Prediction of Natural History of Neuromuscular Properties After Stroke Using Fugl-Meyer Scores at 1 Month

Mirbagheri, M.M.; Lilaonitkul, Thanan; Rymer, William Z.

doi:10.1177/1545968310390222

Cited by 20 publications

(11 citation statements)

References 44 publications

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“…The majority of patients showed stable or increasing spasticity over time (Figure 3). This is in line with previous reports using biomechanical measures (4, 11), and does not support the view that spasticity declines over time in parallel with motor recovery (44).…”

Section: Discussionsupporting

confidence: 67%

“…The use of a validated biomechanical assessment (11) could improve diagnostic accuracy by separately measuring the neural component (NC) and non-neural components contributing to passive stretch-resistance (12). Further, improved diagnostic accuracy also opens new opportunities for longitudinal characterization (4, 11), and for charting the relation between severity and lesion location using modern imaging techniques (13). Given that reducing post-stroke spasticity may be associated with improved active range of movement (7) we hypothesized that hand spasticity early post-stroke would relate to poor hand motor recovery.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery

et al. 2019

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Objective: This longitudinal observational study investigated how neural stretch-resistance in wrist and finger flexors develops after stroke and relates to motor recovery, secondary complications, and lesion location. Methods: Sixty-one patients were assessed at 3 weeks (T1), three (T2), and 6 months (T3) after stroke using the NeuroFlexor method and clinical tests. Magnetic Resonance Imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL) and to perform voxel-based lesion symptom mapping. Results: NeuroFlexor assessment demonstrated spasticity (neural component [NC] >3.4N normative cut-off) in 33% of patients at T1 and in 51% at T3. Four subgroups were identified: early Severe spasticity ( n = 10), early Moderate spasticity ( n = 10), Late developing spasticity ( n = 17) and No spasticity ( n = 24). All except the Severe spasticity group improved significantly in Fugl-Meyer Assessment (FMA-HAND) to T3. The Severe and Late spasticity groups did not improve in Box and Blocks Test. The Severe spasticity group showed a 25° reduction in passive range of movement and more frequent arm pain at T3. wCST-LL correlated positively with NC at T1 and T3, even after controlling for FMA-HAND and lesion volume. Voxel-based lesion symptom mapping showed that lesioned white matter below cortical hand knob correlated positively with NC. Conclusion: Severe hand spasticity early after stroke is negatively associated with hand motor recovery and positively associated with the development of secondary complications. Corticospinal tract damage predicts development of spasticity. Early quantitative hand spasticity measurement may have potential to predict motor recovery and could guide targeted rehabilitation interventions after stroke.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery

et al. 2019

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“…We have previously used this technique to demonstrate that ankle stiffness is strongly dependent on ankle angle in both healthy and spastic subjects (Mirbagheri et al, 2001, Mirbagheri et al, 2007). This method is valid (Alibiglou et al, 2008) and sensitive enough to detect the nature of mechanical abnormalities associated with spasticity throughout the progression of disease and following specific treatments (Mirbagheri et al, 2011, Mirbagheri et al, 2012, Mirbagheri et al, 2009). This method separates the measured joint torque due to perturbations into intrinsic (musculotendinous) and reflex contributions.…”

Section: Methodsmentioning

confidence: 99%

Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury

Mirbagheri

Kindig

Niu

2015

Clinical Neurophysiology

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Objective We sought to determine the therapeutic effect of robotic-assisted step training (RAST) on neuromuscular abnormalities associated with spasticity by characterization of their recovery patterns in people with spinal cord injury (SCI). Methods Twenty-three motor-incomplete SCI subjects received one-hour RAST sessions three times per week for four weeks, while an SCI control group received no training. Neuromuscular properties were assessed using ankle perturbations prior to and during the training, and a system-identification technique quantified stretch reflex and intrinsic stiffness magnitude and modulation with joint position. Growth-mixture modeling classified subjects based on similar intrinsic and reflex recovery patterns. Results All recovery classes in the RAST group presented significant (p<0.05) reductions in intrinsic and reflex stiffness magnitude and modulation with position; the control group presented no changes over time. Subjects with larger baseline abnormalities exhibited larger reductions, and over longer training periods. Conclusions Our findings demonstrate that RAST can effectively reduce neuromuscular abnormalities, with greater improvements for subjects with higher baseline abnormalities. Significance Our findings suggest, in addition to its primary goal of improving locomotor patterns, RAST can also reduce neuromuscular abnormalities associated with spasticity. These findings also demonstrate that these techniques can be used to characterize neuromuscular recovery patterns in response to various types of interventions.

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“…In the future rehabilitation practitioners may use this information to predict, with a known confidence level, whether or not a new patient will respond positively to an intervention based on their baseline clinical scores. This technique has successfully classed stroke survivors based on their recovery patterns 37 .…”

Section: Introductionmentioning

confidence: 99%

Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury

Duffell

Brown

Mirbagheri

2014

Neurorehabil Neural Repair

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Background Spinal cord injury (SCI) results in impaired function and ankle joint spasticity is a common secondary complication. Different interventions have been trialed with variable results. Objective We investigated the effects of pharmacological and physical (locomotor training) interventions on function in people living with incomplete motor function loss due to SCI, and used different analytical techniques to understand whether functional levels affect recovery with different interventions. Methods Participants with an incomplete SCI were assigned to three groups; no intervention, Lokomat or tizanidine. Outcome measures were the 10-meter walk test (10MWT), 6-minute walk test (6MWT) and the Timed-up and go (TUG). Participants were classified in two ways; i) based on achieving an improvement above the minimally important difference (MID) and; ii) using Growth Mixture Modeling (GMM). Functional levels of participants that achieved the MID were compared and Random Coefficient Regression (RCR) was used to assess recovery in GMM classes. Results Overall, walking speed and endurance improved, with no difference between interventions. Only a small number of participants achieved the MID. Both MID and GMM-RCR analyses revealed that tizanidine improved endurance in high functioning participants. GMM-RCR classification also showed that speed and mobility improved after locomotor training. Conclusions Improvements in function were achieved in a limited number of people with SCI. Using the MID and GMM techniques, differences in responses to interventions between high and low functioning participants could be identified. These techniques may therefore have potential to be used for characterizing therapeutic effects due to different interventions.

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Prediction of Natural History of Neuromuscular Properties After Stroke Using Fugl-Meyer Scores at 1 Month

Abstract: The logistical regression class may enable us to accurately predict reflex responses during the first year, allowing us to apportion impairment between central and peripheral mechanisms.

Cited by 20 publications

References 44 publications

Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery

Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery

Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury

Interventions to Reduce Spasticity and Improve Function in People With Chronic Incomplete Spinal Cord Injury

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