemiplegia.


Asunto(s)
Terapia por Estimulación Eléctrica , Mano/fisiopatología , Hemiplejía/fisiopatología , Músculo Esquelético/fisiopatología , Recuperación de la Función , Accidente Cerebrovascular/fisiopatología , Adulto , Estudios de Factibilidad , Femenino , Hemiplejía/rehabilitación , Hemiplejía/terapia , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Rango del Movimiento Articular , Accidente Cerebrovascular/terapia , Rehabilitación de Accidente Cerebrovascular , Resultado del Tratamiento , Muñeca/fisiopatología
7.
Artículo en Inglés | MEDLINE | ID: mdl-23366957

RESUMEN

Recently there has been an increase in the number of stroke patients with motor paralysis. Appropriate re-afferent sensory feedback synchronized with a voluntary motor intention would be effective for promoting neural plasticity in the stroke rehabilitation. Therefore, BCI technology is considered to be a promising approach in the neuro-rehabilitation. To estimate human motor intention, an event-related desynchronization (ERD), a feature of electroencephalogram (EEG) evoked by motor execution or motor imagery is usually used. However, there exists various factors that affect ERD production, and its neural mechanism is still an open question. As a preliminary stage, we evaluate mutual effects of intrinsic (voluntary motor imagery) and extrinsic (visual and somatosensory stimuli) factors on the ERD production. Experimental results indicate that these three factors are not always additively interacting with each other and affecting the ERD production.


Asunto(s)
Atención/fisiología , Mapeo Encefálico/métodos , Interfaces Cerebro-Computador , Sincronización Cortical/fisiología , Electroencefalografía/métodos , Imaginación/fisiología , Movimiento/fisiología , Algoritmos , Potenciales Evocados Motores/fisiología , Femenino , Humanos , Masculino , Adulto Joven
8.
Neurorehabil Neural Repair ; 25(6): 565-9, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21436391

RESUMEN

BACKGROUND: Transcranial direct current stimulation (tDCS) of the motor cortex can enhance the performance of a paretic upper extremity after stroke. Reported effects on lower limb (LL) function are sparse. OBJECTIVE: The authors examined whether tDCS can increase the force production of the paretic quadriceps. METHODS: In this double-blind, crossover, sham-controlled experimental design, 8 participants with chronic subcortical stroke performed knee extension using their hemiparetic leg before, during, and after anodal or sham tDCS of the LL motor cortex representation in the affected hemisphere. Affected hand-grip force was also recorded. RESULTS: The maximal knee-extension force increased by 21 N (13.2%, P < .01) during anodal tDCS compared with baseline and sham stimulation. The increase persisted less than 30 minutes. Maximal hand-grip force did not change. CONCLUSIONS: Anodal tDCS transiently enhanced knee extensor strength. The modest increase was specific to the LL. Thus, tDCS might augment the rehabilitation of stroke patients when combined with lower extremity strengthening or functional training.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Corteza Motora/fisiopatología , Debilidad Muscular/rehabilitación , Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Debilidad Muscular/fisiopatología , Paresia/fisiopatología , Músculo Cuádriceps/fisiopatología , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Estimulación Magnética Transcraneal/métodos
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