Alterations of tactile and anatomical spatial representations of the hand after stroke.

Stroke often causes long-term motor and somatosensory impairments. Motor planning and tactile perception rely on spatial body representations. However, the link between altered spatial body representations, motor deficit and tactile spatial coding remains unclear. This study investigates the relationship between motor deficits and alterations of anatomical (body) and tactile spatial representations of the hand in 20 post-stroke patients with upper limb hemiparesis. Anatomical and tactile spatial representations were assessed from 10 targets (nails and knuckles) respectively cued verbally by their anatomical name or using tactile stimulations. Two distance metrics (hand width and finger length) and two structural measures (relative organization of targets positions and angular deviation of fingers from their physical posture) were computed and compared to clinical assessments, normative data and lesions sites. Over half of the patients had altered anatomical and/or tactile spatial representations. Metrics of tactile and anatomical representations showed common variations, where a wider hand representation was linked to more severe motor deficits. In contrast, alterations in structural measures were not concomitantly observed in tactile and anatomical representations and did not correlate with clinical assessments. Finally, a preliminary analysis showed that specific alterations in tactile structural measures were associated with dorsolateral prefrontal stroke lesions. This study reveals shared and distinct characteristics of anatomical and tactile hand spatial representations, reflecting different mechanisms that can be affected differently after stroke: metrics and location of tactile and anatomical representations were partially shared while the structural measures of tactile and anatomical representations had distinct characteristics.

Post-Stroke Impairments of Manual Dexterity and Finger Proprioception: Their Contribution to Upper Limb Activity Capacity.

BACKGROUND: Knowing how impaired manual dexterity and finger proprioception affect upper limb activity capacity is important for delineating targeted post-stroke interventions for upper limb recovery. OBJECTIVES: To investigate whether impaired manual dexterity and finger proprioception explain variance in post-stroke activity capacity, and whether they explain more variance than conventional clinical assessments of upper limb sensorimotor impairments. METHODS: Activity capacity and hand sensorimotor impairments were assessed using clinical measures in N = 42 late subacute/chronic hemiparetic stroke patients. Dexterity was evaluated using the Dextrain Manipulandum to quantify accuracy of visuomotor finger force-tracking (N = 36), timing of rhythmic tapping (N = 36), and finger individuation (N = 24), as well as proprioception (N = 27). Stepwise multivariate and hierarchical linear regression models were used to identify impairments best explaining activity capacity. RESULTS: Dexterity and proprioceptive components significantly increased the variance explained in activity capacity: (i) Box and Block Test was best explained by baseline tonic force during force-tracking and tapping frequency (adjusted R2 = .51); (ii) Motor Activity Log was best explained by success rate in finger individuation (adjusted R2 = .46); (iii) Action Research Arm Test was best explained by release of finger force and proprioceptive measures (improved reaction time related to use of proprioception; adjusted R2 = .52); and (iv) Moberg Pick-Up test was best explained by proprioceptive function (adjusted R2 = .18). Models excluding dexterity and proprioception variables explained up to 19% less variance. CONCLUSIONS: Manual dexterity and finger proprioception explain unique variance in activity capacity not captured by conventional impairment measures and should be assessed when considering the underlying causes of post-stroke activity capacity limitations.URL: https://www.clinicaltrials.gov. Unique identifier: NCT03934073.

Efficacy of interactive manual dexterity training after stroke: a pilot single-blinded randomized controlled trial.

OBJECTIVE: To compare the efficacy of Dextrain Manipulandum™ training of dexterity components such as force control and independent finger movements, to dose-matched conventional therapy (CT) post-stroke. METHODS: A prospective, single-blind, pilot randomized clinical trial was conducted. Chronic-phase post-stroke patients with mild-to-moderate dexterity impairment (Box and Block Test (BBT) > 1) received 12 sessions of Dextrain or CT. Blinded measures were obtained before and after training and at 3-months follow-up. Primary outcome was BBT-change (after-before training). Secondary outcomes included changes in motor impairments, activity limitations and dexterity components. Corticospinal excitability and short intracortical inhibition (SICI) were measured using transcranial magnetic stimulation. RESULTS: BBT-change after training did not differ between the Dextrain (N = 21) vs CT group (N = 21) (median [IQR] = 5[2-7] vs 4[2-7], respectively; P = 0.36). Gains in BBT were maintained at the 3-month post-training follow-up, with a non-significant trend for enhanced BBT-change in the Dextrain group (median [IQR] = 3[- 1-7.0], P = 0.06). Several secondary outcomes showed significantly larger changes in the Dextrain group: finger tracking precision (mean ± SD = 0.3 ± 0.3N vs - 0.1 ± 0.33N; P < 0.0018), independent finger movements (34.7 ± 25.1 ms vs 7.7 ± 18.5 ms, P = 0.02) and maximal finger tapping speed (8.4 ± 7.1 vs 4.5 ± 4.9, P = 0.045). At follow-up, Dextrain group showed significantly greater improvement in Motor Activity Log (median/IQR = 0.7/0.2-0.8 vs 0.2/0.1-0.6, P = 0.05). Across both groups SICI increased in patients with greater BBT-change (Rho = 0.80, P = 0.006). Comparing Dextrain subgroups with maximal grip force higher/lower than median (61.2%), BBT-change was significantly larger in patients with low vs high grip force (7.5 ± 5.6 vs 2.9 ± 2.8; respectively, P = 0.015). CONCLUSIONS: Although immediate improvements in gross dexterity post-stroke did not significantly differ between Dextrain training and CT, our findings suggest that Dextrain enhances recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial. Trial registration ClinicalTrials.gov NCT03934073 (retrospectively registered).

[Early post stroke rehabilitation care]. / Prise en charge rééducative précoce après un accident vasculaire cérébral.

Stroke represent the leading cause of non-traumatic disability in France. Post stroke rehabilitation should be considered as soon as clinical state patient is stabilized. In addition to early primary and secondary cardiovascular prevention, specific evaluation of neuro-motor, neuro-orthopedic, cognitive, sensory and psychological impairments is necessary. It allows adopting the appropriate rehabilitation strategies for rehabilitation to reduce disability, acquire maximum independence and assure well-being and a satisfactory sustainable quality of life. The organization of this care is multidisciplinary. It requires appropriate guidance of each patient based on impairments' severity, complex individual and environmental parameters each requiring specific competencies. A coordinated care pathway optimizes therapeutic means available for reducing post-stroke disability.

Prise en charge rééducative précoce après un accident vasculaire cérébral. L'accident vasculaire cérébral (AVC) est la première cause de handicap non traumatique en France. La prise en charge rééducative des patients après AVC doit être envisagée dès la stabilisation clinique. Outre la prévention cardiovasculaire primaire et secondaire précoce, l'évaluation spécifique des déficiences neuromotrices, neuro-orthopédiques, cognitives, sensorielles et psychologiques est nécessaire. Elle permet de mettre en place les stratégies adaptées de rééducation et de réadaptation pour limiter les incapacités, acquérir une autonomie maximale et obtenir une qualité de vie satisfaisante. L'organisation de cette prise en charge est multidisciplinaire. Elle nécessite l'orientation de chaque patient en fonction de la sévérité de ses déficiences, de ses paramètres personnels médicaux et psychologiques, ainsi que des paramètres environnementaux pouvant justifier des besoins particuliers. Un parcours de soins coordonné permet d'optimiser les moyens thérapeutiques disponibles pour réduire le handicap après un AVC.

A novel method for the quantification of key components of manual dexterity after stroke.

BACKGROUND: A high degree of manual dexterity is a central feature of the human upper limb. A rich interplay of sensory and motor components in the hand and fingers allows for independent control of fingers in terms of timing, kinematics and force. Stroke often leads to impaired hand function and decreased manual dexterity, limiting activities of daily living and impacting quality of life. Clinically, there is a lack of quantitative multi-dimensional measures of manual dexterity. We therefore developed the Finger Force Manipulandum (FFM), which allows quantification of key components of manual dexterity. The purpose of this study was (i) to test the feasibility of using the FFM to measure key components of manual dexterity in hemiparetic stroke patients, (ii) to compare differences in dexterity components between stroke patients and controls, and (iii) to describe individual profiles of dexterity components in stroke patients. METHODS: 10 stroke patients with mild-to-moderate hemiparesis and 10 healthy subjects were recruited. Clinical measures of hand function included the Action Research Arm Test and the Moberg Pick-Up Test. Four FFM tasks were used: (1) Finger Force Tracking to measure force control, (2) Sequential Finger Tapping to measure the ability to perform motor sequences, (3) Single Finger Tapping to measure timing effects, and (4) Multi-Finger Tapping to measure the ability to selectively move fingers in specified combinations (independence of finger movements). RESULTS: Most stroke patients could perform the tracking task, as well as the single and multi-finger tapping tasks. However, only four patients performed the sequence task. Patients showed less accurate force control, reduced tapping rate, and reduced independence of finger movements compared to controls. Unwanted (erroneous) finger taps and overflow to non-tapping fingers were increased in patients. Dexterity components were not systematically related among each other, resulting in individually different profiles of deficient dexterity. Some of the FFM measures correlated with clinical scores. CONCLUSIONS: Quantifying some of the key components of manual dexterity with the FFM is feasible in moderately affected hemiparetic patients. The FFM can detect group differences and individual profiles of deficient dexterity. The FFM is a promising tool for the measurement of key components of manual dexterity after stroke and could allow improved targeting of motor rehabilitation.

[Functional impairment in patients with rheumatoid spondylitis of the pelvis]. / Evaluation du retentissement fonctionnel de la pelvispondylite rhumatismale a propos de 30 cas.

AIM: To assess functional impairment in patients with rheumatoid pelvispondylite. METHODS: cross-sectional study conducted on patients with rheumatoid pelvispondylite. Data are collected in a form specifying the epidemiological and demographic data, disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), metrological static and dynamic examination. Evaluation of functional impairment by Bath Ankylosing Spondylitis Functional Index (BASFI), and likert scale assessing social, economic and physical disability. RESULTS: 30 patients (22 men), the mean age is 37.2 years old; twenty one patients are without work. The mean duration of disease is 13.36 years, 50% are annoyed by morning stiffness than one hour, spinal pain and fatigue. The average value of BASDAI is 43.72/100; the average value of EVA fatigue is 56.16/100. The average value of BASFI is 56.36/100. An important or very important social, economic and physical disability was felt among 67% of the patients, which is correlated with duration of the disease, the BASDAI index, work, and the BASFI index. CONCLUSION: The functional impairment caused is statistically correlated with the intensity of the pain, the fatigue, the morning stiffness and BASDAI index, This impact on the quality of life is increased by the low level of education and poor professional integration.