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MOvement control in STroke - clinical and laboratory assessments and in relation to brain imaging with fMRI (MOST study)

Title of Project

MOvement control in STroke - clinical and laboratory assessments
and in relation to brain imaging with fMRI (MOST study)

Project status

Present

Subject areas

Neuroscience, Physiotherapy

Head of research

Charlotte Häger, Department of Community Medicine and Rehabilitation

Brain activity maps in an MR scanner from a control subject (upper panel) and a subject with stroke (bottom panels) during left and right hand’s finger motions with thumb motion (DIG1) as baseline. Reliable and sensitive analysis methods that enable quantification of body motion are required in order to analyze body function after stroke and assess related rehabilitation strategies. Current clinical functional tests mainly report if a person can complete a task and how long it takes. There is also a lack of specific knowledge about how recovery after a stroke progresses and in what way brain damage leads to reduced body function. After stroke, some reorganization of affected functions occurs in the brain, but the degree and consequences of such is still unclear. Functional magnetic resonance imaging (fMRI) synchronized with optical motion cameras can give insights into relationships between activity patterns in different brain areas and the individual’s movement capacity. Further, structural connectivity analyses coupled with the cortical activity patterns observed during finger movements offers an insight into how the brain, both structurally and functionally, has responded to the stroke.
The aim of this project is to investigate the relationships between clinical and laboratory-based tests of arm, hand and upper body function after a stroke, and to relate brain activity to the ability to move fingers individually.
Methods: 35 participants diagnosed with stroke (caused by infarction or hemorrhaging) are recruited from the University Hospital of Umeå (NUS). Inclusion criteria are remaining affects in one arm/hand at least 3 months after hospitalization, medical stability, certain voluntary movement ability in the arm/hand (can lift the arm and/or hand from a surface), ability to walk a short distance indoors without aids, and capable of understanding both auditory and written information. Persons with other illnesses/disabilities which affect movement capacity in the arms and/or legs are excluded. For the fMRI study, participants are excluded if they have metal in their body, which can cause a risk for the person, tattoos on the shoulder/back, and/or claustrophobia. Age- and gender-matched controls are recruited via advertising, leisure societies, relatives and friends.
Arm and hand function of the participants are measured by clinical assessment methods and laboratory-based motion analysis. For the latter, a high-speed camera-based motion capture system registers the positions of 44 passive reflective markers, which are affixed to the body with double-sided adhesive tape on specific anatomical landmarks. Two video cameras and two multicomponent force plates, which register ground reaction forces during gait, combine to provide an advanced movement analysis system (U-Motion Lab, Physiotherapy, Umeå University).

Subgroups of 24 subjects each also participate in a study on brain activity coupled with the ability to move fingers individually. These participants perform individual finger movements seated in a motion laboratory, with and without visual feedback from their own hands. They also perform this finger test lying in an MR scanner while brain activity and finger movements are recorded simultaneously (Umeå center for Functional Brain Imaging, Umeå University).
Knowledge contribution: This research enables an improvement of today’s clinical tests of particularly arm and hand function after stroke. A deeper understanding of the mechanisms regarding recovery after stroke facilitate customized rehabilitation strategies.

Key words: Stroke, motion capture, 3D, upper limb, gait, motor control, movement analysis, fMRI, brain

Project members

Name Title Exam Funding
Charlotte Häger Professor, Leg fysioterapeut PhD fysiologi, Fysioterapeut Medicinsk fakultet
Helena Grip PhD PhD, civilingenjör teknisk fysik Medicinsk teknik, FOU-enheten, VLL
Anna-Maria Johansson Post doc PhD psykologi Anslag Promobilia
Jonas Selling Forskningsingenjör Civilingenjör tekn fysik Anslag
Gudrun Johansson PhD student, Leg fysioterapeut MSc Fysioterapi, Umeå univ, VLL
Andrew Strong Forskningsassistent Bachelor in sports science, UK Anslag

External Funding (1000SEK)

Head of Project Sponsoring Institution 2011 2012 2013 2014 2015 2016 2017
Charlotte Häger Stroke-Riksförbundet 25 105
Charlotte Häger Strokeforskningen i Norrlands insamlingsstiftelse 25
Charlotte Häger Promobilia 200
Charlotte Häger Strategic Research Programme in Care Sciences (SFO-V), 2012 for a post-doc 450 450
Charlotte Häger ALF Västerbottens läns landsting (VLL) investeringsmedel 141
Charlotte Häger Strategiska ALF-medel för PET/CT och MR forskning 108 90
Gudrun Johansson VLL, ALF doktorandmedel 309 200 200
Gudrun Johansson VLL FoU 30 160
Anna-Maria Johansson Promobilia, post doc medel 500 750 250

Selected publications

  1. Frykberg GE, Johansson GM, Schelin L, Häger CK (2014) The Arm Posture Score for assessing arm swing during gait: An evaluation of adding rotational components and the effect of different gait speeds. Gait & Posture 40(1):64-9

  2. Johansson, GM, Frykberg GE, Grip H, Weidenhielm-Broström E and Häger CK. (2014) Assessment of arm movements during gait in stroke - the Arm Posture Score. Gait and Posture 40 (4), 549-555

  3. Johansson G, Häger CK (2012) Measurement properties of The Motor Evaluation Scale for Upper Extremity in Stroke Patients. Disability and Rehabilitation 2012;34(4):288-94.

Local Partners

Docent Carl-Johan Boraxbekk, Demografiska databasen
Professor Louise Rönnqvist, Inst för psykologi
Universitetslektor Lina Schelin, Inst för Statistik

National Partners

Associate professor Eva Weidenhielm-Broström
Karolinska Institute
Stockholm, Sweden

International Partners

Professor Mindy F Levin
McGill University
Montreal, Quebec. Canada

Externally financed team members

Anna-Maria Johansson, Post-doc, Promobilia

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