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@#Objective To apply the surface electromyography (sEMG) in the evaluation of hand motor function for patients with hemiplegia after stroke. Methods From January to August, 2018, 43 hemiplegic patients with hand dysfunction after stroke were selected. All the patients received comprehensive rehabilitation for four weeks. Their root mean square (RMS) and integrated electromyography (iEMG) of wrist flexor (WF), wrist extensor (WE), extensor digitorum (ED) and abductor pollicis brevis (APB) were measured before and after treatment, while they were assessed with Fugl-Meyer Assessment (FMA) and Brunnstrom's stages for the affected hand. Results The FMA score and Brunnstrom's stages, as well as the RMS and iEMG of WF, WE, ED and APB increased after treatment (Z > 2.496, t > 5.361, P < 0.05). The FMA score positively correlated with the RMS and iEMG of WF, WE, ED and APB (r = 0.423-0.732, P < 0.05). The Brunnstrom's stages positively correlated with the RMS of WE, ED and ABP (r = 0.343-0.467, P < 0.05) and the iEMG of WF, WE and ABP (r = 0.223-0.328, P < 0.05). Multiple linear stepwise regression drew the RMS of ED and iEMG of WE as the related factors for FMA (t > 4.243, P < 0.001), and RMS of ED as the related factors for Brunnstrom's stages (t = 4.707, P < 0.001). Conclusions EMG is an effective tool to evaluate the motor function of hand for stroke patient as an objective and quantitative assessment, especially those of WE and ED.
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@#This is the first Indian case report of a biopsy proven temporal arteritis that presented as acute ischemic stroke. The 60 year old woman presented with an isolated pure motor flaccid fractional weakness of the left distal hand, as a rare stroke chameleon due to isolated infarction of the ‘hand motor cortex’ area. The hand motor cortex infarction masquerades as ‘pseudoperipheral palsy’.
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OBJECTIVE: To observe the therapeutic effect of balance acupuncture combined with motor relearning training for upper limb and hand functions of stroke patients. METHODS: Sixty-two stroke patients were randomly divided into balance acupuncture group (n＝31) and routine acupuncture group (n＝31). For patients of the balance acupuncture group, Piantan, Jiantong and Wantong points on the healthy side were used. When Jiantong point taken, the acupuncture needle was removed after the patient experienced an electric shock-like spreading needling sensation. When Wantong point employed, the needle was removed after the patient experienced a local, intensified or spreading needling sensation. When Piantan point used, the needle was retained after the patient experienced an electric shock-like needling sensation, then, the motor relearning training was conducted, and the needle was removed immediately after the training. For patients of the routine acupuncture group, Jianyu(LI 15), Jianzhen (SI 9), Quchi (LI 11), etc. were needled with the needles retained for 30 min after getting needling sensations. The motor relearning training was also carried out after removal of the needle. The treatment in both groups was performed once daily, 6 days a week, and lasted for 8 weeks. The Fugl-Meyer score and motor function scale (MAS) of the upper limb, and the fine performance score and motor function score of the hand were assessed before and after the treatment. RESULTS: Following treatment, the Fugl-Meyer score and MAS of the upper limbs, and the motor function score and fine performance score of the hand were significantly increased in both groups compared with pre-treatment in each group (P<0.05 ), suggesting a functional improvement of both upper limb and hand. The therapeutic effect of the balance acupuncture was obviously superior to that of routine acupuncture in improving functions of both the upper limb and hand (P<0.05)．. CONCLUSION: Balance acupuncture combined with motor relearning training is helpful to improve the comprehensive function of the upper limb and hand in stroke patients.
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Objective To explore the effectiveness of a myoelectricity-driven hand robot on the recovery of hand motor function early after a stroke.Methods Thirty stroke survivors were randomly assigned to either a control group (n=15) or an experimental group (n =15).Both groups received routine rehabilitation exercises,while the experimental group additionally received hand training using a robotic hand exoskeleton.Before and after 4 weeks of treatment,the motor function of the wrist and fingers in both groups were measured using the Fugl-Meyer assessment.Spasticity in the index,middle,ring and little fingers was quantified using the modified Ashworth scale.The muscle force of the fourth finger,thumb and all of the fingers during maximum voluntary extension and flexion were recorded using the robot's surface electromyography system.Results Significant increases in the average Fugl-Meyer scores in both groups were observed after 4 weeks of treatment,but the experimental group's average score was by then significantly higher than that of the control group.The experimental group's average Ashworth score and the average sEMG amplitudes were also significantly better than those of the control group.Conclusion Supplementing routine rehabilitation exercises with a hand robot can improve hand motor function and muscle force significantly,as well as relieving hand spasticity early after a stroke.
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Objective To identify Chinese character writing related cortex (WRC) and its relationship with hand motor cortical areas. Methods Ten native Chinese-speaking, right-hand volunteers were recruited in the study. NTMS mapping was conducted during picture naming task. The WRC were mapped based on nTMS-induced impairment of Chinese character writing. The extent and area of WRC was calculated. The right-hand motor representations were mapped while motor-evoked potentials were produced under nTMS stimulation. EMG data and coordinates of positive stimulus were recorded. The relationship between WRC and hand motor cortex (HMC) was analyzed on the basis of area comparison and distance calculation. Results The cortical areas related to Chinese character writing were mapped successfully in all subjects by nTMS. WRC was primarily centered in left posterior middle frontal gyrus (pMFG) (86%,55/64). The mean WRC area (161.03 mm2 ±62.58mm2) was significantly smaller than the mean HMC area (589.50 mm2±227.34mm2) (P<0.001). The WRC and HMC were not conjoined or overlapped in the dominant hemisphere. The distance between those two was 12.58mm±2.71mm. Conclusions NTMS can provide reliable assistance in mapping WRC areas. The WRC is relatively fixed and centralized in pMFG but is not overlapped with the HMC.
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Objective To study the characteristics of the hand motor cortex in ataxia patients during active and passive finger-to-thumb opposition movements using bold oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI). Methods Ten right-handed healthy volunteers and 16 ataxia patients with motor cortex lesions were selected, and whole-brain BOLD-fMRI examinations were made while the subjects were performing the active and passive movements. Activated volume and intensity were recorded from the corresponding motor cortex and analyzed quantitatively. Meanwhile, the patients' coordination was evaluated using the international cooperative ataxia rating scale (ICARS). Results During passive movement of the ataxia patient's affected hands, the ipsilateral supplementary motor area (SMA) activated volume was larger than that during normal ipsilateral hand movement, and the activation intensity was also higher than that in the healthy controls. The ipsilateral cerebellum activated volume and intensity were significantly lower than those in the control group, and the frequency of appearance of the cerebellum was also less. The patients' activated volume and intensity in the ipsilateral cerebellum showed no correlation with ICARS scores. Conclusions When the ataxia patients' affected side cerebellum was dysfunctional, the ipsilateral SMA could compensate for the weak cerebellum function. The ICARS does not reflect cerebellum function.
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OBJECTIVE: To determine the relationship of hand motor function recovery and Tatu's vascular territory classification of brain lesion in acute stroke. METHOD: Thirty one patients with acute cerebral infarct were included. We divided them into two groups. One had cerebral lesions supplied by the leptomeningeal branches of cerebral artery and the other by the perforating branches of cerebral artery. The leptomeningeal group was subdivided into middle cerebral artery group (LMCA) and posterior cerebral artery group (LPCA). The perforating group was again divided by perforating branch of the middle cerebral artery group (PMCA) and anterior choroidal artery group (PACoA). The diffusion weighted magnetic resonance image was used as a reference image. The hand motor recovery was scored by physical examination at admission and discharge. Score 0 was for no motion, 1 was for synergy movement, and 2 was for isolated hand movement. RESULTS: Eight patients were in LMCA group, while 3 were in LPCA group. Eight were in PMCA group, and twelve patients were in PACoA group. The distribution of the hand motor recovery at admission was score 0 (3,1,5,8, for LMCA, LPCA, PMCA, PACoA), 1 (2,1,1,4) and 2 (3,1,2,0), while at discharge, score 0 (3,0,4,4), 1 (0,0,1,5) and 2 (5,3,3,3). Hand functions significantly improved at discharge compared with those at admission in all groups. Especially in PACoA group, the significant better recovery at discharge was achieved.(p<0.05) Isolated hand movement at discharge was significantly better at the leptomeningeal group than perforating group.(p<0.05). CONCLUSION: Tatu's atlas may be helpful to predict the recovery of hand function for initial assessment of stroke rehabilitation.
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Objective To identify the neural substrates of three motor tasks (repetitive and sequential fin-get-to-thumb opposition movements in turn, making fates, fingers passive flexion-extension movements in turn) of dominant and subdominant hands by using the whole-brain functional magnetic resonance imaging. Methods Ten right-handed healthy volunteers were scanned while they were performing the movement tasks with their right and left fingers. The motor cortex active volume and intensity was recorded. Quantitive analysis of motor cortex was conducted with paired t test. Results Under the three hand motor tasks, activation volumes in SMC during movements of the subdominant hand were significantly larger than those during movements of the dominant hand (P < 0. 05). Activation volumes during finger-to-thumb opposition movements and passive bendlng-extending fingers movements were significantly larger than those during movements of making fasts (P < 0.05). Activation intensity during passive ben-ding-extending fingers movements was significantly larger than those during movements of making fasts (P < 0.05). Conclusion The representation of the Motor Cortex is related to the complexity of the hand motor exercises. Quantitive criterion as volume and intensity approves the dissymmetry of cortex activation by dominant and subdominant fingers'movements. It is practicable and credible to adopt invariable fingers passive flexion-extension movements in turn in the study on BOLD-fMRI.
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Objective To observe any change in the active volume of the hand motor cortex during rehabilitation therapy after acute cerebral infarction and analyze the mechanisms involved in motor function rehabilitation.Metbods Of 16 patients with acute brain infarction,8 were administered routine intemal medicine treatment only,while and the other 8 received rehabilitation therapy in addition.Before treatment and after 14 days,the patients were assessed with functional magnetic resonance imaging(fMRI)and the Fugl-Meyer assessment of motor function (FMA).The active volume of the motor cortex was compared between the two groups of patients.Ten healthy volunteers were examined with fMRI to confirm the location and the volume ofthe active area when performing the sanle exercises.Results After treatment,all the 16 patients showed increased motor cortex active volume,and their FMA scores also increased.Those receiving rehabilitation therapy improved tO a significantly greater extent than those treated with internal medicine treatment alone.Conclusion Rehabilitation of patients with acute infarction Can activate a greater volume of the motor cortex and promote functional recovery.
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The event-related desynchronization/synchronization(ERD/ERS) time courses of lower and upper alpha band rhythms during hand motor imagery are investigated respectively by Fourier Sectral Entropy (FSE) in this paper. By analyzing one group of BCI competition data, it was found that FSE within upper alpha band displays a pronounced increase and decrease over contralateral and ipsilaterai brain areas respectively at the onset of hand motor imagery, which is corresponding to the antagonistic ERD/ERS patterns in previous studies. Different from the upper alpha activity pattern, FSE within lower alpha band displays a consistent increase over both two hemispheres hand representative areas. The preliminary results show that FSE could disclose the different behaviors of the upper and lower alpha band rhythms so that a new idea with the complexity measure is provided to characterize functional dissociation of lower and upper frequency alpha rhythms in relation to hand motor imagery.
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The event-related desynchronization/synchronization(ERD/ERS) time courses of lower and upper alpha band rhythms during hand motor imagery are investigated respectively by Fourier Sectral Entropy (FSE) in this paper. By analyzing one group of BCI competition data, it was found that FSE within upper alpha band displays a pronounced increase and decrease over contralateral and ipsilateral brain areas respectively at the onset of hand motor imagery, which is corresponding to the antagonistic ERD/ ERS patterns in previous studies. Different from the upper alpha activity pattern, FSE within lower alpha band displays a consistent increase over both two hemispheres hand representative areas. The preliminary results show that FSE could disclose the different behaviors of the upper and lower alpha band rhythms so that a new idea with the complexity measure is provided to characterize functional dissociation of lower and upper frequency alpha rhythms in relation to hand motor imagery.
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OBJECTIVE: The aim of this study was to find out the factors related to the recovery of hand motor function in patients with subcortical hemorrhage. METHOD: We investigated 21 patients with subcortical hemorrhage prospectively. We used their CT and/or MR imaging for the localization and estimation of the size of lesion. The Hand Movement Scale (HMS) was used for evaluation of the hand function. Proprioception, initial shoulder and hand recovery were also measured every month for at least 6 months during the follow up periods. RESULTS: There are 13 patients with putaminal hemorrhage and 8 patients with thalamic hemorrhage. There is no difference in general characteristics between the two groups. When recovery began within 4 weeks after onset, only thalamic hemorrhage patients showed significantly good recovery. Initial shoulder shrug, especially within 4 weeks after onset, could be one of the prognostic factors of good hand motor recovery. Putaminal hemorrhage patients, who had higher scores on the hand movement scale, showed early recovery of proprioceptive function. CONCLUSION: Among many other factors which can be involved in the recovery of hand function in patients with subcortical hemorrhage, the time of initial hand motor recovery, the time of initial shoulder shrug, and proprioceptive function were most important.