Rehabilitation of the hemiparetic gait by nociceptive withdrawal reflex-based functional electrical therapy: a randomized, single-blinded study

Spaich, Erika G.; Svaneborg, Niels; Jørgensen, Helle Rovsing Møller; Andersen, Ole Kæseler

doi:10.1186/1743-0003-11-81

Cited by 25 publications

(27 citation statements)

References 43 publications

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“…Only a few studies have investigated changes in NWR excitability in poststroke hemiparetic patients with spasticity in the lower (Rueterbories, Spaich, & Andersen, 2013; Spaich, Hinge, Arendt‐Nielsen, & Andersen, 2006; Spaich, Svaneborg, Jørgensen, & Andersen, 2014) or upper (Serrao et al., 2012) limbs. These previous studies focused on the chronic phase of stroke, whereas to date no studies have evaluated patients in the acute/subacute phase.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Alvisi

Serrao²,

Conte

et al. 2018

Brain and Behavior

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ObjectivesThe aims of this study were to evaluate the pattern of the nociceptive withdrawal reflex (NWR) of the upper limb at rest and after injection of Botulinum toxin type A (BoNT‐A) in poststroke subacute hemiparetic patients.MethodsFourteen patients with poststroke subacute hemiparesis underwent clinical and instrumental evaluation and BoNT‐A injection. Painful electrical stimulation was applied to induce the NWR. Baseline EMG activity and NWR recordings (EMG and kinematic response) were performed at T0, one month (T1), and three months (T2) after the BoNT‐A injection, as were Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM) scores.ResultsComparison of results at T0, T1, and T2 revealed significant changes in the MAS score for the elbow (p < 0.001) and wrist joints (p < 0.001) and in the FIM score at T0 and T2. BoNT‐A injection had a significant effect on both NWR amplitude and baseline EMG activity in the posterior deltoid (PD) and flexor carpi radialis (FCR) muscles as well as in all averaged muscles. Analysis of elbow kinematics before and after treatment revealed that the reflex probability rates were significantly higher at T1 and T2 than at T0.ConclusionInjection of BoNT‐A in the subacute phase of stroke can modify both the baseline EMG activity and the NWR‐related EMG responses in the upper limb muscles irrespective of the site of injection; furthermore, the reflex‐mediated defensive mechanical responses, that is, shoulder extension and abduction and elbow flexion, increased after treatment. BoNT‐A injection may be a useful treatment in poststroke spasticity with a potential indirect effect on spinal neurons.

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Section: Discussionmentioning

confidence: 99%

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Alvisi

Serrao²,

Conte

et al. 2018

Brain and Behavior

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“…The HL-PA phenomenon was 93 further analyzed after the left UBI. 94 Brain injury induces asymmetry in withdrawal reflexes in rats with transected 95 spinal cord 96The nociceptive withdrawal reflexes are instrumental in investigation of pathological changes in 97 hindlimb neural circuits given that the changes are induced by converging inputs from peripheral 98 afferents and descending motor commands (Schouenborg, 2002;Spaich et al, 2014). We next 99 sought to determine whether UBI in rats with transected spinal cord produces differences in 100 nociceptive contra-and ipsilesional hindlimb withdrawal reflexes.…”

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confidence: 99%

Endocrine signaling mediates asymmetric motor deficits after unilateral brain injury

Lukoyanov¹,

Watanabe²,

Carvalho³

et al. 2020

Preprint

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26A paradigm in neurology is that brain injury-induced motor deficits (e.g. hemiparesis and 27 hemiplegia) arise due to aberrant activity of descending neural pathways. We discovered that a 28 unilateral injury of the hindlimb sensorimotor cortex of rats with completely transected thoracic 29 spinal cord produces hindlimb postural asymmetry with contralateral flexion, and asymmetric 30 changes in nociceptive hindlimb withdrawal reflexes and gene expression patterns in lumbar spinal 31 cord. The injury-induced postural effects were abolished by prior hypophysectomy and were 32 mimicked by transfusion of serum from animals with unilateral brain injury. Antagonists of the 33 opioid and vasopressin receptors blocked formation of hindlimb postural asymmetry suggesting 34 that these neurohormones mediate effects of brain injury on lateralized motor responses. Our data 35 indicate that descending neural control of spinal circuits is complemented by a previously 36 unknown humoral signaling from injured brain to the contra-and ipsilesional hindlimbs, and 37 suggest the existence of a body side-specific neuroendocrine regulation in bilaterally symmetric 38 animals. 39 In this study we challenge the neurological paradigm by investigating whether a unilaterally 62 injured brain may signal to the lumbar spinal cord through non-spinal mechanism. We applied a 63 "reversed strategy" protocol in which brain injury was performed after complete transection of the 64 spinal cord at a superior thoracic level. 65 66 Results 67Brain injury induces postural asymmetry in rats with transected spinal cord 68 We first demonstrated that the unilateral injury of the hindlimb representation area of the 69 sensorimotor cortex in rats induces formation of HL-PA (Figure 1A,D,E; Figure 1-figure 70 supplement 1). The effect was evident under pentobarbital anesthesia within 5 min after the lesion 71 and lasted for 14 days. The HL-PA median values and probability to develop HL-PA greater than 72 the 1 mm threshold were markedly higher in rats with UBI (n = 8) compared to those with sham 73 surgery (sham; n = 7). The UBI rats displayed a contralesional hindlimb flexion which correlated 74 with motor deficits of the same limb in the beam-working and ladder rung tests (UBI, n = 11/12; 75 sham, n = 8) (Figure 1B,C). The UBI rats showed the high number of slips of the contralesional 76 hindlimb compared to the ipsilesional limb, and to both hindlimbs in rats with sham surgery. 77 Consistent with earlier studies (Chamberlain et al., 1963; DiGiorgio, 1929; Hultborn & Malmsten, 78 1983; Rossignol & Frigon, 2011;Wolpaw, 2012), the HL-PA was retained after complete 79 transection of the spinal cord performed at the T2-T3 level (Figure 1-figure supplement 1E-G). 80 We hypothesized that the HL-PA is maintained either due to neuroplastic changes in the lumbar 81 spinal cord induced through the descending neural tracts before spinalization, or due to non-spinal 82 cord mediated signaling from the injured brain to the lumbar neural circui...

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“…Inspired by Spaich's work on hemiparetic gait , we stimulated the arch of the foot as shown in Fig. .…”

Section: Methodsmentioning

confidence: 99%

Effects of Sensitive Electrical Stimulation‐Based Somatosensory Cueing in Parkinson's Disease Gait and Freezing of Gait Assessment

et al. 2017

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This study aims to investigate the effect of a somatosensory cueing on gait disorders in subjects with Parkinson's disease (PD). After having performed stepping in place and timed up and go assessing tasks, 13 participants with PD were equipped with an electrical stimulator and an inertial measurement unit (IMU) located under the lateral malleolus on the sagittal plane. Electrodes were positioned under the arch of the foot and electrical stimulation (ES) parameters (five 500 µs/phase charge-balanced biphasic pulses delivered at 200 Hz, repeated four times at 10 Hz) adjusted to deliver a sensitive signal. Online IMU signal was processed in order to trigger ES at heel off detection. Starting from a quiet standing posture, subjects were asked to walk at their preferred speed on a path including 5 m straight line, u-turn, and walk around tasks. Three situations were considered: no stimulation baseline precondition (C0), ES condition (C1), and no stimulation baseline post-condition (C0bis), for eliminating a learning effect possibility. In ES condition (C1) the time to execute the different tasks was globally decreased in all the subjects (n = 13). Participants' results were then grouped regarding whether they experienced freezing of gait (FOG) or not during C0 no stimulation baseline precondition. In "freezer" subjects (n = 9), the time to complete the entire path was reduced by 19%. FOG episodes occurrence was decreased by 12% compared to baseline conditions. This preliminary work showed a positive global effect on gait and FOG in PD by a somatosensory cueing based on sensitive electrical stimulation.

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Rehabilitation of the hemiparetic gait by nociceptive withdrawal reflex-based functional electrical therapy: a randomized, single-blinded study

Cited by 25 publications

References 43 publications

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

Endocrine signaling mediates asymmetric motor deficits after unilateral brain injury

Effects of Sensitive Electrical Stimulation‐Based Somatosensory Cueing in Parkinson's Disease Gait and Freezing of Gait Assessment

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