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Effect of the association of motor imagery exercises and paired associative stimulation in stroke patients (MIPAS)
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Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
ISPR8-1495
ISPR8-1242
Effects of digital smart glove system on motor recovery of upper extremity in subacute stroke patients
Effect of the association of motor imagery exercises and paired associative stimulation in stroke patients (MIPAS)
H. Kim 1,∗ , A. Lee 1 , Y.I. Shin 2 , W.H. Chang 3 , K.H. Koo 3 , H. Seong 2 , Y.H. Kim 1,3 1 Sungkyunkwan University, Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science and Technology, Seoul, Republic of Korea 2 Pusan National University School of Medicine, Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan, Republic of Korea 3 Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Seoul, Republic of Korea ∗ Corresponding author. E-mail address: [email protected], [email protected] (H. Kim) Introduction/Background This study aimed to investigate the ® effect of novel rehabilitation system, Rapael Smart Glove (NEOFECT, Yongin, Korea), on recovery of upper extremity in subacute stroke patients. Material and method Forty-one subacute stroke patients (24 females; mean age 60.4 ± 13.3 years) with hemiparesis were enrolled from two medical centers in this prospective, singleblind, randomized controlled study. All patients were treated with 40 therapeutic sessions during 4 weeks, five times a week, an hour per day. In experimental group, each session consisted of training using the Smart Glove for 30 min and conventional OT (Occupational Therapy) for 30 min. Control group received conventional OT for 60 min per day. Functional assessments and fNIRS measurement was conducted before (T0), immediately after (T1), and 1 month after (T2) the intervention. Repeated-measures ANOVA was used for statistical analysis. Results Thirty-two participants (15 experimental and 17 control groups) completed all intervention process. No serious complication was reported in both groups. Repeated-measures ANOVA demonstrated that scores for FMA upper-limb parameters and all subtest scores of Jebsen-Taylor Hand Function Test except writing were significantly improved in experimental group compared to control group (P < 0.05). In fNIRS measurement, oxyhemoglobin concentration of ipsilesional motor cortex was more increased during affected hand movement in experimental group compared to control group. Conclusion The results of this study revealed that combination ® of Rapael Smart Glove training with conventional OT was more effective to improve upper limb motor function than conventional OT alone in subacute stroke patients (This research was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C0570) and a grant from the NRF (NRF-2017R1A2A1A05000730) funded by the Korean government). Keywords Stroke; Upper extremity rehabilitation; Functional recovery Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.061
N. Brihmat 1,∗ , M. Tarri 1 , X. De Boissezon 2 , D. Gasq 2 , I. Loubinoux 1 , P. Marque 2 , E. Castel-Lacanal 2 1 UMR 1214, Inserm/UPS, ToNIC, neurosciences, Toulouse, France 2 Service de MPR, CHU Rangueil, neurosciences, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (N. Brihmat) Introduction/Background Paired associative stimulation (PAS) is a non-invasive brain stimulation method that modulate cortical plasticity. Motor imagery (MI) can be used as an alternative to movement execution (ME) after stroke. In this study, we want to compare the motor and electrophysiological effects of a session combining PAS and MI exercises to sessions where only one of the intervention was delivered. Material and method MIPAS is a prospective, randomized, crossover study. Twenty-three stroke patients with hemiparesis (mean age = 52 ± 13 years; time post-stroke = 10 ± 22 months; Upperlimb Fugl-Meyer Score (FMS) = 28 ± 13/66; Kinesthetic and Visual Imagery score (KVIQ S) = 119 ± 23/140) were included and randomely assigned to one of the three 15 minutes session: PAS + MI; PAS; placebo PAS + MI. The PAS intervention consists of a combination of electrical stimulation of the hemiplegic Extensor Carpi Radialis (ECR) with cortical magnetic stimulation of the ECR cortical representation. In MI condition, the patient is instructed to imagine extension of his hemiplegic wrist and in Placebo PAS intervention, we used a sham probe. We compared the surface variation of the Motor Evoked Potential (MEP) of the ECR and the amplitude of Active Extension (AE) of the hemiplegic side after each session. Results In comparison with the other two sessions, significant facilitation associated with motor improvement was observed 15 after the end of session placebo PAS + MI (PEM(C) = +62% ± 96.7%; EA(C) = +2.9 ± 6.7◦ ). Significant motor improvement were observed after the sessions PAS + MI and PAS (EA(A) = 4.1 ± 8.1◦ ; EA(B) = 5.4 ± 6.1◦ ) but not association with cortical excitability changes. The motor improvement after the session PAS was significantly higher in comparison with that observed after session placebo PAS + MI. Conclusion Only the session Placebo PAS + MI seems to induce increased cortical excitability associated with motor improvement, the other sessions inducing only motor effect. Keywords Stroke; Paired associative stimulation; Motor imagery Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.062
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
ISPR8-1495
ISPR8-1242
Effects of digital smart glove system on motor recovery of upper extremity in subacute stroke patients
Effect of the association of motor imagery exercises and paired associative stimulation in stroke patients (MIPAS)
H. Kim 1,∗ , A. Lee 1 , Y.I. Shin 2 , W.H. Chang 3 , K.H. Koo 3 , H. Seong 2 , Y.H. Kim 1,3 1 Sungkyunkwan University, Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science and Technology, Seoul, Republic of Korea 2 Pusan National University School of Medicine, Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan, Republic of Korea 3 Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Seoul, Republic of Korea ∗ Corresponding author. E-mail address: [email protected], [email protected] (H. Kim) Introduction/Background This study aimed to investigate the ® effect of novel rehabilitation system, Rapael Smart Glove (NEOFECT, Yongin, Korea), on recovery of upper extremity in subacute stroke patients. Material and method Forty-one subacute stroke patients (24 females; mean age 60.4 ± 13.3 years) with hemiparesis were enrolled from two medical centers in this prospective, singleblind, randomized controlled study. All patients were treated with 40 therapeutic sessions during 4 weeks, five times a week, an hour per day. In experimental group, each session consisted of training using the Smart Glove for 30 min and conventional OT (Occupational Therapy) for 30 min. Control group received conventional OT for 60 min per day. Functional assessments and fNIRS measurement was conducted before (T0), immediately after (T1), and 1 month after (T2) the intervention. Repeated-measures ANOVA was used for statistical analysis. Results Thirty-two participants (15 experimental and 17 control groups) completed all intervention process. No serious complication was reported in both groups. Repeated-measures ANOVA demonstrated that scores for FMA upper-limb parameters and all subtest scores of Jebsen-Taylor Hand Function Test except writing were significantly improved in experimental group compared to control group (P < 0.05). In fNIRS measurement, oxyhemoglobin concentration of ipsilesional motor cortex was more increased during affected hand movement in experimental group compared to control group. Conclusion The results of this study revealed that combination ® of Rapael Smart Glove training with conventional OT was more effective to improve upper limb motor function than conventional OT alone in subacute stroke patients (This research was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (HI15C0570) and a grant from the NRF (NRF-2017R1A2A1A05000730) funded by the Korean government). Keywords Stroke; Upper extremity rehabilitation; Functional recovery Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.061
N. Brihmat 1,∗ , M. Tarri 1 , X. De Boissezon 2 , D. Gasq 2 , I. Loubinoux 1 , P. Marque 2 , E. Castel-Lacanal 2 1 UMR 1214, Inserm/UPS, ToNIC, neurosciences, Toulouse, France 2 Service de MPR, CHU Rangueil, neurosciences, Toulouse, France ∗ Corresponding author. E-mail address: [email protected] (N. Brihmat) Introduction/Background Paired associative stimulation (PAS) is a non-invasive brain stimulation method that modulate cortical plasticity. Motor imagery (MI) can be used as an alternative to movement execution (ME) after stroke. In this study, we want to compare the motor and electrophysiological effects of a session combining PAS and MI exercises to sessions where only one of the intervention was delivered. Material and method MIPAS is a prospective, randomized, crossover study. Twenty-three stroke patients with hemiparesis (mean age = 52 ± 13 years; time post-stroke = 10 ± 22 months; Upperlimb Fugl-Meyer Score (FMS) = 28 ± 13/66; Kinesthetic and Visual Imagery score (KVIQ S) = 119 ± 23/140) were included and randomely assigned to one of the three 15 minutes session: PAS + MI; PAS; placebo PAS + MI. The PAS intervention consists of a combination of electrical stimulation of the hemiplegic Extensor Carpi Radialis (ECR) with cortical magnetic stimulation of the ECR cortical representation. In MI condition, the patient is instructed to imagine extension of his hemiplegic wrist and in Placebo PAS intervention, we used a sham probe. We compared the surface variation of the Motor Evoked Potential (MEP) of the ECR and the amplitude of Active Extension (AE) of the hemiplegic side after each session. Results In comparison with the other two sessions, significant facilitation associated with motor improvement was observed 15 after the end of session placebo PAS + MI (PEM(C) = +62% ± 96.7%; EA(C) = +2.9 ± 6.7◦ ). Significant motor improvement were observed after the sessions PAS + MI and PAS (EA(A) = 4.1 ± 8.1◦ ; EA(B) = 5.4 ± 6.1◦ ) but not association with cortical excitability changes. The motor improvement after the session PAS was significantly higher in comparison with that observed after session placebo PAS + MI. Conclusion Only the session Placebo PAS + MI seems to induce increased cortical excitability associated with motor improvement, the other sessions inducing only motor effect. Keywords Stroke; Paired associative stimulation; Motor imagery Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.062