Grip strength differences in middle-aged and older adults and individuals with stroke.

BACKGROUND: How the natural deterioration of aging, sex difference, and pathological effect of stroke affect the prediction of hand strength is still unknown. AIM: This study aimed to compare and predict grip strength in both hands between normal controls (NCs) and stroke patients. DESIGN: Observational, cross-sectional study. SETTING: Two urban hospitals and the community. POPULATION: A total of 160 participants aged from 40 to 80 (80 NCs and stroke patients) were recruited. METHODS: The Jamar® Plus+ Digital Hand Dynamometer was used to measure the grip strength. Stroke participants were additionally assessed by the Fugl-Meyer Assessment and Modified Ashworth Scale. RESULTS: The linear regression models of the grip strength in both right and left hands were good fits (the adjusted R2 of 0.680-0.751) between NCs and stroke patients with either the right dominant or left non-dominant hand affected. Group (NCs versus stroke), sex, and age were sequentially the first three statistically significant predictors in the grip strength of both hands between NCs and stroke patients with either the right dominant or left non-dominant hand affected. CONCLUSIONS: The pathological, sex, and age effects play complementary roles in predicting the grip strength in middle-aged and older adults between NCs and stroke patients. CLINICAL REHABILITATION IMPACT: In clinical practice, the recovery of the grip strength in stroke patients should take pathological, sex, and age effects together with the right dominant or left non-dominant hand affected into consideration, rather than merely comparing the differences in the grip strength of both right and left hands as a reference.

Machine learning predicts clinically significant health related quality of life improvement after sensorimotor rehabilitation interventions in chronic stroke.

Health related quality of life (HRQOL) reflects individuals perceived of wellness in health domains and is often deteriorated after stroke. Precise prediction of HRQOL changes after rehabilitation interventions is critical for optimizing stroke rehabilitation efficiency and efficacy. Machine learning (ML) has become a promising outcome prediction approach because of its high accuracy and easiness to use. Incorporating ML models into rehabilitation practice may facilitate efficient and accurate clinical decision making. Therefore, this study aimed to determine if ML algorithms could accurately predict clinically significant HRQOL improvements after stroke sensorimotor rehabilitation interventions and identify important predictors. Five ML algorithms including the random forest (RF), k-nearest neighbors (KNN), artificial neural network, support vector machine and logistic regression were used. Datasets from 132 people with chronic stroke were included. The Stroke Impact Scale was used for assessing multi-dimensional and global self-perceived HRQOL. Potential predictors included personal characteristics and baseline cognitive/motor/sensory/functional/HRQOL attributes. Data were divided into training and test sets. Tenfold cross-validation procedure with the training data set was used for developing models. The test set was used for determining model performance. Results revealed that RF was effective at predicting multidimensional HRQOL (accuracy: 85%; area under the receiver operating characteristic curve, AUC-ROC: 0.86) and global perceived recovery (accuracy: 80%; AUC-ROC: 0.75), and KNN was effective at predicting global perceived recovery (accuracy: 82.5%; AUC-ROC: 0.76). Age/gender, baseline HRQOL, wrist/hand muscle function, arm movement efficiency and sensory function were identified as crucial predictors. Our study indicated that RF and KNN outperformed the other three models on predicting HRQOL recovery after sensorimotor rehabilitation in stroke patients and could be considered for future clinical application.

Development and user experience of an innovative multi-mode stroke rehabilitation system for the arm and hand for patients with stroke.

Many individuals with stroke experience upper-limb motor deficits, and a recent trend is to develop novel devices for enhancing their motor function. This study aimed to develop a new upper-limb rehabilitation system with the integration of two rehabilitation therapies into one system, digital mirror therapy (MT) and action observation therapy (AOT), and to test the usability of this system. In the part I study, the new system was designed to operate in multiple training modes of digital MT (i.e., unilateral and bilateral modes) and AOT (i.e., pre-recorded and self-recorded videos) with self-developed software. In the part II study, 4 certified occupational therapists and 10 stroke patients were recruited for evaluating usability. The System Usability Scale (SUS) (maximum score = 100) and a self-designed questionnaire (maximum score = 50) were used. The mean scores of the SUS were 79.38 and 80.00, and those of the self-designed questionnaire were 41.00 and 42.80, respectively, for the therapists and patients after using this system, which indicated good usability and user experiences. This novel upper-limb rehabilitation system with good usability might be further used to increase the delivery of two emerging rehabilitation therapies, digital AOT and MT, to individuals with stroke.

Age and sex differences in the biomechanical and viscoelastic properties of upper limb muscles in middle-aged and older adults: A pilot study.

Whether muscle properties gradually change with age and how muscle properties are affected by sex remain unclear. In this study, we investigated the influence of age and sex on the biomechanical and viscoelastic properties of arm muscles in middle-aged and older adults. In this cross-sectional study, 80 healthy participants were divided by sex (male and female), and each sex group, by 10-year age ranges (40-49, 50-59, 60-69, and 70-79 years). Muscle properties, including tone, stiffness, elasticity, and mechanical stress relaxation time, were measured with the MyotonPRO. Our results showed that the muscle tone and elasticity of the deltoid and flexor carpi radialis, and the muscle tone of the flexor carpi ulnaris, were significantly greater in men than in women, whereas the stress relaxation time of the triceps was significantly greater in women than in men. Significantly greater muscle stiffness in the biceps brachii was found in the participants over 50 years old. Less muscle elasticity was found in the deltoid, triceps, and flexor carpi ulnaris in those over 70 years old. In conclusion, age and sex have considerable impacts on upper-limb muscle properties in middle-aged and older adults, which should be taken into consideration when planning health promotion projects.

Predictors of In-Hospital Mortality for Road Traffic Accident-Related Severe Traumatic Brain Injury.

(1) Background: Road traffic accidents (RTAs) are the leading cause of pediatric traumatic brain injury (TBI) and are associated with high mortality. Few studies have focused on RTA-related pediatric TBI. We conducted this study to analyze the clinical characteristics of RTA-related TBI in children and to identify early predictors of in-hospital mortality in children with severe TBI. (2) Methods: In this 15-year observational cohort study, a total of 618 children with RTA-related TBI were enrolled. We collected the patients' clinical characteristics at the initial presentations in the emergency department (ED), including gender, age, types of road user, the motor components of the Glasgow Coma Scale (mGCS) score, body temperature, blood pressure, blood glucose level, initial prothrombin time, and the intracranial computed tomography (CT) Rotterdam score, as potential mortality predictors. (3) Results: Compared with children exhibiting mild/moderate RTA-related TBI, those with severe RTA-related TBI were older and had a higher mortality rate (p < 0.001). The in-hospital mortality rate for severe RTA-related TBI children was 15.6%. Compared to children who survived, those who died in hospital had a higher incidence of presenting with hypothermia (p = 0.011), a lower mGCS score (p < 0.001), a longer initial prothrombin time (p < 0.013), hyperglycemia (p = 0.017), and a higher Rotterdam CT score (p < 0.001). Multivariate analyses showed that the mGCS score (adjusted odds ratio (OR): 2.00, 95% CI: 1.28-3.14, p = 0.002) and the Rotterdam CT score (adjusted OR: 2.58, 95% CI: 1.31-5.06, p = 0.006) were independent predictors of in-hospital mortality. (4) Conclusions: Children with RTA-related severe TBI had a high mortality rate. Patients who initially presented with hypothermia, a lower mGCS score, a prolonged prothrombin time, hyperglycemia, and a higher Rotterdam CT score in brain CT analyses were associated with in-hospital mortality. The mGCS and the Rotterdam CT scores were predictive of in-hospital mortality independently.

Modulation of Functional Connectivity in Response to Mirror Visual Feedback in Stroke Survivors: An MEG Study.

BACKGROUND: Several brain regions are activated in response to mirror visual feedback (MVF). However, less is known about how these brain areas and their connectivity are modulated in stroke patients. This study aimed to explore the effects of MVF on brain functional connectivity in stroke patients. MATERIALS AND METHODS: We enrolled 15 stroke patients who executed Bilateral-No mirror, Bilateral-Mirror, and Unilateral-Mirror conditions. The coherence values among five brain regions of interest in four different frequency bands were calculated from magnetoencephalographic signals. We examined the differences in functional connectivity of each two brain areas between the Bilateral-No mirror and Bilateral-Mirror conditions and between the Bilateral-Mirror and Unilateral-Mirror conditions. RESULTS: The functional connectivity analyses revealed significantly stronger connectivity between the posterior cingulate cortex and primary motor cortex in the beta band (adjusted p = 0.04) and possibly stronger connectivity between the precuneus and primary visual cortex in the theta band (adjusted p = 0.08) in the Bilateral-Mirror condition than those in the Bilateral-No mirror condition. However, the comparisons between the Bilateral-Mirror and Unilateral-Mirror conditions revealed no significant differences in cortical coherence in all frequency bands. CONCLUSIONS: Providing MVF to stroke patients may modulate the lesioned primary motor cortex through visuospatial and attentional cortical networks.

Mirror Visual Feedback Induces M1 Excitability by Disengaging Functional Connections of Perceptuo-Motor-Attentional Processes during Asynchronous Bimanual Movement: A Magnetoencephalographic Study.

Mirror visual feedback (MVF) has been shown to increase the excitability of the primary motor cortex (M1) during asynchronous bimanual movement. However, the functional networks underlying this process remain unclear. We recruited 16 healthy volunteers to perform asynchronous bimanual movement, that is, their left hand performed partial range of movement while their right hand performed normal full range of movement. Their ongoing brain activities were recorded by whole-head magnetoencephalography during the movement. Participants were required to keep both hands stationary in the control condition. In the other two conditions, participants were required to perform asynchronous bimanual movement with MVF (Asy_M) and without MVF (Asy_w/oM). Greater M1 excitability was found under Asy_M than under Asy_w/oM. More importantly, when receiving MVF, the visual cortex reduced its functional connection to brain regions associated with perceptuo-motor-attentional process (i.e., M1, superior temporal gyrus, and dorsolateral prefrontal cortex). This is the first study to demonstrate a global functional network of MVF during asynchronous bimanual movement, providing a foundation for future research to examine the neural mechanisms of mirror illusion in motor control.

Predictors of In-Hospital Mortality for School-Aged Children with Severe Traumatic Brain Injury.

Traumatic brain injury (TBI) is the leading cause of mortality in children. There are few studies focused on school-aged children with TBI. We conducted this study to identify the early predictors of in-hospital mortality in school-aged children with severe TBI. In this 10 year observational cohort study, a total of 550 children aged 7-18 years with TBI were enrolled. Compared with mild/moderate TBI, children with severe TBI were older; more commonly had injury mechanisms of traffic accidents; and more neuroimage findings of subarachnoid hemorrhage (SAH), subdural hemorrhage (SDH), parenchymal hemorrhage, cerebral edema, and less epidural hemorrhage (EDH). The in-hospital mortality rate of children with severe TBI in our study was 23%. Multivariate analysis showed that falls, being struck by objects, motor component of Glasgow coma scale (mGCS), early coagulopathy, and SAH were independent predictors of in-hospital mortality. We concluded that school-aged children with severe TBI had a high mortality rate. Clinical characteristics including injury mechanisms of falls and being struck, a lower initial mGCS, early coagulopathy, and SAH are predictive of in-hospital mortality.

Motor Cortical Activity during Observing a Video of Real Hand Movements versus Computer Graphic Hand Movements: An MEG Study.

Both action observation (AO) and virtual reality (VR) provide visual stimuli to trigger brain activations during the observation of actions. However, the mechanism of observing video movements performed by a person's real hand versus that performed by a computer graphic hand remains uncertain. We aimed to investigate the differences in observing the video of real versus computer graphic hand movements on primary motor cortex (M1) activation by magnetoencephalography. Twenty healthy adults completed 3 experimental conditions: the resting state, the video of real hand movements (VRH), and the video of computer graphic hand movements (CGH) conditions with the intermittent electrical stimuli simultaneously applied to the median nerve by an electrical stimulator. The beta oscillatory activity (~20 Hz) in the M1 was collected, lower values indicating greater activations. To compare the beta oscillatory activities among the 3 conditions, the Friedman test with Bonferroni correction (p-value < 0.017 indicating statistical significance) were used. The beta oscillatory activities of the VRH and CGH conditions were significantly lower than that of the resting state condition. No significant difference in the beta oscillatory activity was found between the VRH and CGH conditions. Observing hand movements in a video performed by a real hand and those by a computer graphic hand evoked comparable M1 activations in healthy adults. This study provides some neuroimaging support for the use of AO and VR in rehabilitation, but no differential activations were found.

Predicting clinically significant motor function improvement after contemporary task-oriented interventions using machine learning approaches.

BACKGROUND: Accurate prediction of motor recovery after stroke is critical for treatment decisions and planning. Machine learning has been proposed to be a promising technique for outcome prediction because of its high accuracy and ability to process large volumes of data. It has been used to predict acute stroke recovery; however, whether machine learning would be effective for predicting rehabilitation outcomes in chronic stroke patients for common contemporary task-oriented interventions remains largely unexplored. This study aimed to determine the accuracy and performance of machine learning to predict clinically significant motor function improvements after contemporary task-oriented intervention in chronic stroke patients and identify important predictors for building machine learning prediction models. METHODS: This study was a secondary analysis of data using two common machine learning approaches, which were the k-nearest neighbor (KNN) and artificial neural network (ANN). Chronic stroke patients (N = 239) that received 30 h of task-oriented training including the constraint-induced movement therapy, bilateral arm training, robot-assisted therapy and mirror therapy were included. The Fugl-Meyer assessment scale (FMA) was the main outcome. Potential predictors include age, gender, side of lesion, time since stroke, baseline functional status, motor function and quality of life. We divided the data set into a training set and a test set and used the cross-validation procedure to construct machine learning models based on the training set. After the models were built, we used the test data set to evaluate the accuracy and prediction performance of the models. RESULTS: Three important predictors were identified, which were time since stroke, baseline functional independence measure (FIM) and baseline FMA scores. Models for predicting motor function improvements were accurate. The prediction accuracy of the KNN model was 85.42% and area under the receiver operating characteristic curve (AUC-ROC) was 0.89. The prediction accuracy of the ANN model was 81.25% and the AUC-ROC was 0.77. CONCLUSIONS: Incorporating machine learning into clinical outcome prediction using three key predictors including time since stroke, baseline functional and motor ability may help clinicians/therapists to identify patients that are most likely to benefit from contemporary task-oriented interventions. The KNN and ANN models may be potentially useful for predicting clinically significant motor recovery in chronic stroke.

Cortical neural activity evoked by bilateral and unilateral mirror therapy after stroke.

OBJECTIVE: This study aimed to investigate the differential effects of bilateral and unilateral mirror therapy (MT) on motor cortical activations in stroke patients by magnetoencephalography (MEG). METHODS: Sixteen stroke patients and 16 right-handed healthy volunteers were recruited. All participants were required to perform 4 conditions: resting, no mirror with bilateral hand movements (Bilateral-No mirror), mirror with bilateral hand movements (Bilateral-Mirror) and mirror with unilateral hand movements (Unilateral-Mirror). Beta oscillatory activities in the primary motor cortex (M1) were collected during each condition using MEG. The percentage change of beta oscillatory activity was calculated for each condition to correct the baseline differences. RESULTS: In the stroke group, the percentage change of M1 beta oscillatory activity significantly decreased more in the Bilateral-Mirror condition than in the Bilateral-No mirror and Unilateral-Mirror conditions. In the healthy group, no significant differences in the percentage change of beta oscillatory activity were found among the 3 conditions. Further, a significant difference in the percentage change of beta oscillatory activity only in the Bilateral-Mirror condition was found between the 2 groups. CONCLUSIONS: This study provides new information on the differential cortical activations modulated by bilateral and unilateral MT. SIGNIFICANCE: Bilateral MT led to greater M1 neural activities than unilateral MT and bilateral movements without a mirror in stroke patients.

Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study.

BACKGROUND: The timing of transcranial direct current stimulation (tDCS) with neurorehabilitation interventions may affect its modulatory effects. Motor function has been reported to be modulated by the timing of tDCS; however, whether the timing of tDCS would also affect restoration of daily function and upper extremity motor control with neurorehabilitation in stroke patients remains largely unexplored. Mirror therapy (MT) is a potentially effective neurorehabilitation approach for improving paretic arm function in stroke patients. This study aimed to determine whether the timing of tDCS with MT would influence treatment effects on daily function, motor function and motor control in individuals with chronic stroke. METHODS: This study was a double-blinded randomized controlled trial. Twenty-eight individuals with chronic stroke received one of the following three interventions: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). Participants received interventions for 90 min/day, 5 days/week for 4 weeks. Daily function was assessed using the Nottingham Extended Activities of Daily Living Scale. Upper extremity motor function was assessed using the Fugl-Meyer Assessment Scale. Upper extremity motor control was evaluated using movement kinematic assessments. RESULTS: There were significant differences in daily function between the three groups. The SEQ group had greater improvement in daily function than the CON and SHAM groups. Kinematic analyses showed that movement time of the paretic hand significantly reduced in the SEQ group after interventions. All three groups had significant improvement in motor function from pre-intervention to post-intervention. CONCLUSION: The timing of tDCS with MT may influence restoration of daily function and movement efficiency of the paretic hand in chronic stroke patients. Sequentially applying tDCS prior to MT seems to be advantageous for enhancing daily function and hand movement control, and may be considered as a potentially useful strategy in future clinical application. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02827864 . Registered on 29th June, 2016.

Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study.

BACKGROUND: Action observation therapy and mirror therapy, two promising rehabilitation strategies, are aimed at enhancing the motor learning and functional improvement of stroke patients through different patterns of visual feedback and observation. OBJECTIVE: This study investigated and compared the treatment effects of the action observation therapy, mirror therapy, and active control intervention on motor and functional outcomes of stroke patients. METHODS: Twenty-one patients with subacute stroke were recruited in this study. All patients were randomly assigned to the action observation therapy, mirror therapy, or active control intervention for 3 weeks. Outcome measures were conducted at baseline, immediately after treatment, and at 3-month follow-up. The primary outcome was the Fugl-Meyer Assessment, and secondary outcomes included the Box and Block Test, Functional Independence Measure, and Stroke Impact Scale. Descriptive analyses and the number of patients whose change score achieved minimal clinically important difference were reported. RESULTS: Both the action observation therapy and active control intervention showed similar improvements on the Fugl-Meyer Assessment, Box and Block Test, and Stroke Impact Scale. Moreover, the action observation therapy had a greater improvement on the Functional Independence Measure than the other 2 groups did. However, the mirror therapy group gained the least improvements on the outcomes. CONCLUSION: The preliminary results found that the patients in the action observation therapy and active control intervention groups had comparable benefits, suggesting that the 2 treatments might be used as an alternative to each other. A further large-scale study with at least 20 patients in each group to validate the study findings is needed. This trial is registered with NCT02871700.

Dysfunction of Inferior Parietal Lobule During Sensory Gating in Patients With Amnestic Mild Cognitive Impairment.

Patients with amnestic mild cognitive impairment (aMCI) demonstrate significant cognitive deficits, especially in the memory aspect. The memory deficiency might be attributed to the difficulties in the inhibitory function to suppress redundant stimuli. Sensory gating (SG) refers to the attenuation of neural responses to the second identical stimulus in a paired-click paradigm, in which auditory stimuli are delivered in pairs with inter-stimulus intervals (ISI) of 500 ms and inter-pair intervals of 6-8 s. It is considered as an electrophysiological signal to reflect the brain's automatic response to gate out repetitive sensory inputs. However, there has been no study systematically investigating SG function in aMCI patients. Thus, the present study used magnetoencephalography (MEG) to record neuromagnetic responses to a paired-click paradigm in 23 healthy controls (HC) and 26 aMCI patients. The Stimulus 2/Stimulus 1 (S2/S1) amplitude ratio was used to represent the SG function. Compared to HC, aMCI patients showed M50 SG deficits in the left inferior frontal gyrus (IFG) and right inferior parietal lobule (IPL). M100 SG defects were also observed in the right IPL. Based on the ROIs showing significant between-group SG differences, we found that a more deficient M50 SG function in the right IPL was associated with poorer performance in the immediate recall of Logic Memory (LM), Chinese Version Verbal Learning Test (CVVLT) and Digit Span Backward (DSB) Test. Furthermore, the M50 SG ratios of the right IPL together with the neuropsychological performance of LM and CVVLT demonstrated very good accuracy in the discrimination of aMCI from HC. In conclusion, compared to HC, aMCI patients showed a significant SG deficit in the right IPL, which was correlated with the auditory short-term memory function. We suggest the combination of SG in the right IPL, LM and CVVLT to be sensitive indicators to differentiate aMCI patients from HC.

Predictors of Clinically Important Changes in Actual and Perceived Functional Arm Use of the Affected Upper Limb After Rehabilitative Therapy in Chronic Stroke.

OBJECTIVE: To identify the predictors of minimal clinically important changes in actual and perceived functional arm use of the affected upper limb after rehabilitative therapy. DESIGN: Retrospective, observational cohort study. SETTING: Outpatient rehabilitation settings. PARTICIPANTS: A cohort of 94 patients with chronic stroke. INTERVENTIONS: Patients received robot-assisted therapy, mirror therapy, or combined therapy for 4 weeks. MAIN OUTCOME MEASURES: The primary outcome measures, assessed pre- and post intervention, included actual functional arm use measured by an accelerometer and perceived functional arm use measured by the Motor Activity Log (MAL). Candidate predictors included age, sex, time after stroke, side of stroke, and scores on the Fugl-Meyer Assessment, Modified Ashworth Scale, Medical Research Council scale, Wolf Motor Function Test, MAL (quality of movement), and Nottingham Extended Activities of Daily Living. RESULTS: Being male (odds ratio [OR], 3.17; 95% CI, 1.13-8.87) and having a higher than median Medical Research Council score (OR, 2.68; 95% CI, 1.12-6.41) significantly predicted minimal clinically important changes assessed by an accelerometer. Fugl-Meyer Assessment scores (odds ratio, 1.06; 95% CI, 1.02-1.11) were a significant predictor of achieving clinically important changes in MAL amount of use. Wolf Motor Function Test (quality) scores (OR, 3.05; 95% CI, 1.38-6.77) could predict clinically important improvements in MAL quality of movement. CONCLUSIONS: Predictors of clinically important changes in the use of the affected upper limb after robot-assisted therapy, mirror therapy, or combined therapy in patients with chronic stroke for 4 weeks differ for actual vs perceived use. Further studies are recommended to validate these findings in a larger sample.

Determinants of quality of life in the older residents of long-term care facilities using the World Health Organization International Classification of Functioning, Disability and Health framework in Taiwan.

Objectives: The purpose of this study was to identify determinants within the International Classification of Functioning, Disability and Health as a conceptual framework regarding the quality of life of older long-term care facility residents.Methods: A questionnaire-based cross-sectional design was conducted. All participants (n = 210) completed a questionnaire that included the Sheltered Care Environmental Scale, the Beck Depression Inventory, the Short Physical Performance Battery, the Mini-Mental State Examination, the World Health Organization Disability Assessment Schedule, and the World Health Organization Quality of Life Scale. The outcome was assessed using mixed-design multiple regression with a covariance model and hierarchical regression.Results: Personal factors, environmental factors, body function and structures, and activity and participation explained 35.9%, 18.5%, 25.2%, and 52.1% of the variability in quality of life, respectively. The hierarchical model included 10 variables and explained 84.3% of the total variability in quality of life.Conclusions: Activity and participation showed high explanatory power for the quality of life of older long-term care facility residents. The influence of activity and participation in the older population is an important issue, although these factors remain relatively unexplored. This exploratory study used the International Classification of Functioning, Disability and Health as a conceptual framework to provide a more sophisticated understanding of quality of life.Implications for rehabilitationAlthough the viewpoint of quality of life involves many more factors than an understanding of an individual disease or disability condition, activity and participation were found to be the most important factors.Simple clinical measures, such as activity limitations and participation restrictions, can be used as clinical markers of quality of life, thus enabling rehabilitation professionals to determine the quality of life of older people in institutions.The conceptual framework of determinants of quality of life that this study reports may be helpful for rehabilitation professionals to explore with patients to implement interventions.

The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study.

The priming effect of mirror visual feedback can be simply provided by inexpensive mirror therapy (MT), which exhibits beneficial effects on sensorimotor recovery in stroke. The present study was a single-blind pretest-posttest study that examined whether the priming effect of mirror visual feedback on bilateral task practice would render better outcomes. Twenty-three patients with chronic stroke were randomized to receive hospital-based task-oriented MT or bilateral arm training (BAT) for 4 weeks at 90 minutes/day, 3 days/week and a home practice for 30-40 minutes/day, 5 days/week. There was the potential trend for MT to improve temperature sense as measured by the revised Nottingham Sensory Assessment (Cohen's d = 1.00; 95% confidence interval, -0.09 to 2.09), and MT increased the Stroke Impact Scale 3.0 total score (d = 0.89; 0.003 to 1.71). MT also showed a trend for greater improvements in the Motor Activity Log (amount of use: d = 0.62; -0.24 to 1.44; quality of movement: d = 0.50; -0.35 to 1.31). MT involving bilateral movement practice with the priming effect of mirror visual feedback may render beneficial effects. The unilateral approach or MT augmented by extra feedback might be appropriate modifications.

Modulation of Motor Cortical Activities by Action Observation and Execution in Patients with Stroke: An MEG Study.

Action observation therapy has recently attracted increasing attention; however, the mechanisms through which action observation and execution (AOE) modulate neural activity in stroke patients remain unclear. This study was aimed at investigating the effects of action observation and two types of AOE on motor cortical activations after stroke using magnetoencephalography. Twenty patients with stroke and 20 healthy controls were recruited for the collection of data on the beta oscillatory activity in the primary motor cortex (M1). All participants performed the conditions of resting, observation only, and video observation combined with execution (video AOE). Stroke patients performed one additional condition of affected hand observation combined with execution (affected hand AOE). The relative change index of beta oscillations was calculated, and nonparametric tests were used to examine the differences in conditions. In stroke patients, the relative change index of M1 beta oscillatory activity under the video AOE condition was significantly lower than that under the observation only and affected hand AOE conditions. Moreover, M1 cortical activity did not significantly differ under the observation only and affected hand AOE conditions. For healthy controls, the relative change index under the video AOE condition was significantly lower than that under the observation only condition. In addition, no significant differences in relative change indices were found under the observation only and video AOE conditions between the 2 groups. This study provides new insight into the neural mechanisms underlying AOE, which supports the use of observing videos of normal movements during action observation therapy in stroke rehabilitation.

The relationship between trunk acceleration parameters and kinematic characteristics during walking in patients with stroke.

[Purpose] Limited literature has investigated the relationships between acceleration-based gait characteristics and kinematic information from motion analysis systems in gait analysis. The purpose of this study is to determine whether acceleration-based gait characteristics were associated with gait characteristics by motion analysis systems in patients with stroke. [Participants and Methods] Seventeen patients with stroke walked along a 10-m-long walkway at their comfortable speed. Trunk acceleration was measured with an accelerometer. Several reflective markers over bony landmarks on the lower extremities were used to capture movements. We evaluated the correlations of variables calculated between the trunk accelerometers and the motion analysis system. [Results] Walking speed was positively correlated with harmonic ratios along the anteroposterior axis and stride regularity along the vertical and anteroposterior axes. Harmonic ratios were associated with the stance phase percent on the unaffected side. Stride regularity was associated with the stance phase percent on both sides. Smaller interstride variability was associated with smaller peak ankle plantarflexion during both phases and greater peak ankle dorsiflexion during swing phase. Stride regularity is positively associated with maximal knee flexion during swing phase. [Conclusion] Relationships with spatiotemporal and joint kinematic parameters from the motion analysis system support the potential use of accelerometers.

Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis.

OBJECTIVE: This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients. DESIGN: Systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker. REVIEW METHODS: Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy. RESULTS: Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge's g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge's g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge's g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge's g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge's g = 0.661 and 0.783). CONCLUSION: This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.