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P25.12 Robotic rehabilitation in chronic stroke: neuroplastic and clinical effects
14th ECCN / 4th ICTMS/DCS was used referred as global arm VAS and segmental arm VAS (shoulder, elbow, wrist, thumb). Results: Men had significantly higher two-point discrimination than women. Non significant differences (between men and women) were observed in severity stroke, quality of life, motor function, pain and in the other sensibility modalities evaluated. Conclusions: The study suggests a different two-point discrimination between men and women in a sample of patients with non significant differences in severity stroke. Further neurophysiological studies are needed to understand the underlying mechanisms. P25.12 Robotic rehabilitation in chronic stroke: neuroplastic and clinical effects G. Pellegrino1 , L. Tomasevic2 , M. Tombini1 , G. Assenza1 , F. Vernieri1 , F. Zappasodi3 , C. Porcaro2 , S. Graziadio4 , V. Giacobbe5 , M.L. Blefari5 , E. Guglielmelli5 , L. Zollo5 , G. Cavallo5 , R. Fini1 , E. Fabrizio1 , E. Gallotta6 , S. Sterzi6 , P.M. Rossini1 , F. Tecchio2 1 Department of Neurology, Campus Bio-Medico University, Rome, Italy, 2 LET’S, ISTC, CNR, Ospedale Fatebenefratelli, Isola Tiberina, Rome, Italy, 3 Dip. Neuroscience and Imaging, “G. D’Annunzio” University, Chieti, Italy, 4 Institute of Neuroscience, Newcastle University, Newcastle, United Kingdom, 5 Laboratory of Biomedical Robotics & EMC, 6 Medicina Fisica e Riabilitazione, Campus Bio-Medico University, Rome, Italy Introduction: Neuro-rehabilitation is the main tool to pursue the recovery after stroke, the major cause of disability, often due to an upper limb motor impairment. More than 6 months after stroke brain plasticity is the crucial element in pursuing of further motor control improvements. Objectives: To evaluate the clinical changes and brain plastic reorganizations induced by a robot-aided rehabilitation program (through MIT-manus system) in chronic stroke patients. Methods: We recruited 6 patients with an upper limb motor impairment in chronic phase of stroke (5M, mean age 60±19, mean period from stroke onset 2 years). They underwent a 8 weeks MIT-manus neurorehabilitation program. At the beginning and at the end of the training (T0 and T1) clinical evaluation was assessed via Fugl-Meyer Assessment (FMA) scale and brain activity was recorded by 32-channel EEG at both rest and during median nerve sensory stimuli. The primary somatosensory sources (FS_S1) of the affected hemisphere (AH) and of the unaffected one (UH) were obtained by the Functional Source Separation (FSS) method, a source extraction technique based on functional constrains. AH and UH FS_S1 Power Spectral Density (PSD) delta to gamma bands at rest and during median nerve stimulation were measured. Results: After the training an improvement of upper limb motor performance paired with FS_S1 PSD changes both at rest and during stimulation condition were found. At T0 we observed a global low AH FS_S1 activity, an higher UH FS_S1 delta power and a great FS_S1 power asymmetry between AH and UH in both conditions. At T1 we found a FS_S1 activity enhancement, a reduction of UH FS_S1 delta power and a more symmetric FS_S1 activity in both conditions. Conclusions: A MIT-Manus based rehabilitation program is able to induce a further improvement of motor performance and a brain plastic reorganization with the achievement of a more physiologic pattern in a chronic stroke patient population. P25.13 Brain activation on walking visual illusion A. Matsuo1 , T. Ishikawa1 , T. Fukui1 , M. Hiyamizu1 , H. Maeoka1 , S. Morioka1 1 Department of Physical Therapy, Kio University, Nara, Japan Introduction: The paradigm of mirror therapy has been studied in painrelated syndromes and motor-related syndromes. The focus of these studies has been on potential clinical effects such as the reduction in pain and the improvement of motor function. Mirror therapy may also contribute to modulate cortical and spinal excitability. Recently, a walking visual illusion is applied to the treatment of the neuropathic pain of the lower extremity. Objective: The aim of this study is to investigate the neuronal basis for the effects of walking visual illusion in healthy subjects. Methods: Ten healthy subjects were recruited and the changes in concentration of oxygenated hemoglobin (oxy-Hb) by using functional near-infrared spectroscopy (fNIRS) were examined during a virtual
S175 walking, walking observation and control task. As a virtual condition, with a mirror placed in front of a screen, subjects aligned their own upper body with a film of a lower body walking. As a walking observation condition, the subjects observed the video that others walked. As a virtual walking control condition, we used a movie containing graphical illustrations, without images of human movement, specifically no gait actions. We used a 49 channel fNIRS system, and region of interest analysis was performed on the primary motor area, supplementary motor area, premotor area and parietal area. Results: The oxy-Hb on the right parietal and the right primary motor area significantly increased during virtual walking, whereas there were no significant difference on the others area. Conclusions: In this first study on the neuronal correlates of the walking virtual illusion in healthy subjects, we showed that the virtual walking increases activity in the right parietal and the right primary motor area. We guess that these activations show the integration of the vision and the somatosensory information in the right hemisphere and the increase in an excitability on the sensorimotor linkage. P25.14 Clinical and electrophysiologic changes after injection of botulinum toxin type A in children with spastic cerebral palsy Y.-T. Kim1 1 Department of Rehabilitation Medicine, Catholic University Medical College, Seoul, Korea, Republic Introduction: Injections of botulinum toxin are the useful method to control the spasticity in children with cerebral palsy. Objectives: To evaluate the clinical improvement and electrophysiologic changes of botulinum toxin type-A (BoNT-A) using late response studies in children with spastic cerebral palsy. Methods: A total 12 children (aged 18 months-10 years) with spastic cerebral palsy were investigated. The types of cerebral palsy were 7 diplegia, 1 hemiplegia, and 4 tetraplegia. All children underwent clinical evaluation for spasticity according to the modified Ashworth scale and range of joint motion in lower extremities, and F-wave and H-reflex studies to tibial nerve stimulations before the injections, 2 weeks and 3 months after BoNT-A injections. In all children, gastrocnemius muscles were injected and in some cases hip adductor, hip flexors and knee flexor muscles were also injected according to the status of spasticity. Results: The values of the modified Ashworth scale significantly reduced and the range of joint motion in lower extremities significantly increased after BoNT-A injections (p < 0.05). The minimal latency of F-wave significantly increased after BoNT-A injections (p < 0.05), but there were no significant differences of maximal amplitude, mean amplitude and persistence of F-wave, and F/M amplitude ratio between before and after BoNT-A injections. The minimal latencies of H-reflex and M-wave significantly increased, and the maximal amplitude of H-reflex significantly reduced 2 weeks after injections, and H/M amplitude ratio reduced significantly 2 weeks and 3 months after injections (p < 0.05). Conclusions: In children with spastic cerebral palsy, there were significant electrophysiologic changes after BoNT-A injections. Especially, H-reflex may be the electrophysiological procedure for the evaluation of the effect of BoNT-A injections in children with spastic cerebral palsy. P25.15 Influence of the brain activity in observation conditions on balance learning M. Hiyamizu1 , H. Maeoka1 , A. Matsuo1 , S. Morioka1 Department of Physical Therapy, Kio University, Nara, Japan
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Introduction: Observational learning has been demonstrated to be effective in the motor skill learning. However, the issue of what are optimal observation conditions for balance learning has not been clarified Aim: The purpose of this study was to clarify a relationship between brain activity and differences in observation conditions on balance learning in healthy subjects. Methods: Fifteen healthy subjects (12 men and 3 women, mean age: 20.5) participated in this study. The subjects were randomly assigned to the control group, Another-Observation (AO) group and Self-Observation (SO) group. The balance task required subjects to stand on a platform tilting to the left and right, and to try to keep the platform as close to horizontal as possible. The control group performed the balance task. The AO group performed the task alternately with observing another person
S175 walking, walking observation and control task. As a virtual condition, with a mirror placed in front of a screen, subjects aligned their own upper body with a film of a lower body walking. As a walking observation condition, the subjects observed the video that others walked. As a virtual walking control condition, we used a movie containing graphical illustrations, without images of human movement, specifically no gait actions. We used a 49 channel fNIRS system, and region of interest analysis was performed on the primary motor area, supplementary motor area, premotor area and parietal area. Results: The oxy-Hb on the right parietal and the right primary motor area significantly increased during virtual walking, whereas there were no significant difference on the others area. Conclusions: In this first study on the neuronal correlates of the walking virtual illusion in healthy subjects, we showed that the virtual walking increases activity in the right parietal and the right primary motor area. We guess that these activations show the integration of the vision and the somatosensory information in the right hemisphere and the increase in an excitability on the sensorimotor linkage. P25.14 Clinical and electrophysiologic changes after injection of botulinum toxin type A in children with spastic cerebral palsy Y.-T. Kim1 1 Department of Rehabilitation Medicine, Catholic University Medical College, Seoul, Korea, Republic Introduction: Injections of botulinum toxin are the useful method to control the spasticity in children with cerebral palsy. Objectives: To evaluate the clinical improvement and electrophysiologic changes of botulinum toxin type-A (BoNT-A) using late response studies in children with spastic cerebral palsy. Methods: A total 12 children (aged 18 months-10 years) with spastic cerebral palsy were investigated. The types of cerebral palsy were 7 diplegia, 1 hemiplegia, and 4 tetraplegia. All children underwent clinical evaluation for spasticity according to the modified Ashworth scale and range of joint motion in lower extremities, and F-wave and H-reflex studies to tibial nerve stimulations before the injections, 2 weeks and 3 months after BoNT-A injections. In all children, gastrocnemius muscles were injected and in some cases hip adductor, hip flexors and knee flexor muscles were also injected according to the status of spasticity. Results: The values of the modified Ashworth scale significantly reduced and the range of joint motion in lower extremities significantly increased after BoNT-A injections (p < 0.05). The minimal latency of F-wave significantly increased after BoNT-A injections (p < 0.05), but there were no significant differences of maximal amplitude, mean amplitude and persistence of F-wave, and F/M amplitude ratio between before and after BoNT-A injections. The minimal latencies of H-reflex and M-wave significantly increased, and the maximal amplitude of H-reflex significantly reduced 2 weeks after injections, and H/M amplitude ratio reduced significantly 2 weeks and 3 months after injections (p < 0.05). Conclusions: In children with spastic cerebral palsy, there were significant electrophysiologic changes after BoNT-A injections. Especially, H-reflex may be the electrophysiological procedure for the evaluation of the effect of BoNT-A injections in children with spastic cerebral palsy. P25.15 Influence of the brain activity in observation conditions on balance learning M. Hiyamizu1 , H. Maeoka1 , A. Matsuo1 , S. Morioka1 Department of Physical Therapy, Kio University, Nara, Japan
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Introduction: Observational learning has been demonstrated to be effective in the motor skill learning. However, the issue of what are optimal observation conditions for balance learning has not been clarified Aim: The purpose of this study was to clarify a relationship between brain activity and differences in observation conditions on balance learning in healthy subjects. Methods: Fifteen healthy subjects (12 men and 3 women, mean age: 20.5) participated in this study. The subjects were randomly assigned to the control group, Another-Observation (AO) group and Self-Observation (SO) group. The balance task required subjects to stand on a platform tilting to the left and right, and to try to keep the platform as close to horizontal as possible. The control group performed the balance task. The AO group performed the task alternately with observing another person