Deans' stroke musings: Corticospinal Excitability as a Predictor of Functional Gains at the Affected Upper Limb Following Robotic Training in Chronic Stroke Survivors

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, October 16, 2014

Corticospinal Excitability as a Predictor of Functional Gains at the Affected Upper Limb Following Robotic Training in Chronic Stroke Survivors

I wish they would just take all these damned studies on robotic training and just make a stroke protocol out of it. Stop studying it and deliver some results! That is what a great stroke association would do instead of just putting out press releases.
http://nnr.sagepub.com/content/28/9/819?etoc

¹Université de Sherbrooke, Sherbrooke, Quebec, Canada
²University of California; Irvine, CA, USA

Marie-Hélène Milot, Université de Sherbrooke, Faculté de médecine et des sciences de la santé, École de réadaptation, Centre de recherche sur le vieillissement, 1036 Belvédère sud, Sherbrooke, Québec, J1H 4C4, Canada. Email: marie-helene.milot@usherbrooke.ca

Abstract

Background. Robotic training can help improve function of a paretic limb following a stroke, but individuals respond differently to the training. A predictor of functional gains might improve the ability to select those individuals more likely to benefit from robot-based therapy. Studies evaluating predictors of functional improvement after a robotic training are scarce. One study has found that white matter tract integrity predicts functional gains following a robotic training of the hand and wrist.

Objective. To determine the predictive ability of behavioral and brain measures in order to improve selection of individuals for robotic training.

Methods: Twenty subjects with chronic stroke participated in an 8-week course of robotic exoskeletal training for the arm. Before training, a clinical evaluation, functional magnetic resonance imaging (fMRI), diffusion tensor imaging, and transcranial magnetic stimulation (TMS) were each measured as predictors. Final functional gain was defined as change in the Box and Block Test (BBT). Measures significant in bivariate analysis were fed into a multivariate linear regression model.

Results. Training was associated with an average gain of 6 ± 5 blocks on the BBT (P < .0001). Bivariate analysis revealed that lower baseline motor-evoked potential (MEP) amplitude on TMS, and lower laterality M1 index on fMRI each significantly correlated with greater BBT change. In the multivariate linear regression analysis, baseline MEP magnitude was the only measure that remained significant.

Conclusion. Subjects with lower baseline MEP magnitude benefited the most from robotic training of the affected arm. These subjects might have reserve remaining for the training to boost corticospinal excitability, translating into functional gains.