Isaac Sorinola

The Effect of Coil Type and Navigation on the Reliability of Transcranial Magnetic Stimulation

The objective of this study was to investigate reliability of transcranial magnetic stimulation (TMS) parameters for three coil systems; hand-held circular and figure-of-eight and navigated figure-of-eight coils. Stimulus response curves, intracortical inhibition (SICI) and facilitation (ICF) were studied in the right first dorsal interosseus muscle of 10 healthy adults. Each coil system was tested twice per subject. Navigation was conducted by a custom built system. Cortical excitability showed moderate-to-good reliability for the hand-held and navigated figure-of-eight coils (Intraclass correlation coefficients (ICCs) 0.55-0.89). The circular coil showed poor reliability for motor evoked potential (MEP) amplitude at 120% resting motor threshold (RMT; MEP<;sub>;120<;/sub>;) and MEP sum (ICCs 0.09 & 0.48). Reliability for SICI was good for all coil systems when an outlier was removed (ICCs 0.87-0.93), but poor for ICF (ICCs <; 0.3). The circular coil had a higher MEP<;sub>;120<;/sub>; than the navigated figure-of-eight coil (p = 0.004). Figure-of-eight coils can be used confidently to investigate cortical excitability over time. ICF should be interpreted with caution. The navigation device frees the experimenter and enables tracking of the position of the coil and subject. The results help guide the choice of coil system for longitudinal measurements of motor cortex function.

Electromyographic Response to Manual Passive Stretch of the Hemiplegic Wrist: Accuracy, Reliability, and Correlation With Clinical Spasticity Assessment and Function

Background. The management of spasticity is important in neurorehabilitation and needs to be assessed accurately. The commonly used clinical tools have been criticized for lack of validity and sensitivity. Objective. To investigate the reliability of electromyographic (EMG) response to manual stretches of the hemiplegic wrist and its correlation with clinical assessments of spasticity and physical function. Methods. EMG activity was measured in 10 stroke patients and control participants (53.7 ± 10 and 32 ± 9.1 years respectively, mean ± SEM) during 3 cycles of 10 seconds passive manual movements of the wrist at 60 to 360° • s-1. Isometric maximal voluntary contractions (MVC) strength, range of movement (ROM) of the wrist flexors and extensors, spasticity (Modified Ashworth Scale [MAS]) and hand function (Block and Box Test [BBT]) were also assessed. Results. EMG activity of the stroke patients increased with velocity from 4% to 40% MVC (P < .001) but there was none in the controls. It was unaffected by repetition and good to moderate reliability occurred at all speeds (ICC, 0.71-0.81). EMG correlated negatively with MVC strength (r = -.9), active wrist flexion ROM ( r = -.8), and hand function scores (r = —.7), but not with clinical measures of spasticity except at the lowest velocity (r = .72). Conclusions. Consistent and accurate stretch velocities and EMG responses can be achieved with manual wrist stretches for the assessment of the neural component of spasticity. These objective tests did not correlate well with the standard clinical assessment of spasticity. They showed significant negative relationships with function, indicating that increased reflex excitability contributes to hand disability after stroke.

The Effect of Combined Somatosensory Stimulation and Task-Specific Training on Upper Limb Function in Chronic Stroke A Double-Blind Randomized Controlled Trial

Background. Somatosensory stimulation (SS) is a potential adjuvant to stroke rehabilitation, but the effect on function needs further investigation. Objective. To explore the effect of combining SS with task-specific training (TST) on upper limb function and arm use in chronic stroke survivors and determine underlying mechanisms. Methods. In this double-blinded randomized controlled trial (ISRCTN 05542931), 33 patients (mean 37.7 months poststroke) were block randomized to 2 groups: active or sham SS. They received 12 sessions of 2 hours of SS (active or sham) to all 3 upper limb nerves immediately before 30 minutes of TST. The primary outcome was the Action Research Arm Test (ARAT) score. Secondary outcomes were time to perform the ARAT, Fugl-Meyer Assessment score (FM), Motor Activity Log (MAL), and Goal Attainment Scale (GAS). Underlying mechanisms were explored using transcranial magnetic stimulation stimulus–response curves and intracortical inhibition. Outcomes were assessed at baseline, immediately following the intervention (mean 2 days), and 3 and 6 months (mean 96 and 190 days) after the intervention. Results. The active group (n = 16) demonstrated greater improvement in ARAT score and time immediately postintervention (between-group difference; P < .05), but not at 3- or 6-month follow-ups (P > .2). Within-group improvements were seen for both groups for ARAT and GAS, but for the active group only for FM and MAL (P < .05). Corticospinal excitability did not change. Conclusions. Long-lasting improvements in upper limb function were observed following TST. Additional benefit of SS was seen immediately post treatment, but did not persist and the underlying mechanisms remain unclear.

Does additional exercise improve trunk function recovery in stroke patients? A meta-analysis

BACKGROUND The restoration of trunk function following stroke is a key component of rehabilitation, however there is limited evidence of the efficacy of additional trunk training. OBJECTIVES To evaluate the efficacy of trunk exercises added to conventional rehabilitation on functional outcomes. METHODS Relevant randomised controlled trials (RCTs), published up to July 2012, evaluating the effect of the addition of trunk exercises to conventional rehabilitation on functional outcomes were identified in Medline, Cinahl, Embase, Pubmed, PEDro, Web of Science and Scopus databases. Findings were summarised across studies as mean or standardised mean differences (MD or SMD) with 95% confidence intervals. RESULTS Six RCTs with 155 participants and a mean PEDro score of 6.5 (range 6 to 8) were included. Data from two to five studies were pooled in meta-analyses that showed a moderate, non-significant effect of additional trunk exercise on trunk performance, (SMD = 0.50; 95% CI -0.25, 1.25; P = 0.19); large effects on standing balance, SMD = 0.72 (95% CI -0.01, 1.45 P = 0.05); and walking ability, (SMD = 0.81; 95% CI 0.30, 1.33. P = 0.002) and a small, non-significant effect, MD = 10.03 (95% CI -15.70, 35.75. P = 0.44) on functional independence. CONCLUSIONS There is moderate evidence that the addition of specific trunk exercise to conventional early stroke rehabilitation significantly improve standing balance and mobility after stroke; however the evidence was weak for the effect of additional trunk exercise on trunk performance and in functional independence.

The effect of an exercise ball on trunk muscle responses to rapid limb movement

The use of exercise balls as an aid to facilitate improvements in posture in patients with trunk weakness is widely advocated. However, mechanisms underlying any effect on postural mechanisms have received little attention. This study compared the increases in trunk EMG activity in response to limb movement when seated on an exercise ball or on a chair in 16 healthy, moderately active subjects. At the sound of an auditory cue, the subjects carried out either hip flexion or arm flexion (unilateral or bilateral), as fast as possible, whilst sitting on an exercise ball or a standard chair. The amplitude of EMG activity was recorded from selected trunk muscles (erector spinae, external obliques, internal obliques and rectus abdominis) and either an upper limb muscle (deltoid) or a lower limb muscle (rectus femoris). There were minimal differences in amplitudes of EMG activity in any of the trunk muscles between the conditions (ball or chair) following the upper limb movements. These results suggest that there is no benefit in simple arm flexion movements whilst seated on the exercise ball in comparison to a chair. The onset and amplitude of the rectus abdominis (RA) and external obliques (EO) were significantly different between conditions in the hip flexion protocol. However, they do suggest significant benefit in decreasing RA and EO muscle activity onsets and increasing amplitude in the hip flexion condition. These results may have implications for rehabilitation of those with trunk muscle deficits such as stroke.

Self-perceived utilization of the paretic arm in chronic stroke requires high upper limb functional ability.

Objective To explore potential predictors of self-reported paretic arm use at baseline and after task-specific training (TST) in survivors of stroke. Design Data were obtained from a randomized controlled trial of somatosensory stimulation and upper limb TST in chronic stroke. Setting University laboratory. Participants Chronic (≥3mo) survivors of stroke (N=33; mean age, 62y; mean stroke duration, 38mo). Interventions Participants received 12 sessions of TST preceded by either active (n=16) or sham (n=17) somatosensory stimulation to all 3 peripheral nerves. Main Outcome Measures Demographic and clinical characteristics were entered stepwise into multiple linear regression analyses to determine the factors that best predict baseline Motor Activity Log (MAL) amount of use rating and change 3 months after TST. Results The Action Research Arm Test (ARAT) score predicted the amount of use at baseline (R2=.47, P<.001); in using this model, an ARAT score of 54 (maximum of 57) is required to score 2.5 on the MAL (use described as between rarely and sometimes). After TST the change in the ARAT score predicted the change in the amount of use (R2=.31, P=.001). The predictive power of the model for change at 3 months increased if the Fugl-Meyer Assessment wrist component score was added (R2=.41, P=.001). Conclusions Utilization of the paretic upper limb in activities of daily living requires high functional ability. The increase in self-reported arm use after TST is dependent on the change in functional ability. These results provide further guidance for rehabilitation decisions.

Effect of Somatosensory Stimulation of Two and Three Nerves on Upper Limb Function in Healthy Individuals

BACKGROUND AND PURPOSE Improvement in motor function has been reported in healthy subjects following somatosensory stimulation (SS) of individual upper limb peripheral nerves. This effect could have beneficial applications in rehabilitation, but there is little knowledge of the effects of stimulating multiple upper limb nerves. This study evaluated the effects of SS of two and three nerves on hand function. METHODS A single blind within-group repeated measures design was utilized. Ten healthy subjects (27.1 ± 5.4 years [mean ± SD], three men) were recruited and, after a familiarization session, were given SS to the ipsilateral hand in a randomized order to two (ulnar and median) and three (ulnar, median and radial) nerves on two occasions separated by at least one week. The time required to complete the Jebsen-Taylor Hand Function Test (JTHFT) and handgrip strength of the ipsilateral hand were measured before and immediately after each SS session. RESULTS Total JTHFT time decreased significantly by an average of 3.58 ± 2.75 s (9.9%; P = 0.003) and 4.10 ± 3.20 s (11.6%; P = 0.003) following SS to two and three nerves, respectively, but no difference between the two was found. Handgrip strength decreased significantly by 1.82 ± 1.91 kgf (P = 0.015) following SS to three nerves only. CONCLUSIONS This study suggests that SS of three nerves may facilitate motor training but may also induce a reduction in muscle performance. Further studies are needed to determine the clinical implications of these findings for neurological rehabilitation.

A life of living death: the experiences of people living with chronic low back pain in rural Nigeria.

Abstract Purpose: This study explored the experiences of people living with non-specific chronic low back pain (CLBP) in a rural Nigerian community. Method: Qualitative in-depth semi-structured face-to-face interviews were conducted with purposively sampled participants until data saturation. Questions explored back pain beliefs, coping/management strategies and daily activities. Thematic analysis of transcripts was performed using the Framework approach. Results: Themes showed that back pain beliefs were related to manual labour/deprivation, infection/degeneration, spiritual/cultural beliefs and rural–urban divide. These beliefs impacted on gender roles resulting in adaptive or maladaptive coping. Adaptive coping was facilitated by positive beliefs, such as not regarding CLBP as an illness, whereas viewing CLBP as illness stimulated maladaptive coping strategies. Spirituality was associated with both adaptive and maladaptive coping. Maladaptive coping strategies led to dissatisfaction with health care in this community. Conclusions: CLBP-related disability in rural Nigeria is strongly influenced by beliefs that facilitate coping strategies that either enhance or inhibit recovery. Interventions should therefore target maladaptive beliefs while emphasizing behavioural modification. Implications for Rehabilitation Non-specific chronic low back pain (CLBP) is highly prevalent and responsible for much pain and disability in rural Nigeria. No qualitative study has investigated the experiences of people living with CLBP in rural Nigeria or any other rural African context. Qualitative study of peoples’ experiences of living with CLBP in rural Nigeria has the potential of exposing complex socio-cultural and psychological factors associated with CLBP which has potential implications for designing effective interventions. The results of this study may inform the development of complex interventions for reducing the disability associated with CLBP in rural Nigeria and other rural African contexts.

Effect of dual tasking on postural responses to rapid lower limb movement while seated on an exercise ball

Postural adjustments are used by the central nervous system to pre-empt and correct perturbations in balance during voluntary body movements. Alteration in these responses is associated with a number of neuromuscular/musculoskeletal conditions. Attention has been identified as important in this system; performing a concurrent cognitive task has been suggested to reduce the efficacy of this postural control. The aim of this study was to examine the effect of concurrent cognitive tasking on anticipatory postural adjustments while sitting on an exercise ball with a view to help inform future rehabilitation programmes. Bilateral EMG activity was recorded from the external and internal obliques, rectus abdominis, erector spinae and the right rectus femoris of 20 healthy subjects (9 males) with mean (SD) age of 21.88 (0.86) years (range 21-24 years). A rapid hip flexion protocol was carried out under three conditions: no concurrent task, counting out loud up from one and completing a serial sevens task. The addition of the cognitive task delayed and reduced the EMG in the prime mover muscle but had little impact on the responses of the trunk muscles within the time frame of the anticipatory responses; suggestive of a decoupling of voluntary and postural control mechanisms. The results of this study suggest that perhaps the clinical effects of dual task may not be largely due to changes in anticipatory postural adjustments. However, it would be important to compare these results to those seen in older and functionally impaired individuals as this would be more representative of the typical population undertaking such rehabilitation programmes.

Assessing self-reported disability in a low-literate population with chronic low back pain: cross-cultural adaptation and psychometric testing of Igbo Roland Morris disability questionnaire

Abstract Purpose: Cross-culturally adapt and validate the Igbo Roland Morris Disability Questionnaire. Method: Cross-cultural adaptation, test–retest, and cross-sectional psychometric testing. Roland Morris Disability Questionnaire was forward and back translated by clinical/non-clinical translators. An expert committee appraised the translations. Twelve participants with chronic low back pain pre-tested the measure in a rural Nigerian community. Internal consistency using Cronbach’s alpha; test–retest reliability using intra-class correlation coefficient and Bland–Altman plot; and minimal detectable change were investigated in a convenient sample of 50 people with chronic low back pain in rural and urban Nigeria. Pearson’s correlation analyses using the eleven-point box scale and back performance scale, and exploratory factor analysis were used to examine construct validity in a random sample of 200 adults with chronic low back pain in rural Nigeria. Ceiling and floor effects were investigated in the two samples. Results: Modifications gave the option of interviewer-administration and reflected Nigerian social context. The measure had excellent internal consistency (α = 0.91) and intraclass correlation coefficient (ICC =0.84), moderately high correlations (r > 0.6) with performance-based disability and pain intensity, and a predominant uni-dimensional structure, with no ceiling or floor effects. Conclusions: Igbo Roland Morris Disability Questionnaire is a valid and reliable measure of pain-related disability. Implications for rehabilitation Low back pain is the leading cause of years lived with disability worldwide, and is particularly prevalent in rural Nigeria, but there are no self-report measures to assess its impact due to low literacy rates. This study describes the cross-cultural adaptation and validation of a core self-report back pain specific disability measure in a low-literate Nigerian population. The Igbo Roland Morris Disability Questionnaire is a reliable and valid measure of self-reported disability in Igbo populations as indicated by excellent internal consistency (α = 0.91) and intra-class correlation coefficient (ICC =0.84), moderately high correlations (r > 0.6) with performance-based disability and pain intensity that supports a pain-related disability construct, a predominant one factor structure with no ceiling or floor effects. The measure will be useful for researchers and clinicians examining the factors associated with low back pain disability or the effects of interventions on low back pain disability in this culture. This measure will support global health initiatives concurrently involving people from several cultures or countries, and may inform cross-cultural disability research in other populations.