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Movement disorders occur in association with stroke and may have important clinical implications.
We reviewed the medical literature regarding the clinical phenomenology, prevalence, localization and etiologic implications, and treatments for movement disorders occurring after stroke in adult patients.
Movement disorders occur uncommonly after stro...
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... Individuals with post-stroke chorea tend to be older than those with other post-stroke movement disorders. 7 Although there are few reported cases, the most consistent neuropathological finding in patients with hemiballism after stroke is an ischemic lesion in the contralateral subthalamic nucleus (STn) (Figure 1). 4 Lesions are occasionally found outside of the STn, including the caudate nucleus, putamen, and thalamus. ...
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Hemichorea is a recurrent, non-rhythmic, abnormal, and involuntary hyperkinetic movement disorder of one side of the body. The most common post-stroke hyperkinetic movement disorder is hemichorea. Similar cases have been presented in the literature before. Choreiform movements occur when the balance between direct and indirect pathways in the contr...
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... No outdoor data was collected for S6, so we only present results from S3 and S14 out of the lab. of a single IMU at the pelvis to capture multiple kinematic and kinetic features of gait in healthy individuals [53]. However, in addition to increased stride-by-stride kinematic variability [23], people post-stroke can also experience tremors [54] that introduce additional noise into IMU data. Moreover, IMU calibration and placement sensitivity are known challenges in the field [55], [56], and the increased presence of nonsagittal plane motion, such as gait compensations [57], may further complicate the relationship between IMU placement and kinetic measurements. ...
Gait rehabilitation is critical for regaining locomotor independence after neuromotor injuries like stroke. Rehabilitation literature indicates the need for such therapy to continue beyond the clinic in order to maintain motor function and support recovery. However, implementing community-based rehabilitation requires the ability to monitor gait in the real-world with clinically relevant accuracies. Despite advances in machine learning, achieving this performance with single sensing modalities has been challenging using wearable sensors like inertial measurement units (IMUs) and pressure insoles. Here, we investigate the benefits of multi-modal sensing by integrating IMU and insole data to develop individualized machine learning models in people post-stroke that estimate propulsion, a key biomechanical variable. We show that in the lab, IMU + Insole models improve performance with an average root-mean- squared-error (RMSE) of 0.80 %bodyweight (%BW) across the stance phase. We obtain RMSEs of 0.71 %BW for peak paretic propulsion and 0.19 %BW s for paretic propulsion impulse, which are within corresponding clinical thresholds. We then explore the application of this algorithm to track propulsion changes in the real-world for two participants during variable-speed walking and two participants during active gait interventions, either functional electrical stimulation or exosuit-applied resistance. For these participants, we observe similar changes in measured propulsion in the lab and estimated propulsion out of the lab across speeds and interventions. Overall, this work aims to address the challenges in applying machine learning methods for individuals post-stroke and presents an investigation into the feasibility of developing estimation methods for real-world propulsion estimation during gait rehabilitation.
... The thalamus is the motor and sensory relay structure, and lesions in this location may cause abnormal involuntary movements, including delayed-onset dystonia [3][4][5]. It has been proposed that dystonia can be induced by disruption of the cortico-striato-pallido-thalamo-cortical loop and disinhibition of thalamocortical projections caused by blockade of GPi/STN inhibitory fibers [11,12]. According to the CT scan, as the brain MRI was not possible to perform, no ischemic lesions were described in the basal ganglia and in the subcortical white matter of the brain in our patient, in regions that are traditionally attributed to play a key role in the development of lingual dystonia. ...
... 3 Chung et al showed basal ganglis (STn, caudate, putamen) and cortical lesions contralateral to the affected side on MRI. 7 Hemiballism is closely associated with these lesions. 4 Transient ischemic attack can also cause Hemichorea symptoms. 8 It has also been described in MRI brain negative lesion presenting in large vessel disease on angiography which subsided the symptom on treating the stenosis. ...
Hyperkinetic movement disorders of acute onset are rare manifestation of acute ischemic stroke.
They are believed to be due to lesion in basal ganglia specifically to sub thalamic nuclei. Intravenous thrombolysis in this cases can prevent major disability. Here is a case of a 32 years old lady who had sudden onset of involuntary movements of left upper and lower limb with weakness of left side of the body. She was brought to the hospital within one hour of onset of her symptoms. Her vitals, blood sugars and CT brain plain was normal. Intravenous thrombolysis was done. She had complete resolution of symptoms in next 48 hours. MRI brain with angiography infarct in right caudate, putamen and anterior limb of internal capsule, M1 segment stenosis of right middle cerebral artery for which she was referred for carotid revascularization. Thus early identification and prompt treatment helps in prevention of disability.
... They represent about 20% of cases and often take the form of focal or hemidystonia. [3] The delay in developing dystonia after stroke can be from 1 day to 5 years. [4] Post-stroke dystonia has been attributed to lesions of the putamen (the most common site), caudate, pallidum, thalamus, and the midbrain. ...
... [4] Post-stroke dystonia has been attributed to lesions of the putamen (the most common site), caudate, pallidum, thalamus, and the midbrain. [3] It has been suggested that dystonia can be induced by an interruption of the cortico-striato-pallido-thalamo-cortical loop. This disturbance proposed to be caused by specific lesions in the sensorimotor part of the striation pallidal complex and/or the putamen, is thought to increase thalamocortical drive, which in turn induces dystonia. ...
Dystonia is the second most common movement disorder after stroke. Occurrences of involuntary movements have been reported in 1%–4% of patients with ischemic and hemorrhagic strokes affecting the basal ganglia, thalamus, and/or their connections. The time course for the development of movement disorders varies considerably from the day of the onset of stroke to several years later and it also depends on the type of movement disorder. At the moment, for many of these disorders, the knowledge of pharmacological treatment is still inadequate. Deep brain stimulation is the surgical treatment option for dystonia; however, its therapeutic mechanism is poorly understood. A 50-year-old male patient with complaints of uncontrolled involuntary movements of the right upper limb associated with pain and fatigue for more than a month, with a history of cerebrovascular accident three months back, was admitted at Government Ayurvedic Hospital. The case was diagnosed as dystonia and correlated with Akshepaka (~clonic convulsions) explained in Ayurveda . This case of poststroke dystonia is managed with Shirodhara (~therapeutic oil-streaming over the head) and Nasya (~medication through nasal route) for a period of 21 days. The patient was assessed based on the Fahn–Marsden Rating Scale, with a score of “12” before and “0” after the management. The patient got complete relief within a span of 21 days, which is worth reporting. This case study demonstrates that dystonia (~ Akshepaka ) in acute phase can be managed by Ayurvedic Panchakarma (~five internal bio-cleansing therapies) procedures. This protocol may be utilized in various other movement disorders with an extended period for efficient results.
... Because approximately 46% of PSMD cases develop within 7 d poststroke, they overlap with early seizures; therefore, differential diagnosis is vital (61). PSMD after an ischemic stroke can appear quickly, usually within 1 month (61,62). The frequencies of abnormal movements were as follows: dystonia (23%), chorea (16%), and myoclonus (15%) (61,62). ...
... PSMD after an ischemic stroke can appear quickly, usually within 1 month (61,62). The frequencies of abnormal movements were as follows: dystonia (23%), chorea (16%), and myoclonus (15%) (61,62). Chorea and myoclonus often occur within 7 d (61,62). ...
... The frequencies of abnormal movements were as follows: dystonia (23%), chorea (16%), and myoclonus (15%) (61,62). Chorea and myoclonus often occur within 7 d (61,62). Movement disorders after a hemorrhagic stroke, commonly including dystonia and tremor, appear more frequently after 6 months (61,62). ...
Poststroke seizure is a potential complication of stroke, which is the most frequent acute symptomatic seizure in adults. Patients with stroke may present with an abnormal or aggressive behavior accompanied by altered mental status and symptoms, such as hemiparesis, dysarthria, and sensory deficits. Although stroke manifestations that mimic seizures are rare, diagnosing poststroke seizures can be challenging when accompanied with negative postictal symptoms. Differential diagnoses of poststroke seizures include movement disorders, syncope, and functional (nonepileptic) seizures, which may present with symptoms similar to seizures. Furthermore, it is important to determine whether poststroke seizures occur early or late. Seizures occurring within and after 7 d of stroke onset were classified as early and late seizures, respectively. Early seizures have the same clinical course as acute symptomatic seizures; they rarely recur or require long-term antiseizure medication. Conversely, late seizures are associated with a risk of recurrence similar to that of unprovoked seizures in a patient with a focal lesion, thereby requiring long-term administration of antiseizure medication. After diagnosis, concerns regarding treatment strategies, treatment duration, and administration of primary and secondary prophylaxis often arise. Antiseizure medication decisions for the initiation of short-term primary and long-term secondary seizure prophylaxis should be considered for patients with stroke. Antiseizure drugs such as lamotrigine, carbamazepine, lacosamide, levetiracetam, phenytoin, and valproate may be administered. Poststroke seizures should be diagnosed systematically through history with differential diagnosis; in addition, classifying them as early or late seizures can help to determine treatment strategies.
... Post-stroke movement disorders are uncommon in adults. Despite limited data, it is considered that under 1% of stroke patients are expected to develop acute or delayed hyperkinetic movement disorders [1]. The clinical picture can be very variable, with cases of hemiballismus-hemichorea [2], tremor [3], myoclonus [4], and dystonia [5] being reported in the literature. ...
... This variability in timing may impact the duration required for partial motor function recovery and the development of aberrant neural circuitry. However, the good news is that the majority of acute-onset stroke-related movement disorders are resolved within six months [1]. ...
Background. Hemiballismus is a rare hyperkinetic movement disorder characterized by irregular, poorly patterned, high amplitude involuntary movements of the limbs on one side of the body. While being usually a consequence of subthalamic nucleus lesions, hemiballismus is uncommonly associated with stroke in adults. Moreover, many debates remain regarding the physiopathology behind post-stroke hemiballismus and its optimal treatment. Case reports. In this context, the article aims to present two intriguing cases of hemiballismus arising from ischemic stroke, illustrating the intricate interplay between vascular pathology and movement disorders. Case 1 involves a 72-year-old female presenting with sudden onset left hemiballismus following incomplete right middle cerebral artery infarction, who received intravenous thrombolysis and had a good outcome. Case 2, an 80-year-old female presenting with abrupt onset right hemiballismus, with a suboptimal therapeutic response but self-remission after three months. Considering the inconclusive imaging results, this case highlights the diagnostic challenges and dilemmas encountered in the management of post-stroke hemiballismus. Conclusions. The authors propose a discussion by comparing the selected case reports with currently available data from the literature, focusing on the diagnosis and possible therapeutic strategies. These two cases underscore the importance of early recognition and tailored management of post-stroke hemiballismus, enriching the understanding of this movement disorder.
... 9 Asteriksis juga telah dijelaskan dalam hubungannya dengan stroke, mungkin disebabkan oleh disregulasi traktus dari sistem lobus cerebello-brainstem-thalamofrontal. 24 Stereotipi adalah gerakan tanpa tujuan yang berulang dan seragam pada area tubuh berbeda, terkait dengan infark daerah parietal dan striatal. 9 ...
Gangguan gerak merupakan kondisi kelainan neurologis yang memengaruhi kecepatan, kelancaran, kualitas, dan kemudahan bergerak. Gejala gangguan gerak pada pasien stroke dapat terjadi pada fase akut ataupun setelahnya. Gangguan gerak dapat khas sesuai lokasi lesi. Movement disorder is a condition of neurological disorder that affects speed, smoothness, quality, and ease of movement. Symptoms of movement disorders in stroke patients can occur during and after the acute phase. Variations in movement disorders can be typical based on the location of the stroke lesion.
... Stroke is a major cause of disability and mortality globally (Feigin et al., 2022), often leading to motor impairments such as muscle spasms and movement disorders that can severely impact the quality of life of stroke survivors (Bansil et al., 2012). Rehabilitation therapy can aid in restoring motor function, improving mobility, and enhancing independence in performing daily activities (Wagenaar et al., 1990). ...
... Exoskeleton robots for lower limb rehabilitation have become a research hotspot in the field of stroke rehabilitation due to their ability to support and maintain balance for stroke survivors while assisting them in completing rehabilitation training tasks (Li et al., 2015). However, to fully harness the benefits of lower limb rehabilitation exoskeleton robots, adaptive control algorithms that can adapt to different situations in survivors' daily lives or rehabilitation training are necessary (Bansil et al., 2012). In recent years, there has been growing interest in using motion intention recognition algorithms to improve the adaptive control of lower limb exoskeleton robots in stroke rehabilitation (Masengo et al., 2023). ...
Stroke is a significant cause of disability worldwide, and stroke survivors often experience severe motor impairments. Lower limb rehabilitation exoskeleton robots provide support and balance for stroke survivors and assist them in performing rehabilitation training tasks, which can effectively improve their quality of life during the later stages of stroke recovery. Lower limb rehabilitation exoskeleton robots have become a hot topic in rehabilitation therapy research. This review introduces traditional rehabilitation assessment methods, explores the possibility of lower limb exoskeleton robots combining sensors and electrophysiological signals to assess stroke survivors' rehabilitation objectively, summarizes standard human-robot coupling models of lower limb rehabilitation exoskeleton robots in recent years, and critically introduces adaptive control models based on motion intent recognition for lower limb exoskeleton robots. This provides new design ideas for the future combination of lower limb rehabilitation exoskeleton robots with rehabilitation assessment, motion assistance, rehabilitation treatment, and adaptive control, making the rehabilitation assessment process more objective and addressing the shortage of rehabilitation therapists to some extent. Finally, the article discusses the current limitations of adaptive control of lower limb rehabilitation exoskeleton robots for stroke survivors and proposes new research directions.
... First, a chance to diagnose PD instead of vascular parkinsonism should be considered-it has been reported that the rate of misdiagnosis of PD accounts for approximately 15%-30% of cases. 42 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. In conclusion, this nationwide population-based cohort study demonstrated that stroke survivors have an increased risk of developing PD. ...
BACKGROUND
Previous studies have examined the risk of stroke in patients with Parkinson’s disease (PD), but the incidence of PD onset among stroke survivors and its risk according to severity of post-stroke disabilities is scarcely investigated. This study aims to determine whether the risk of PD is increased among stroke survivors using a retrospective cohort with a large population-based database.
METHOD
We used data collected by the Korean National Health Insurance Service from 2010–2018 and examined 307,361 stroke survivors and 380,917 sex-and age-matched control subjects to uncover the incidence of PD. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (CI), and the risk of PD was compared according to presence and severity of disability.
RESULTS
During 4.31 years of follow-up, stroke survivors had a 1.67 times higher risk of PD compared to matched control subjects (adjusted HR, 1.67; 95% CI, 1.57–1.78). The risk of PD was greater among stroke survivors with disabilities than among those without disabilities, even after adjustment for multiple covariates (adjusted HR, 1.72; 95% CI, 1.55– 1.91 and adjusted HR, 1.66; 95% CI, 1.56–1.77, respectively).
CONCLUSION
Our study demonstrated increased risk of PD onset among stroke survivors. Health professionals need to pay careful attention to detecting movement disorders as clues for diagnosing PD.
... Being able to coordinate enables us to perform daily tasks like walking, eating, typing, playing an instrument, or dancing. Loss of this essential ability significantly affects quality of life and has been studied extensively in patients who have suffered a stroke (Bansil et al. 2012) have Parkinson's disease (Mazzoni et al. 2012) or have sustained a traumatic brain injury (TBI) causing motor problems (O'Suilleabhain and Dewey 2004). When performing bimanual movements, young, healthy individuals perform these activities with ease, whereas this ability to coordinate with precision declines as individuals age (Morrison and Newell 2012). ...
... The experiment was performed using the Kinarm upper limb robotic exoskeleton. The Kinarm exoskeleton has been utilized in primate studies, human research studies, along with clinical assessments to diagnose stroke and other motor deficits (Bansil et al. 2012). At a sampling rate of up to 1000 Hz, it is able to accurately and precisely quantify motor and sensory characteristics of both healthy and neurologically disabled participants (Kenzie et al. 2014;Dukelow et al. 2010). ...
Bimanual in-phase and anti-phase coordination modes represent two basic movement patterns with distinct characteristics—homologous muscle contraction and non-homologous muscle contraction, respectively. A method to understand the contribution of each limb to the overall coordination pattern involves detuning (Δω) the natural eigenfrequency of each limb. In the present experiment, we experimentally broke the symmetry between the two upper limbs by adding elastic and viscous force fields using a Kinarm robot exoskeleton. We measured the effect of this symmetry breaking on coordination stability as participants performed bimanual in-phase and anti-phase movements using their left and right hand in 1:1 frequency locking mode. Differences between uncoupled frequencies were manipulated via the application of viscous & elastic force fields and using fast and slow oscillation frequencies with a custom task developed using the Kinarm robotic exoskeleton. The effects of manipulating the asymmetry between the limbs were measured through the mean and variability of relative phase (ϕ) from the intended modes of 0 ° or 180 °. In general, participants deviated less from intended phase irrespective of coordination mode in all matched conditions, except for when elastic loads are applied to both arms in the anti-phase coordination. Second, we found that when force fields were mismatched participants exhibited a larger deviation from the intended phase. Overall, there was increased phase deviation during anti-phase coordination. Finally, participants exhibited higher variability in relative phase in mismatched force conditions compared to matched force conditions, with overall higher variability during anti-phase coordination mode. We extend previous research by demonstrating that symmetry breaking caused by force differences between the limbs disrupts stability in each coordination mode.
