Different methods of neurorehabilitative treatments: An integrated neurophysiological evaluation in stroke patients

R. Traversa, M. M. Filippi, P. Cicmelli, M. G. Palmicn, M. Oliven, T. Shimizu, P. M. Rossini

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Transcranial Magnetic Stimulation (TMS) is largely employed as non-invasive and painless technique for detecting the characteristics of excitability and conductivity of the central motor system. The aim of the study was to better understand some neurophysiological differences between two main methodological ncurorehabilitative treatments utilising TMS. TMS was performed in 13 patients affected by a monohemispheric stroke during the period of neurorchabilitative treatment. The patients were clinically evaluated by Canadian Neurological Scale. Barthel Index and Rivermead. They were divided into two groups: the first one (7 pts) was following a cognitive (Perfetti) approach; the second one was treated according to Bobath's method (6 pts). Motor Evoked Potentials (MEPs) were recorded in the affected (AH) and the unaffected (UH) hemispheres from Deltoid (DEL), Extensor Digitorum Comums (ECD), Flexor Carpi Radialis (FCR); Opponens (OPP) and Abductor Digiti Minimi (ADM) muscles. Relaxed and contracted MEPs were recorded in five different sessions from TO to T4, the last session being four months after To. In two sessions, Tl and T3, MEPs were also recorded while the patients actively executed a specific motor task usually performed during neurorehabilitativc treatment (Perfetti or Bobath). SEPs by medial nerve stimulation were bilaterally recorded. H reflexes from FCR muscle of paretic and non paretic arms were recorded during relaxation, voluntary contraction and during predefined motor task. Eighteen F-waves were recorded from ADM muscles of both sides during ulnar nerve supramaximal stimulation at wnst. The excitability threshold (Eth) was higher than normal in the .AH through all the session progressively reducing from TO to T4 (from 75,3 % ±9.8 in TO to 64,88% ±19,7 in T4). MEPs amplitude in relaxed condition was significantly reduced in the AH with respect to the UH and remained fairly stable through the follow-up. Amplitudes of MEPs during contraction were significantly and asimmetrically smaller for the AH, They progressively increased reaching a plateau at T3. During manoeuvre there was an increase of MEPs amplitude from Tl to T3. MEPs latency during relaxation was significantly increased in the AH shortening in the following recording sessions, almost regaining the normal range values in T4. On the other hand, during voluntary contraction and also during the rehabilitative manoeuvres, the MEPs latency did not show significant variation. Clinical scores were always ameliorating. Until now, the electrophysiological data did not evidence any significant differences between the two rehabilitative approaches.

Original languageEnglish
Pages (from-to)49
Number of pages1
JournalItalian Journal of Neurological Sciences
Issue number4
Publication statusPublished - 1997

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Neurology

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