Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

BACKGROUND: The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. OBJECTIVE: To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. METHODS: Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. RESULTS: A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. CONCLUSION: The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Effects of myofascial release technique in patients with unilateral cervical radiculopathy: A single blind-randomized clinical trial.

OBJECTIVE: The aim of this study was to investigate the effectiveness of the myofascial release technique in individuals diagnosed with unilateral cervical radiculopathy. MATERIALS AND METHODS: Thirty-four cervical radiculopathy patients were randomly assigned to either the myofascial release group or the exercise group. Both groups received conventional treatment. Additionally, the exercise group performed stretching and strengthening exercises while the myofascial release group received the myofascial release technique. The pain pressure threshold, muscle strength, cervical range of motion, pain, and disability variables were assessed for all patients. RESULTS: The myofascial release group demonstrated significantly larger improvements in flexion (p = 0.001), extension (p = 0.037), left rotation (p = 0.012), and left lateral flexion (p = 0.001) range of motions compared to the exercise group. Muscle strength in the wrist flexors (p < 0.001), wrist extensors (p < 0.010), biceps (p < 0.001) and triceps (p < 0.001) were significantly higher in the myofascial release group compared to the exercise group. And, again, the myofascial release group demonstrated significantly larger improvements in wrist flexors (p < 0.001), wrist extensors (p < 0.001), biceps (p < 0.001), triceps (p < 0.001), pectorals (p < 0.001), subscapularis (p < 0.001), upper trapezius (p = 0.002), and the pain pressure threshold. Finally, the myofascial release group demonstrated statistically significant improvements in pain (p < 0.001) and disability (p < 0.001) scales compared to the exercise group. CONCLUSION: Evaluation of the arm muscle strength and pain pressure threshold variables in patients with cervical radiculopathy may benefit clinicians in the preparation of treatments. Cervical radiculopathy symptoms may improve after the application of myofascial release techniques. A customized cervical exercise program and conventional treatment could be added to the non-surgical treatment of cervical radiculopathy.

The Effect of the Powerball Gyroscope as a Treatment Device for Nonspecific Wrist Pain.

OBJECTIVE: The aim of this study was to determine the effect of using the Powerball gyroscope as a treatment device on pain and change in endurance in nonspecific wrist pain. METHODS: This study was a within-participants pre- and postintervention study consisting of 40 participants between ages 18 and 35 with an equal male-to-female ratio. The participants used the Powerball gyroscope for 5 minutes per treatment session. Treatment comprised 12 sessions carried out 3 × per week over a 4-week period. Participants completed objective and subjective data before the first, seventh, and 12th sessions. Objective data were recorded using the Jamar dynamometer to measure grip strength. Subjective data were gathered using the Patient-Rated Wrist Evaluation Questionnaire. Participants then used the Powerball gyroscope in the hand with the affected wrist. The Wilcoxon signed rank test and 1-way repeated-measures analysis of variance were used to analyze the changes. RESULTS: A significant decrease in pain was noted throughout the study, but the most significant changes occurred between the seventh and 12th treatment sessions (P < .01). A significant increase in grip strength was also noted throughout the study, with the greater increase in grip strength occurring during the first 7 treatments (P < .02). CONCLUSION: The Powerball gyroscope showed a change in outcome regarding nonspecific wrist pain and grip strength.

Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis.

BACKGROUND: Clinical trials have demonstrated some benefits of electromyogram-triggered/controlled neuromuscular electrical stimulation (EMG-NMES) on motor recovery of upper limb (UL) function in patients with stroke. However, EMG-NMES use in clinical practice is limited due to a lack of evidence supporting its effectiveness. OBJECTIVE: To perform a systematic review and meta-analysis to determine the effects of EMG-NMES on stroke UL recovery based on each of the International Classification of Functioning, Disability, and Health (ICF) domains. METHODS: Database searches identified clinical trials comparing the effect of EMG-NMES versus no treatment or another treatment on stroke upper extremity motor recovery. A meta-analysis was done for outcomes at each ICF domain (Body Structure and Function, Activity and Participation) at posttest (short-term) and follow-up periods. Subgroup analyses were conducted based on stroke chronicity (acute/subacute, chronic phases). Sensitivity analysis was done by removing studies rated as poor or fair quality (PEDro score <6). RESULTS: Twenty-six studies (782 patients) met the inclusion criteria. Fifty percent of them were considered to be of high quality. The meta-analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain. No evidence was found in favor of EMG-NMES for the Activity and Participation domain. EMG-NMES had a stronger effect for each ICF domain in chronic (≥3 months) compared to acute/subacute phases. CONCLUSION: EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke.

Pain, fatigue, function and participation among long-term manual wheelchair users partnered with a mobility service dog.

PURPOSE: To assess the effects of a mobility service dog (MSD) on pain, fatigue, wheelchair-related functional tasks, participation and satisfaction among manual wheelchair users over a nine-month period. METHOD: A longitudinal study with repeated assessment times before and three, six and nine months after intervention was achieved. Intervention consisted in partnering each participant with a MSD. The setting is a well-established provincial service dog training school and participants homes. A convenience sample of 24 long-term manual wheelchair users with a spinal cord injury was involved. Outcome measures were: Wheelchair User's Shoulder Pain Index (WUSPI), Rate of Perceived Exertion (RPE), vitality scale from the SF-36, grip strength, Wheelchair Skills Test (WST), Canadian Occupational Performance Measure (COPM), Reintegration to Normal Living Index (RNLI), Life Space Assessment, Psychosocial Impact of Assistive Devices Scale (PIADS) and Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0). RESULTS: Shoulder and wrist pain as well as fatigue decreased significantly over time with the use of a MSD as evidenced by scores from WUSPI, RPE and SF-36 (feeling less worn out). Manual wheelchair propulsion skills (steep slopes, soft surfaces and thresholds) improved significantly over time as confirmed by the WST. Participation increased significantly over time as revealed by the COPM (for five occupations) and the RNLI (for five items). Satisfaction with the MSD was high over time (QUEST: nine items) and with a high positive psychosocial impact (PIADS: 10 items). CONCLUSION: MSD represents a valuable mobility assistive technology option for manual wheelchair users. IMPLICATIONS FOR REHABILITATION For manual wheelchair users partenered with mobility service dog  â€¢ Shoulder pain and fatigue significantly decreased and continued to decrease between the third and sixth month and the ninth month. • Performance with propelling the wheelchair up steep slopes increased from 41 to 88% and on soft surfaces increased from 53 to 100% after 3 months, respectively. • Occupational performance satisfaction was significantly increased for mobility in relation with the transfers, navigating in a natural environment and picking up objects. • High satisfaction towards psychosocial competency, psychosocial adequacy and self-esteem were reported at months three, six and nine.

A Pulsed Electrical Joint Stimulator for the Treatment of Osteoarthritis of the Hand and Wrist.

The hand is commonly affected by osteoarthritis (OA). The development and progression of OA are believed to involve inflammation, even in the early stages of the disease. Inflammatory and proinflammatory cytokines have also been shown to be elevated in the flexor tenosynovium of idiopathic carpal tunnel syndrome (CTS). A large percentage of patients with hand OA also have a concomitant CTS. This study evaluated the results of a pulsed electrical joint stimulator in patients who had hand OA with or without CTS. Pain, tenderness, and swelling; grip strength and pinch force; and Patient and Physician Global Assessment and Disabilities of the Arm, Shoulder and Hand (DASH) results were evaluated. The primary efficacy outcome was pain due to OA in the study hand in the past 48 hours. Secondary outcomes consisted of OA pain in the study thumb in the past 48 hours, grip strength, pinch force, and Patient and Physician Global Assessment and DASH results. All 7 outcome parameters improved in OA patients. On physical examination, individual finger and wrist joints had also improved regarding pain, swelling, and tenderness. In the subset of patients with CTS, CTS pain, paresthesia, weakness, and all CTS symptoms had significantly improved. Patient and Physician Global Assessment and DASH results and pinch force were also significantly improved. This pulsed electrical joint stimulator is effective in providing clinically relevant and statistically significant reductions in the signs and symptoms of OA of the hand and CTS. It could be a useful modality for the treatment of patients who have one of these conditions or both. [Orthopedics. 2018; 41(4):e550-e556.].

Five-day course of paired associative stimulation fails to improve motor function in stroke patients.

BACKGROUND: Non-invasive brain stimulation has been studied as a therapeutic adjunct for upper-limb recovery in patients with stroke. One type of stimulation, paired associative stimulation (PAS), has effects on plasticity in both patients and healthy participants. Lasting several hours, these effects are reversible and topographically specific. OBJECTIVE: The goal was to investigate the presence of a lasting increase in motor cortex plasticity for extensor wrist muscles - extensor carpi radialis (ECR) - and an improvement in upper-limb function after 5 days of daily PAS in patients at the subacute post-stroke stage. METHODS: A total of 24 patients (mean [SD] age 50.1 [12.1] years, weeks since stroke 10.1 [5.3]) were included in a double-blind, placebo-controlled trial and randomly assigned to the PAS or sham group (n=13 and n=11). For the PAS group, patients underwent a 5-day course of electrical peripheral stimulation combined with magnetic cortical stimulation applied to the ECR muscle in a single daily session at 0.1Hz for 30min; patients with sham treatment received minimal cortical stimulation. Both patient groups underwent 2 hr of conventional physiotherapy. Variations in the motor evoked potential (MEP) surface area of the ECR muscle and Fugl-Meyer Assessment-Upper-Limb motor scores were analysed up to day 12. RESULTS: The 2 groups did not differ in electrophysiological or motor parameters. Repeated PAS sessions seemed to affect only patients with low initial cortical excitability. We found considerable variability in PAS effects between patients and across the sessions. CONCLUSION: We failed to induce a lasting effect with PAS in the present study. PAS does not seem to be the main method for post-stroke brain stimulation. Perhaps recruitment of patients could be more selective, possibly targeting those with a wide altered ipsilesional corticomotor pathway.

Immediate effect of mental practice with and without mirror therapy on muscle activation in hemiparetic stroke patients.

Mental practice (MP) consists of the repeated mental rehearsal of a physical skill without movement, called motor imagery (MI). Studies show that MP and MI associated mirror therapy (MPMT) may improve muscle control of the upper limbs in hemiparesis. This study aimed to evaluate muscle activation during active flexion of the wrist (MA), MP, and MPMT in patients with history of stroke and hemiparesis. Individuals diagnosed with stroke showing sequelae of upper limb hemiparesis were enrolled. The flexor carpi ulnaris was analyzed using electromyography during tasks (MA, MP, MPMT) involving wrist flexion. Greater electromyographic activity was detected during MP and MPMT techniques compared to active movement (p = 0.02). There was no significant difference between MP and MPMT (p = 0.56). These results were found in both the affected limb and unaffected limb. Immediate effects on muscle activation are experienced during MP and MPMT, and muscle activity was similar with both therapies.

Physical therapy under hypnosis for the treatment of patients with type 1 complex regional pain syndrome of the hand and wrist: Retrospective study of 20 cases.

Type 1 complex regional painful syndrome (CRPS-1) has a complex physiopathology. The aim of this study was to evaluate the effectiveness of physical therapy under hypnotherapy to treat this condition. Twenty patients with CRPS-1 at the wrist and hand were evaluated retrospectively: 13 women and 7 men with an average age of 56 years (34-75). Thirteen patients were in the inflammatory phase and 7 in the dystrophic phase. The main endpoints were pain (VAS, analgesic use), stiffness (wrist and finger range of motion), and strength (pinch and grasp). Secondary endpoints were functional scores (QuickDASH, PWRE), patient satisfaction, return to work, and side effects. Results were satisfactory in all cases after 5.4 sessions on average. VAS decreased by 4 points, PWRE-pain by 4.1 points, and analgesic use was limited to paracetamol upon request. Finger and wrist range of motion increased and the QuickDASH decreased by 34 points, PRWE-function by 3.8 points, pinch strength increased 4 points, and grasp strength by 10 points. Return to work was possible in 80% of the cases. All patients were satisfied or very satisfied with the treatment. Physical therapy under hypnosis appears to be an effective treatment for CRPS-1 at the wrist and hand no matter the etiology.

Laser acupuncture versus reflexology therapy in elderly with rheumatoid arthritis.

The purposes of this study are to determine and compare efficacy of laser acupuncture versus reflexology in elderly with rheumatoid arthritis. Thirty elderly patients with rheumatoid arthritis aged between 60 and 70 years were classified into two groups, 15 patients each. Group A received laser acupuncture therapy (904 nm, beam area of 1cm2, power 100 mW, power density 100 mW/cm2, energy dosage 4 J, energy density 4 J/cm2, irradiation time 40 s, and frequency 100,000 Hz). The acupuncture points that were exposed to laser radiation are LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, and HT7. While group B received reflexology therapy, both offered 12 sessions over 4 weeks. The changes in RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints were measured at the beginning and end of treatment. There was significant decrease in RAQoL, HAQ, IL-6, and MDA pre/posttreatment for both groups (p < 0.05); significant increase in ATP pre/posttreatment for both groups (p < 0.05); significant increase in ankle dorsi-flexion, plantar-flexion, wrist flexion, extension, and ulnar deviation ROM pre/posttreatment in group A (p < 0.05); and significant increase in ankle dorsi-flexion and ankle plantar-flexion ROM pre/posttreatment in group B (p < 0.05). Comparison between both groups showed a statistical significant decrease in MDA and a statistical significant increase in ATP in group A than group B. Percent of changes in MDA was 41.82%↓ in group A versus 21.68%↓ in group B; changes in ATP was 226.97%↑ in group A versus 67.02%↑ in group B. Moreover, there was a statistical significant increase in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation in group A than group B. Laser therapy is associated with significant improvement in MDA and ATP greater than reflexology. In addition, it is associated with significant improvement in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation greater than reflexology in elderly patients with rheumatoid arthritis.

Giving Them a Hand: Wearing a Myoelectric Elbow-Wrist-Hand Orthosis Reduces Upper Extremity Impairment in Chronic Stroke.

OBJECTIVE: To determine the immediate effect of a portable, myoelectric elbow-wrist-hand orthosis on paretic upper extremity (UE) impairment in chronic, stable, moderately impaired stroke survivors. DESIGN: Observational cohort study. SETTING: Outpatient rehabilitation clinic. PARTICIPANTS: Participants exhibiting chronic, moderate, stable, poststroke, UE hemiparesis (N=18). INTERVENTIONS: Subjects were administered a battery of measures testing UE impairment and function. They then donned a fabricated myoelectric elbow-wrist-hand orthosis and were again tested on the same battery of measures while wearing the device. MAIN OUTCOME MEASURES: The primary outcome measure was the UE Section of the Fugl-Meyer Scale. Subjects were also administered a battery of functional tasks and the Box and Block (BB) test. RESULTS: Subjects exhibited significantly reduced UE impairment while wearing the myoelectric elbow-wrist-hand orthosis (FM: t17=8.56, P<.0001) and increased quality in performing all functional tasks while wearing the myoelectric elbow-wrist-hand orthosis, with 3 subtasks showing significant increases (feeding [grasp]: z=2.251, P=.024; feeding [elbow]: z=2.966, P=.003; drinking [grasp]: z=3.187, P=.001). Additionally, subjects showed significant decreases in time taken to grasp a cup (z=1.286, P=.016) and increased gross manual dexterity while wearing a myoelectric elbow-wrist-hand orthosis (BB test: z=3.42, P<.001). CONCLUSIONS: Results suggest that UE impairment, as measured by the Fugl-Meyer Scale, is significantly reduced when donning a myoelectric elbow-wrist-hand orthosis, and these changes exceeded the Fugl-Meyer Scale's clinically important difference threshold. Further, utilization of a myoelectric elbow-wrist-hand orthosis significantly increased gross manual dexterity and performance of certain functional tasks. Future work will integrate education sessions to increase subjects' ability to perform multijoint functional movements and attain consistent functional changes.

Education, night splinting and exercise versus usual care on recovery and conversion to surgery for people awaiting carpal tunnel surgery: a protocol for a randomised controlled trial.

INTRODUCTION: Carpal tunnel syndrome (CTS) is a prevalent upper limb condition that results in significant individual and socioeconomic costs. Large patient numbers, long outpatient waiting times and traditional referral pathways in public health systems create delays in accessing treatment for this condition. Alternative care pathways aimed at streamlining access to treatment and reducing the need for surgical intervention warrant further investigation. METHODS: A randomised, single-blind controlled clinical trial will be conducted. 128 participants aged 18-75 years with CTS will be recruited from the carpal tunnel surgery waitlists of participating public hospitals. Suitable participants will be stratified for severity and randomly allocated to either receive therapy (education, provision of splints and a home exercise programme) or standard care (continuing on the waitlist without hand therapy intervention for the duration of the study). Outcomes will be measured at baseline and after 6 weeks and 6 months. Primary outcomes are conversion to surgery ratio and perceived effect via the Global Rating of Change Scale.Secondary measures include patient satisfaction, and monitoring of symptoms and function using outcome measures including the Boston CTS Questionnaire, Disability of Arm, Shoulder and Hand Questionnaire, Patient-Specific Functional Scale, patient completed diagram of symptoms and Self-reported Leeds Assessment of Neuropathic Symptoms and Signs pain scale. DISCUSSION: This paper outlines the design and rationale for a randomised controlled trial that aims to assess the efficacy of an alternative care pathway for the management of patients with CTS while on the surgery waitlist. It is anticipated that the outcomes of this study will contribute to improved and expedited management of this common condition in a public hospital setting. ETHICS AND DISSEMINATION: Ethics approval was granted by the Princess Alexandra Hospital Centres for Health Research (HREC/13/QPAH/434-SSA/13/QPAH/447) and the Medical Research Ethics Committee at the University of Queensland. Results will be disseminated via conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER: ACTRN12613001095752.

A Clinical Trial with Brazilian Arnica (Solidago chilensis Meyen) Glycolic Extract in the Treatment of Tendonitis of Flexor and Extensor Tendons of Wrist and Hand.

One of the Brazilian arnicas, Solidago chilensis Meyen, is a species of the Asteraceae family. This plant is known by this common name because it shares remarkably similar organoleptic properties with the genus Arnica L., also within the family Asteraceae. We examined the effectiveness of the S. chilensis fluid extract used externally for treating tendinitis of flexor and extensor tendons of wrist and hand in placebo-controlled double-blind clinical pharmacological studies. This study was approved by the Ethical Committee for Scientific Research in Human Beings at University Vila Velha-UVV. Two daily skin applications on the arm skin of a gel cream containing a 5% glycolic plant extract were administered to eight volunteers for 21 days. Among the volunteers, one of their arms was used as the placebo group, and the other one was used as a test group. Statistical data analyses demonstrated a significant reduction in the perception of pain in the arms in the test group, when it was compared to those receiving only the placebo.

Efficacy and safety of transcutaneous electrical acupoint stimulation to treat muscle spasticity following brain injury: a double-blinded, multicenter, randomized controlled trial.

OBJECTIVE: This study was aimed at evaluating the clinical efficacy and safety of transcutaneous electrical acupoint stimulation (TEAS) to treat muscle spasticity after brain injury (Chinese Clinical Trial Registry: ChiCTR-TRC-11001310). METHODS: A total of 60 patients with muscle spasticity after brain injury were randomized to the following 3 groups: 100, 2, and 0 Hz (sham) TEAS. The acupoints Hegu (LI4)--Yuji (LU10) and Zusanli (ST36)--Chengshan (BL57) on the injured side were stimulated at 0, 2, or 100 Hz, 5 times per week for 4 weeks. The patients were followed up for 1 and 2 months after the treatments. The effects of the treatments on muscle spasticity at the wrist, thumb, the other 4 fingers, elbow, shoulder, knee, and ankle were evaluated by the Modified Ashworth Scale, and the effects on disability were assessed by the Disability Assessment Scale. The walking capability was evaluated by the Holden functional ambulation classification score. The overall performance was assessed by the Global Assessment Scale score and the improved Barthel Index. The safety of the treatments administered was also monitored. RESULTS: The wrist spasticity was significantly reduced from baseline at weeks 2, 3, and 4 of treatment and at the 1- and 2-month follow-up visits in the 100 Hz group (P < 0.01). Compared with 2 Hz or sham TEAS, 100 Hz TEAS decreased wrist spasticity at weeks 2, 3, and 4 of treatment and 1 month after treatment (P < 0.001). The other endpoints were not affected by the treatments. No treatment-emergent adverse events were reported during treatments and follow-up visits. CONCLUSIONS: TEAS appears to be a safe and effective therapy to relieve muscle spasticity after brain injury, although large-scale studies are required to further verify the findings. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-TRC-11001310 http://www.chictr.org.

Wrist Rehabilitation Assisted by an Electromyography-Driven Neuromuscular Electrical Stimulation Robot After Stroke.

BACKGROUND: Augmented physical training with assistance from robot and neuromuscular electrical stimulation (NMES) may introduce intensive motor improvement in chronic stroke. OBJECTIVE: To compare the rehabilitation effectiveness achieved by NMES robot-assisted wrist training and that by robot-assisted training. METHODS: This study was a single-blinded randomized controlled trial with a 3-month follow-up. Twenty-six hemiplegic subjects with chronic stroke were randomly assigned to receive 20-session wrist training with an electromyography (EMG)-driven NMES robot (NMES robot group, n = 11) and with an EMG-driven robot (robot group, n = 15), completed within 7 consecutive weeks. Clinical scores, Fugl-Meyer Assessment (FMA), Modified Ashworth Score (MAS), and Action Research Arm Test (ARAT) were used to evaluate the training effects before and after the training, as well as 3 months later. An EMG parameter, muscle co-contraction index, was also applied to investigate the session-by-session variation in muscular coordination patterns during the training. RESULTS: The improvement in FMA (shoulder/elbow, wrist/hand) obtained in the NMES robot group was more significant than the robot group (P < .05). Significant improvement in ARAT was achieved in the NMES robot group (P < .05) but absent in the robot group. NMES robot-assisted training showed better performance in releasing muscle co-contraction than the robot-assisted across the training sessions (P < .05). CONCLUSIONS: The NMES robot-assisted wrist training was more effective than the pure robot. The additional NMES application in the treatment could bring more improvements in the distal motor functions and faster rehabilitation progress.

Neuroplasticity of imagined wrist actions after spinal cord injury: a pilot study.

Motor imagery (MI - i.e., the mental representation of an action without physically executing it) stimulates brain motor networks and promotes motor learning after spinal cord injury (SCI). An interesting issue is whether the brain networks controlling MI are being reorganized with reference to spared motor functions. In this pilot study, we tested using magnetoencephalography (MEG) whether changes in cortical recruitment during MI were related to the motor changes elicited by rehabilitation. Over a 1-year period of inclusion, C6 SCI participants (n = 4) met stringent criteria for inclusion in a rehabilitation program focused on the tenodesis prehension (i.e., a compensatory prehension enabling seizing of objects in spite of hand and forearm muscles paralysis). After an extended baseline period of 5 weeks including repeated MEG and chronometric assessments of motor performance, MI training was embedded to the classical course of physiotherapy for five additional weeks. Posttest MEG and motor performance data were collected. A group of matched healthy control participants underwent a similar procedure. The MI intervention resulted in changes in the variability of the wrist extensions, i.e., a key movement of the tenodesis grasp (p < .05). Interestingly, the extent of cortical recruitment, quantified by the number of MEG activation sources recorded within Brodmann areas 1-8 during MI of the wrist extension, significantly predicted actual movement variability changes across sessions (p < .001). However, no such relationship was present for movement times. Repeated measurements afforded a reliable statistical power (range .70-.97). This pilot study does not provide straightforward evidence of MI efficacy, which would require a randomized controlled trial. Nonetheless, the data showed that the relationship between action and imagery of spared actions may be preserved after SCI.

NMES with rTMS for moderate to severe dysfunction after stroke.

BACKGROUND: Motor dysfunction after stroke might be improved by neuromuscular electrical stimulation (NMES) combined with 1 Hz repetitive transcranial magnetic stimulation (rTMS) in patients with moderate and severe motor dysfunction. OBJECTIVE: This preliminary study tested the effect of this treatment combination. METHODS: Fifteen patients (60.5 ± 10.3 years old) participated in the study. All patients had been affected by cerebral artery infarction or hemorrhage and had moderate or severe motor dysfunction in their affected hand. The patients received NMES at paretic wrist extensor muscles combined with rTMS over the unaffected M1 hemisphere twice a day, six days/week over two weeks. All participants underwent the following battery of tests to evaluate the motor function of the affected hand: Upper limb Fugl-Meyer Assessment (UFMA), Wolf Motor Function Test (WMFT), and Box and Block Test (BBT). RESULTS: UFMA, WMFT, and BBT scores improved significantly after the study. CONCLUSIONS: These results suggest that NMES combined with rTMS could be useful for recovery of moderate and severe motor function after stroke.

Effects of neuromuscular electrical stimulation on the wrist and finger flexor spasticity and hand functions in cerebral palsy.

PURPOSE: To evaluate the effects of neuromuscular electrical stimulation on wrist range of motion, wrist and finger flexor spasticity, and hand functions in patients with unilateral cerebral palsy. METHOD: Twenty-four children with unilateral spastic cerebral palsy (14 boys and 10 girls) between the ages of 5 and 14 years were randomized into neuromuscular electrical stimulation and control groups. Conventional exercises were applied, and static volar wrist-hand orthosis was administered to all patients 5 days a week for 6 weeks. Additionally, 30-minute neuromuscular electrical stimulation sessions were applied to the wrist extensor muscles in the neuromuscular electrical stimulation group. Patients were evaluated by Zancolli Classification System, Manual Ability Classification System, and Abilhand-Kids Test. RESULTS: Compared with baseline, a significant increase was evident in active wrist extension angle at the fourth and sixth weeks in both groups (all P < 0.001), more prominent in the neuromuscular electrical stimulation group at the fourth and sixth weeks (P = 0.015 and P = 0.006, respectively). A decrease was observed in the spasticity values in the neuromuscular electrical stimulation group at the fourth and sixth weeks (P = 0.002 and P = 0.001, respectively) and in the control group only at the sixth week (P = 0.008). Abilhand-Kids values improved only in the neuromuscular electrical stimulation group (P < 0.001). CONCLUSION: Neuromuscular electrical stimulation application in addition to conventional treatments is effective in improving active wrist range of motion, spasticity, and hand functions in cerebral palsy.