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Levin, M. F., Banina, M. C., Frenkel-Toledo, S., Berman, S., Soroker, N., Solomon, J. M., et al. (2018). Personalized upper limb training combined with anodal-tDCS for sensorimotor recovery in spastic hemiparesis: study protocol for a randomized controlled trial. Trials, 19(1), 7.
Abstract: BACKGROUND: Recovery of voluntary movement is a main rehabilitation goal. Efforts to identify effective upper limb (UL) interventions after stroke have been unsatisfactory. This study includes personalized impairment-based UL reaching training in virtual reality (VR) combined with non-invasive brain stimulation to enhance motor learning. The approach is guided by limiting reaching training to the angular zone in which active control is preserved (“active control zone”) after identification of a “spasticity zone”. Anodal transcranial direct current stimulation (a-tDCS) is used to facilitate activation of the affected hemisphere and enhance inter-hemispheric balance. The purpose of the study is to investigate the effectiveness of personalized reaching training, with and without a-tDCS, to increase the range of active elbow control and improve UL function. METHODS: This single-blind randomized controlled trial will take place at four academic rehabilitation centers in Canada, India and Israel. The intervention involves 10 days of personalized VR reaching training with both groups receiving the same intensity of treatment. Participants with sub-acute stroke aged 25 to 80 years with elbow spasticity will be randomized to one of three groups: personalized training (reaching within individually determined active control zones) with a-tDCS (group 1) or sham-tDCS (group 2), or non-personalized training (reaching regardless of active control zones) with a-tDCS (group 3). A baseline assessment will be performed at randomization and two follow-up assessments will occur at the end of the intervention and at 1 month post intervention. Main outcomes are elbow-flexor spatial threshold and ratio of spasticity zone to full elbow-extension range. Secondary outcomes include the Modified Ashworth Scale, Fugl-Meyer Assessment, Streamlined Wolf Motor Function Test and UL kinematics during a standardized reach-to-grasp task. DISCUSSION: This study will provide evidence on the effectiveness of personalized treatment on spasticity and UL motor ability and feasibility of using low-cost interventions in low-to-middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02725853 . Initially registered on 12 January 2016.
Keywords: Neurorehabilitation; Spasticity; Spatial threshold; Stroke; tDCS
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Kaufman-Cohen, Y., Friedman, J., Levanon, Y., Jacobi, G., Doron, N., & Portnoy, S. (2018). Wrist Plane of Motion and Range During Daily Activities. Am J Occup Ther, 72(6), 1–10.
Abstract: OBJECTIVE. The dart-throwing motion (DTM) is a multiplane wrist motion that is needed for many daily occupations. Mobilization along the DTM plane may be essential for rehabilitation after wrist injury, but DTM angles are reported for the dominant hand alone, so their relevance to injury in the nondominant hand cannot be surmised. The aim of this study was to quantify the DTM plane angles for both hands during different activities of daily living (ADLs).
METHOD. Forty-three healthy participants wore a twin-axis electrogoniometer during ADLs. RESULTS. No significant differences were found between the DTM plane angles of the dominant (20°�45°) and nondominant (15°�40°) hands. These angles varied by task and across participants. CONCLUSION. The DTM plane is a functional motion used by both hands during ADLs. Because the DTM plane angle differs among hands, tasks, and individual clients, wrist rehabilitation involving the DTM plane should not be limited to a singular DTM plane angle.OBJECTIVE. The dart-throwing motion (DTM) is a multiplane wrist motion that is needed for many daily occupations. Mobilization along the DTM plane may be essential for rehabilitation after wrist injury, but DTM angles are reported for the dominant hand alone, so their relevance to injury in the nondominant hand cannot be surmised. The aim of this study was to quantify the DTM plane angles for both hands during different activities of daily living (ADLs). METHOD. Forty-three healthy participants wore a twin-axis electrogoniometer during ADLs. RESULTS. No significant differences were found between the DTM plane angles of the dominant (20°�45°) and nondominant (15°�40°) hands. These angles varied by task and across participants. CONCLUSION. The DTM plane is a functional motion used by both hands during ADLs. Because the DTM plane angle differs among hands, tasks, and individual clients, wrist rehabilitation involving the DTM plane should not be limited to a singular DTM plane angle. |