- Email: [email protected]
Motor evoked potentials of upper-limbs predict aphasia recovery
e48
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
R middle frontal gyrus (BA 46), R insular cortex and R caudate nucleus. Moreover, the R caudate nucleus and R middle frontal gyrus were associated with the clinical language performance. Conclusion Inhibitory rTMS protocol may facilitate language recovery without compromising beneficial contralesional reorganization. Conversely, this regimen enhances the expression of newly organized areas for the improvement language performance in post-stroke non-fluent aphasic patients, particularly the caudate nucleus and middle frontal gyrus, likely through intercortical modulating mechanisms. Keywords Post-stroke non-fluent aphasia; Repetitive transcranial magnetic stimulation (rTMS); Functional magnetic resonance imaging (fMRI) Disclosure of interest The authors have not supplied their declaration of competing interest. Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.104. https://doi.org/10.1016/j.rehab.2018.05.104 ISPR8-2665
Leukoaraiosis is not predictive of aphasia recovery M. Hatier 1,2,∗ , I. Sibon 3,4 , A. Hauwelle 2,5 , T. Tourdias 6,7 , H. Cassoudesalle 1,2 , P. Dehail 1,2 , M. Villain 8 , C. Gil-Jardiné 9 , B. Glize 1,2 1 CHU de Bordeaux, Department of physical medicine and rehabilitation, Bordeaux, France 2 EA4136, University of Bordeaux, Bordeaux, France 3 CHU de Bordeaux, Stroke Unit, Bordeaux, France 4 University of Bordeaux, Incia, CNRS UMR5287, Bordeaux, France 5 CHU de Clermont-Ferrand, Department of physical medicine and rehabilitation, Clermont-Ferrand, France 6 CHU de Bordeaux, neuroimagerie diagnostique et thérapeutique, Bordeaux, France 7 Inserm, U1215, Neurocentre Magendie, Bordeaux, France 8 AP–HP Salpêtrière, Department of physical medicine and rehabilitation, Paris, France 9 CHU de Bordeaux, Emergency, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (M. Hatier) Introduction/Background Stroke-related aphasia affects 20% to 40% stroke patients and early prediction of aphasia recovery remains extremely difficult to predict. Leukoaraiosis LA is recognised as one of the neuroimaging features of cerebral small vessel disease and is associated with brain disturbances. LA is known to be associated with long term cognitive decline, mood disorders, gait disability and has a negative impact of post-stroke functional outcome. The aim of this study was to determine whether the extent of LA could contribute to the prediction of recovery from post-stroke aphasia. Material and method Hundred and ten right handed aphasic patients with analyzable MRI sequences were included and assessed as soon as possible within fourteen days after a first left hemispheric stroke. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, and Flair images were imported. Lesions were drawn manually in order to measure the lesion size, as well as the volume of LA in Flair sequences. Results Good recovery from aphasia was significantly associated with lower severity of aphasia initially (P < 0.001) and smaller
lesions (P < 0.001). No significant association was found between the volume of LA and recovery from aphasia, even adjusted to the lesion size or age in a multi variable model. Conclusion The extent of leukoaraiosis is not a predictor of aphasia recovery, even adjusted to the lesion size or age. Hence, aphasia recovery seems to be poorly influenced by diffuse lesions of sub-cortical white matter, strengthening the idea of crucial and localised brain areas and networks involved in recovery. Keywords Aphasia; Stroke; Leukoaraiosis Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.105 ISPR8-2667
Motor evoked potentials of upper-limbs predict aphasia recovery B. Glize 1,∗ , M. Villain 2 , M. Laganaro 3 , D. Guehl 4 , P. Dehail 5 , P.A. Joseph 5 , I. Sibon 6 1 University of Bordeaux, EA 4136, Bordeaux, France 2 AP–HP Pitié-Salpétrière, service MPR, Paris, France 3 Université de Genève, neuropsycholinguistique, Genève, Switzerland 4 CHU de Bordeaux, exploration du système nerveux, Bordeaux, France 5 CHU de Bordeaux, service MPR, Bordeaux, France 6 CHU de Bordeaux, stroke unit, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (B. Glize) Introduction/Background Recovery from aphasia remains difficult to predict. Among the language features predicting recovery from aphasia, production scores such as repetition or phonology seem to be more relevant predictors than only severity. As motor cortex is strongly involved in language processes, both production and perception, the present study aimed to determine whether the integration of an electrophysiological measure of the motor networks using motor-evoked potentials MEP in the acute phase of stroke can improve the prediction of recovery from post-stroke aphasia. Material and method Hundred and twelve patients with aphasia within 14 days after a first ischemic or haemorrhagic stroke completed the study. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6 month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. MEPs were recorded from the abductor pollicis brevis muscle and orbicularis oris. The resting motor threshold (rMT) was defined for each muscle and a ratio between left and right rMT (rMTr) was calculated for upper-limbs and for lips. Results A first-level model, including only clinical variables (i.e. initial severity) predicted severity at six months for severe patients. When the rMTr of upper limbs was added in a second-level model, the predictive power significantly increased from 41 to 51%, as well as adding in a third-level model rMTr of upper-limbs and initial fibres number ratio of the corticospinal tracts (41 to 55%). With the changes of severity as the dependent variable, the same factors made a significant contribution and the predictive power of a second-level model increased from 4 to 20% to the same extent as in a third-level model (4% to 27%). Conclusion Added with usual clinical factors, MEPs of upperlimbs and lips contribute to the prediction of aphasia recovery, particularly for patients with severe aphasia initially. Keywords Aphasia; Recovery prediction; Motor evoked potential Disclosure of interest The authors have not supplied their declaration of competing interest.
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.106.
e49
A3.07 Neurological and mental health conditions–Nerve injury
https://doi.org/10.1016/j.rehab.2018.05.106 ISPR8-2081 ISPR8-2165
“Is grass really greener on the other side?”–A study of analogy perception across age groups
M. Thomas ∗ , G. Bajaj Kasturba Medical College, Audiology and Speech Language Pathology, Mangalore Karnataka, India ∗ Corresponding author. E-mail address: [email protected] (M. Thomas) Introduction/Background Analogy perception serves as the basis for numerous other kinds of human thinking, reasoning and successful communication. Since it is a complex cognitive communicative task it would be worth exploring how the age effects the accuracy and speed of processing. Hence, the present study is to evaluate the effect of age on analogy perception. The objectives of the study were to explore age related changes in the accuracy and speed of analogy perception. Material and method A cross-sectional study design. Participated are divided it into three groups based on their age. Group 1 consisted of 12 participants between the age group 20–30 years. Group 2 consisted of 10 participants between the age group 30–50 years. Group 3 consisted of 7 participants between the age group 60–75 years. 18 stimuli were on 18 different slides using the software called the paradigm experiment version 2.1.0.95 (86). The subjects were expected to read the entire conversational context and judge the interpretation of the used analogy from the four choices. Responses were recorded along with the time elapsed between the emergence of the slide and pressing the button to give the response. Reaction time were also noted. The data was collected from the participants was tabulated and analyzed on MSexcel. Results The descriptive statistics was applied to analyse the accuracy and reaction time of the subjects of all the groups. Conclusion Analogy perception is an integral part of the successful communication. Studies have shown that analogies are a series of leaps involving high level perception, activation of concepts in long term memory, transfer to short term memory, partial and context-dependent unpacking of chunks, and then further high-level perception (Hofstader, 1996). We recommend usage of analogy mapping as a significant process which should be included in routine cognitive communicative assessments. This would surely enable us to understand various cognitive linguistic processes in a healthy as well as a pathologically ageing brain. Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.107
Evaluation of balance performance in vestibular loss patients using virtual reality system and Single leg stance test Q. Shen 1,∗ , C. de Waele 1 , M. Gras 2 , P. Bendahan 2 , G. Lamas 3 CNRS UMR8257, University Paris Descartes, Cognition and Action Group, Paris, France 2 ESPHI, La Ciotat, France 3 Pitié-Salpêtrière Hospital, ENT Department, Paris, France ∗ Corresponding author. E-mail address: [email protected] (Q. Shen)
1
Introduction/Background This study is to evaluate the balance performance in unilateral vestibular loss (UVL) and bilateral vestibular loss (BVL) patients by using a new visual perturbation system including virtual reality (VR), Wii Balance Board (WBB), rubber foam, and a wearable accelerometer for body sway parameter quantification. Balance ability during 25s single leg stance was also assessed. Material and method Forty-six normal subjects and 27 vestibular loss patients were recruited. Subjects were instructed to stand on WBB plus foam, and to wear a goggle delivering VR image. Two visual conditions were assessed: stable visual world (VR0.0) and perturbed visual world (VR0.1). Each condition lasted for 25 s. Subjects wore one 3D accelerometer attached on the site of L5 vertebra. The balance performance was quantified by calculating the average “jerk” at X, Y, and Z axis during the test. Patients who fell during the test were removed from “jerk” analysis. The body sway was also measured during single leg stance at eye open and eye closed condition. Results All normal subjects and patients completed VR0.0 without falling. No normal subjects fell at VR0.0; whereas 33% UVL patients and all BVL patients fell. At VR0.0, the average “jerk” in healthy subjects is 2.10 ± 0.98 (min–max: 0.68–5.59), and in patients is 4.97 ± 2.84 (min–max: 0.80–14.82). At VR0.1, the average “jerk” in normal subjects is 3.54 ± 1.73 (min–max: 0.68–8.68), while in UVL patients is 10.62 ± 4.70 (min–max: 1.10–16.33). In one leg stance test, the “jerk” was also significantly increased in UVL patients compared to normal subjects. Conclusion The new visual perturbation system and single leg stance test allows clinicians to efficiently evaluate balance performance and visual dependency at clinical settings. The body sway parameter “jerk” successfully distinguished vestibular deficit patients from healthy subjects. This system may be used in rehabilitation program to follow the improvement of balance performance in vestibular loss patients. Keywords Balance; Virtual reality; Vestibular loss Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.108
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
R middle frontal gyrus (BA 46), R insular cortex and R caudate nucleus. Moreover, the R caudate nucleus and R middle frontal gyrus were associated with the clinical language performance. Conclusion Inhibitory rTMS protocol may facilitate language recovery without compromising beneficial contralesional reorganization. Conversely, this regimen enhances the expression of newly organized areas for the improvement language performance in post-stroke non-fluent aphasic patients, particularly the caudate nucleus and middle frontal gyrus, likely through intercortical modulating mechanisms. Keywords Post-stroke non-fluent aphasia; Repetitive transcranial magnetic stimulation (rTMS); Functional magnetic resonance imaging (fMRI) Disclosure of interest The authors have not supplied their declaration of competing interest. Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.104. https://doi.org/10.1016/j.rehab.2018.05.104 ISPR8-2665
Leukoaraiosis is not predictive of aphasia recovery M. Hatier 1,2,∗ , I. Sibon 3,4 , A. Hauwelle 2,5 , T. Tourdias 6,7 , H. Cassoudesalle 1,2 , P. Dehail 1,2 , M. Villain 8 , C. Gil-Jardiné 9 , B. Glize 1,2 1 CHU de Bordeaux, Department of physical medicine and rehabilitation, Bordeaux, France 2 EA4136, University of Bordeaux, Bordeaux, France 3 CHU de Bordeaux, Stroke Unit, Bordeaux, France 4 University of Bordeaux, Incia, CNRS UMR5287, Bordeaux, France 5 CHU de Clermont-Ferrand, Department of physical medicine and rehabilitation, Clermont-Ferrand, France 6 CHU de Bordeaux, neuroimagerie diagnostique et thérapeutique, Bordeaux, France 7 Inserm, U1215, Neurocentre Magendie, Bordeaux, France 8 AP–HP Salpêtrière, Department of physical medicine and rehabilitation, Paris, France 9 CHU de Bordeaux, Emergency, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (M. Hatier) Introduction/Background Stroke-related aphasia affects 20% to 40% stroke patients and early prediction of aphasia recovery remains extremely difficult to predict. Leukoaraiosis LA is recognised as one of the neuroimaging features of cerebral small vessel disease and is associated with brain disturbances. LA is known to be associated with long term cognitive decline, mood disorders, gait disability and has a negative impact of post-stroke functional outcome. The aim of this study was to determine whether the extent of LA could contribute to the prediction of recovery from post-stroke aphasia. Material and method Hundred and ten right handed aphasic patients with analyzable MRI sequences were included and assessed as soon as possible within fourteen days after a first left hemispheric stroke. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. Good recovery at M6 was defined as an ASRS = 4–5. In a first step, axial diffusion-weighted images, or T2*-weighted images for intra-cerebral haemorrhage, and Flair images were imported. Lesions were drawn manually in order to measure the lesion size, as well as the volume of LA in Flair sequences. Results Good recovery from aphasia was significantly associated with lower severity of aphasia initially (P < 0.001) and smaller
lesions (P < 0.001). No significant association was found between the volume of LA and recovery from aphasia, even adjusted to the lesion size or age in a multi variable model. Conclusion The extent of leukoaraiosis is not a predictor of aphasia recovery, even adjusted to the lesion size or age. Hence, aphasia recovery seems to be poorly influenced by diffuse lesions of sub-cortical white matter, strengthening the idea of crucial and localised brain areas and networks involved in recovery. Keywords Aphasia; Stroke; Leukoaraiosis Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.105 ISPR8-2667
Motor evoked potentials of upper-limbs predict aphasia recovery B. Glize 1,∗ , M. Villain 2 , M. Laganaro 3 , D. Guehl 4 , P. Dehail 5 , P.A. Joseph 5 , I. Sibon 6 1 University of Bordeaux, EA 4136, Bordeaux, France 2 AP–HP Pitié-Salpétrière, service MPR, Paris, France 3 Université de Genève, neuropsycholinguistique, Genève, Switzerland 4 CHU de Bordeaux, exploration du système nerveux, Bordeaux, France 5 CHU de Bordeaux, service MPR, Bordeaux, France 6 CHU de Bordeaux, stroke unit, Bordeaux, France ∗ Corresponding author. E-mail address: [email protected] (B. Glize) Introduction/Background Recovery from aphasia remains difficult to predict. Among the language features predicting recovery from aphasia, production scores such as repetition or phonology seem to be more relevant predictors than only severity. As motor cortex is strongly involved in language processes, both production and perception, the present study aimed to determine whether the integration of an electrophysiological measure of the motor networks using motor-evoked potentials MEP in the acute phase of stroke can improve the prediction of recovery from post-stroke aphasia. Material and method Hundred and twelve patients with aphasia within 14 days after a first ischemic or haemorrhagic stroke completed the study. The severity of aphasia was assessed using the Aphasia Severity Rating Scale (ASRS) at baseline and 6 month (M6) after the stroke. The ASRS is a 6-point Likert scale from the lowest score 0 to 5. A severe aphasia initially was defined as an ASRS score < 3. MEPs were recorded from the abductor pollicis brevis muscle and orbicularis oris. The resting motor threshold (rMT) was defined for each muscle and a ratio between left and right rMT (rMTr) was calculated for upper-limbs and for lips. Results A first-level model, including only clinical variables (i.e. initial severity) predicted severity at six months for severe patients. When the rMTr of upper limbs was added in a second-level model, the predictive power significantly increased from 41 to 51%, as well as adding in a third-level model rMTr of upper-limbs and initial fibres number ratio of the corticospinal tracts (41 to 55%). With the changes of severity as the dependent variable, the same factors made a significant contribution and the predictive power of a second-level model increased from 4 to 20% to the same extent as in a third-level model (4% to 27%). Conclusion Added with usual clinical factors, MEPs of upperlimbs and lips contribute to the prediction of aphasia recovery, particularly for patients with severe aphasia initially. Keywords Aphasia; Recovery prediction; Motor evoked potential Disclosure of interest The authors have not supplied their declaration of competing interest.
Oral abstracts / Annals of Physical and Rehabilitation Medicine 61S (2018) e1–e102
Appendix A Supplementary data Supplementary data associated with this article can be found, in the online version, at https://doi.org/10.1016/j.rehab.2018.05.106.
e49
A3.07 Neurological and mental health conditions–Nerve injury
https://doi.org/10.1016/j.rehab.2018.05.106 ISPR8-2081 ISPR8-2165
“Is grass really greener on the other side?”–A study of analogy perception across age groups
M. Thomas ∗ , G. Bajaj Kasturba Medical College, Audiology and Speech Language Pathology, Mangalore Karnataka, India ∗ Corresponding author. E-mail address: [email protected] (M. Thomas) Introduction/Background Analogy perception serves as the basis for numerous other kinds of human thinking, reasoning and successful communication. Since it is a complex cognitive communicative task it would be worth exploring how the age effects the accuracy and speed of processing. Hence, the present study is to evaluate the effect of age on analogy perception. The objectives of the study were to explore age related changes in the accuracy and speed of analogy perception. Material and method A cross-sectional study design. Participated are divided it into three groups based on their age. Group 1 consisted of 12 participants between the age group 20–30 years. Group 2 consisted of 10 participants between the age group 30–50 years. Group 3 consisted of 7 participants between the age group 60–75 years. 18 stimuli were on 18 different slides using the software called the paradigm experiment version 2.1.0.95 (86). The subjects were expected to read the entire conversational context and judge the interpretation of the used analogy from the four choices. Responses were recorded along with the time elapsed between the emergence of the slide and pressing the button to give the response. Reaction time were also noted. The data was collected from the participants was tabulated and analyzed on MSexcel. Results The descriptive statistics was applied to analyse the accuracy and reaction time of the subjects of all the groups. Conclusion Analogy perception is an integral part of the successful communication. Studies have shown that analogies are a series of leaps involving high level perception, activation of concepts in long term memory, transfer to short term memory, partial and context-dependent unpacking of chunks, and then further high-level perception (Hofstader, 1996). We recommend usage of analogy mapping as a significant process which should be included in routine cognitive communicative assessments. This would surely enable us to understand various cognitive linguistic processes in a healthy as well as a pathologically ageing brain. Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.107
Evaluation of balance performance in vestibular loss patients using virtual reality system and Single leg stance test Q. Shen 1,∗ , C. de Waele 1 , M. Gras 2 , P. Bendahan 2 , G. Lamas 3 CNRS UMR8257, University Paris Descartes, Cognition and Action Group, Paris, France 2 ESPHI, La Ciotat, France 3 Pitié-Salpêtrière Hospital, ENT Department, Paris, France ∗ Corresponding author. E-mail address: [email protected] (Q. Shen)
1
Introduction/Background This study is to evaluate the balance performance in unilateral vestibular loss (UVL) and bilateral vestibular loss (BVL) patients by using a new visual perturbation system including virtual reality (VR), Wii Balance Board (WBB), rubber foam, and a wearable accelerometer for body sway parameter quantification. Balance ability during 25s single leg stance was also assessed. Material and method Forty-six normal subjects and 27 vestibular loss patients were recruited. Subjects were instructed to stand on WBB plus foam, and to wear a goggle delivering VR image. Two visual conditions were assessed: stable visual world (VR0.0) and perturbed visual world (VR0.1). Each condition lasted for 25 s. Subjects wore one 3D accelerometer attached on the site of L5 vertebra. The balance performance was quantified by calculating the average “jerk” at X, Y, and Z axis during the test. Patients who fell during the test were removed from “jerk” analysis. The body sway was also measured during single leg stance at eye open and eye closed condition. Results All normal subjects and patients completed VR0.0 without falling. No normal subjects fell at VR0.0; whereas 33% UVL patients and all BVL patients fell. At VR0.0, the average “jerk” in healthy subjects is 2.10 ± 0.98 (min–max: 0.68–5.59), and in patients is 4.97 ± 2.84 (min–max: 0.80–14.82). At VR0.1, the average “jerk” in normal subjects is 3.54 ± 1.73 (min–max: 0.68–8.68), while in UVL patients is 10.62 ± 4.70 (min–max: 1.10–16.33). In one leg stance test, the “jerk” was also significantly increased in UVL patients compared to normal subjects. Conclusion The new visual perturbation system and single leg stance test allows clinicians to efficiently evaluate balance performance and visual dependency at clinical settings. The body sway parameter “jerk” successfully distinguished vestibular deficit patients from healthy subjects. This system may be used in rehabilitation program to follow the improvement of balance performance in vestibular loss patients. Keywords Balance; Virtual reality; Vestibular loss Disclosure of interest The authors have not supplied their declaration of competing interest. https://doi.org/10.1016/j.rehab.2018.05.108