Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis.

BACKGROUND: Enhancement of sensory input in the form of repetitive peripheral sensory stimulation (RPSS) can enhance excitability of the motor cortex and upper limb performance. OBJECTIVE: To perform a systematic review and meta-analysis of effects of RPSS compared with control stimulation on improvement of motor outcomes in the upper limb of subjects with stroke. METHODS: We searched studies published between 1948 and December 2017 and selected 5 studies that provided individual data and applied a specific paradigm of stimulation (trains of 1-ms pulses at 10 Hz, delivered at 1 Hz). Continuous data were analyzed with means and standard deviations of differences in performance before and after active or control interventions. Adverse events were also assessed. RESULTS: There was a statistically significant beneficial effect of RPSS on motor performance (standard mean difference between active and control RPSS, 0.67; 95% CI, 0.09-1.24; I2 = 65%). Only 1 study included subjects in the subacute phase after stroke. Subgroup analysis of studies that only included subjects in the chronic phase showed a significant effect (1.04; 95% CI, 0.66-1.42) with no heterogeneity. Significant results were obtained for outcomes of body structure and function as well as for outcomes of activity limitation according to the International Classification of Function, Disability and Health, when only studies that included subjects in the chronic phase were analyzed. No serious adverse events were reported. CONCLUSIONS: RPSS is a safe intervention with potential to become an adjuvant tool for upper extremity paresis rehabilitation in subjects with stroke in the chronic phase.

A Brazilian-Portuguese version of the Kinesthetic and Visual Motor Imagery Questionnaire.

Motor imagery has emerged as a potential rehabilitation tool in stroke. The goals of this study were: 1) to develop a translated and culturally-adapted Brazilian-Portugese version of the Kinesthetic and Visual Motor Imagery Questionnaire (KVIQ20-P); 2) to evaluate the psychometric characteristics of the scale in a group of patients with stroke and in an age-matched control group; 3) to compare the KVIQ20 performance between the two groups. Test-retest, inter-rater reliabilities, and internal consistencies were evaluated in 40 patients with stroke and 31 healthy participants. In the stroke group, ICC confidence intervals showed excellent test-retest and inter-rater reliabilities. Cronbach's alpha also indicated excellent internal consistency. Results for controls were comparable to those obtained in persons with stroke. The excellent psychometric properties of the KVIQ20-P should be considered during the design of studies of motor imagery interventions for stroke rehabilitation.

A Brazilian-Portuguese version of the Kinesthetic and Visual Motor Imagery Questionnaire / Versão brasileira do Questionário de Imagética Motora Cinestésica e Visual

ABSTRACT Motor imagery has emerged as a potential rehabilitation tool in stroke. The goals of this study were: 1) to develop a translated and culturally-adapted Brazilian-Portugese version of the Kinesthetic and Visual Motor Imagery Questionnaire (KVIQ20-P); 2) to evaluate the psychometric characteristics of the scale in a group of patients with stroke and in an age-matched control group; 3) to compare the KVIQ20 performance between the two groups. Methods Test-retest, inter-rater reliabilities, and internal consistencies were evaluated in 40 patients with stroke and 31 healthy participants. Results In the stroke group, ICC confidence intervals showed excellent test-retest and inter-rater reliabilities. Cronbach's alpha also indicated excellent internal consistency. Results for controls were comparable to those obtained in persons with stroke. Conclusions The excellent psychometric properties of the KVIQ20-P should be considered during the design of studies of motor imagery interventions for stroke rehabilitation.

RESUMO A Imagética Mental é uma ferramenta em potencial para a reabilitação de indivíduos com doenças cerebrovasculares. Os objetivos desse estudo foram: 1) Desenvolver uma versão traduzida e adaptada culturalmente do Questionário de Imagética Motora Cinestésica e Visual (KVIQ20-P); 2) Avaliar as características psicométricas da escala nesse grupo e em controles; 3) Comparar o desempenho na escala entre os dois grupos. Métodos Confiabilidades teste-reteste, interexaminador, assim como consistências internas da KVIQ20-P foram avaliadas em 40 indivíduos com AVC e em 31 controles. Resultados No grupo de pacientes, os intervalos de confiança mostraram excelentes confiabilidades teste-reteste e interexaminador. O alfa de Cronbach indicou uma excelente consistência interna. Os resultados no grupo controle foram comparáveis aos obtidos nos pacientes. Conclusões As excelentes propriedades psicométricas da KVIQ20-P devem ser consideradas durante o desenho de estudos de Imagética Mental para a reabilitação de indivíduos com doenças cerebrovasculares.

Magnetic fields in noninvasive brain stimulation.

The idea that magnetic fields could be used therapeutically arose 2000 years ago. These therapeutic possibilities were expanded after the discovery of electromagnetic induction by the Englishman Michael Faraday and the American Joseph Henry. In 1896, Arsène d'Arsonval reported his experience with noninvasive brain magnetic stimulation to the scientific French community. In the second half of the 20th century, changing magnetic fields emerged as a noninvasive tool to study the nervous system and to modulate neural function. In 1985, Barker, Jalinous, and Freeston presented transcranial magnetic stimulation, a relatively focal and painless technique. Transcranial magnetic stimulation has been proposed as a clinical neurophysiology tool and as a potential adjuvant treatment for psychiatric and neurologic conditions. This article aims to contextualize the progress of use of magnetic fields in the history of neuroscience and medical sciences, until 1985.

Um estudo do processo expressivo de afásicos sob enfoque da psicologia junguiana / A study of the aphasics expressive process under the jungian psychological focus

Este artigo descreve uma pesquisa exploratória em que se aplica técnica expressiva plástica a afásicos de expressão, vítimas de acidente vascular cerebral isquêmico (AVCI) no hemisfério esquerdo. Objetivo: Investigar os resultados da intervenção realizando estudos de caso com base no método clínico e análise qualitativa, com enfoque teórico da psicologia junguiana. Método: Utiliza testes antes e depois da intervenção, como critério externo: a técnica projetiva HTP - House-Tree-Person, aponta mudanças de personalidade condizentes com as observadas no processo; o teste de percepção emocional International Affective Picture System - IAPS, e seu sistema de registro de respostas Self-Assessment Manikin - SAM, auxilia a lançar hipóteses sobre a transformação emocional dos participantes; o European Brain Injury Questionnaire - EBIQ, fornece substratos para discutir a transformação da visão dos sujeitos sobre seus próprios problemas. Mediante o método do Discurso do Sujeito Coletivo identifica etapas do processo expressivo com conteúdos comuns ao grupo atendido. Resultados: Os resultados dos estudos de caso, do DSC e dos instrumentos de avaliação revelam que, ao final, os participantes, sem exceção, mostraram-se fortalecidos, mais próximos da sua própria realidade e enriquecidos no contato consigo mesmos e com o mundo externo. Conclusão: Os instrumentos de avaliação o confirmam, assinalando o valor terapêutico da técnica proposta e sugerindo que esta forma de intervenção pode ser útil no processo de reabilitação de afásicos

This article describes a exploratory research that applies a plastic expressive technique in expression aphasics, victims of ischemic stroke in the left hemisphere. Objetive: Investigates the intervention results through case studies based on the clinical method and qualitative analysis, with the theoretical focus on jungian psychology. Method: It uses tests before and after the intervention, such as external criterion. The projective thechnique House-Tree-Person - HTP, shows consonant results with the ones observed on expressive process; the emotional perception test International Affective Picture System - IAPS and its response record system Self-Assessment Manikin - SAM, enables to launch hypothesis on the emotional transformation of participants; the European Brain Injury Questionnaire - EBIQ, offers substratum to discuss the transformation of the subjects own vision of their problems. Through the Collective Subject Discourse method, identifies stages of the expressive process with contents common to the group. Results: The results of the case studies, the DSC and assessment tools reveal that, in the end, the participants, without exception, were strengthened, closer to their own reality and enriched in touch with themselves and with the outside world. Conclusion: Assessment tools to confirm by ticking the therapeutic value of the proposed technique and suggesting that this form of intervention may be helpful in the process of rehabilitation of aphasic.

Home-based nerve stimulation to enhance effects of motor training in patients in the chronic phase after stroke: a proof-of-principle study.

BACKGROUND: Somatosensory stimulation in the form of repetitive peripheral nerve stimulation (RPSS) is a promising strategy to improve motor function of the upper limb in chronic stroke. Home-based RPSS may be an alternative to hospital-based RPSS. OBJECTIVES: To investigate the feasibility and safety of an innovative program of home-based RPSS combined with motor training and to collect preliminary data on the efficacy of this program to enhance hand motor function in patients in the chronic phase after stroke. METHODS: Twenty patients were randomized to either active or sham RPSS associated with daily motor training performed at home over 4 consecutive weeks. All the patients were able to perform tasks of the Jebsen-Taylor Test (JTT). The primary outcome measures were feasibility, evaluated by self-reported compliance with the intervention, and safety (adverse events). Secondary outcomes comprised improvements in hand function in the JTT after end of treatment and after a 4-month follow-up period. RESULTS: There were no relevant adverse events. Compliance with RPSS and motor training was significantly greater in the active group than in the sham group. Upper extremity performance improved significantly more in the active group compared with the sham group at the end of treatment. This difference remained significant 4 months later, even when differences in compliance with motor training were considered. CONCLUSIONS: Home-based active RPSS associated with motor training was feasible, was safe, and led to long-lasting enhancement of paretic arm performance in the chronic phase after stroke for those who can perform the JTT. These results point to the need for an efficacy trial.

Effects of somatosensory stimulation on motor function after subacute stroke.

BACKGROUND: Previous works showed potentially beneficial effects of a single session of peripheral nerve sensory stimulation (PSS) on motor function of a paretic hand in patients with subacute and chronic stroke. OBJECTIVE: To investigate the influence of the use of different stimulus intensities over multiple sessions (repetitive PSS [RPSS]) paired with motor training. METHODS: To address this question, 22 patients were randomized within the second month after a single hemispheric stroke in a parallel design to application of 2-hour RPSS at 1 of 2 stimulus intensities immediately preceding motor training, 3 times a week, for 1 month. Jebsen-Taylor test (JTT, primary endpoint measure), pinch force, Functional Independence Measure (FIM), and corticomotor excitability to transcranial magnetic stimulation were measured before and after the end of the treatment month. JTT, FIM scores, and pinch force were reevaluated 2 to 3 months after the end of the treatment. RESULTS: Baseline motor function tests were comparable across the 2 RPSS intensity groups. JTT improved significantly in the lower intensity RPSS group but not in the higher intensity RPSS group at month 1. This difference between the 2 groups reduced by months 2 to 3. CONCLUSIONS: These results indicate that multiple sessions of RPSS could facilitate training effects on motor function after subacute stroke depending on the intensity of stimulation. It is proposed that careful dose-response studies are needed to optimize parameters of RPSS stimulation before designing costly, larger, double-blind, multicenter clinical trials.

Effects of somatosensory stimulation on motor function in chronic cortico-subcortical strokes.

Somatosensory stimulation enhances aspects of motor function in patients with chronic, predominantly subcortical infarcts. We investigated the effects of somatosensory stimulation on motor function in stroke patients with predominantly cortical involvement in the middle cerebral artery territory in a double-blind, pseudorandomized crossover trial. Motor performance was evaluated with the Jebsen-Taylor test before, after 2-hour somatosensory stimulation, and after subsequent motor training (n=11). In one experimental session, patients were submitted to median nerve stimulation (MNS) and in the other session, to control stimulation (CS). The order of the sessions was counterbalanced across patients. Improvement in performance in the Jebsen-Taylor test after somatosensory stimulation and after motor training was significantly greater in the MNS session than in the CS session. Additionally, patients who received MNS in the second session maintained the beneficial effects of training 30 days later. A single MNS session improves hand motor function in patients with chronic cortico-subcortical strokes and appears to favor consolidation of training effects. Somatosensory stimulation may be an adjuvant tool for stroke rehabilitation in patients with cortical lesions.

Bilateral occipital infarcts associated with carotid atherosclerosis and a persistent hypoglossal artery.

The persistent hypoglossal artery (PHA) is the second most common persistent embryological carotid-basilar connection and usually represents an incidental finding in cerebral arteriograms. The hypoglossal artery connects the primordial carotid artery with the longitudinal neural arteries, which later form the basilar artery. The PHA leaves the internal carotid artery as an extracranial branch, enters the skull through the anterior condyloid foramen, the hypoglossal canal and joins the caudal portion of the basilar artery. We report magnetic resonance and digital subtraction angiography findings in the first case of bilateral occipital infarctions associated with PHA and carotid atherosclerosis. The probable mechanism underlying bilateral occipital infarcts was embolism from the carotid territory to the posterior cerebral arteries. PHA may present a challenge in diagnosis and management of patients with carotid atherosclerosis and vertebrobasilar ischemia.