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Zhang J, Xiao X, Jin Q, Li J, Zhong D, Li Y, Qin Y, Zhang H, Liu X, Xue C, Zheng Z, Jin R. The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis. Front Neurol 2023; 14:1137320. [PMID: 37144004 PMCID: PMC10151521 DOI: 10.3389/fneur.2023.1137320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 05/06/2023] Open
Abstract
Background Due to motor function insufficiency, patients with post-stroke motor dysfunction (PSMD) have limitations in performing an activity, feel restricted during social participation, and feel impaired in their quality of life. Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique, but its effectiveness on PSMD after stroke still remains controversial. Objective This meta-analysis and trial sequential analysis (TSA) aimed to comprehensively evaluate the effect and safety of CIMT for PSMD. Methods Four electronic databases were searched from their inception to 1 January 2023 to identify randomized controlled trials (RCTs) investigating the effectiveness of CIMT for PSMD. Two reviewers independently extracted the data and assessed the risk of bias and reporting quality. The primary outcome was a motor activity log for the amount of use (MAL-AOU) and the quality of movement (MAL-QOM). RevMan 5.4, Statistical Package for Social Sciences (SPSS) 25.0, and STATA 13.0 software were used for statistical analysis. The certainty of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. We also performed the TSA to assess the reliability of the evidence. Results A total of 44 eligible RCTs were included. Our results showed that CIMT combined with conventional rehabilitation (CR) was superior to CR in improving MAL-AOU and MAL-QOM scores. The results of TSA indicated that the above evidence was reliable. Subgroup analysis demonstrated that CIMT (≥6 h per day or duration ≤ 20 days) combined with CR was more effective than CR. Meanwhile, both CIMT and modified CIMT (mCIMT) combined with CR were more efficient than CR at all stages of stroke. No severe CIMT-related adverse events occurred. Conclusion CIMT may be an optional and safe rehabilitation therapy to improve PSMD. However, due to limited studies, the optimal protocol of CIMT for PSMD was undetermined, and more RCTs are required for further exploration. Clinical trial registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143490, identifier: CRD42019143490.
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Affiliation(s)
- Jiaming Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qizu Jin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Qin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Hong Zhang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chen Xue
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhong Zheng
- Center for Neurobiological Detection, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Zhong Zheng
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Rongjiang Jin
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Aloraini SM. Effects of constraint-induced movement therapy for the lower extremity among individuals post-stroke: A randomized controlled clinical trial. NeuroRehabilitation 2022; 51:421-431. [DOI: 10.3233/nre-220139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Stroke often leads to lower extremity impairments that significantly hinders functional recovery. OBJECTIVE: To investigate the effectiveness of constraint-induced movement therapy for the lower extremity (CIMT-LE) for improving balance and ambulation among people post-stroke. METHODS: A randomized controlled, single-blinded clinical trial was conducted. Participants were recruited and randomized into one of two groups: CIMT-LE group and control. Outcome measures were the Fugl-Meyer assessment of lower extremity, Berg balance scale, ten-meter walk test and six-minute walk test. Outcome measures were collected at baseline, following the conclusion of the therapeutic programs and after three months. RESULTS: 38 participants were enrolled in the study (19 in each group). No significant differences were found between groups at baseline. At the conclusion of therapeutic programs, both groups showed significant changes compared to baseline. However, changes seen in the CIMT-LE were clinically significant. Further, at three months following the conclusion of the program, the recorded improvements were retained by participants. CONCLUSION: A CIMT-LE program compared to an intensity-matched conventional program yielded significant clinical improvements among people post-stroke. These improvements were seen in lower extremity motor recovery, postural balance and gait speed. Furthermore, these improvements were retained three months following the conclusion of the therapeutic program.
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Affiliation(s)
- Saleh M. Aloraini
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 51452, Saudi Arabia
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Zhan G, Chen S, Ji Y, Xu Y, Song Z, Wang J, Niu L, Bin J, Kang X, Jia J. EEG-Based Brain Network Analysis of Chronic Stroke Patients After BCI Rehabilitation Training. Front Hum Neurosci 2022; 16:909610. [PMID: 35832876 PMCID: PMC9271662 DOI: 10.3389/fnhum.2022.909610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/25/2022] [Indexed: 12/05/2022] Open
Abstract
Traditional rehabilitation strategies become difficult in the chronic phase stage of stroke prognosis. Brain–computer interface (BCI) combined with external devices may improve motor function in chronic stroke patients, but it lacks comprehensive assessments of neurological changes regarding functional rehabilitation. This study aimed to comprehensively and quantitatively investigate the changes in brain activity induced by BCI–FES training in patients with chronic stroke. We analyzed the EEG of two groups of patients with chronic stroke, one group received functional electrical stimulation (FES) rehabilitation training (FES group) and the other group received BCI combined with FES training (BCI–FES group). We constructed functional networks in both groups of patients based on direct directed transfer function (dDTF) and assessed the changes in brain activity using graph theory analysis. The results of this study can be summarized as follows: (i) after rehabilitation training, the Fugl–Meyer assessment scale (FMA) score was significantly improved in the BCI–FES group (p < 0.05), and there was no significant difference in the FES group. (ii) Both the global and local graph theory measures of the brain network of patients with chronic stroke in the BCI–FES group were improved after rehabilitation training. (iii) The node strength in the contralesional hemisphere and central region of patients in the BCI–FES group was significantly higher than that in the FES group after the intervention (p < 0.05), and a significant increase in the node strength of C4 in the contralesional sensorimotor cortex region could be observed in the BCI–FES group (p < 0.05). These results suggest that BCI–FES rehabilitation training can induce clinically significant improvements in motor function of patients with chronic stroke. It can improve the functional integration and functional separation of brain networks and boost compensatory activity in the contralesional hemisphere to a certain extent. The findings of our study may provide new insights into understanding the plastic changes of brain activity in patients with chronic stroke induced by BCI–FES rehabilitation training.
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Affiliation(s)
- Gege Zhan
- Laboratory for Neural Interface and Brain Computer Interface, State Key Laboratory of Medical Neurobiology, Engineering Research Center of AI and Robotics, Ministry of Education, Shanghai Engineering Research Center of AI and Robotics, MOE Frontiers Center for Brain Science, Institute of AI and Robotics, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Shugeng Chen
- Department of Rehabilitation Medicine, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanyun Ji
- Shanghai Jinshan Zhongren Geriatric Nursing Hospital, Shanghai, China
| | - Ying Xu
- Shanghai Jinshan Zhongren Geriatric Nursing Hospital, Shanghai, China
| | - Zuoting Song
- Laboratory for Neural Interface and Brain Computer Interface, State Key Laboratory of Medical Neurobiology, Engineering Research Center of AI and Robotics, Ministry of Education, Shanghai Engineering Research Center of AI and Robotics, MOE Frontiers Center for Brain Science, Institute of AI and Robotics, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Junkongshuai Wang
- Laboratory for Neural Interface and Brain Computer Interface, State Key Laboratory of Medical Neurobiology, Engineering Research Center of AI and Robotics, Ministry of Education, Shanghai Engineering Research Center of AI and Robotics, MOE Frontiers Center for Brain Science, Institute of AI and Robotics, Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Lan Niu
- Ji Hua Laboratory, Foshan, China
| | | | - Xiaoyang Kang
- Laboratory for Neural Interface and Brain Computer Interface, State Key Laboratory of Medical Neurobiology, Engineering Research Center of AI and Robotics, Ministry of Education, Shanghai Engineering Research Center of AI and Robotics, MOE Frontiers Center for Brain Science, Institute of AI and Robotics, Academy for Engineering and Technology, Fudan University, Shanghai, China
- Ji Hua Laboratory, Foshan, China
- Yiwu Research Institute of Fudan University, Yiwu, China
- Research Center for Intelligent Sensing, Zhejiang Lab, Hangzhou, China
- *Correspondence: Xiaoyang Kang
| | - Jie Jia
- Department of Rehabilitation Medicine, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
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4
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Wang D, Xiang J, He Y, Yuan M, Dong L, Ye Z, Mao W. The Mechanism and Clinical Application of Constraint-Induced Movement Therapy in Stroke Rehabilitation. Front Behav Neurosci 2022; 16:828599. [PMID: 35801093 PMCID: PMC9253547 DOI: 10.3389/fnbeh.2022.828599] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Constraint-induced movement therapy (CIMT) has been widely applied in stroke rehabilitation, and most relevant studies have shown that CIMT helps improve patients' motor function. In practice, however, principal issues include inconsistent immobilization durations and methods, while incidental issues include a narrow application scope and an emotional impact. Although many studies have explored the possible internal mechanisms of CIMT, a mainstream understanding has not been established.
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Affiliation(s)
- Dong Wang
- Affiliated Hospital of Chengdu University, Chengdu, China
| | - Junlu Xiang
- Chengdu Women’s and Children’s Central Hospital, Chengdu, China
| | - Ying He
- Affiliated Hospital of Chengdu University, Chengdu, China
| | - Min Yuan
- Affiliated Hospital of Chengdu University, Chengdu, China
| | - Li Dong
- Affiliated Hospital of Chengdu University, Chengdu, China
| | - Zhenli Ye
- Affiliated Hospital of Chengdu University, Chengdu, China
| | - Wei Mao
- Chengdu Integrated TCM and Western Medical Hospital, Chengdu, China
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5
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Roby-Brami A, Jarrassé N, Parry R. Impairment and Compensation in Dexterous Upper-Limb Function After Stroke. From the Direct Consequences of Pyramidal Tract Lesions to Behavioral Involvement of Both Upper-Limbs in Daily Activities. Front Hum Neurosci 2021; 15:662006. [PMID: 34234659 PMCID: PMC8255798 DOI: 10.3389/fnhum.2021.662006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/27/2021] [Indexed: 01/02/2023] Open
Abstract
Impairments in dexterous upper limb function are a significant cause of disability following stroke. While the physiological basis of movement deficits consequent to a lesion in the pyramidal tract is well demonstrated, specific mechanisms contributing to optimal recovery are less apparent. Various upper limb interventions (motor learning methods, neurostimulation techniques, robotics, virtual reality, and serious games) are associated with improvements in motor performance, but many patients continue to experience significant limitations with object handling in everyday activities. Exactly how we go about consolidating adaptive motor behaviors through the rehabilitation process thus remains a considerable challenge. An important part of this problem is the ability to successfully distinguish the extent to which a given gesture is determined by the neuromotor impairment and that which is determined by a compensatory mechanism. This question is particularly complicated in tasks involving manual dexterity where prehensile movements are contingent upon the task (individual digit movement, grasping, and manipulation…) and its objective (placing, two step actions…), as well as personal factors (motivation, acquired skills, and life habits…) and contextual cues related to the environment (presence of tools or assistive devices…). Presently, there remains a lack of integrative studies which differentiate processes related to structural changes associated with the neurological lesion and those related to behavioral change in response to situational constraints. In this text, we shall question the link between impairments, motor strategies and individual performance in object handling tasks. This scoping review will be based on clinical studies, and discussed in relation to more general findings about hand and upper limb function (manipulation of objects, tool use in daily life activity). We shall discuss how further quantitative studies on human manipulation in ecological contexts may provide greater insight into compensatory motor behavior in patients with a neurological impairment of dexterous upper-limb function.
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Affiliation(s)
- Agnès Roby-Brami
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Nathanaël Jarrassé
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France
| | - Ross Parry
- ISIR Institute of Intelligent Systems and Robotics, AGATHE Team, CNRS UMR 7222, INSERM U 1150, Sorbonne University, Paris, France.,LINP2-AAPS Laboratoire Interdisciplinaire en Neurosciences, Physiologie et Psychologie: Activité Physique, Santé et Apprentissages, UPL, Paris Nanterre University, Nanterre, France
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6
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Forster A, Ozer S, Crocker TF, House A, Hewison J, Roberts E, Dickerson J, Carter G, Hulme C, Fay M, Richardson G, Wright A, McKevitt C, McEachan R, Foy R, Barnard L, Moreau L, Prashar A, Clarke D, Hardicre N, Holloway I, Brindle R, Hall J, Burton LJ, Atkinson R, Hawkins RJ, Brown L, Cornwall N, Dawkins B, Meads D, Schmitt L, Fletcher M, Speed M, Grenfell K, Hartley S, Young J, Farrin A. Longer-term health and social care strategies for stroke survivors and their carers: the LoTS2Care research programme including cluster feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
It is reported that the longer-term outcomes for stroke survivors are poor, with a range of unmet needs identified.
Objectives
The aims were to develop and test a longer-term stroke care strategy focused on improving the quality of life of stroke survivors and their carers by addressing unmet needs, and maintenance and enhancement of participation (i.e. involvement in life situations).
Design
Five overlapping workstreams were undertaken – (1) refinement of content by semistructured interviews with stroke survivors and their carers and by a review of the literature to inform content and delivery of the care strategy; (2) exploration of service models by national survey and focus groups with purposely selected services; (3) intervention development by interaction with a reference group of stroke survivors, carers, and health and social care professionals; (4) refinement and pilot implementation of the developed intervention in three stroke services (case studies); and (5) a cluster randomised controlled feasibility trial in 10 stroke services across England and Wales.
Setting
The intervention development work and feasibility trial were in stroke services (inclusive of primary, secondary, community and social care provision) across England and Wales.
Participants
Participants were stroke survivors resident in the community and their carers, and health and social care professionals in the included stroke services.
Data sources
Interviews with 28 stroke survivors and their carers at least 9 months post stroke ascertained their needs and the barriers to and facilitators of addressing those needs. Additional literature reviews identified 23 needs. No evidence-based interventions to address these needs were reported; self-management was highlighted as a possible delivery mechanism. In workstream 2, a national survey revealed that the most common model of stroke service provision was care up to 12 months post stroke, reported by 46 (40%) services. Thirty-five (30%) services provided care up to 6 months post stroke and 35 (30%) provided care beyond 12 months, thus identifying 6 months post stroke as an appropriate delivery point for a new intervention. Through focus groups in a range of services, stroke survivors’ perceived unmet needs and the barriers to and enablers of service provision were identified.
Intervention
Using information obtained in workstreams 1 and 2 and working closely with a stakeholder reference group, we developed an intervention based on the unmet needs prioritised by stroke survivors and their carers (workstream 3). In workstream 4, action groups (clinicians, stroke survivors and researchers) were established in three stroke services that led implementation in their service and contributed to the iterative refinement of the intervention, associated training programme and implementation materials. The intervention (called New Start) was delivered at 6 months post stroke. Key components were problem-solving self-management with survivors and carers, help with obtaining usable information, and helping survivors and their carers build sustainable, flexible support networks.
Results
A cluster randomised feasibility trial (workstream 5) was successfully implemented in 10 stroke services across England and Wales, with associated process and health economic evaluations. Five services were randomised to provide New Start, while five continued with usual care; 269 participants were recruited. Progression criteria – in terms of our pre-determined (red, amber, green) criteria for progress to a full trial: target stroke survivor recruitment rates were achieved, on average, across sites (24.1 per site over 6 months, green); 216 (80.3%) registered stroke survivors returned follow-up questionnaires at 9 months (84.1% in the intervention arm and 75.8% in the usual care arm, green); according to data reported by sites, overall, 95.2% of registered stroke survivors were offered at least one session of the intervention (green); all five intervention sites had at least two facilitators deemed competent, delivered the New Start intervention and provided it to stroke survivors (green). However, at some sites, there were concerns regarding the number of stroke survivors being offered, accepting and receiving the intervention. Only small differences in outcomes and costs were observed between the New Start and usual care groups, and considerable uncertainty around the cost-effectiveness remains.
Conclusions
We report a complex programme of work that has described the longer-term needs of stroke survivors and highlighted evidence and service gaps. Working closely with stroke survivors, an intervention was developed that has been refined in three services and feasibility tested in a cluster randomised controlled trial. Further refinement of the target population and optimisation of the intervention materials is required prior to a full randomised controlled trial evaluation.
Future work
Optimisation of the intervention, and clearer specification of recipients, are required prior to a full trial evaluation.
Trial registration
Current Controlled Trials ISRCTN38920246.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anne Forster
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Seline Ozer
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Thomas F Crocker
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Allan House
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Division of Health Services Research, School of Medicine, University of Leeds, Leeds, UK
| | | | - Josie Dickerson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Gill Carter
- Patient and public involvement contributor, York, UK
| | - Claire Hulme
- College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Alan Wright
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Christopher McKevitt
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Robbie Foy
- Division of Primary Care, Palliative Care and Public Health, School of Medicine, University of Leeds, Leeds, UK
| | - Lorna Barnard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lauren Moreau
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Arvin Prashar
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Clarke
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Natasha Hardicre
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ivana Holloway
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Richard Brindle
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Hall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Louisa-Jane Burton
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ross Atkinson
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rebecca J Hawkins
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Academic Unit for Ageing and Stroke Research, University of Leeds, Leeds, UK
| | - Lesley Brown
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Nicola Cornwall
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Laetitia Schmitt
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Marie Fletcher
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Speed
- Patient and public involvement contributor, York, UK
| | - Katie Grenfell
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - John Young
- Academic Unit for Ageing and Stroke Research, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Learning outcomes physiotherapy in neurology – a structured consensus finding of the Austrian University Network Physiotherapy in Neurology (ÖHPN) / Learning Outcomes Physiotherapie in der Neurologie – eine strukturierte Konsensfindung des österreichischen Hochschulnetzwerkes Physiotherapie in der Neurologie (ÖHPN). INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2020. [DOI: 10.2478/ijhp-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background
European Standards and Guidelines for Quality Assurance in tertiary education at Universities of Applied Sciences recommend a high level of competence orientation. This can be achieved and evaluated by the definition of Learning Outcomes. Furthermore, these Outcomes can assure a comparison of the level of education after graduation. Efforts should be made to achieve this form of Quality Assurance for the professional education of physiotherapists.
Objective
The aim of this paper is to state consensus of the Austrian Universities of Applied Sciences Network for Physiotherapy in Neurology through the definition of shared Learning Outcomes for the field of Neurology for undergraduate physiotherapy students.
Methods
Based on the guidelines of the European Qualification Framework (EQF), Physio Austria (Austrian Association of Physiotherapists) published the competency profile for physiotherapists describing learning outcomes of EQF levels 6 as the first study cycle with Bachelor degree. Specific learning outcomes for Physiotherapy in Neurology were added for the further development and differentiated assurance of Quality Standards in coordination with experts from the Universities of Applied Sciences in Austria.
Results
In addition to the Learning Outcomes described in the competency profile of Physio Austria, this consensus paper describes those specifically for the EQF Level 6 of physiotherapy in neurology. Specifications in neurology were made for the following roles: Expert in Physiotherapy, Communicator, Teamworker, Health Promoter, Innovator, Health Professional.
Conclusion
Recommendations for quality assurance in tertiary education are actively pursued across all participating Universities of Applied Sciences. This allows a better comparability of the educational standards in Physiotherapy in Neurology in Europe as well as internationally. This is of great importance for physiotherapists as health professionals.
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Luo Z, Zhou Y, He H, Lin S, Zhu R, Liu Z, Liu J, Liu X, Chen S, Zou J, Zeng Q. Synergistic Effect of Combined Mirror Therapy on Upper Extremity in Patients With Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:155. [PMID: 32300326 PMCID: PMC7144801 DOI: 10.3389/fneur.2020.00155] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023] Open
Abstract
Background: There is an increasing trend for researchers to combine mirror therapy with another rehabilitation therapy when treating the upper extremity of patients with stroke. Objective: To evaluate the synergistic effect of combined mirror therapy (MT) on the upper extremity in patients with stroke and to judge efficacies of four combined mirror therapy subgroups [EMGBF group: electromyographic biofeedback (EMGBF) + MT; MG group: mesh glove (MG) + MT; AT group: acupuncture (AT) + MT; ES group: EMG-triggered electrical stimulation (ES) + MT]. Methods: CNKI, Wan Fang, VIP, Web of Science, ScienceDirect, PubMed, OVID LWW, and Cochrane were used. We searched these databases for randomized controlled trials published from January 2013 to August 2019, which presented results of combining mirror therapy with other rehabilitation therapies. Quality assessments were performed using the Cochrane Handbook criteria in order to accurately review interventions. The primary outcomes were measured by the Fugl–Meyer Assessment—upper extremity (FMA-UE). Results: Ten trials, with a total of 444 patients whose upper limb functions were damaged after stroke, were included in the meta-analysis. Compared with the control group, a remarkable effect of combined mirror therapy [all: weight mean difference in random effects model (WMD): 8.07, 95% confidence interval (CI) 5.87, 10.26] on functional recovery of the upper limb was detected. However, a high value of heterogeneity (χ2 = 20.09, df = 9; I2 = 55%) was found. The subgroup analysis (EMGBF group: WMD = 8.95, 95% CI 6.33, 11.58; ES group: WMD = 10.14, 95% CI: 5.67, 15.01) showed moderate improvement in functional recovery of the upper extremity in patients with stroke when mirror therapy was combined with conventional therapy. Furthermore, no difference in efficacy on upper extremity in patients with stroke was observed between the EMGBF group and the ES group. Conclusion: Despite the heterogeneity, the results indicate that combining mirror therapy with another rehabilitation therapy on the upper extremity in patients with stroke is better than single rehabilitation therapy. However, more randomized controlled clinical trials and larger sample sizes are required for an in-depth meta-analysis.
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Affiliation(s)
- Zhonghua Luo
- First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yuqing Zhou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - He He
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shanshan Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen Liu
- Department of Rehabilitation Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoli Liu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuping Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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9
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Schladen MM, Koumpouros Y, Sandison M, Casas R, Lum P. Conceptualization of Hand-TaPS to measure the subjective experience of dynamic hand orthoses in promoting functional recovery at home after stroke. ACTA ACUST UNITED AC 2020; 32:285-294. [PMID: 34421288 DOI: 10.3233/tad-200289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Dynamic exoskeleton orthoses provide assistance needed to complete movements that would otherwise be impossible after stroke. Beyond the demonstration of their effectiveness, the subjective experience of dynamic orthoses also needs to be considered. OBJECTIVE To support functional recovery after stroke through the development of Hand-TaPS (Task Practice after Stroke), an instrument to evaluate dynamic hand orthoses in home therapy. METHODS Dynamic hand orthosis subject matter experts (N = 14), professionals and consumers, considered the items of PYTHEIA, a valid and reliable instrument merging well-tested, assistive technology (AT) assessment items with those tuned to the greater complexity of emerging technologies. Experts reflected on how each item aligned with their personal experience of dynamic orthosis use. Interpretative Phenomenological Analysis guided identification of themes. RESULTS Four themes (5/20 items) appraised highly relevant for Hand-TaPS. The remaining eight themes (15/20 items) were deemed in need of modification. CONCLUSIONS Dynamic hand orthoses constitute a special case of AT; the assistance they provide targets therapy, not ADLs. Our work to develop Hand-TaPS provides a clear example of the theoretical difference between rehabilitative and assistive technology and underscores the importance of consideration of how a device is used in its assessment.
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Affiliation(s)
- Manon M Schladen
- MedStar Health Research Institute, Hyattsville, MD, USA.,Department of Rehabilitation Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Yiannis Koumpouros
- Department of Informatics and Computer Engineering, University of West Attica, Aigaleio, Greece
| | - Melissa Sandison
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - Rafael Casas
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
| | - Peter Lum
- Department of Biomedical Engineering, The Catholic University of America, Washington, DC, USA
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10
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Alarie C, Gagnon IJ, Quilico E, Swaine B. Characteristics and outcomes of physical activity interventions for individuals with mild traumatic brain injury: a scoping review protocol. BMJ Open 2019; 9:e027240. [PMID: 31221883 PMCID: PMC6589025 DOI: 10.1136/bmjopen-2018-027240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/19/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major public health problem, and it is estimated that 85% of TBIs are diagnosed as mild and are commonly referred to as a concussion. In adults, symptoms are expected to resolve within 10-14 days after the injury, but up to 15% of individuals continue to have symptoms beyond this period. Recent clinical recommendations suggest the use of physical activity (PA) as a therapy to manage persisting symptoms. However, the recommendations regarding PA lack clarity about important intervention parameters to help clinicians deliver the intervention. The objectives of this scoping review are thus to identify the characteristics, the measurement tools, the health-related outcomes and the reported effectiveness of PA-based interventions for adults with persisting symptoms of a mild TBI (mTBI). METHODS AND ANALYSIS This scoping review protocol will follow Arksey and O'Malley's six-step iterative process enhanced by another study and will be conducted by a team of researchers and clinical experts. Five databases (MEDLINE, CINAHL, PsycINFO, SPORTDiscuss and Embase), as well as Google, will be searched using an extensive search strategy to capture relevant scientific and grey literature. Articles will be selected if they report on an intervention designed to have an impact on health-related outcomes or participation among individuals having sustained an mTBI. A data extraction form based on the Consensus on Exercise Reporting Template and the Template for Intervention Description and Replication checklists will be created. Quantitative and qualitative data will be analysed accordingly, synthesised and collated in tables. ETHICS AND DISSEMINATION This scoping review generates new knowledge from published and publicly available literature; thus, an ethical approval is unnecessary to conduct this research. Dissemination of the results will involve all team members in activities aimed to facilitate knowledge uptake among TBI rehabilitation clinical experts locally, nationally and internationally.
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Affiliation(s)
- Christophe Alarie
- École de Réadaptation, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Trauma, Montreal Children’s Hospital of the McGill University Health Center, Montréal, Québec, Canada
| | - Enrico Quilico
- Rehabilitation Science Institute, University of Toronto, Toronto, Canada
| | - Bonnie Swaine
- École de Réadaptation, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal metropolitain, Montréal, Québec, Canada
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11
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Wei WXJ, Fong KNK, Chung RCK, Cheung HKY, Chow ESL. "Remind-to-Move" for Promoting Upper Extremity Recovery Using Wearable Devices in Subacute Stroke: A Multi-Center Randomized Controlled Study. IEEE Trans Neural Syst Rehabil Eng 2018; 27:51-59. [PMID: 30475722 DOI: 10.1109/tnsre.2018.2882235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper examined the effects of "Remind-to-Move" (RTM) via vibration cueing using wearable devices to increase the use of the affected upper limb and integrate upper limb activities undertaken at home in patients with subacute stroke after inpatient discharge. In a multi-centered randomized controlled trial, 84 eligible patients from four general hospitals, who had a first stroke in the last six months, were randomly allocated to either an experimental, sham, or control group, stratified by arm function levels. Patients in the experimental group were treated by RTM, using wearable devices for three consecutive hours daily, over four weeks. The sham group used sham devices, and the control group received usual care alone. A masked assessor evaluated the patients at 0th, 4th, 8th, and 12th weeks using outcome measures included arm function tests, motor activity log, and movement recorded by the devices. Results showed that there was a significant group by time interaction, and the average movement amount and Action Research Arm Test score in the experimental group were significantly higher than in the sham group. This paper demonstrates that RTM via wearable devices used for the hemiplegic upper extremities could promote more arm recovery than the sham or control and, hence, produce an optimal functional improvement for subacute stroke patients.
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12
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Yang Y, Zhao Q, Zhang Y, Wu Q, Jiang X, Cheng G. Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis. Neuroscience 2018; 390:318-336. [PMID: 29981364 DOI: 10.1016/j.neuroscience.2018.06.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Abstract
Mirror therapy (MT) as a relatively new rehabilitation technique has been widely applied in stroke patients. A number of randomized controlled trials (RCTs) have investigated the effects of MT for stroke survivors. The main purpose of this network meta-analysis was to investigate the effects of MT on motor function, activities of daily living (ADL), and pain perception in stroke survivors. Several databases were searched to identify RCTs evaluating the effects of MT in stroke patients to perform this network meta-analysis. Thirty-seven RCTs (42 analyses, 1685 subjects) were eligible for inclusion in the meta-analysis. Standard meta-analysis showed that MT significantly improved of motor function according to the increased Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), and decreased Modified Ashworth Scale (MAS) score. In addition, ADL was promoted by MT as the elevated Modified Barthel Index (MBI) and Motor Activity Log (MAL) score. Moreover, MT effectively relieved the pain of stroke patients as the Visual Analog Scale (VAS) score was reduced. Subgroup analyses and meta-regressions identified that the sources of heterogeneity might be different intervention arms and duration of interventions. Network meta-analysis showed that MT combined with electrical stimulation (ES) for less than 4 weeks along with conventional rehabilitation therapy (CT), and MT accompanied with CT for less than 4 weeks might be the most suitable interventions for improvement of motor function and ADL, respectively. Overall, MT could effectively improve motor function and ADL, as well as relieve pain for stroke survivors. The study was registered at PROSPERO (CRD42017081742).
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Affiliation(s)
- Yue Yang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Qingchun Zhao
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Yingshi Zhang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Qiong Wu
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Xiaowen Jiang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Gang Cheng
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
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13
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Kiper P, Pirowska A, Stożek J, Baba A, Agostini M, Turolla A. Current knowledge on selected rehabilitative methods used in post-stroke recovery. REHABILITACJA MEDYCZNA 2018. [DOI: 10.5604/01.3001.0011.6823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Understanding brain plasticity after stroke is important in developing rehabilitation strategies. Active movement therapies show considerable promise but their individual application is still not fully implemented. Among the analysed, available therapeutic modalities, some became widely used in therapeutic practice. Thus, we selected three relatively new methods, i.e. mirror therapy, motor imagery and constraint-induced movement therapy (CIMT). Mirror therapy was initially used in the treatment of phantom pain in patients with amputated limbs and later, in stroke patients. Motor imagery is widely used in sport to improve performance, which raises the possibility of applying it both as a rehabilitative method and in accessing the motor network independently of recovery. Whereas CIMT is based on the paradigm that impairment of arm function is exacerbated by learned non-use and that this, in turn, leads to loss of cortical representation in the upper limb.
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Affiliation(s)
- Pawel Kiper
- Fondazione Ospedale San Camillo IRCCS, Venezia, Italy
| | | | - Joanna Stożek
- Akademia Wychowania Fizycznego, Katedra Rehabilitacji Klinicznej, Kraków / Department of Clinical Rehabilitation, University of Physical Education, Kraków, Poland
| | - Alfonc Baba
- Fondazione Ospedale San Camillo IRCCS, Venezia, Italy
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14
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Lin SH, Dionne TP. Interventions to Improve Movement and Functional Outcomes in Adult Stroke Rehabilitation: Review and Evidence Summary. J Particip Med 2018; 10:e3. [PMID: 33052128 PMCID: PMC7434068 DOI: 10.2196/jopm.8929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/02/2017] [Indexed: 12/30/2022] Open
Abstract
Background Patients who have had a stroke may not be familiar with the terminology nor have the resources to efficiently search for evidence-based rehabilitation therapies to restore movement and functional outcomes. Recognizing that a thorough systematic review on this topic is beyond the scope of this article, we conducted a rapid review evidence summary to determine the level of evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Objective The objective of this study was to find evidence for common rehabilitation interventions to improve movement/motor and functional outcomes in adults who have had a stroke. Methods Medline Complete, PubMed, CINAHL Complete, Cochrane Database, Rehabilitation and Sports Medicine Source, Dissertation Abstracts International, and National Guideline Clearinghouse, from 1996 to April of 2016, were searched. From 348 articles, 173 met the following inclusion criteria: (1) published systematic reviews or meta-analyses, (2) outcomes target functional movement or motor skills of the upper and lower limbs, (3) non-pharmacological interventions that are commonly delivered to post-stroke population (acute and chronic), (4) human studies, and (5) English. Evidence tables were created to analyze the findings of systematic reviews and meta-analyses by category of interventions and outcomes. Results This rapid review found that the following interventions possess credible evidence to improve functional movement of persons with stroke: cardiorespiratory training, therapeutic exercise (ie, strengthening), task-oriented training (task-specific training), constraint-induced movement therapy (CIMT), mental practice, and mirror therapy. Neuromuscular electrical stimulation (NMES) (ie, functional electrical stimulation) shows promise as an intervention for stroke survivors. Conclusions Most commonly delivered therapeutic interventions to improve motor recovery after a stroke possess moderate quality evidence and are effective. Future research recommendations, such as optimal timing and dosage, would help rehabilitation professionals tailor interventions to achieve the best outcomes for stroke survivors.
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Affiliation(s)
- Susan Hamady Lin
- Institute of Health Professions, Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, United States
| | - Timothy P Dionne
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, NY, United States
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15
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Perez-Marcos D, Chevalley O, Schmidlin T, Garipelli G, Serino A, Vuadens P, Tadi T, Blanke O, Millán JDR. Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. J Neuroeng Rehabil 2017; 14:119. [PMID: 29149855 PMCID: PMC5693522 DOI: 10.1186/s12984-017-0328-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/31/2017] [Indexed: 01/05/2023] Open
Abstract
Background Technology-mediated neurorehabilitation is suggested to enhance training intensity and therefore functional gains. Here, we used a novel virtual reality (VR) system for task-specific upper extremity training after stroke. The system offers interactive exercises integrating motor priming techniques and embodied visuomotor feedback. In this pilot study, we examined (i) rehabilitation dose and training intensity, (ii) functional improvements, and (iii) safety and tolerance when exposed to intensive VR rehabilitation. Methods Ten outpatient stroke survivors with chronic (>6 months) upper extremity paresis participated in a ten-session VR-based upper limb rehabilitation program (2 sessions/week). Results All participants completed all sessions of the treatment. In total, they received a median of 403 min of upper limb therapy, with 290 min of effective training. Within that time, participants performed a median of 4713 goal-directed movements. Importantly, training intensity increased progressively across sessions from 13.2 to 17.3 movements per minute. Clinical measures show that despite being in the chronic phase, where recovery potential is thought to be limited, participants showed a median improvement rate of 5.3% in motor function (Fugl-Meyer Assessment for Upper Extremity; FMA-UE) post intervention compared to baseline, and of 15.4% at one-month follow-up. For three of them, this improvement was clinically significant. A significant improvement in shoulder active range of motion (AROM) was also observed at follow-up. Participants reported very low levels of pain, stress and fatigue following each session of training, indicating that the intensive VR intervention was well tolerated. No severe adverse events were reported. All participants expressed their interest in continuing the intervention at the hospital or even at home, suggesting high levels of adherence and motivation for the provided intervention. Conclusions This pilot study showed how a dedicated VR system could deliver high rehabilitation doses and, importantly, intensive training in chronic stroke survivors. FMA-UE and AROM results suggest that task-specific VR training may be beneficial for further functional recovery both in the chronic stage of stroke. Longitudinal studies with higher doses and sample sizes are required to confirm the therapy effectiveness. Trial registration This trial was retrospectively registered at ClinicalTrials.gov database (registration number NCT03094650) on 14 March 2017.
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Affiliation(s)
| | - Odile Chevalley
- MindMaze SA, Lausanne, Switzerland.,Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Thomas Schmidlin
- Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | | | - Andrea Serino
- MindMaze SA, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Tej Tadi
- MindMaze SA, Lausanne, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - José D R Millán
- Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Chair in Brain-Machine Interface, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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16
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Neyedli HF, Sampaio-Baptista C, Kirkman MA, Havard D, Lührs M, Ramsden K, Flitney DD, Clare S, Goebel R, Johansen-Berg H. Increasing Lateralized Motor Activity in Younger and Older Adults using Real-time fMRI during Executed Movements. Neuroscience 2017; 378:165-174. [PMID: 28214578 PMCID: PMC5953409 DOI: 10.1016/j.neuroscience.2017.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 01/08/2023]
Abstract
Healthy adults performed movements while receiving neurofeedback from real-time fMRI. Two experiments were performed, one with younger and one with older adults. Neurofeedback (NF) represented the laterality of activation in the motor cortices. The NF groups produced more lateralized activity than the sham group.
Neurofeedback training involves presenting an individual with a representation of their brain activity and instructing them to alter the activity using the feedback. One potential application of neurofeedback is for patients to alter neural activity to improve function. For example, there is evidence that greater laterality of movement-related activity is associated with better motor outcomes after stroke; so using neurofeedback to increase laterality may provide a novel route for improving outcomes. However, we must demonstrate that individuals can control relevant neurofeedback signals. Here, we performed two proof-of-concept studies, one in younger (median age: 26 years) and one in older healthy volunteers (median age: 67.5 years). The purpose was to determine if participants could manipulate laterality of activity between the motor cortices using real-time fMRI neurofeedback while performing simple hand movements. The younger cohort trained using their left and right hand, the older group trained using their left hand only. In both studies participants in a neurofeedback group were able to achieve more lateralized activity than those in a sham group (younger adults: F(1,23) = 4.37, p < 0.05; older adults: F(1,15) = 9.08, p < 0.01). Moreover, the younger cohort was able to maintain the lateralized activity for right hand movements once neurofeedback was removed. The older cohort did not maintain lateralized activity upon feedback removal, with the limitation being that they did not train with their right hand. The results provide evidence that neurofeedback can be used with executed movements to promote lateralized brain activity and thus is amenable for testing as a therapeutic intervention for patients following stroke.
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Affiliation(s)
- Heather F Neyedli
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Cassandra Sampaio-Baptista
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Matthew A Kirkman
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David Havard
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, The Netherlands Brain Innovation B.V., Maastricht, The Netherlands
| | - Katie Ramsden
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David D Flitney
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stuart Clare
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Maastricht University, The Netherlands Brain Innovation B.V., Maastricht, The Netherlands
| | - Heidi Johansen-Berg
- Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Bang DH. Effect of Modified Constraint-Induced Movement Therapy Combined with Auditory Feedback for Trunk Control on Upper Extremity in Subacute Stroke Patients with Moderate Impairment: Randomized Controlled Pilot Trial. J Stroke Cerebrovasc Dis 2016; 25:1606-1612. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 02/16/2016] [Accepted: 03/15/2016] [Indexed: 01/06/2023] Open
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Komar A, Ashley K, Hanna K, Lavallee J, Woodhouse J, Bernstein J, Andres M, Reed N. Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury. Phys Occup Ther Pediatr 2016; 36:186-203. [PMID: 26565125 DOI: 10.3109/01942638.2015.1076557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM A pretest-posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance. METHODS 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test. RESULTS Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = -3.63, p = <.001; QUEST Grasps: Z = -3.10, p = .002; QUEST Dissociated Movement: Z = -2.51, p = .012; COPM Performance: Z = -3.64, p = <.001; COPM Satisfaction: Z = -3.64, p = <.001). Across individuals, clinically significant improvements were found in 65% of participants' AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal. CONCLUSIONS This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury.
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Affiliation(s)
- Alyssa Komar
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Kelsey Ashley
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Kelly Hanna
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Julia Lavallee
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Janet Woodhouse
- b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Janet Bernstein
- b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Matthew Andres
- b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,c Bloorview Research Institute , Toronto , Ontario , Canada
| | - Nick Reed
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada.,b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,c Bloorview Research Institute , Toronto , Ontario , Canada.,d Rehabilitation Sciences Institute , University of Toronto , Toronto , Ontario , Canada
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19
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Choo PL, Gallagher HL, Morris J, Pomeroy VM, van Wijck F. Correlations between arm motor behavior and brain function following bilateral arm training after stroke: a systematic review. Brain Behav 2015; 5:e00411. [PMID: 26807338 PMCID: PMC4714643 DOI: 10.1002/brb3.411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/22/2015] [Accepted: 09/02/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bilateral training (BT) of the upper limb (UL) might enhance recovery of arm function after stroke. To better understand the therapeutic potential of BT, this study aimed to determine the correlation between arm motor behavior and brain structure/function as a result of bilateral arm training poststroke. METHODS A systematic review of quantitative studies of BT evaluating both UL motor behavior and neuroplasticity was conducted. Eleven electronic databases were searched. Two reviewers independently selected studies, extracted data and assessed methodological quality, using the Effective Public Health Practice Project (EPHPP) tool. RESULTS Eight studies comprising 164 participants met the inclusion criteria. Only two studies rated "strong" on the EPHPP tool. Considerable heterogeneity of participants, BT modes, comparator interventions and measures contraindicated pooled outcome analysis. Modes of BT included: in-phase and anti-phase; functional movements involving objects; and movements only. Movements were mechanically coupled, free, auditory-cued, or self-paced. The Fugl-Meyer Assessment (UL section) was used in six of eight studies, however, different subsections were used by different studies. Neural correlates were measured using fMRI and TMS in three and five studies, respectively, using a wide variety of variables. Associations between changes in UL function and neural plasticity were inconsistent and only two studies reported a statistical correlation following BT. CONCLUSIONS No clear pattern of association between UL motor and neural response to BT was apparent from this review, indicating that the neural correlates of motor behavior response to BT after stroke remain unknown. To understand the full therapeutic potential of BT and its different modes, further investigation is required.
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Affiliation(s)
- Pei Ling Choo
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Helen L. Gallagher
- School of Health and Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Jacqui Morris
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
| | - Valerie M. Pomeroy
- Acquired Brain Injury Rehabilitation Alliance (ABIRA)NorwichUK
- University of East AngliaNorwichUK
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20
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Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev 2015; 2015:CD004433. [PMID: 26446577 PMCID: PMC6465192 DOI: 10.1002/14651858.cd004433.pub3] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In people who have had a stroke, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitative interventions. Despite preserving or recovering movement ability after stroke, sometimes people do not fully realise this ability in their everyday activities. Constraint-induced movement therapy (CIMT) is an approach to stroke rehabilitation that involves the forced use and massed practice of the affected arm by restraining the unaffected arm. This has been proposed as a useful tool for recovering abilities in everyday activities. OBJECTIVES To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in people with hemiparesis after stroke. SEARCH METHODS We searched the Cochrane Stroke Group trials register (last searched June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 1, 2015), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (1982 to January 2015), and the Physiotherapy Evidence Database (PEDro; January 2015). SELECTION CRITERIA Randomised control trials (RCTs) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. DATA COLLECTION AND ANALYSIS One author identified trials from the results of the electronic searches according to the inclusion and exclusion criteria, three review authors independently assessed methodological quality and risk of bias, and extracted data. The primary outcome was disability. MAIN RESULTS We included 42 studies involving 1453 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The majority of studies were underpowered (median number of included participants was 29) and we cannot rule out small-trial bias. Eleven trials (344 participants) assessed disability immediately after the intervention, indicating a non-significant standard mean difference (SMD) 0.24 (95% confidence interval (CI) -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies involving 858 participants), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P value 0.004) in favour of CIMT. Three studies involving 125 participants explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment. AUTHORS' CONCLUSIONS CIMT is a multi-faceted intervention where restriction of the less affected limb is accompanied by increased exercise tailored to the person's capacity. We found that CIMT was associated with limited improvements in motor impairment and motor function, but that these benefits did not convincingly reduce disability. This differs from the result of our previous meta-analysis where there was a suggestion that CIMT might be superior to traditional rehabilitation. Information about the long-term effects of CIMT is scarce. Further trials studying the relationship between participant characteristics and improved outcomes are required.
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Affiliation(s)
- Davide Corbetta
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Valeria Sirtori
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Greta Castellini
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
| | - Lorenzo Moja
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanItaly20133
| | - Roberto Gatti
- University Vita‐Salute San RaffaeleSchool of PhysiotherapyVia Olgettina, 58MilanItaly20132
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Armijo-Olivo S, Saltaji H, da Costa BR, Fuentes J, Ha C, Cummings GG. What is the influence of randomisation sequence generation and allocation concealment on treatment effects of physical therapy trials? A meta-epidemiological study. BMJ Open 2015; 5:e008562. [PMID: 26338841 PMCID: PMC4563231 DOI: 10.1136/bmjopen-2015-008562] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To determine if adequacy of randomisation and allocation concealment is associated with changes in effect sizes (ES) when comparing physical therapy (PT) trials with and without these methodological characteristics. DESIGN Meta-epidemiological study. PARTICIPANTS A random sample of randomised controlled trials (RCTs) included in meta-analyses in the PT discipline were identified. INTERVENTION Data extraction including assessments of random sequence generation and allocation concealment was conducted independently by two reviewers. To determine the association between sequence generation, and allocation concealment and ES, a two-level analysis was conducted using a meta-meta-analytic approach. PRIMARY AND SECONDARY OUTCOME MEASURES association between random sequence generation and allocation concealment and ES in PT trials. RESULTS 393 trials included in 43 meta-analyses, analysing 44,622 patients contributed to this study. Adequate random sequence generation and appropriate allocation concealment were accomplished in only 39.7% and 11.5% of PT trials, respectively. Although trials with inappropriate allocation concealment tended to have an overestimate treatment effect when compared with trials with adequate concealment of allocation, the difference was non-statistically significant (ES=0.12; 95% CI -0.06 to 0.30). When pooling our results with those of Nuesch et al, we obtained a pooled statistically significant value (ES=0.14; 95% CI 0.02 to 0.26). There was no difference in ES in trials with appropriate or inappropriate random sequence generation (ES=0.02; 95% CI -0.12 to 0.15). CONCLUSIONS Our results suggest that when evaluating risk of bias of primary RCTs in PT area, systematic reviewers and clinicians implementing research into practice should pay attention to these biases since they could exaggerate treatment effects. Systematic reviewers should perform sensitivity analysis including trials with low risk of bias in these domains as primary analysis and/or in combination with less restrictive analyses. Authors and editors should make sure that allocation concealment and random sequence generation are properly reported in trial reports.
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Affiliation(s)
- Susan Armijo-Olivo
- CLEAR Outcomes (Connecting Leadership, Education and Research)Research Program, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Rehabilitation Medicine, Rehabilitation Research Center, University of Alberta, Edmonton, Alberta, Canada
| | - Humam Saltaji
- Orthodontic Graduate Clinic, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Bruno R da Costa
- Universitat Bern, Institute of Primary Health Care, Bern, Switzerland
| | - Jorge Fuentes
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Physical Therapy, Catholic University of Maule, Talca, Chile
| | - Christine Ha
- Faculty of Rehabilitation Medicine, Rehabilitation Research Center, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G Cummings
- Faculty of Nursing, CLEAR Outcomes (Connecting Leadership Education & Research) Research Program, University of Alberta, Edmonton Clinic Health Academy|University of Alberta, Edmonton, Alberta, Canada
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Barzel A, Ketels G, Stark A, Tetzlaff B, Daubmann A, Wegscheider K, van den Bussche H, Scherer M. Home-based constraint-induced movement therapy for patients with upper limb dysfunction after stroke (HOMECIMT): a cluster-randomised, controlled trial. Lancet Neurol 2015; 14:893-902. [PMID: 26231624 DOI: 10.1016/s1474-4422(15)00147-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Barzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gesche Ketels
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Stark
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Britta Tetzlaff
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hendrik van den Bussche
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kwakkel G, Veerbeek JM, van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol 2015; 14:224-34. [PMID: 25772900 DOI: 10.1016/s1474-4422(14)70160-7] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for the rehabilitation of patients. Original CIMT includes constraining of the non-paretic arm and task-oriented training. Modified versions also apply constraining of the non-paretic arm, but not as intensive as original CIMT. Behavioural strategies are mostly absent for both modified and original CIMT. With forced use therapy, only constraining of the non-paretic arm is applied. The original and modified types of CIMT have beneficial effects on motor function, arm-hand activities, and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas there is no evidence for the efficacy of constraint alone (as used in forced use therapy). The type of CIMT, timing, or intensity of practice do not seem to affect patient outcomes. Although the underlying mechanisms that drive modified and original CIMT are still poorly understood, findings from kinematic studies suggest that improvements are mainly based on adaptations through learning to optimise the use of intact end-effectors in patients with some voluntary motor control of wrist and finger extensors after stroke.
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Affiliation(s)
- Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands; Amsterdam Rehabilitation Research Center, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands.
| | - Janne M Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
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Armijo-Olivo S, da Costa BR, Cummings GG, Ha C, Fuentes J, Saltaji H, Egger M. PEDro or Cochrane to Assess the Quality of Clinical Trials? A Meta-Epidemiological Study. PLoS One 2015; 10:e0132634. [PMID: 26161653 PMCID: PMC4498768 DOI: 10.1371/journal.pone.0132634] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 06/16/2015] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE There is debate on how the methodological quality of clinical trials should be assessed. We compared trials of physical therapy (PT) judged to be of adequate quality based on summary scores from the Physiotherapy Evidence Database (PEDro) scale with trials judged to be of adequate quality by Cochrane Risk of Bias criteria. DESIGN Meta-epidemiological study within Cochrane Database of Systematic Reviews. METHODS Meta-analyses of PT trials were identified in the Cochrane Database of Systematic Reviews. For each trial PeDro and Cochrane assessments were extracted from the PeDro and Cochrane databases. Adequate quality was defined as adequate generation of random sequence, concealment of allocation, and blinding of outcome assessors (Cochrane criteria) or as trials with a PEDro summary score ≥5 or ≥6 points. We combined trials of adequate quality using random-effects meta-analysis. RESULTS Forty-one Cochrane reviews and 353 PT trials were included. All meta-analyses included trials with PEDro scores ≥5, 37 (90.2%) included trials with PEDro scores ≥6 and only 22 (53.7%) meta-analyses included trials of adequate quality according to the Cochrane criteria. Agreement between PeDro and Cochrane was poor for PeDro scores of ≥5 points (kappa = 0.12; 95% CI 0.07 to 0.16) and slight for ≥6 points (kappa 0.24; 95% CI 0.16-0.32). When combining effect sizes of trials deemed to be of adequate quality according to PEDro or Cochrane criteria, we found that a substantial difference in the combined effect size (≥0.15) was evident in 9 (22%) out of the 41 meta-analyses for PEDro cutoff ≥5 and 10 (24%) for cutoff ≥6. CONCLUSIONS The PeDro and Cochrane approaches lead to different sets of trials of adequate quality, and different combined treatment estimates from meta-analyses of these trials. A consistent approach to assessing RoB in trials of physical therapy should be adopted.
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Affiliation(s)
- Susan Armijo-Olivo
- CLEAR (Connecting Leadership, Education, and Research) Outcomes Research Program, University of Alberta, Faculty of Nursing, University of Alberta, Edmonton, Canada
- Rehabilitation Research Center, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Bruno R. da Costa
- Universitat Bern, Institute of Primary Health Care, Gesellschaftstrasse 49, Bern, 3013, Switzerland
| | - Greta G. Cummings
- CLEAR (Connecting Leadership, Education, and Research) Outcomes Research Program, University of Alberta, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Christine Ha
- Rehabilitation Research Center, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Jorge Fuentes
- Rehabilitation Research Center, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
- Catholic University of Maule, Department of Physical Therapy, Talca, Chile
| | - Humam Saltaji
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthias Egger
- Institute of Social & Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Frykberg GE, Vasa R. Neuroplasticity in action post-stroke: Challenges for physiotherapists. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2015. [DOI: 10.3109/21679169.2015.1039575] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Claflin ES, Krishnan C, Khot SP. Emerging treatments for motor rehabilitation after stroke. Neurohospitalist 2015; 5:77-88. [PMID: 25829989 DOI: 10.1177/1941874414561023] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although numerous treatments are available to improve cerebral perfusion after acute stroke and prevent recurrent stroke, few rehabilitation treatments have been conclusively shown to improve neurologic recovery. The majority of stroke survivors with motor impairment do not recover to their functional baseline, and there remains a need for novel neurorehabilitation treatments to minimize long-term disability, maximize quality of life, and optimize psychosocial outcomes. In recent years, several novel therapies have emerged to restore motor function after stroke, and additional investigational treatments have also shown promise. Here, we familiarize the neurohospitalist with emerging treatments for poststroke motor rehabilitation. The rehabilitation treatments covered in this review will include selective serotonin reuptake inhibitor medications, constraint-induced movement therapy, noninvasive brain stimulation, mirror therapy, and motor imagery or mental practice.
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Affiliation(s)
- Edward S Claflin
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Sandeep P Khot
- Department of Neurology, University of Washington, Seattle, WA, USA
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Donoso Brown EV, Dudgeon BJ, Gutman K, Moritz CT, McCoy SW. Understanding upper extremity home programs and the use of gaming technology for persons after stroke. Disabil Health J 2015; 8:507-13. [PMID: 25953349 DOI: 10.1016/j.dhjo.2015.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 02/01/2015] [Accepted: 03/13/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Many persons post-stroke continue to have difficulty using their more involved upper extremity and home programs may be poorly adhered to limiting the amount of practice an individual receives. More information on the experience of traditional home program and the acceptability of a novel home intervention was sought. OBJECTIVE To qualitatively describe 1) upper extremity use at home, 2) previous home exercise or activity programs, and 3) the acceptability of a novel upper extremity home program, NeuroGame Therapy (NGT), that combines surface electromyography (sEMG) biofeedback and a commercial computer game. METHODS A purposeful sample of ten persons with moderate to severe upper extremity motor impairment used the NGT intervention in their home for four weeks and completed nested (pre and post) one-on-one interviews. Written transcripts from the interviews were coded and themes were identified to address stated objectives. RESULTS Participants reported that while use of their upper extremity in daily activities was recommended it occurred infrequently. Most participants described previous home programs as being non-specific, were often not carried out as recommended or were self-modified. Participants found NGT to be engaging and motivating, but reported minimal changes in the functional uses of their upper extremity. CONCLUSION These findings suggest that after stroke upper extremity use may be infrequent and home program approaches could be re-examined. NGT was reported to be an acceptable home intervention, but it will require further development and study to understand its value and role in post-stroke rehabilitation.
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Affiliation(s)
- Elena V Donoso Brown
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; Duquesne University, Department of Occupational Therapy, Rangos School of Health Sciences, 600 Forbes Ave, Pittsburgh, PA 15282, USA.
| | - Brian J Dudgeon
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; University of Alabama at Birmingham, Department of Occupational Therapy, School of Health Professions, SHPB 353, 1720 2nd Ave South, Birmingham, AL 35294-1212, USA
| | - Karli Gutman
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA
| | - Chet T Moritz
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA; University of Washington, School of Medicine, Department of Physiology & Biophysics, 1959 N.E. Pacific St., Seattle, WA 98195, USA
| | - Sarah Westcott McCoy
- University of Washington, School of Medicine, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., Seattle, WA 98195, USA
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Castellini G, Gianola S, Banzi R, Corbetta D, Gatti R, Sirtori V, Gluud C, Moja L. Constraint-induced movement therapy: trial sequential analysis applied to Cochrane collaboration systematic review results. Trials 2014; 15:512. [PMID: 25542215 PMCID: PMC4307139 DOI: 10.1186/1745-6215-15-512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 12/10/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Trial sequential analysis (TSA) may establish when firm evidence about the efficacy of interventions is reached in a cumulative meta-analysis, combining a required information size with adjusted thresholds for conservative statistical significance. Our aim was to demonstrate TSA results on randomized controlled trials (RCTs) included in a Cochrane systematic review on the effectiveness of constraint-induced movement therapy (CIMT) for stroke patients. METHODS We extracted data on the functional independence measure (FIM) and the action research arm test (ARAT) from RCTs that compared CIMT versus other rehabilitative techniques. Mean differences (MD) were analyzed using a random-effects model. We calculated the information size and the cumulative Z-statistic, applying the O'Brien-Fleming monitoring boundaries. RESULTS We included data from 14 RCTs. In the conventional meta-analysis (seven trials, 233 patients), the effect of CIMT on FIM was reported as significant (MD 2.88, 95% CI 0.08 to 5.68; P = 0.04). The diversity-adjusted required information size was 142 patients, and the cumulative Z-score did not cross the trial sequential monitoring boundary for benefit (adjusted 95% CI -0.02 to 5.78). The effect of CIMT on ARAT (nine trials, 199 patients) was reported as significant (MD 7.78, 95% CI 1.19 to 14.37; P = 0.02). However, the diversity-adjusted required information size was 252 patients, and the Z-score did not cross the trial sequential monitoring boundary for benefit (adjusted 95% CI -0.06 to 15.62). CONCLUSIONS Although conventional meta-analyses of CIMT reached statistical significance, their overall results remain inconclusive and might be spurious. Researchers should not be overconfident on CIMT efficacy based on the results of meta-analyses and derived recommendations.
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Affiliation(s)
- Greta Castellini
- />Health Professional Science of Rehabilitation, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Silvia Gianola
- />Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
| | - Rita Banzi
- />IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa, 19, 20156 Milan, Italy
| | - Davide Corbetta
- />Unit of Functional Recovery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Roberto Gatti
- />Unit of Functional Recovery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
- />School of Physiotherapy, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Valeria Sirtori
- />Unit of Functional Recovery, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - Christian Gluud
- />Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Lorenzo Moja
- />Clinical Epidemiology Unit, IRCCS Orthopedic Institute Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milan, Italy
- />Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36, 20133 Milano, Italy
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 2014:CD010820. [PMID: 25387001 PMCID: PMC6469541 DOI: 10.1002/14651858.cd010820.pub2] [Citation(s) in RCA: 346] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Improving upper limb function is a core element of stroke rehabilitation needed to maximise patient outcomes and reduce disability. Evidence about effects of individual treatment techniques and modalities is synthesised within many reviews. For selection of effective rehabilitation treatment, the relative effectiveness of interventions must be known. However, a comprehensive overview of systematic reviews in this area is currently lacking. OBJECTIVES To carry out a Cochrane overview by synthesising systematic reviews of interventions provided to improve upper limb function after stroke. METHODS SEARCH METHODS We comprehensively searched the Cochrane Database of Systematic Reviews; the Database of Reviews of Effects; and PROSPERO (an international prospective register of systematic reviews) (June 2013). We also contacted review authors in an effort to identify further relevant reviews. SELECTION CRITERIA We included Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs) of patients with stroke comparing upper limb interventions with no treatment, usual care or alternative treatments. Our primary outcome of interest was upper limb function; secondary outcomes included motor impairment and performance of activities of daily living. When we identified overlapping reviews, we systematically identified the most up-to-date and comprehensive review and excluded reviews that overlapped with this. DATA COLLECTION AND ANALYSIS Two overview authors independently applied the selection criteria, excluding reviews that were superseded by more up-to-date reviews including the same (or similar) studies. Two overview authors independently assessed the methodological quality of reviews (using a modified version of the AMSTAR tool) and extracted data. Quality of evidence within each comparison in each review was determined using objective criteria (based on numbers of participants, risk of bias, heterogeneity and review quality) to apply GRADE (Grades of Recommendation, Assessment, Development and Evaluation) levels of evidence. We resolved disagreements through discussion. We systematically tabulated the effects of interventions and used quality of evidence to determine implications for clinical practice and to make recommendations for future research. MAIN RESULTS Our searches identified 1840 records, from which we included 40 completed reviews (19 Cochrane; 21 non-Cochrane), covering 18 individual interventions and dose and setting of interventions. The 40 reviews contain 503 studies (18,078 participants). We extracted pooled data from 31 reviews related to 127 comparisons. We judged the quality of evidence to be high for 1/127 comparisons (transcranial direct current stimulation (tDCS) demonstrating no benefit for outcomes of activities of daily living (ADLs)); moderate for 49/127 comparisons (covering seven individual interventions) and low or very low for 77/127 comparisons.Moderate-quality evidence showed a beneficial effect of constraint-induced movement therapy (CIMT), mental practice, mirror therapy, interventions for sensory impairment, virtual reality and a relatively high dose of repetitive task practice, suggesting that these may be effective interventions; moderate-quality evidence also indicated that unilateral arm training may be more effective than bilateral arm training. Information was insufficient to reveal the relative effectiveness of different interventions.Moderate-quality evidence from subgroup analyses comparing greater and lesser doses of mental practice, repetitive task training and virtual reality demonstrates a beneficial effect for the group given the greater dose, although not for the group given the smaller dose; however tests for subgroup differences do not suggest a statistically significant difference between these groups. Future research related to dose is essential.Specific recommendations for future research are derived from current evidence. These recommendations include but are not limited to adequately powered, high-quality RCTs to confirm the benefit of CIMT, mental practice, mirror therapy, virtual reality and a relatively high dose of repetitive task practice; high-quality RCTs to explore the effects of repetitive transcranial magnetic stimulation (rTMS), tDCS, hands-on therapy, music therapy, pharmacological interventions and interventions for sensory impairment; and up-to-date reviews related to biofeedback, Bobath therapy, electrical stimulation, reach-to-grasp exercise, repetitive task training, strength training and stretching and positioning. AUTHORS' CONCLUSIONS Large numbers of overlapping reviews related to interventions to improve upper limb function following stroke have been identified, and this overview serves to signpost clinicians and policy makers toward relevant systematic reviews to support clinical decisions, providing one accessible, comprehensive document, which should support clinicians and policy makers in clinical decision making for stroke rehabilitation.Currently, no high-quality evidence can be found for any interventions that are currently used as part of routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions. Effective collaboration is urgently needed to support large, robust RCTs of interventions currently used routinely within clinical practice. Evidence related to dose of interventions is particularly needed, as this information has widespread clinical and research implications.
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Affiliation(s)
- Alex Pollock
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Sybil E Farmer
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Marian C Brady
- Glasgow Caledonian UniversityNursing, Midwifery and Allied Health Professions Research UnitBuchanan HouseCowcaddens RoadGlasgowUKG4 0BA
| | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | - Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Frederike van Wijck
- Glasgow Caledonian UniversityInstitute for Applied Health Research and the School of Health and Life SciencesGlasgowUK
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Sterr A, O'Neill D, Dean PJA, Herron KA. CI Therapy is Beneficial to Patients with Chronic Low-Functioning Hemiparesis after Stroke. Front Neurol 2014; 5:204. [PMID: 25368598 PMCID: PMC4202624 DOI: 10.3389/fneur.2014.00204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 09/27/2014] [Indexed: 11/13/2022] Open
Abstract
CI therapy is effective in patients with relatively good levels of residual arm function but its applicability to patients with low-functioning hemiparesis is not entirely clear. In the present study, we examined the feasibility and efficacy of the CI therapy concept in patients with very limited upper arm function prior to treatment, and further tested how the length of daily shaping training and constraining the good arm affects treatment outcome. In a baseline-controlled design, 65 chronic patients were treated with 2 weeks of modified CI therapy. Patients were randomly allocated to four treatment groups receiving 90 or 180 min of daily shaping training applied with or without constraint, respectively. Outcome was measured through the Reliable Change Index, which was calculated for parameters of motor function, health, and psychological wellbeing. Follow-up data were collected at 6 and 12 months. Two analyses were conducted, a whole-group analysis across all 65 participants and a sub-group analysis contrasting the four treatment variants. The whole-group analysis showed a significant treatment effect, which was largely sustained after 1 year. The sub-group analysis revealed a mixed picture; while improvements against the baseline period were observed in all four subgroups, 180 min of daily shaping training coupled with the constraint yielded better outcome on the MAL but not the WMFT, while for 90 min of training the level of improvement was similar for those who wore the constraint and those who did not. Together these results suggest that, at least in those patients available for follow-up measures, modified CI therapy induces sustained improvements in motor function in patients with chronic low-functioning hemiparesis. The absence of clear differences between the four treatment variants points to a complex relationship between the length of daily shaping training and the constraint in this patient group, which is likely to be mediated by fatigue and/or compliance with the constraint.
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Affiliation(s)
- Annette Sterr
- School of Psychology, University of Surrey , Guildford , UK
| | - Darragh O'Neill
- School of Life and Medical Sciences, University College London , London , UK
| | | | - Katherine A Herron
- Pain Management Centre, National Hospital for Neurology and Neurosurgery, University College London , London , UK
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Bang DH, Shin WS, Choi SJ. The effects of modified constraint-induced movement therapy combined with trunk restraint in subacute stroke: a double-blinded randomized controlled trial. Clin Rehabil 2014; 29:561-9. [PMID: 25246609 DOI: 10.1177/0269215514552034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 08/27/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint in subacute stroke patients. DESIGN Double-blind, randomized controlled trial. SETTING Rehabilitation clinic. PARTICIPANTS Eighteen subacute stroke patients with moderate motor impairment. INTERVENTIONS The patients were treated with either mCIMT combined with trunk restraint or mCIMT for 5 days per week for 4 weeks. The mCIMT combined with trunk restraint group participated in structured intervention sessions for use of the more affected upper-extremity in task-oriented activities with trunk restraint for 1 hour per day, and with the less affected upper-extremity restrained for 5 hours per day weeks. The mCIMT group followed the same protocol without trunk restraint. MAIN OUTCOME MEASURES The outcome measures included the action research arm test (ARAT), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), the motor activity log (MAL) and the maximal elbow extension angle during reaching (MEEAR) were completed at baseline and post intervention. RESULTS The mCIMT combined with trunk restraint group exhibited more improved in the ARAT, FMA, MBI, MAL and MEEAR compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (P = 0.046), FMA (P = 0.008), MBI (P = 0.001), MAL-AOU (P = 0.024), MAL-QOM (P = 0.010) and MEEAR (P = 0.001) between groups. CONCLUSIONS These results suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in subacute stroke patients with moderate motor impairment.
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Affiliation(s)
- Dae-Hyouk Bang
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
| | - Won-Seob Shin
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea Department of Physical Therapy, Natural Science College, Daejeon University, Daejeon, Republic of Korea
| | - Sung-Jin Choi
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
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Blicher JU, Near J, Næss-Schmidt E, Stagg CJ, Johansen-Berg H, Nielsen JF, Østergaard L, Ho YCL. GABA levels are decreased after stroke and GABA changes during rehabilitation correlate with motor improvement. Neurorehabil Neural Repair 2014; 29:278-86. [PMID: 25055837 DOI: 10.1177/1545968314543652] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE γ-Aminobutyric acid (GABA) is the dominant inhibitory neurotransmitter in the brain and is important in motor learning. We aimed to measure GABA content in primary motor cortex poststroke (using GABA-edited magnetic resonance spectroscopy [MRS]) and in relation to motor recovery during 2 weeks of constraint-induced movement therapy (CIMT). METHODS Twenty-one patients (3-12 months poststroke) and 20 healthy subjects were recruited. Magnetic resonance imaging structural T1 and GABA-edited MRS were performed at baseline and after CIMT, and once in healthy subjects. GABA:creatine (GABA:Cr) ratio was measured by GABA-edited MRS. Motor function was measured using Wolf Motor Function Test (WMFT). RESULTS Baseline comparison between stroke patients (n = 19) and healthy subjects showed a significantly lower GABA:Cr ratio in stroke patients (P < .001) even after correcting for gray matter content in the voxel (P < .01) and when expressing GABA relative to N-acetylaspartic acid (NAA; P = .03). After 2 weeks of CIMT patients improved significantly on WMFT, but no consistent change across the group was observed for the GABA:Cr ratio (n = 17). However, the extent of improvement on WMFT correlated significantly with the magnitude of GABA:Cr changes (P < .01), with decreases in GABA:Cr ratio being associated with better improvements in motor function. CONCLUSIONS In patients 3 to 12 months poststroke, GABA levels are lower in the primary motor cortex than in healthy subjects. The observed association between GABA and recovery warrants further studies on the potential use of GABA MRS as a biomarker in poststroke recovery.
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Affiliation(s)
- Jakob Udby Blicher
- Aarhus University, Aarhus, Denmark Hammel Neurorehabilitation and Research Centre, Aarhus University Hospital, Hammel, Denmark
| | - Jamie Near
- McGill University, Montreal, Quebec, Canada
| | - Erhard Næss-Schmidt
- Hammel Neurorehabilitation and Research Centre, Aarhus University Hospital, Hammel, Denmark
| | | | | | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation and Research Centre, Aarhus University Hospital, Hammel, Denmark
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Armijo-Olivo S, Ospina M, da Costa BR, Egger M, Saltaji H, Fuentes J, Ha C, Cummings GG. Poor reliability between Cochrane reviewers and blinded external reviewers when applying the Cochrane risk of bias tool in physical therapy trials. PLoS One 2014; 9:e96920. [PMID: 24824199 PMCID: PMC4019638 DOI: 10.1371/journal.pone.0096920] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/13/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) trials by comparing ratings from Cochrane review authors with those of blinded external reviewers. METHODS Randomized controlled trials (RCTs) in PT were identified by searching the Cochrane Database of Systematic Reviews for meta-analysis of PT interventions. RoB assessments were conducted independently by 2 reviewers blinded to the RoB ratings reported in the Cochrane reviews. Data on RoB assessments from Cochrane reviews and other characteristics of reviews and trials were extracted. Consensus assessments between the two reviewers were then compared with the RoB ratings from the Cochrane reviews. Agreement between Cochrane and blinded external reviewers was assessed using weighted kappa (κ). RESULTS In total, 109 trials included in 17 Cochrane reviews were assessed. Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external reviewers was poor (κ = 0.02, 95%CI: -0.06, 0.06]). Inter-rater reliability on individual domains of the RoB tool was poor (median κ = 0.19), ranging from κ = -0.04 ("Other bias") to κ = 0.62 ("Sequence generation"). There was also no agreement (κ = -0.29, 95%CI: -0.81, 0.35]) in the overall RoB assessment at the meta-analysis level. CONCLUSIONS Risk of bias assessments of RCTs using the RoB tool are not consistent across different research groups. Poor agreement was not only demonstrated at the trial level but also at the meta-analysis level. Results have implications for decision making since different recommendations can be reached depending on the group analyzing the evidence. Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed.
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Affiliation(s)
- Susan Armijo-Olivo
- CLEAR (Connecting Leadership and Research) Outcomes Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Rehabilitation Medicine, Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Maria Ospina
- Emergency Medicine Strategic Clinical Network, Alberta Health Services, Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canadá
| | - Bruno R. da Costa
- Department of Physical Therapy, Florida International University, Miami, Florida, United States of America
| | - Matthias Egger
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Humam Saltaji
- Orthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton, Alberta, Canadá
| | - Jorge Fuentes
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Catholic University of Maule, Department of Physical Therapy, Talca, Maule, Chile
| | - Christine Ha
- Rehabilitation Research Center, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Greta G. Cummings
- CLEAR (Connecting Leadership and Research) Outcomes Research Program, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Aloraini SM, Mackay-Lyons M, Boe S, McDonald A. Constraint-induced movement therapy to improve paretic upper-extremity motor skills and function of a patient in the subacute stage of stroke. Physiother Can 2014; 66:56-9. [PMID: 24719510 DOI: 10.3138/ptc.2012-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Saleh M Aloraini
- School of Physiotherapy, Dalhousie University ; College of Applied Medical Sciences, Qassim University, Saudi Arabia
| | | | - Shaun Boe
- School of Physiotherapy, Dalhousie University
| | - Alison McDonald
- Acquired Brain Injury Program, QEII Health Sciences Centre, Halifax, N.S
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Sandel ME. Dr. Herman Kabat: neuroscience in translation … from bench to bedside. PM R 2014; 5:453-61. [PMID: 23790816 DOI: 10.1016/j.pmrj.2013.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Affiliation(s)
- M Elizabeth Sandel
- Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, CA, USA.
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Kwon JY, Chang WH, Chang HJ, Yi SH, Kim MY, Kim EH, Kim YH. Changes in diffusion tensor tractographic findings associated with constraint-induced movement therapy in young children with cerebral palsy. Clin Neurophysiol 2014; 125:2397-403. [PMID: 24746686 DOI: 10.1016/j.clinph.2014.02.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether constraint-induced movement therapy (CIMT) could lead to changes in diffusion tensor tractography (DTT) associated with clinical improvement in young children with unilateral cerebral palsy (CP). METHODS A standardized pediatric CIMT protocol (4weeks, 120h of constraint) was used on 10 children with unilateral CP who were younger than 5years. DTT was performed in five participants before and after the intervention. Clinical outcome was measured by using the Pediatric Motor Activity Log (PMAL), Quality of Upper Extremity Skills Test (QUEST), and self-care domain of the Pediatric Evaluation of Disability Inventory. RESULTS In two patients, the affected corticospinal tract (CST) visible on pretreatment DTT became more prominent on posttreatment DTT. In one patient, the affected CST was not visible on pretreatment DTT, but was visible on posttreatment DTT. All the clinical outcomes significantly improved in the CIMT group compared with the control group. Changes in the PMAL how often scale (PMAL-HO) score significantly differed between the CIMT and control groups. CONCLUSIONS Changes in the properties of the affected CST on DTT were accompanied with improved arm function after CIMT in the children with CP. SIGNIFICANCE CIMT might lead to CST reorganization in young children with CP.
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Affiliation(s)
- Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Republic of Korea
| | - Hyun Jung Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Sook-Hee Yi
- Department of Pediatric Rehabilitation, Seoul, Republic of Korea
| | - Min-Young Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Eun-Hye Kim
- Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Republic of Korea.
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Hughes AM, Burridge JH, Demain SH, Ellis-Hill C, Meagher C, Tedesco-Triccas L, Turk R, Swain I. Translation of evidence-based Assistive Technologies into stroke rehabilitation: users' perceptions of the barriers and opportunities. BMC Health Serv Res 2014; 14:124. [PMID: 24620739 PMCID: PMC4007558 DOI: 10.1186/1472-6963-14-124] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 02/23/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. METHODS Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. RESULTS 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. CONCLUSION Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation.
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Affiliation(s)
- Ann-Marie Hughes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- Electronics and Computer Sciences, Faculty of Physical & Applied Sciences, University of Southampton, Southampton, UK
| | | | | | | | - Claire Meagher
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Ruth Turk
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ian Swain
- School of Design, Engineering and Computing, Bournemouth University, Bournemouth, UK
- Clinical Science and Engineering, Salisbury NHS Foundation Trust, Salisbury, UK
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Modulation of cortical interhemispheric interactions by motor facilitation or restraint. Neural Plast 2014; 2014:210396. [PMID: 24707408 PMCID: PMC3953668 DOI: 10.1155/2014/210396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/13/2014] [Indexed: 11/28/2022] Open
Abstract
Cortical interhemispheric interactions in motor control are still poorly understood and it is important to clarify how these depend on inhibitory/facilitatory limb movements and motor expertise, as reflected by limb dominance. Here we addressed this problem using functional magnetic resonance imaging (fMRI) and a task involving dominant/nondominant limb mobilization in the presence/absence of contralateral limb restraint. In this way we could modulate excitation/deactivation of the contralateral hemisphere. Blocks of arm elevation were alternated with absent/present restraint of the contralateral limb in 17 participants. We found the expected activation of contralateral sensorimotor cortex and ipsilateral cerebellum during arm elevation. In addition, only the dominant arm elevation (hold period) was accompanied by deactivation of ipsilateral sensorimotor cortex, irrespective of presence/absence of contralateral restraint, although the latter increased deactivation. In contrast, the nondominant limb yielded absent deactivation and reduced area of contralateral activation upon restriction. Our results provide evidence for a difference in cortical communication during motor control (action facilitation/inhibition), depending on the “expertise” of the hemisphere that controls action (dominant versus nondominant). These results have relevant implications for the development of facilitation/inhibition strategies in neurorehabilitation, namely, in stroke, given that fMRI deactivations have recently been shown to reflect decreases in neural responses.
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What Does the Cochrane Collaboration Say about Rehabilitation of the Arm after Stroke? Physiother Can 2014; 65:398. [PMID: 24396171 DOI: 10.3138/ptc.65.4.cochrane] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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de Jong LD, Dijkstra PU, Gerritsen J, Geurts ACH, Postema K. Combined arm stretch positioning and neuromuscular electrical stimulation during rehabilitation does not improve range of motion, shoulder pain or function in patients after stroke: a randomised trial. J Physiother 2013; 59:245-54. [PMID: 24287218 DOI: 10.1016/s1836-9553(13)70201-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
QUESTION Does static stretch positioning combined with simultaneous neuromuscular electrical stimulation (NMES) in the subacute phase after stroke have beneficial effects on basic arm body functions and activities? DESIGN Multicentre randomised trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS Forty-six people in the subacute phase after stroke with severe arm motor deficits (initial Fugl-Meyer Assessment arm score ≤ 18). INTERVENTION In addition to conventional stroke rehabilitation, participants in the experimental group received arm stretch positioning combined with motor amplitude NMES for two 45-minute sessions a day, five days a week, for eight weeks. Control participants received sham arm positioning (ie, no stretch) and sham NMES (ie, transcutaneous electrical nerve stimulation with no motor effect) to the forearm only, at a similar frequency and duration. OUTCOME MEASURES The primary outcome measures were passive range of arm motion and the presence of pain in the hemiplegic shoulder. Secondary outcome measures were severity of shoulder pain, restrictions in performance of activities of daily living, hypertonia, spasticity, motor control and shoulder subluxation. Outcomes were assessed at baseline, mid-treatment, at the end of the treatment period (8 weeks) and at follow-up (20 weeks). RESULTS Multilevel regression analysis showed no significant group effects nor significant time × group interactions on any of the passive range of arm motions. The relative risk of shoulder pain in the experimental group was non-significant at 1.44 (95% CI 0.80 to 2.62). CONCLUSION In people with poor arm motor control in the subacute phase after stroke, static stretch positioning combined with simultaneous NMES has no statistically significant effects on range of motion, shoulder pain, basic arm function, or activities of daily living. TRIAL REGISTRATION NTR1748.
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Affiliation(s)
- Lex D de Jong
- School of Physiotherapy, Hanze University of Applied Sciences, Groningen; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen.
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Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010820] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Effect of a robotic restraint gait training versus robotic conventional gait training on gait parameters in stroke patients. Exp Brain Res 2013; 232:31-42. [PMID: 24212255 DOI: 10.1007/s00221-013-3717-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 09/22/2013] [Indexed: 10/26/2022]
Abstract
Kinematic and kinetic gait parameters have never been assessed following robotic-assisted gait training in hemiparetic patients. Previous studies suggest that restraint of the non-paretic lower limb during gait training could be a useful rehabilitation approach for hemiparetic patients. The aim of this study is to compare a new Lokomat(®) asymmetrical restraint paradigm (with a negative kinematic constraint on the non-paretic limb and a positive kinematic constraint on the paretic limb) with a conventional symmetrical Lokomat(®) training in hemiparetic subjects. We hypothesized that hip and knee kinematics on paretic side would be more improved after the asymmetrical Lokomat(®) training than after the conventional training. In a prospective observational controlled study, 26 hemiparetic subjects were randomized to one of the two groups Lokomat(®) experimental gait training (LE) or Lokomat(®) conventional gait training (LC). They were assessed using 3D gait analysis before, immediately after the 20 min of gait training and following a 20-min rest period. There was a greater increase in peak knee flexion on the paretic side following LE than LC (p = 0.04), and each type of training induced different changes in vertical GRF during single-support phase on the paretic side. Several other spatiotemporal, kinematic and kinetic gait parameters were similarly improved after both types of training. Lokomat(®) restrained gait training with a negative kinematic constraint on the non-paretic limb and a positive kinematic constraint on the paretic limb appears to be an effective approach to specifically improve knee flexion in the paretic lower limb in hemiparetic patients. This study also highlights spatiotemporal, kinematic and kinetic improvements after Lokomat(®) training, in hemiparetic subjects, rarely investigated before.
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Barzel A, Ketels G, Tetzlaff B, Krüger H, Haevernick K, Daubmann A, Wegscheider K, Scherer M. Enhancing activities of daily living of chronic stroke patients in primary health care by modified constraint-induced movement therapy (HOMECIMT): study protocol for a cluster randomized controlled trial. Trials 2013; 14:334. [PMID: 24124993 PMCID: PMC3853576 DOI: 10.1186/1745-6215-14-334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke leads to constant rehabilitation needs even at the chronic stage. However, although many stroke patients receive physical or occupational therapy in primary health care, treatment prescriptions do not generally specify therapeutic goals; in particular, participation is not established as an explicit therapeutic goal in the ambulatory setting. The primary aim of this study is to evaluate the efficacy of a therapy regimen for chronic stroke patients (modified 'constraint-induced movement therapy (CIMT) at home') with impaired hand or arm function with regard to the prerequisites of participation in everyday activities: a sufficient arm and hand function. 'CIMT at home' will be compared with conventional physical and occupational therapy ('therapy as usual'). METHODS/DESIGN The study is a parallel cluster randomized controlled trial with therapy practices as clusters (n = 48). After written consent from the patients (n = 144), the therapists will be randomly assigned to treat either the intervention or the control group. Blinded external assessors will evaluate the patients using standardized outcome measures before and after the intervention, and six months later. The two coprimary endpoint assessments of arm and hand function as prerequisites for participation (defined as equal involvement in activities of daily living) are the motor activity log (quality of arm and hand use) and the Wolf motor function test (arm and hand function). These assessments are made four weeks post-treatment and relativized to baseline performance. Changes in primary outcomes will be analyzed with mixed models, which consider the hierarchical structure of the data and will be adjusted to the baseline measurements and sex. The primary analysis will be the comparison of the two randomized groups, with respect to the adjusted averages for each of the two coprimary endpoints. To keep an overall significance level of 5%, the two endpoints will be tested at the significance level of 5% each in hierarchical order. DISCUSSION A modification of the CIMT, feasible in the patients' homes (CIMT at home), appears to be a promising therapeutic approach in the ambulatory care of chronic stroke patients. With proven efficacy and practicality, a participation-oriented, stroke-specific treatment would be available in primary care. TRIAL REGISTRATION ClinicalTrials.gov NCT01343602.
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Affiliation(s)
- Anne Barzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Gesche Ketels
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Britta Tetzlaff
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Heike Krüger
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Kerstin Haevernick
- Physiotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Harris J. Clinician's Commentary on Stevenson et al.(1.). Physiother Can 2013; 64:414. [PMID: 23997397 DOI: 10.3138/ptc.2011-24-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jocelyn Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
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Stevenson T, Thalman L, Christie H, Poluha W. Constraint-Induced Movement Therapy Compared to Dose-Matched Interventions for Upper-Limb Dysfunction in Adult Survivors of Stroke: A Systematic Review with Meta-analysis. Physiother Can 2013; 64:397-413. [PMID: 23997396 DOI: 10.3138/ptc.2011-24] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To summarize the existing literature examining constraint-induced movement therapy (CIMT), relative to dose-matched control interventions, for upper-limb (UL) dysfunction in adult survivors of stroke. METHODS CINAHL, Cochrane Library, Embase, NARIC/CIRRIE-Rehabdata, PEDro, PubMed, Scopus, and Web of Science were searched from their inception to February 2011. Trial quality was described using the PEDro scale. The findings were summarized with meta-analysis. RESULTS For the 22 trials identified, the mean (SD) PEDro score was 6.4 (1.2). Meta-analysis showed CIMT to be superior to dose-matched interventions based on indicators of UL motor capacity (15 trials, n=432; standardized mean difference [SMD]=0.47, 95% CI, 0.27-0.66) and UL ability (14 trials, n=352; SMD=0.80, 95% CI, 0.57-1.02); Functional Independence Measure scores (6 trials, n=182; mean difference [MD]=5.05, 95% CI, 2.23-7.87); and Motor Activity Log scores (Amount of Use: 12 trials, n=318; MD=1.05, 95% CI, 0.85-1.24; Quality of Movement: 11 trials, n=330; MD=0.89, 95% CI, 0.69-1.08). CONCLUSIONS Compared to control interventions of equal duration and dose, CIMT produced greater improvements in a variety of indicators of UL function in adult survivors of a stroke with residual movement of their upper limb.
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Affiliation(s)
- Ted Stevenson
- Department of Rehabilitation Services, St. Boniface Hospital
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Kim JH, Chung EJ, Lee BH. A study of analysis of the brain wave with respected to action observation and motor imagery: a pilot randomized controlled trial. J Phys Ther Sci 2013; 25:779-82. [PMID: 24259851 PMCID: PMC3820384 DOI: 10.1589/jpts.25.779] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/01/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to compare the effects of action observation
training and motor imagery training on recovery from chronic stroke. [Subjects] Thirty
patients (who were over six months post stroke) participated in this study and were
randomly allocated to three groups. [Methods] The action observation training group
practiced additional action observation training for five 30-minute sessions over a
four-week period. The motor imagery training group practiced additional motor imagery
training for five 30-minute sessions over a four-week period. Electroencephalogram were
used to compare brain waves between the three groups. [Results] The action observation
group showed significant changes in relative alpha power in Fp1 and Fp2 and relative beta
power in Fp2 and C3. [Conclusion] Action observation induces higher levels of cognitive
activities than motor imagery and physical training. Action observation is expected to be
more effective for stroke patients.
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Affiliation(s)
- Jung-Hee Kim
- Department of Physical Therapy, College of Health Science, Sahmyook University
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Turolla A, Dam M, Ventura L, Tonin P, Agostini M, Zucconi C, Kiper P, Cagnin A, Piron L. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. J Neuroeng Rehabil 2013; 10:85. [PMID: 23914733 PMCID: PMC3734026 DOI: 10.1186/1743-0003-10-85] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 06/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recent evidence has demonstrated the efficacy of Virtual Reality (VR) for stroke rehabilitation nonetheless its benefits and limitations in large population of patients have not yet been studied. OBJECTIVES To evaluate the effectiveness of non-immersive VR treatment for the restoration of the upper limb motor function and its impact on the activities of daily living capacities in post-stroke patients. METHODS A pragmatic clinical trial was conducted among post-stroke patients admitted to our rehabilitation hospital. We enrolled 376 subjects who had a motor arm subscore on the Italian version of the National Institutes of Health Stroke Scale (It-NIHSS) between 1 and 3 and without severe neuropsychological impairments interfering with recovery. Patients were allocated to two treatments groups, receiving combined VR and upper limb conventional (ULC) therapy or ULC therapy alone. The treatment programs consisted of 2 hours of daily therapy, delivered 5 days per week, for 4 weeks. The outcome measures were the Fugl-Meyer Upper Extremity (F-M UE) and Functional Independence Measure (FIM) scales. RESULTS Both treatments significantly improved F-M UE and FIM scores, but the improvement obtained with VR rehabilitation was significantly greater than that achieved with ULC therapy alone. The estimated effect size of the minimal difference between groups in F-M UE and FIM scores was 2.5 ± 0.5 (P < 0.001) pts and 3.2 ± 1.2 (P = 0.007) pts, respectively. CONCLUSIONS VR rehabilitation in post-stroke patients seems more effective than conventional interventions in restoring upper limb motor impairments and motor related functional abilities. TRIAL REGISTRATION Italian Ministry of Health IRCCS Research Programme 2590412.
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Affiliation(s)
- Andrea Turolla
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
| | - Mauro Dam
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
| | - Laura Ventura
- Department of Statistics, University of Padova, Via Cesare Battisti, 241 – 35121 Padova, Italy
| | - Paolo Tonin
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
| | - Michela Agostini
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
| | - Carla Zucconi
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
| | - Pawel Kiper
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
| | - Annachiara Cagnin
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
- Department of Neuroscience: SNPSRR, University of Padova, Via Giustiniani, 5 – 35128 Padova, Italy
| | - Lamberto Piron
- I.R.C.C.S. Fondazione Ospedale San Camillo, Via Alberoni, 70-30126 Venezia-Lido, Italy
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Adrienne C, Manigandan C. Inpatient occupational therapists hand-splinting practice for clients with stroke: A cross-sectional survey from Ireland. J Neurosci Rural Pract 2013; 2:141-9. [PMID: 21897676 PMCID: PMC3159349 DOI: 10.4103/0976-3147.83579] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Hand splinting after stroke is a common practice despite inadequate evidence. This warrants a better understanding of the therapists’ splinting practice, to develop clinically meaningful treatment options. Aims: The study examined the nature and prevalence of the factors associated with therapists’ hand splinting practice and their perceived splinting efficacy. Settings and Design: A cross-sectional national survey of hand-splinting practice among inpatient occupational therapists (OTs) in Ireland. Materials and Methods: Sixty-two therapists participated in this national survey. Statistical analysis used A number of factors were analyzed to explore their relationship with therapists’ perception of splint efficacy using Spearman's rank order correlation. Results: 53(85.5%) out of 62 survey respondents prescribed splints to their clients at the time of taking the survey. To reduce spasticity, to correct contractures and thus increase range of motion (ROM) were the commonly used splinting goals. These were the goals that were significantly associated with the therapists’ splinting efficacy too. Conclusions: Hand-splint prescription following stroke was found to be a common practice among OTs who perceive splints to be quite effective. A custom-made, volar forearm-based wrist-hand splint is the preferred splint among therapists to achieve a number of clinical aims such as improving ROM, stretching soft tissue contractures and reducing spasticity in the upper extremity. A wide variety of splinting regimens is currently practiced, reflecting the lack of a universally accepted and comprehensive practice guideline to regulate therapy. Methodologically valid clinical trials evaluating the efficacy of therapist-preferred splints in achieving their favored outcomes are needed. Development of common, universally accepted therapeutic guidelines based on comprehensive scientific review of such studies is thus needed.
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Affiliation(s)
- Cormican Adrienne
- Occupational Therapy Discipline, School of Health Sciences, National University of Ireland, Galway, Ireland
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Noninvasive strategies to promote functional recovery after stroke. Neural Plast 2013; 2013:854597. [PMID: 23864962 PMCID: PMC3707231 DOI: 10.1155/2013/854597] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/02/2013] [Indexed: 01/17/2023] Open
Abstract
Stroke is a common and disabling global health-care problem, which is the third most common cause of death and one of the main causes of acquired adult disability in many countries. Rehabilitation interventions are a major component of patient care. In the last few years, brain stimulation, mirror therapy, action observation, or mental practice with motor imagery has emerged as interesting options as add-on interventions to standard physical therapies. The neural bases for poststroke recovery rely on the concept of plasticity, namely, the ability of central nervous system cells to modify their structure and function in response to external stimuli. In this review, we will discuss recent noninvasive strategies employed to enhance functional recovery in stroke patients and we will provide an overview of neural plastic events associated with rehabilitation in preclinical models of stroke.
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Sterr A, Dean PJA, Vieira G, Conforto AB, Shen S, Sato JR. Cortical thickness changes in the non-lesioned hemisphere associated with non-paretic arm immobilization in modified CI therapy. NEUROIMAGE-CLINICAL 2013; 2:797-803. [PMID: 24179830 PMCID: PMC3777789 DOI: 10.1016/j.nicl.2013.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 11/11/2022]
Abstract
Recent evidence suggests that immobilization of the upper limb for 2–3 weeks induces changes in cortical thickness as well as motor performance. In constraint induced (CI) therapy, one of the most effective interventions for hemiplegia, the non-paretic arm is constrained to enforce the use of the paretic arm in the home setting. With the present study we aimed to explore whether non-paretic arm immobilization in CI therapy induces structural changes in the non-lesioned hemisphere, and how these changes are related to treatment benefit. 31 patients with chronic hemiparesis participated in CI therapy with (N = 14) and without (N = 17) constraint. Motor ability scores were acquired before and after treatment. Diffusion tensor imaging (DTI) data was obtained prior to treatment. Cortical thickness was measured with the Freesurfer software. In both groups cortical thickness in the contralesional primary somatosensory cortex increased and motor function improved with the intervention. However the cortical thickness change was not associated with the magnitude of motor function improvement. Moreover, the treatment effect and the cortical thickness change were not significantly different between the constraint and the non-constraint groups. There was no correlation between fractional anisotropy changes in the non-lesioned hemisphere and treatment outcome. CI therapy induced cortical thickness changes in contralesional sensorimotor regions, but this effect does not appear to be driven by the immobilization of the non-paretic arm, as indicated by the absence of differences between the constraint and the non-constraint groups. Our data does not suggest that the arm immobilization used in CI therapy is associated with noticeable cortical thinning.
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