NeuroRehabilitation - Volume 39, issue 3

Authors: Powell, Elizabeth S. | Carrico, Cheryl | Westgate, Philip M. | Chelette, Kenneth C. | Nichols, Laurie | Reddy, Lakshmi | Salyers, Emily | Ward, Andrea | Sawaki, Lumy

Article Type: Research Article

Abstract: BACKGROUND : Intensive motor training is a therapeutic intervention that supports recovery of movement function after stroke by capitalizing on the brain’s capacity for neuroplastic change. Peripheral nerve stimulation and transcranial direct current stimulation are neuromodulation techniques that can upregulate neuroplasticity and, in turn, enhance outcomes of motor training after stroke. Few studies have investigated possible adjuvant effects between peripheral nerve stimulation, transcranial direct current stimulation, and intensive motor training. OBJECTIVE: This proof-of-concept study investigated whether timing variations in neuromodulation paired with robot-assisted motor training effect differential outcomes for subjects with chronic, moderate-to-severe upper extremity impairment after stroke. …METHODS: Ten subjects in the chronic phase (>12 months after stroke) of recovery completed the study. Subjects received 10 daily sessions of transcranial direct current stimulation either at the start (n  = 4) or at the end (n  = 6) of peripheral nerve stimulation preceding intensive motor training. Pre-post changes in motor function (Fugl-Meyer Assessment; Stroke Impact Scale) and neuroplasticity (transcranial magnetic stimulation) were assessed by condition. RESULTS: Significant improvement in Stroke Impact Scale (p  = 0.02) and no change in Fugl-Meyer Assessment were associated with the start condition. No changes in Stroke Impact Scale and Fugl-Meyer Assessment were associated with the end condition. Only 1 subject in the start group had measurable neuroplastic responses and demonstrated an increase in ipsilesional cortical map volume. Only 1 subject in the end group had measurable neuroplastic responses and demonstrated a decrease in ipsilesional cortical map volume. Opposite shifts in ipsilesional cortical centers of gravity occurred relative to condition. CONCLUSION: In cases of moderate-to-severe impairment after stroke, transcranial direct current stimulation at the start, rather than the end, of peripheral nerve stimulation prior to motor training may effect better functional outcomes. Future research with a larger sample size is needed to validate the findings of this proof-of-concept study. Show more

Keywords: Peripheral nerve stimulation, transcranial direct current stimulation, neuroplasticity, transcranial magnetic stimulation, robot-assisted upper extremity motor training

DOI: 10.3233/NRE-161375

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 439-449, 2016

Authors: Norup, Anne | Guldberg, Anne-Mette | Friis, Claus Radmer | Deurell, Eva Maria | Forchhammer, Hysse Birgitte

Article Type: Research Article

Abstract: OBJECTIVE: To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke. METHODS: For a period of three months, all stroke patients with visual or visuo-attentional deficits were registered, and data concerning etiology, severity and localization of the stroke and initial visual symptoms were registered. One month after discharge patients were contacted for follow-up. RESULTS: Of 349 acute stroke admissions, 84 (24.1%) had visual …or visuo-attentional deficits initially. Of these 84 patients, informed consent was obtained from 22 patients with a mean age of 67.7 years(SD 10.1), and the majority was female (59.1%). Based on the initial neurological examination, 45.4% had some kind of visual field defect, 27.2% had some kind of oculomotor nerve palsy, and about 31.8% had some kind of inattention or visual neglect. The patients were contacted for a phone-based follow-up one month after discharge, where 85.7% reported changes in their vision since their stroke. CONCLUSION: In this consecutive sample, a quarter of all stroke patients had visual or visuo-attentional deficits initially. This emphasizes how professionals should have increased awareness of the existence of such deficits after stroke in order to provide the necessary interdisciplinary assessment and rehabilitation. Show more

Keywords: Stroke, visual deficits, vision disorders, visual rehabilitation, and early rehabilitation

DOI: 10.3233/NRE-161376

Citation: NeuroRehabilitation, vol. 39, no. 3, pp. 451-461, 2016