Electroencephalography as a post-stroke assessment method: An updated review. / Electroencefalografía como método de evaluación tras un ictus. Una revisión actualizada.

Given that stroke is currently a serious problem in the population, employing more reliable and objective techniques for determining diagnosis and prognosis is necessary in order to enable effective clinical decision-making. EEG is a simple, low-cost, non-invasive tool that can provide information about the changes occurring in the cerebral cortex during the recovery process after stroke. EEG provides data on the evolution of cortical activation patterns which can be used to establish a prognosis geared toward harnessing each patient's full potential. This strategy can be used to prevent compensation and maladaptive plasticity, redirect treatments, and develop new interventions that will let stroke patients reach their new maximum motor levels.

Use of virtual reality systems as proprioception method in cerebral palsy: clinical practice guideline.

INTRODUCTION: The limitations in performing functional activities in children and adolescents with cerebral palsy are important. The use of virtual reality systems is a new treatment approach that reinforces task-oriented motor learning. The purpose of this guide is to study the impact of the use of virtual reality systems in the improvement and acquisition of functional skills, and to evaluate the scientific evidence to determine the strength of recommendation of such interventions. DEVELOPMENT: All available full-text articles, regardless of their methodology, were included. The following data bases were consulted: PubMed (Medline), PEDro, EMBASE (OVID-Elsevier), Cochrane Library, Medline (OVID), CINAHL, ISI Web Knowledge. An assessment was made of methodological quality, the level of scientific evidence, and the strength of recommendations using the tools: Critical Review Form - Quantitative Studies and the Guidelines for Critical Review Form - Quantitative Studies and U.S. Preventive Services Task Force. Finally, we included 13 articles and 97 participants were recruited. We obtained significant improvements in outcome measures that assessed postural control and balance, upper limb function, the selective joint control, and gait. CONCLUSIONS: The guide has some limitations: the limited number of patients enrolled, clinical diversity and age range, as well as the methodological quality of existing trials. Virtual reality is a promising tool in the treatment of children with cerebral palsy. There is strong scientific evidence of an acceptable recommendation for the use of virtual reality systems in the treatment of cerebral palsy.

Use of recognition of laterality through implicit motor imagery for the improvement of postural control and balance in subacute stroke patients: a randomized controlled study. / Uso del reconocimiento de la lateralidad a través de imaginería motora implícita para la mejora del control postural y el equilibrio en pacientes con ictus subagudo: un estudio controlado aleatorizado.

INTRODUCTION: Motor Imagery techniques may be used as a complement to the recovery of motor sequelae after a stroke, as during the evocation of a movement the activation of neuronal circuits involved in the actual execution of the movement occurs. PATIENTS AND METHODS: A simple-blind randomized controlled trial was conducted. A total of 38 patients were randomly assigned to a study group. Both groups performed, for four weeks, five weekly sessions of neurorehabilitation and three weekly sessions of experimental or control intervention, respectively.The experimental group training the recognition of laterality, while the control group the recognition of body parts. Participants were evaluated pre and post intervention with posturography parameters -Sway area (AREA), Sway path length (LONG), difference in weigthload between lower limbs (DIFLOAD)-, the Berg Balance scale (BBS), the Barthel Index (BI), the Time Up and Go Test (TUG), the Functional Ambulation Categories (FAC), and the quality-of-life scale for stroke (ECVI-38). RESULTS: After performing the intragroup analysis, statistical significance was obtained for AREA (p < 0.001), LONG (p = 0.04), DIFLOAD (p = 0.02), BBS (p < 0.001), BI (p < 0.001), FAC (p < 0.001), and ECVI-38 (p < 0.001) in the experimental group; and for DIFLOAD (p = 0.01), BBS (p = 0.001), BI (p = 0.001), TUG (p = 0.04), FAC (p = 0.03), and ECVI-38 (p = 0.003) in the control group. In the intergroup analysis, statistical significance was obtained for AREA (p = 0.03), BBS (p = 0.03), FAC (p = 0.02) and ECVI-38 (p = 0.002) at postintervention time. CONCLUSIONS: Combined use of physical rehabilitation and recognition of laterality through implicit motor imagery tasks, improves balance and functions related to postural control in subacute stroke patients.

TITLE: Uso del reconocimiento de la lateralidad a través de imaginería motora implícita para la mejora del control postural y el equilibrio en pacientes con ictus subagudo: un estudio controlado aleatorizado.Introducción. Las técnicas de imaginería motora pueden utilizarse como complemento a la recuperación de las secuelas motoras tras un ictus, ya que durante la evocación de un movimiento se produce la activación de los circuitos neuronales implicados en la ejecución de éste. Pacientes y métodos. Se realizó un ensayo controlado aleatorizado simple ciego. Treinta y ocho pacientes en total fueron asignados aleatoriamente a cada grupo de estudio. Ambos grupos realizaron, durante cuatro semanas, cinco sesiones semanales de neurorrehabilitación y tres sesiones semanales de intervención experimental o control. El grupo experimental entrenaba el reconocimiento de la lateralidad, mientras que el grupo de control lo hacía con el reconocimiento de partes del cuerpo. Los participantes fueron evaluados antes y después de la intervención con parámetros posturográficos (área de barrido, longitud del recorrido de oscilación y porcentaje de diferencia de carga de peso entre los miembros inferiores), la escala de equilibrio de Berg (BBS), el índice de Barthel, el test Time Up and Go, la clasificación funcional de la deambulación (FAC) y la escala de calidad de vida para el ictus (ECVI-38). Resultados. Después de realizar el análisis intragrupo, se obtuvo significación estadística para el área de barrido (p menor de 0,001), la longitud del recorrido de oscilación (p = 0,04), el porcentaje de diferencia de carga de peso entre los miembros inferiores (p = 0,02), la BBS (p menor de 0,001), el índice de Barthel (p menor de 0,001), la FAC (p menor de 0,001) y la ECVI-38 (p menor de 0,001) en el grupo experimental; y para el porcentaje de diferencia de carga de peso entre los miembros inferiores (p = 0,01), la BBS (p = 0,001), el índice de Barthel (p = 0,001), el Time Up and Go (p = 0,04), la FAC (p = 0,03) y la ECVI-38 (p = 0,003) en el grupo de control. En el análisis intergrupo se obtuvo significación estadística para el área de barrido (p = 0,03), la BBS (p = 0,03), la FAC (p = 0,02) y la ECVI-38 (p = 0,002) en el momento posterior a la intervención. Conclusiones. El uso combinado de rehabilitación física y reconocimiento de la lateralidad a través de tareas de imaginería motora implícita mejora el equilibrio y las funciones relacionadas con el control postural en pacientes con ictus subagudo.

[Observational gait scale for persons with lower extremity amputation. Design and content validity]. / Escala observacional de la marcha del sujeto con amputación de la extremidad inferior: diseño y validez de contenido.

INTRODUCTION: Gait pattern is altered in persons with lower extremity amputation. To assess gait pattern, it is important to use observational gait scales with a good content validity. OBJECTIVES: To design an observational gait scale and to analyze its content validity. MATERIAL AND METHODS: An expert committee was formed to obtain a version of the scale. The same committee was responsible for evaluating the scale. The content validity index (CVI) was calculated, both for each item and for the global scale. RESULTS: The main kinematic and spatiotemporal alterations were selected to design the items. The scale consists of 2sections and 25 items, with a maximum score of 35 points. An overall CVI score of 0.90 was obtained, and an index of validity for most items with values higher than 0.78. CONCLUSION: The Observational gait scale for persons with amputation of the lower extremity showed excellent content validity according to the CVI obtained. Future studies should evaluate its reliability and construct validity.

[Training cortical signals by means of a BMI-EEG system, its evolution and intervention. A case report]. / Entrenamiento de las señales corticales a traves de un sistema BMI-EEG, evolucion e intervencion. A proposito de un caso.

INTRODUCTION: In the last years, new technologies such as the brain-machine interfaces (BMI) have been incorporated in the rehabilitation process of subjects with stroke. These systems are able to detect motion intention, analyzing the cortical signals using different techniques such as the electroencephalography (EEG). This information could guide different interfaces such as robotic devices, electrical stimulation or virtual reality. CASE REPORT: A 40 years-old man with stroke with two months from the injury participated in this study. We used a BMI based on EEG. The subject's motion intention was analyzed calculating the event-related desynchronization. The upper limb motor function was evaluated with the Fugl-Meyer Assessment and the participant's satisfaction was evaluated using the QUEST 2.0. The intervention using a physical therapist as an interface was carried out without difficulty. CONCLUSIONS: The BMI systems detect cortical changes in a subacute stroke subject. These changes are coherent with the evolution observed using the Fugl-Meyer Assessment.

TITLE: Entrenamiento de las señales corticales a traves de un sistema BMI-EEG, evolucion e intervencion. A proposito de un caso.Introduccion. En los ultimos años estan incorporandose nuevas tecnologias en el tratamiento fisioterapeutico de pacientes con ictus, como las interfaces cerebro-maquina ­brain-machine interface (BMI)­, capaces de detectar la intencion de movimiento analizando las señales corticales por medio de diferentes tecnicas, como la electroencefalografia (EEG). Estas señales se traducen en comandos con el fin de realizar una funcion. Caso clinico. Varon de 40 años con ictus de dos meses de evolucion, en el cual se empleo un dispositivo BMI-EEG. La intencion de movimiento del sujeto se analizo calculando la desincronizacion relacionada con el evento. La funcion motora del miembro superior fue evaluada con la escala de Fugl-Meyer, y el nivel de satisfaccion del paciente, mediante el cuestionario QUEST 2.0. La intervencion se llevo a cabo sin dificultad siendo el fisioterapeuta la interfaz. Conclusiones. Los sistemas BMI-EEG detectan cambios corticales en un sujeto con ictus subagudo. Estos cambios son coherentes con los cambios observados en escalas clinicas.

Detection of the onset of upper-limb movements based on the combined analysis of changes in the sensorimotor rhythms and slow cortical potentials.

OBJECTIVE: Characterizing the intention to move by means of electroencephalographic activity can be used in rehabilitation protocols with patients' cortical activity taking an active role during the intervention. In such applications, the reliability of the intention estimation is critical both in terms of specificity 'number of misclassifications' and temporal accuracy. Here, a detector of the onset of voluntary upper-limb reaching movements based on the cortical rhythms and the slow cortical potentials is proposed. The improvement in detections due to the combination of these two cortical patterns is also studied. APPROACH: Upper-limb movements and cortical activity were recorded in healthy subjects and stroke patients performing self-paced reaching movements. A logistic regression combined the output of two classifiers: (i) a naïve Bayes classifier trained to detect the event-related desynchronization preceding the movement onset and (ii) a matched filter detecting the bereitschaftspotential. The proposed detector was compared with the detectors by using each one of these cortical patterns separately. In addition, differences between the patients and healthy subjects were analysed. MAIN RESULTS: On average, 74.5 ± 13.8% and 82.2 ± 10.4% of the movements were detected with 1.32 ± 0.87 and 1.50 ± 1.09 false detections generated per minute in the healthy subjects and the patients, respectively. A significantly better performance was achieved by the combined detector (as compared to the detectors of the two cortical patterns separately) in terms of true detections (p = 0.099) and false positives (p = 0.0083). SIGNIFICANCE: A rationale is provided for combining information from cortical rhythms and slow cortical potentials to detect the onsets of voluntary upper-limb movements. It is demonstrated that the two cortical processes supply complementary information that can be summed up to boost the performance of the detector. Successful results have been also obtained with stroke patients, which supports the use of the proposed system in brain-computer interface applications with this group of patients.