Clinical study on the correlation of the functional status of upper limb motor neurons with motor function in patients with stroke_West China Medical Journal

Authors：

SHAO Zhen ^1,2 , ZHOU Ting ¹ , CHEN Wenli ¹ , LIU Bo ¹ , ZHU Xingguo ³ , GONG Yuanyuan ¹ , HUANG Jia ¹ , HE Yikang ¹ , XIANG Jie ² ,  WANG Hongxing ¹

1. Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu 210000, P. R. China;
2. Department of Rehabilitation Medicine, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;
3. School of Sports and Health, Nanjing Institute of Physical Education, Nanjing, Jiangsu 210000, P. R. China;

Corresponding author：

WANG Hongxing, Email: wang_hongxing@163.com

Keywords：

Stroke; Motor neuron; Motor function; Motor unit number estimation; F wave

DOI：

10.7507/1002-0179.202102045

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Objective To explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and provide guidance for rehabilitation assessment and functional prognosis.Methods The stroke patients who were hospitalized in Department of Rehabilitation Medicine of Zhongda Hospital of Southeast University between November 2020 and January 2021 were selected. Motor unit number estimation (MUNE) and F wave were examined to evaluate the functional status of motor neuron. The Fugl-Meyer Assessment (FMA) and Modified Ashworth Scale (MAS) were used to evaluate the upper limb motor function. The correlations of electrophysiological parameters with FMA score and MAS score were analyzed respectively.Results A total of 42 patients were enrolled, and 16 patients were complicated with carpal flexor spasm on the affected side. Among the 42 stroke patients, the MUNE of the abductor pollicis brevis on the affected side was lower than that on the unaffected side (t=−3.466, P=0.001), and the percentage of F waves with different shapes on the affected side was significantly lower than that on the unaffected side (Z=−5.583, P<0.001). Among the 16 stroke patients with carpal flexor spasm, the F wave amplitude was higher on the affected side than that on the unaffected side (t=2.764, P=0.014), while the F wave latency on the affected side was not statistically significant compared with the unaffected side (Z=−0.595, P=0.552). Among the 42 stroke patients, the affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (r_s=0.377, P=0.014), while the correlation between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant (r_s=0.104, P=0.513). Among the 16 stroke patients with carpal flexor spasm, the affected/unaffected side ratio of the F wave amplitude was positively correlated with the MAS score of the carpi flexor muscle (r_s=0.550, P=0.027).Conclusion Stroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, and which were related to motor function and muscle tone.

Citation： SHAO Zhen, ZHOU Ting, CHEN Wenli, LIU Bo, ZHU Xingguo, GONG Yuanyuan, HUANG Jia, HE Yikang, XIANG Jie, WANG Hongxing. Clinical study on the correlation of the functional status of upper limb motor neurons with motor function in patients with stroke. West China Medical Journal, 2021, 36(5): 595-599. doi: 10.7507/1002-0179.202102045 Copy

1.	Hou S, Zhang H, Li B, et al. Validation and evaluation of the core nursing outcomes evaluation system for inpatients with stroke. Int J Nurs Knowl, 2020, 31(3): 173-179.
2.	Onigata C, Bunno Y. Unpleasant visual stimuli increase the excitability of spinal motor neurons. Somatosens Mot Res, 2020, 37(2): 59-62.
3.	Arasaki K, Igarashi O, Machida T, et al. Reduction in the motor unit number estimate (MUNE) after cerebral infarction. Suppl Clin Neurophysiol, 2009, 60: 189-195.
4.	Li X, Fisher M, Rymer WZ, et al. Application of the f-response for estimating motor unit number and amplitude distribution in hand muscles of stroke survivors. IEEE Trans Neural Syst Rehabil Eng, 2016, 24(6): 674-681.
5.	Manganotti P, Patuzzo S, Cortese F, et al. Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke. Clin Neurophysiol, 2002, 113(6): 936-943.
6.	Lukács M. F wave measurements detecting changes in motor neuron excitability after ischaemic stroke. Electromyogr Clin Neurophysiol, 2007, 47(2): 109-115.
7.	脑卒中患者临床神经功能缺损程度评分标准 (1995). 中华神经科杂志, 1996, 29(6): 381-383.
8.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018. 中华神经科杂志, 2018, 51(9): 666-682.
9.	Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair, 2002, 16(3): 232-240.
10.	Chen CL, Chen CY, Chen HC, et al. Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke. Eur J Phys Rehabil Med, 2019, 55(6): 754-760.
11.	Udby Blicher J, Nielsen JF. Evidence of increased motoneuron excitability in stroke patients without clinical spasticity. Neurorehabil Neural Repair, 2008, 23(1): 14-16.
12.	Hara Y, Masakado Y, Chino N. The physiological functional loss of single thenar motor units in the stroke patients: when does it occur? Does it progress?. Clin Neurophysiol, 2004, 115(1): 97-103.
13.	Hara Y, Akaboshi K, Masakado Y, et al. Physiologic decrease of single thenar motor units in the F-response in stroke patients. Arch Phys Med Rehabil, 2000, 81(4): 418-423.
14.	Qiu Y, Wada Y, Otomo E, et al. Morphometric study of cervical anterior horn cells and pyramidal tracts in medulla oblongata and the spinal cord in patients with cerebrovascular diseases. J Neurol Sci, 1991, 102(2): 137-143.
15.	Taniguchi S, Kimura J, Yamada T, et al. Effect of motion imagery to counter rest-induced suppression of F-wave as a measure of anterior horn cell excitability. Clin Neurophysiol, 2008, 119(6): 1346-1352.
16.	Matsumoto S, Shimodozono M, Etoh S, et al. Beneficial effects of footbaths in controlling spasticity after stroke. Int J Biometeorol, 2010, 54(4): 465-473.
17.	Etoh S, Noma T, Miyata R, et al. Effects of repetitive facilitative exercise on spasticity in the upper paretic limb after subacute stroke. J Stroke Cerebrovasc Dis, 2018, 27(10): 2863-2868.
18.	Noma T, Matsumoto S, Etoh S, et al. Anti-spastic effects of the direct application of vibratory stimuli to the spastic muscles of hemiplegic limbs in post-stroke patients. Brain Inj, 2009, 23(7): 623-631.
19.	王培, 付娟娟, 周停, 等. 脑卒中患者周围神经与肌肉神经电生理特征分析. 中国康复医学杂志, 2018, 33(5): 545-550.
20.	Drory VE, Neufeld MY, Korczyn AD. F-wave characteristics following acute and chronic upper motor neuron lesions. Electromyogr Clin Neurophysiol, 1993, 33(7): 441-446.
21.	Veltsista D, Papapavlou C, Chroni E. F wave analyzer, a system for repeater f-waves detection: application in patients with amyotrophic lateral sclerosis. Clin Neurophysiol, 2019, 130(10): 1954-1961.
22.	Kondo T, Kakuda W, Yamada N, et al. Effects of repetitive transcranial magnetic stimulation and intensive occupational therapy on motor neuron excitability in poststroke hemiparetic patients: a neurophysiological investigation using F-wave parameters. Int J Neurosci, 2015, 125(1): 25-31.
23.	Matsumoto S, Shimodozono M, Etoh S, et al. Anti-spastic effects of footbaths in post-stroke patients: a proof-of-principle study. Complement Ther Med, 2014, 22(6): 1001-1009.
24.	Miyara K, Matsumoto S, Uema T, et al. Effect of whole body vibration on spasticity in hemiplegic legs of patients with stroke. Top Stroke Rehabil, 2018, 25(2): 90-95.
25.	Kouzi I, Trachani E, Anagnostou E, et al. Motor unit number estimation and quantitative needle electromyography in stroke patients. J Electromyogr Kinesiol, 2014, 24(6): 910-916.
26.	Choi IS, Kim JH, Han JY, et al. The correlation between F-wave motor unit number estimation (F-MUNE) and functional recovery in stroke patients. J Korean Med Sci, 2007, 22(6): 1002-1006.

1. Hou S, Zhang H, Li B, et al. Validation and evaluation of the core nursing outcomes evaluation system for inpatients with stroke. Int J Nurs Knowl, 2020, 31(3): 173-179.
2. Onigata C, Bunno Y. Unpleasant visual stimuli increase the excitability of spinal motor neurons. Somatosens Mot Res, 2020, 37(2): 59-62.
3. Arasaki K, Igarashi O, Machida T, et al. Reduction in the motor unit number estimate (MUNE) after cerebral infarction. Suppl Clin Neurophysiol, 2009, 60: 189-195.
4. Li X, Fisher M, Rymer WZ, et al. Application of the f-response for estimating motor unit number and amplitude distribution in hand muscles of stroke survivors. IEEE Trans Neural Syst Rehabil Eng, 2016, 24(6): 674-681.
5. Manganotti P, Patuzzo S, Cortese F, et al. Motor disinhibition in affected and unaffected hemisphere in the early period of recovery after stroke. Clin Neurophysiol, 2002, 113(6): 936-943.
6. Lukács M. F wave measurements detecting changes in motor neuron excitability after ischaemic stroke. Electromyogr Clin Neurophysiol, 2007, 47(2): 109-115.
7. 脑卒中患者临床神经功能缺损程度评分标准 (1995). 中华神经科杂志, 1996, 29(6): 381-383.
8. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018. 中华神经科杂志, 2018, 51(9): 666-682.
9. Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair, 2002, 16(3): 232-240.
10. Chen CL, Chen CY, Chen HC, et al. Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke. Eur J Phys Rehabil Med, 2019, 55(6): 754-760.
11. Udby Blicher J, Nielsen JF. Evidence of increased motoneuron excitability in stroke patients without clinical spasticity. Neurorehabil Neural Repair, 2008, 23(1): 14-16.
12. Hara Y, Masakado Y, Chino N. The physiological functional loss of single thenar motor units in the stroke patients: when does it occur? Does it progress?. Clin Neurophysiol, 2004, 115(1): 97-103.
13. Hara Y, Akaboshi K, Masakado Y, et al. Physiologic decrease of single thenar motor units in the F-response in stroke patients. Arch Phys Med Rehabil, 2000, 81(4): 418-423.
14. Qiu Y, Wada Y, Otomo E, et al. Morphometric study of cervical anterior horn cells and pyramidal tracts in medulla oblongata and the spinal cord in patients with cerebrovascular diseases. J Neurol Sci, 1991, 102(2): 137-143.
15. Taniguchi S, Kimura J, Yamada T, et al. Effect of motion imagery to counter rest-induced suppression of F-wave as a measure of anterior horn cell excitability. Clin Neurophysiol, 2008, 119(6): 1346-1352.
16. Matsumoto S, Shimodozono M, Etoh S, et al. Beneficial effects of footbaths in controlling spasticity after stroke. Int J Biometeorol, 2010, 54(4): 465-473.
17. Etoh S, Noma T, Miyata R, et al. Effects of repetitive facilitative exercise on spasticity in the upper paretic limb after subacute stroke. J Stroke Cerebrovasc Dis, 2018, 27(10): 2863-2868.
18. Noma T, Matsumoto S, Etoh S, et al. Anti-spastic effects of the direct application of vibratory stimuli to the spastic muscles of hemiplegic limbs in post-stroke patients. Brain Inj, 2009, 23(7): 623-631.
19. 王培, 付娟娟, 周停, 等. 脑卒中患者周围神经与肌肉神经电生理特征分析. 中国康复医学杂志, 2018, 33(5): 545-550.
20. Drory VE, Neufeld MY, Korczyn AD. F-wave characteristics following acute and chronic upper motor neuron lesions. Electromyogr Clin Neurophysiol, 1993, 33(7): 441-446.
21. Veltsista D, Papapavlou C, Chroni E. F wave analyzer, a system for repeater f-waves detection: application in patients with amyotrophic lateral sclerosis. Clin Neurophysiol, 2019, 130(10): 1954-1961.
22. Kondo T, Kakuda W, Yamada N, et al. Effects of repetitive transcranial magnetic stimulation and intensive occupational therapy on motor neuron excitability in poststroke hemiparetic patients: a neurophysiological investigation using F-wave parameters. Int J Neurosci, 2015, 125(1): 25-31.
23. Matsumoto S, Shimodozono M, Etoh S, et al. Anti-spastic effects of footbaths in post-stroke patients: a proof-of-principle study. Complement Ther Med, 2014, 22(6): 1001-1009.
24. Miyara K, Matsumoto S, Uema T, et al. Effect of whole body vibration on spasticity in hemiplegic legs of patients with stroke. Top Stroke Rehabil, 2018, 25(2): 90-95.
25. Kouzi I, Trachani E, Anagnostou E, et al. Motor unit number estimation and quantitative needle electromyography in stroke patients. J Electromyogr Kinesiol, 2014, 24(6): 910-916.
26. Choi IS, Kim JH, Han JY, et al. The correlation between F-wave motor unit number estimation (F-MUNE) and functional recovery in stroke patients. J Korean Med Sci, 2007, 22(6): 1002-1006.

West China Medical Journal

Clinical study on the correlation of the functional status of upper limb motor neurons with motor function in patients with stroke

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