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Ranzani R, Razzoli M, Sanson P, Song J, Galati S, Ferrarese C, Lambercy O, Kaelin-Lang A, Gassert R. Feasibility of Adjunct Therapy with a Robotic Hand Orthosis after Botulinum Toxin Injections in Persons with Spasticity: A Pilot Study. Toxins (Basel) 2024; 16:346. [PMID: 39195756 PMCID: PMC11360205 DOI: 10.3390/toxins16080346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/29/2024] Open
Abstract
Upper-limb spasticity, frequent after central nervous system lesions, is typically treated with botulinum neurotoxin type A (BoNT-A) injections to reduce muscle tone and increase range of motion. However, performing adjunct physical therapy post-BoNT-A can be challenging due to residual weakness or spasticity. This study evaluates the feasibility of hand therapy using a robotic hand orthosis (RELab tenoexo) with a mobile phone application as an adjunct to BoNT-A injections. Five chronic spastic patients participated in a two-session pilot study. Functional (Box and Block Test (BBT), Action Research Arm Test (ARAT)), and muscle tone (Modified Ashworth Scale (MAS)) assessments were conducted to assess functional abilities and impairment, along with usability evaluations. In the first session, subjects received BoNT-A injections, and then they performed a simulated unsupervised therapy session with the RELab tenoexo in a second session a month later. Results showed that BoNT-A reduced muscle tone (from 12.2 to 7.4 MAS points). The addition of RELab tenoexo therapy was safe, led to functional improvements in four subjects (two-cube increase in BBT as well as 2.8 points in grasp and 1.3 points in grip on ARAT). Usability results indicate that, with minor improvements, adjunct RELab tenoexo therapy could enhance therapy doses and, potentially, long-term outcomes.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
- Cereneo, Center for Neurology and Rehabilitation, Seestrasse 18, 6354 Vitznau, Switzerland
| | - Margherita Razzoli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Pierre Sanson
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Jaeyong Song
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Salvatore Galati
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126 Milan, Italy;
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
| | - Alain Kaelin-Lang
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6962 Lugano, Switzerland; (S.G.); (A.K.-L.)
- Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Gloriastrasse 37/39, 8092 Zurich, Switzerland; (M.R.); (P.S.); (J.S.); (O.L.); (R.G.)
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Zeynep KU, Damla C, Ebru U. Which Acute Stroke Patients can Walk while Returning Home? Factors Predicting Ambulation. Neurol India 2024; 72:824-829. [PMID: 39216041 DOI: 10.4103/neurol-india.ni_188_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/09/2023] [Indexed: 09/04/2024]
Abstract
PURPOSE Regaining gait is the primary goal in stroke rehabilitation. In this study, we aimed to investigate the effect of premorbid features of acute stroke patients on the ambulatory level. METHODS The study included 174 patients who applied to our rehabilitation clinic within the first month after the onset of stroke. Demographic characteristics of patients, pre-stroke symptoms, and stroke characteristics were questioned from patient files and historical data. The ambulation levels of patients before and after rehabilitation were evaluated with the functional ambulation category. The relationship between demographic characteristics, pre-stroke symptoms, stroke characteristics, and ambulation levels of patients before and after rehabilitation was examined. RESULTS The presence of coronary heart diseases, atrial fibrillation, and nausea/vomiting before stroke were independent negative risk factors on both pre- and post-rehabilitation ambulation levels (P < 0.05). Additionally, advanced age, oxygen, and mechanical ventilation requirement were other negative independent risk factors on post-rehabilitation ambulation levels (P < 0.05). CONCLUSIONS Knowing some of the pre-stroke characteristics of patients while applying rehabilitation programs may be useful in estimating the ambulatory levels on returning home.
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Affiliation(s)
- Kirac Unal Zeynep
- Physical Medicine and Rehabilitation Clinic, Dr Hulusi Alataş Elmadağ State Hospital, Ankara, Turkey
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A Preliminary Study of the Influence of High Intensity Laser Therapy (HILT) on Skin Surface Temperature and Longissimus Dorsi Muscle Tone Changes in Thoroughbred Racehorses with Back Pain. Animals (Basel) 2023; 13:ani13050794. [PMID: 36899651 PMCID: PMC10000047 DOI: 10.3390/ani13050794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The reason for undertaking this study was to investigate soft tissue response to high-intensity laser therapy (HILT) by measuring changes in skin surface temperature and longissimus dorsi muscle tone in the thoracolumbar back area in Thoroughbreds with back pain and diagnosed with and without Kissing Spines Syndrome (KSS). Thoroughbreds aged 3-4 years with clinically presented back pain underwent a radiological examination (to assess a lack or presence of KSS) and longissimus dorsi muscle palpation (to assess muscle tone and pain degree). The subjects were divided into two groups, those with KSS (n = 10) and those without KSS (n = 10). A single HILT treatment on the longissimus dorsi muscle, on the left side, was performed. Thermographic examination and palpation were repeated before and after HILT to assess changes in skin surface temperature and muscle pain response. In both groups, HILT caused a significant increase in skin surface temperature of 2.5 °C on average and a palpation score reduction of 1.5 degrees on average (p = 0.005 for both measurements), without differences in any outcome measures between the groups. Furthermore, the correlation between changes in the average skin surface temperature and the average palpation scores in horses with and without KSS were negative (rho = 0.071 and r = -0.180, respectively; p > 0.05). The results of the present study are encouraging, but further studies with larger samples, a longer follow-up period and comparisons with placebo control groups are needed to draw a more valid conclusion.
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Ranzani R, Chiriatti G, Schwarz A, Devittori G, Gassert R, Lambercy O. An online method to monitor hand muscle tone during robot-assisted rehabilitation. Front Robot AI 2023; 10:1093124. [PMID: 36814447 PMCID: PMC9939644 DOI: 10.3389/frobt.2023.1093124] [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: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction: Robot-assisted neurorehabilitation is becoming an established method to complement conventional therapy after stroke and provide intensive therapy regimes in unsupervised settings (e.g., home rehabilitation). Intensive therapies may temporarily contribute to increasing muscle tone and spasticity, especially in stroke patients presenting tone alterations. If sustained without supervision, such an increase in muscle tone could have negative effects (e.g., functional disability, pain). We propose an online perturbation-based method that monitors finger muscle tone during unsupervised robot-assisted hand therapy exercises. Methods: We used the ReHandyBot, a novel 2 degrees of freedom (DOF) haptic device to perform robot-assisted therapy exercises training hand grasping (i.e., flexion-extension of the fingers) and forearm pronosupination. The tone estimation method consisted of fast (150 ms) and slow (250 ms) 20 mm ramp-and-hold perturbations on the grasping DOF, which were applied during the exercises to stretch the finger flexors. The perturbation-induced peak force at the finger pads was used to compute tone. In this work, we evaluated the method performance in a stiffness identification experiment with springs (0.97 and 1.57 N/mm), which simulated the stiffness of a human hand, and in a pilot study with subjects with increased muscle tone after stroke and unimpaired, which performed one active sensorimotor exercise embedding the tone monitoring method. Results: The method accurately estimates forces with root mean square percentage errors of 3.8% and 11.3% for the soft and stiff spring, respectively. In the pilot study, six chronic ischemic stroke patients [141.8 (56.7) months after stroke, 64.3 (9.5) years old, expressed as mean (std)] and ten unimpaired subjects [59.9 (6.1) years old] were tested without adverse events. The average reaction force at the level of the fingertip during slow and fast perturbations in the exercise were respectively 10.7 (5.6) N and 13.7 (5.6) N for the patients and 5.8 (4.2) N and 6.8 (5.1) N for the unimpaired subjects. Discussion: The proposed method estimates reaction forces of physical springs accurately, and captures online increased reaction forces in persons with stroke compared to unimpaired subjects within unsupervised human-robot interactions. In the future, the identified range of muscle tone increase after stroke could be used to customize therapy for each subject and maintain safety during intensive robot-assisted rehabilitation.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,*Correspondence: Raffaele Ranzani,
| | - Giorgia Chiriatti
- Department of Industrial Engineering and Mathematical Science, Polytechnic University of Marche, Ancona, Italy
| | - Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giada Devittori
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Future Health Technologies, Singapore—ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Future Health Technologies, Singapore—ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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Kim GJ, Lebovich S, Rand D. Perceived Facilitators and Barriers for Actual Arm Use during Everyday Activities in Community Dwelling Individuals with Chronic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11707. [PMID: 36141980 PMCID: PMC9516989 DOI: 10.3390/ijerph191811707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Our aim was to gain a deeper understanding of perceived predictors for actual arm use during daily functional activities. METHODS Qualitative study. Semi-structured interview data collected from individuals with chronic stroke living in the community. Codebook thematic analysis used for the data analysis. RESULTS Six participants 5-18 years post stroke with moderate to severe UE impairment. Three domains were identified: Person, Context, and Task. Themes for the Person domain included mental (cognitive effort, lack of acceptance), behavioral (routines/habits, self-evaluation), and physical (stiffness/fatigue). Themes for the Context domain included social environment (being in public, presence, and actions of others) and time constraints (being in a hurry). Themes for the task domain included necessity to complete bilateral and unilateral tasks, and safety (increased risk of accidents). CONCLUSION Actual arm use is a complex construct related to the characteristics of the person, contextual environment, and the nature of the task. Facilitators included cognitive effort, routines/habits, self-evaluation, and the perceived necessity. Barriers included in lack of acceptance, stiffness/fatigue, being in public, being in a hurry, and risk of ac-cidents. Social support was both a facilitator and a barrier. Our results support the growing call to adopt a broader biopsychosocial framework into rehabilitation delivery.
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Affiliation(s)
- Grace J. Kim
- Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, NY 10003, USA
| | - Shir Lebovich
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Occupational Therapy Services, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Rusu L, Paun E, Marin MI, Hemanth J, Rusu MR, Calina ML, Bacanoiu MV, Danoiu M, Danciulescu D. Plantar Pressure and Contact Area Measurement of Foot Abnormalities in Stroke Rehabilitation. Brain Sci 2021; 11:1213. [PMID: 34573233 PMCID: PMC8469353 DOI: 10.3390/brainsci11091213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluation of plantar pressure in stroke patients is a parameter that could be used for monitoring and comparing how the timing of starting a rehabilitation program effects patient improvement. METHODS We performed the following clinical and functional evaluations: initial moment (T1), intermediate (T2), and final evaluation at one year (T3). At T1 we studied 100 stroke patients in two groups, A and B (each 50 patients). The first group, A, started rehabilitation in the first three months after having a stroke, and group B started after three months from the time of stroke. Due to the impediments observed during rehabilitation, we made biomechanic evaluation for two lots, I and II (each 25 patients). Assessment of the patient was carried out by clinical (neurologic examination), functional (using the Tinetti Functional Gait Assessment Test for classifying the gait), and biomechanical evaluation (maximal plantar pressure (Pmax), contact area (CA), and pressure distribution (COP)). RESULTS The Tinetti scale for gait had the following scores: for group A, from 1.34 at the initial moment (T1) to 10.64 at final evaluation (T3), and for group B, 3.08 at initial moment (T1) to 9 at final evaluation (T3). Distribution of COP in the left hemiparesis was uneven at T1 but evolved after rehabilitation. The right hemiparesis had uniform COP distribution even at T1, explained by motor dominance on the right side. CA and Pmax for lot I increased more than 100%, meaning that there is a possibility for favorable improvement if the patients start the rehabilitation program in the first three months after stroke. For lot II, increases of the parameters were less than lot I. DISCUSSIONS The recovery potential is higher for patients with right hemiparesis. Biomechanic evaluation showed diversity regarding compensatory mechanisms for the paretic and nonparetic lower limb. CONCLUSIONS CA and Pmax are relevant assessments for evaluating the effects on timing of starting a rehabilitation program after a stroke.
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Affiliation(s)
- Ligia Rusu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Elvira Paun
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Mihnea Ion Marin
- Faculty of Mechanics, University of Craiova, 200585 Craiova, Romania
| | - Jude Hemanth
- Department of ECE, Karunya Institute of Technology and Sciences, Coimbatore 641114, India
| | - Mihai Robert Rusu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Mirela Lucia Calina
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | | | - Mircea Danoiu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
| | - Daniel Danciulescu
- Sport Medicine and Physiotherapy Department, University of Craiova, 200585 Craiova, Romania
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SZAKÁCS J, DUICA LC, RACHERIU M. Quality of Life and Negative Affectivity at the Patients with Stroke and Musculoskeletal Disorders. BALNEO AND PRM RESEARCH JOURNAL 2021. [DOI: 10.12680/balneo.2021.449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. Stroke can be a severe debilitating medical condition due to its medical consequences. When it occurs at an individual with pre-existent musculoskeletal disorders, the medical recovery becomes more problematic. Some consequences, like negative affectivity and a reduced quality of life intervene to varying degrees.
Material and method. Our study included 150 outpatients who were diagnosed with stroke and one of five types of musculoskeletal disorders (low back pain, osteoporosis, hand disorders, hip osteoarthritis, knee osteoarthritis). We divided all the patients in five sub-groups. To assess the negative affectivity (anxiety) and quality of life we administered to the patients two scales: the State Trait Anxiety Inventory (STAI) form X1 (anxiety a s a state) and form X2 (anxiety as a trait) and The Quality of Life (QOL).
Results. In patients diagnosed with stroke and osteoporosis, the quality of life was 83.92% of the maximum value. Anxiety as a state rated at an average of 50.5 and anxiety as a trait rated at an average of 45. In the case of stroke and degenerative diseases at the lower limbs, we registered the quality of life of 77.68% in knee osteoarthritis and 75.89% in hip osteoarthritis; anxiety as a condition had an average value of 65 and, as a trait, a value of 63 in knee osteoarthritis, while in hip osteoarthritis the anxiety as a condition, and, in the same time, as a trait, rated both at 49.5. Low back pain in stroke patients had a quality of life of 77.86% of the maximum value; anxiety as a condition was 48 and the anxiety trait has the value of 47. For the patients with stroke and hand disease, the quality of life was assessed at 88.83%. Anxiety as a condition recorded an average value of 48 and the average value of 51 for anxiety as a trait recorded an average value of 51.
Conclusions. The lowest score of quality of life is recorded in the patient diagnosed with stroke and hip osteoarthritis (75.89% of the maximum value). This association converges with body dynamics, as the overlap of these two medical conditions may explain reduced functionality. The value of anxiety as a condition and also as a trait was higher in patients with stroke and osteoarthritis of the knee (65 and 63, respectively). The latter result is understandable, as intense pain and, therefore, discomfort related to osteoarthritis of the knee is well known.
Keywords: stroke, anxiety, quality of life, musculoskeletal conditions,
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Affiliation(s)
- Juliánna SZAKÁCS
- George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Biophysics, Targu Mureș, Romania
| | - Lavinia-Corina DUICA
- Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania 3Hospital of Psychiatry „Doctor Gheorghe Preda” Sibiu, România
| | - Mihaela RACHERIU
- Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania, County Clinical Emergency Hospital, Sibiu, Romania
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Weakened Effective Connectivity Related to Electroacupuncture in Stroke Patients with Prolonged Flaccid Paralysis: An EEG Pilot Study. Neural Plast 2021; 2021:6641506. [PMID: 33777135 PMCID: PMC7969113 DOI: 10.1155/2021/6641506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
Flaccid paralysis in the upper extremity is a severe motor impairment after stroke, which exists for weeks, months, or even years. Electroacupuncture treatment is one of the most widely used TCM therapeutic interventions for poststroke flaccid paralysis. However, the response to electroacupuncture in different durations of flaccid stage poststroke as well as in the topological configuration of the cortical network remains unclear. The objectives of this study are to explore the disruption of the cortical network in patients in different durations of flaccid stage and observe dynamic network reorganization during and after electroacupuncture. Resting-state networks were constructed from 18 subjects with flaccid upper extremity by partial directed coherence (PDC) analysis of multichannel EEG. They were allocated to three groups according to time after flaccid paralysis: the short-duration group (those with flaccidity for less than two months), the medium-duration group (those with flaccidity between two months and six months), and the long-duration group (those with flaccidity over six months). Compared with short-duration flaccid subjects, weakened effective connectivity was presented in medium-duration and long-duration groups before electroacupuncture. The long-duration group has no response in the cortical network during electroacupuncture. The global network measures of EEG data (sPDC, mPDC, and N) indicated that there was no significant difference among the three groups. These results suggested that the network connectivity reduced and weakly responded to electroacupuncture in patients with flaccid paralysis for over six months. These findings may help us to modulate the formulation of electroacupuncture treatment according to different durations of the flaccid upper extremity.
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SILIŞTEANU SC, ANTONESCU E, DUICĂ L. Strategies for the recovery of patients with post stroke sequelae in the context of the COVID-19 pandemic. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction. The performance areas of post-stroke mention negatively correlated determinants in doing daily activities. The intrinsic motor recovery depends on the primary motor deficit. The functional recovery of patients with post-stroke sequelae is not only based on the remission of the functional deficit, but it also depends on the ability to develop adapted motor strategies.The objective of the study was to point out, for the patients with post-stroke sequelae, the sensitive, motor and cognitive changes in the context of the COVID-19 pandemic. Material and method. The study included a number of 18 patients diagnosed with post-stroke sequelae and was conducted for a period of 5 months in an outpatient department. The recovery treatment included sessions of kinetotherapy and occupational therapy. The evaluation of the patients was made in the beginning of the treatment, at its end and at the control after 6 weeks. Scales were used to assess pain, the static and dynamic balance, the gait and the cognitive function. Results. The obtained results were statistically significant for the patients in the group. The values that were obtained by applying the tests and evaluation scales are consistent with the clinical evolution of the patients in the study group. Conclusions. Given the pandemic period we are going through, it is still necessary to carefully evaluate not only the sensory-motor functions of patients with post-stroke sequelae, but also the cognitive functions that are known to influence in some situations the recovery of these patients.
Keywords: post-stroke sequelae, functional recovery, kinetic therapy,
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Affiliation(s)
- Sînziana Călina SILIŞTEANU
- 1. Railway Hospital Iasi - Specialty Ambulatory of Suceava 2. "Stefan cel Mare" University of Suceava FEFS-DSDU
| | - Elisabeta ANTONESCU
- 3. Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România 4. County Clinical Emergency Hospital, Sibiu, România
| | - Lavinia DUICĂ
- 3. Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România
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SILIŞTEANU SC, ANTONESCU E, DUICĂ L. The importance of balance and postural control in the recovery of stroke patients. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction.According to the criteria of WHO, stroke is a health condition that causes focal or global brain disorders (1), but without an apparent nonvascular cause. Stroke is considered the third leading cause of death in industrialized countries and accounts for 9% of all deaths, being considered one of the largest cases of disability in the world. Due to the medical, social and economic consequences that it causes, stroke is considered a public health issue. Purpose of research. The study starts from the idea that in the recovery of stroke patients it is important to have an individualized physiotherapy program adapted to the functional parts of each patient, having the role of improving the static and dynamic balance, of achieving postural control and finally functional independence. Material and method. The study included a number of 22 patients with sequelae stroke. They made physiotherapy, occupational therapy and occupational therapy sessions in the ambulatory, with the length of 1 hour, 3 times a week, in total 15 sessions. The evaluation of the patient was performed in the beginning of the treatment and at the end of it. Scales were used to assess mobility, static and dynamic balance, gait and functional independence. Results. The application of individualized treatment adapted to the functional body of each patient allowed a rapid recovery for the vast majority of the studied patients. The values obtained in the tests and evaluation scales are in accordance with the clinical evolution of the patients. Conclusions.The application of the treatment by kinetic therapy, work therapy and occupational therapy to the 22 patients, for a period of 3 weeks pointed out the reduction of pain, the improvement of movements, the recovery of transfers and gait, the postural improvement.
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Affiliation(s)
- Sînziana Călina SILIŞTEANU
- 1. Railway Hospital Iasi - Specialty Ambulatory of Suceava 2. "Stefan cel Mare" University of Suceava FEFS-DSDU
| | - Elisabeta ANTONESCU
- 3. Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România 4. County Clinical Emergency Hospital, Sibiu, România
| | - Lavinia DUICĂ
- 3. Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România, 5. Hospital of Psychiatry „Doctor Gheorghe Preda” Sibiu, România
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Ranzani R, Viggiano F, Engelbrecht B, Held JPO, Lambercy O, Gassert R. Method for Muscle Tone Monitoring During Robot-Assisted Therapy of Hand Function: A Proof of Concept. IEEE Int Conf Rehabil Robot 2020; 2019:957-962. [PMID: 31374753 DOI: 10.1109/icorr.2019.8779454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Robot-assisted rehabilitation of hand function is becoming an established approach to complement conventional therapy after stroke, particularly in view of its possible unsupervised use to promote an increase in therapy dose. Given their intensive therapy regime, robots may promote a temporary increase in hand muscle tone and spasticity, which may cause pain and negatively affect recovery. To integrate hand muscle tone monitoring into an assessment-driven robot-assisted therapy concept, an online assessment of muscle tone is proposed and incorporated into an exercise. The exercise was preliminarily tested in a pilot study with five chronic stroke survivors (non-spastic at rest) and five healthy participants to identify the range of potential physiological muscle tone change that can happen also in a non-spastic population during a single exercise session. In both groups, the muscle tone level during hand opening was higher in fast 20 mm ramp-and-hold perturbations (150 ms) compared to slow (250 ms) perturbations, and corresponded to a force change of approximately 4-5 N. Despite not being statistically significantly different, in the stroke group the force change (and the speed dependency) increased with exercise time. This information could serve as a basis to develop strategies to continuously adapt the difficulty and activity level required in robot-assisted rehabilitation and to monitor or even control the muscle tone evolution over time.
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Predictors of functional and motor outcomes following upper limb robot-assisted therapy after stroke. Int J Rehabil Res 2019; 42:223-228. [PMID: 30932930 DOI: 10.1097/mrr.0000000000000349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Robot-assisted therapy is an effective treatment for stroke patients and has recently gained popularity. Clinicians and researchers are trying to identify predictors to stratify patients for ensuring better stroke rehabilitation outcomes. However, previous studies have reported controversial results regarding the predictors of upper limb recovery after robot-assisted therapy. Our objective was to determine whether the demographic and clinical characteristics of stroke patients influence the motor and functional outcomes after robot-assisted therapy. We conducted a retrospective analysis of 48 hemiplegic patients who performed upper limb goal-directed tasks using RAPAEL Smart Glove (Neofect, Gyeonggi-do, Republic of Korea). Robot-assisted therapy was administered for 5 days a week over 4 weeks, and each session was for 30 minutes. The parameters of the primary outcomes after robot-assisted therapy were measured with the manual function test and functional independence measure. Correlation analysis showed that age, initial cognitive function, and the initial manual function test and the Modified Ashworth Scale for upper extremity scores were significant factors for independently predicting functional outcomes after robot-assisted therapy. Linear regression analysis revealed that the initial Mini-Mental State Examination (P < 0.001) and initial manual function test (P < 0.001) scores were significant predictors of the primary outcomes. In conclusion, our study suggests that stroke patients presenting with less spasticity, better initial cognitive function, and better initial motor function have a significant correlation with the functional outcomes after robot-assisted therapy.
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Jang MU, Kang J, Kim BJ, Hong JH, Yeo MJ, Han MK, Lee BC, Yu KH, Oh MS, Choi KC, Lee SH, Hong KS, Cho YJ, Park JM, Cha JK, Kim DH, Park TH, Lee KB, Lee SJ, Lee J, Kim JT, Kim DE, Choi JC, Lee J, Lee JS, Gorelick PB, Bae HJ. In-Hospital and Post-Discharge Recovery after Acute Ischemic Stroke: a Nationwide Multicenter Stroke Registry-base Study. J Korean Med Sci 2019; 34:e240. [PMID: 31538419 PMCID: PMC6753366 DOI: 10.3346/jkms.2019.34.e240] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Using data from a large national stroke registry, we aimed to investigate the incidence and determinants of in-hospital and post-discharge recovery after acute ischemic stroke and the independence of their occurrence. METHODS In-hospital recovery was defined as an improvement of 4 points or > 40% in the National Institutes of Health Stroke Scale (NIHSS) score from admission to discharge. Post-discharge recovery was defined as any improvement in the modified Rankin Scale (mRS) score from discharge to 3 months after stroke onset. Two analytic methods (multivariate and multivariable logistic regression) were applied to compare the effects of 18 known determinants of 3-month outcome and to verify whether in-hospital and post-discharge recovery occur independently. RESULTS During 54 months, 11,088 patients with acute ischemic stroke meeting the eligibility criteria were identified. In-hospital and post-discharge recovery occurred in 36% and 33% of patients, respectively. Multivariate logistic regression with an equality test for odds ratios showed that 7 determinants (age, onset-to-admission time, NIHSS score at admission, blood glucose at admission, systolic blood pressure, smoking, recanalization therapy) had a differential effect on in-hospital and post-discharge recovery in the way of the opposite direction or of the same direction with different degree (all P values < 0.05). Both in-hospital and post-discharge recovery occurred in 12% of the study population and neither of them in 43%. The incidence of post-discharge recovery in those with in-hospital recovery was similar to that in those without (33.8% vs. 32.7%, respectively), but multivariable analysis showed that these 2 types of recovery occurred independently. CONCLUSION Our findings suggest that, in patients with acute ischemic stroke, in-hospital and post-discharge recovery may occur independently and largely in response to different factors.
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Affiliation(s)
- Min Uk Jang
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Jihoon Kang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Min Ju Yeo
- Department of Neurology, Hankook General Hospital, Jeju, Korea
| | - Moon Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Ho Yu
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Chan Choi
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Hwa Lee
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Keun Sik Hong
- Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea
| | - Yong Jin Cho
- Department of Neurology, Inje University, Ilsan Paik Hospital, Ilsan, Korea
| | - Jong Moo Park
- Department of Neurology, Eulji University, Eulji General Hospital, Seoul, Korea
| | - Jae Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Dae Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Ji Sung Lee
- Asan Medical Center, Clinical Research Center, Seoul, Korea
| | - Philip B Gorelick
- Department of Translational Science and Molecular Medicine and Mercy Health Hauenstein Neurosciences, Michigan State University College of Human Medicine, Michigan, United States
| | - Hee Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Matsuura A, Karita T, Nakada N, Fukushima S, Mori F. Correlation between changes of contralesional cortical activity and motor function recovery in patients with hemiparetic stroke. Phys Ther Res 2018; 20:28-35. [PMID: 29333360 DOI: 10.1298/ptr.e9911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 06/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the correlation between changes of contralesional cortical excitability evaluated by transcranial magnetic stimulation (TMS) and functional recovery in patients with hemiparetic stroke. METHODS Eight inpatients (mean age: 75.9±13.8 years) with mild to moderate hemiparesis were enrolled. TMS was delivered to the optimal scalp position over the contralesional (ipsilateral to the paresis) primary motor cortex (M1) to activate the unaffected flexor carpi radialis muscle (FCR) while the patient picked up a wooden block with the affected hand. The amplitude of the motor-evoked potential (MEP) was measured and then was divided by the resting MEP amplitude (MEP ratio). For evaluation of motor function, we tested grip strength (GS), performed the upper extremity motor section of the Fugl-Meyer Assessment (FMA-UE), and performed the Purdue Pegboard Test (PPT) when the patients were admitted to our hospital (T1) and 2 months after admission (T2). RESULTS The MEP ratio was significantly decreased at the second examination. The partial correlations between the MEP ratio and FMA-UE at T1, and PPT of an affected hand at T2 were observed while controlling for the period after stroke onset as the confounding variable. CONCLUSION The reduction of contralesional cortical hyperactivity is related to the functional recovery in part, but not related with the period after stroke onset. This suggests that enhanced reduction of contralesional M1 hyperactivity contributes to functional recovery after stroke.
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Affiliation(s)
| | - Tetsuya Karita
- Department of Rehabilitation, Daisen Rehabilitation Hospital
| | - Nao Nakada
- Department of Rehabilitation, Daisen Rehabilitation Hospital
| | | | - Futoshi Mori
- Department of Occupational Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima
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Fakhari Z, Ansari NN, Naghdi S, Mansouri K, Radinmehr H. A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke. NeuroRehabilitation 2017; 40:325-336. [PMID: 28222554 DOI: 10.3233/nre-161420] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Spasticity is a common complication after stroke. Dry needling (DN) is suggested as a novel method for treatment of muscle spasticity. OBJECTIVE To explore the effects of DN on wrist flexors spasticity poststroke. METHODS A single group, pretest-posttest clinical trial was used. Twenty nine patients with stroke (16 male; mean age 54.3 years) were tested at baseline (T0), immediately after DN (T1), and one hour after DN (T2). DN was applied for flexor carpi radialis (FCR) and flexor carpi ulnaris on the affected arm for single session, one minute per muscle. The Modified Modified Ashworth Scale (MMAS), passive resistance force, wrist active and passive range of motion, Box and Block Test, and FCR H-reflex were outcome measures. RESULTS Significant reductions in MMAS scores were seen both immediately after DN and at 1-hour follow-up (median 2 at T0 to 1 at T1 and T2). There were significant improvements in other measures between the baseline values at T0 and those recorded immediately after the DN at T1 or one hour later at T2. CONCLUSIONS This study suggests that DN reduced wrist flexors spasticity and alpha motor neuron excitability in patients with stroke, and improvements persisted for one hour after DN.
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Affiliation(s)
- Zahra Fakhari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Korosh Mansouri
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Physical Medicine and Rehabilitation, Medical School, Iran University of Medical Sciences, Tehran, Iran
| | - Hojjat Radinmehr
- Department of Physiotherapy, School of Rehabilitation, Hamadan University of Medical Sciences, Hamadan, Iran
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Huang PC, Hsieh YW, Wang CM, Wu CY, Huang SC, Lin KC. Predictors of motor, daily function, and quality-of-life improvements after upper-extremity robot-assisted rehabilitation in stroke. Am J Occup Ther 2015; 68:325-33. [PMID: 24797196 DOI: 10.5014/ajot.2014.010546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE A subgroup of patients benefiting most from robot-assisted therapy (RT) has not yet been described. We examined the predictors of improved outcomes after RT. METHOD Sixty-six patients with stroke receiving RT were analyzed. The outcome measures were the Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Stroke Impact Scale (SIS). The potential predictors were age, side of lesion, time since onset, Modified Ashworth Scale (MAS) scores, accelerometer data, Box and Block Test (BBT) scores, and kinematic parameters. RESULTS BBT scores were predictive of FMA (29%) and MAL (9%-15%) improvements. Reduced shoulder flexion synergy, as measured by less shoulder abduction during forward reach, and MAS-distal were predictive of WMFT-function improvements. MAS-distal was predictive of SIS-physical improvements. Demographic variables did not predict outcomes. CONCLUSION Manual dexterity was a valuable predictor of motor impairment and daily function after RT. Outcomes at different levels may have different predictors.
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Affiliation(s)
- Pai-Chuan Huang
- Pai-Chuan Huang, ScD, OTR/L, is Postdoctoral Fellow, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, and Healthy Aging Research Center at Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wei Hsieh
- Yu-Wei Hsieh, PhD, is Assistant Professor, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, and Healthy Aging Research Center at Chang Gung University, Taoyuan, Taiwan
| | - Chin-Man Wang
- Chin-Man Wang, MD, is Attending Physician, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yi Wu
- Ching-Yi Wu, ScD, OTR/L, is Professor and Chair, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, and Healthy Aging Research Center at Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chun Huang
- Shu-Chun Huang, MD, is Attending Physician, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Keh-Chung Lin
- Keh-Chung Lin, ScD, OTR/L, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University and Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, 17, F4, Xu Zhou Road, Taipei, Taiwan;
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Modesto PC, Pinto FCG. Comparison of functional electrical stimulation associated with kinesiotherapy and kinesiotherapy alone in patients with hemiparesis during the subacute phase of ischemic cerebrovascular accident. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:244-8. [PMID: 23588286 DOI: 10.1590/0004-282x20130009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/18/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the functional electrical stimulation associated with functional kinesiotherapy alone in patients after ischemic cerebrovascular accident. METHODS The study included 20 patients who were divided into two groups: Group I (GI): functional electrical stimulation plus functional kinesiotherapy and Group II (GII): functional kinesiotherapy. We evaluated active and passive range of motion, in knee flexion and extension muscle strength, activities of daily living and quality of life. The evaluations were conducted in the pretreatment period, after 10 sessions and after 20 physical therapy sessions. RESULTS There was a significant improvement in all variables studied for both groups. However, significant improvements for the sub-items functional capacity and social aspects were seen only in the patients treated with associated functional electrical stimulation and kinesiotherapy. CONCLUSION Although both groups of patients improved with the treatment, the association of functional electrical stimulation and kinesiotherapy showed superiority in two quality of life items, in the sub-items functional capacity and social aspects.
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Siebers A, Oberg U, Skargren E. The effect of modified constraint-induced movement therapy on spasticity and motor function of the affected arm in patients with chronic stroke. Physiother Can 2010; 62:388-96. [PMID: 21886380 DOI: 10.3138/physio.62.4.388] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to explore the effect of modified constraint-induced movement therapy (CIMT) in a real-world clinical setting on spasticity and functional use of the affected arm and hand in patients with spastic chronic hemiplegia. METHOD A prospective consecutive quasi-experimental study design was used. Twenty patients with spastic hemiplegia (aged 22-67 years) were tested before and after 2-week modified CIMT in an outpatient rehabilitation clinic and at 6 months. The Modified Ashworth Scale (MAS), active range of motion (AROM), grip strength, Motor Activity Log (MAL), Sollerman hand function test, and Box and Block Test (BBT) were used as outcome measures. RESULTS Reductions (p<0.05-0.001) in spasticity (MAS) were seen both after the 2-week training period and at 6-month follow-up. Improvements were also seen in AROM (median change of elbow extension 5°, dorsiflexion of hand 10°), grip strength (20 Newton), and functional use after the 2-week training period (MAL: 1 point; Sollerman test: 8 points; BBT: 4 blocks). The improvements persisted at 6-month follow-up, except for scores on the Sollerman hand function test, which improved further. CONCLUSION Our study suggests that modified CIMT in an outpatient clinic may reduce spasticity and increase functional use of the affected arm in spastic chronic hemiplegia, with improvements persisting at 6 months.
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Affiliation(s)
- A Siebers
- A. Siebers, RPT, MSc: Department of Rehabilitation, County Hospital, Ryhov, Jönköping, Sweden
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Rosa M, Vasconcelos O, Marques A. The influence of two rehabilitation protocols in upper-limb function of stroke patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.9.78036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims A significant decrease in upper-limb functionality occurs after stroke. There are two different approaches to the upper-limb rehabilitation of stroke patients: unilateral and bilateral protocols. The main aim of this study was to assess the differences in the functionality of the hemiparetic upper-limb between individuals with chronic hemiparesis submitted to a unilateral protocol and those submitted to a bilateral protocol. Methods Eight individuals with stroke and chronic hemiparesis were recruited and randomly assigned to one of two groups (four participants in each group). All participants were observed over a period of six weeks, and were evaluated at four different moments of the intervention protocol using the Fulg-Meyer Assessment Scale (FM) (Fulg-Meyer et al, 1975) and the Purdue Pegboard (PP) (Tiffin, 1948). The statistical procedures included percentage evolution and descriptive analysis for each participant. Findings The findings suggest that the unilateral protocol provides better results, when compared with the bilateral protocol. Conclusions This study suggests that unilateral protocols are at least as effective as bilateral protocols for hemiparetic upper-limb rehabilitation.
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Affiliation(s)
| | | | - Alda Marques
- University of Aveiro, Campus Universitário de Santiago, Portugal
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Kästner S. [Intrathecal baclofen therapy in ambulatory patients with spastic hemiparesis following stroke. Short report of two cases]. DER NERVENARZT 2010; 81:1003-1005. [PMID: 20512482 DOI: 10.1007/s00115-010-3029-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Au-Yeung SSY, Hui-Chan CWY. Predicting recovery of dextrous hand function in acute stroke. Disabil Rehabil 2009; 31:394-401. [PMID: 18608431 DOI: 10.1080/09638280802061878] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the clinical characteristics during acute stroke that predicted dextrous function in the paretic hand at 6 months post-stroke. METHOD Fifty-seven patients within 5 days post-stroke were recruited in stroke wards. Recovery of dextrous hand function, indicated by a score of > or =35 of Action Research Arm Test, was assessed weekly in the first 4 weeks then monthly till 6 months post-stroke. The seven predictor candidates evaluated included side and site of brain infarct, stroke severity, cognition, spatial neglect, two-point discrimination (2-PD), muscle tone and muscle strength of the paretic upper extremity (UE). RESULTS Site of infarct, stroke severity, 2-PD and UE muscle strength had independent association with dextrous hand function at 6 months post-stroke. Stepwise multiple logistic regressions showed that the best early predictor was 2-PD in week 1 to 3 (Odds ratio [OR] ranged from 0.51-0.83) and UE muscle strength during the first 2 months post-stroke (OR > or = 1.04). The strongest predictor was muscle strength at week 4 post-stroke, followed by combined 2-PD and muscle strength at week 2 post-stroke. CONCLUSIONS Muscle strength and 2-PD in the paretic UE during the first month post-stroke were the best predictors of dextrous hand function recovery at 6 months.
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Affiliation(s)
- Stephanie S Y Au-Yeung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, SAR, China
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Pediatric stroke recovery: a descriptive analysis. Arch Phys Med Rehabil 2009; 90:657-62. [PMID: 19345783 DOI: 10.1016/j.apmr.2008.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 09/24/2008] [Accepted: 10/07/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate recovery patterns and potential prognostic factors of pediatric stroke. DESIGN Retrospective study. SETTING Acute rehabilitation at a university-based children's hospital. PARTICIPANTS Children (N=44; 25 boys, 19 girls; age range, 8mo-17y) with diagnosis of first-ever stroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Functional outcomes at discharge and 1-year follow-up. Modified Brunnstrom stages, Gross Motor Function Classification System, activities of daily living (ADLs), swallowing, speech, and sphincter function were measured. RESULTS Recovery of swallowing function occurred earlier than other functions in the first 2 to 3 months poststroke. Less than half of the patients were able to use the affected arms and legs without assistive devices. Eleven of 32 patients who initially had poor body control became ambulatory without assistive devices. A total of 18 of 44 patients were able to walk without assistive devices. Bilateral hemisphere lesions and flaccid muscle tone of the affected extremity at stroke onset had a less favorable prognosis in terms of ambulation and ADLs. Hemorrhagic strokes without surgical complications had a better prognosis than nonhemorrhagic strokes. CONCLUSIONS Similar to the adult stroke population, most of the functional recovery in pediatric stroke occurs within the first 2 to 3 months after stroke, but the quality of functional recovery was better in the pediatric population. The lesion size of the stroke was found to be related to prognosis. Additional large cohort studies are suggested to understand the complex similarities and differences in recovery between pediatric and adult stroke.
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Titianova EB, Peurala SH, Pitkänen K, Tarkka IM. Gait reveals bilateral adaptation of motor control in patients with chronic unilateral stroke. Aging Clin Exp Res 2008; 20:131-8. [PMID: 18431080 DOI: 10.1007/bf03324759] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Functional brain imaging has shown that bilateral brain reorganization may occur after unilateral cerebral damage. The present study searched for evidence of bilateral motor control changes in gait in patients with chronic unilateral stroke. METHODS Gait variables (temporal and spatial parameters, footprint peak times (FPPT) and footfall times (FFT)) were recorded in 48 patients with chronic unilateral stroke at their preferred speed, and in 10 healthy volunteers walking from very slowly to very fast on a pressure sensor walkway. The data were divided into 4 groups according to gait velocity. The functional outcome of stroke was measured by the Barthel Index. RESULTS Patients' gait variables reflected their hemiparetic gait pattern. Slower patients had prolonged stance, FPPT and FFT on the non-affected side (NS), and prolonged swing and shorter FPPT and FFT on the affected side (AS). The magnitude of the asymmetry index of these parameters was inversely associated with velocity performance and, at the same time, it characterized how much the control of the clinically healthy (NS) side was altered during walking. Bilateral changes in kinetic and footfall variables in the chronic stage of unilateral stroke were present. CONCLUSIONS Patients chose their preferred walking velocity using stereotyped, alternative gait patterns, in which the contribution of the NS was larger than that of the AS. Alternative gait patterns may partly demonstrate compensatory behavioral strategies adapted by patients.
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Ivanhoe CB, Francisco GE, McGuire JR, Subramanian T, Grissom SP. Intrathecal Baclofen Management of Poststroke Spastic Hypertonia: Implications for Function and Quality of Life. Arch Phys Med Rehabil 2006; 87:1509-15. [PMID: 17084128 DOI: 10.1016/j.apmr.2006.08.323] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Revised: 06/09/2006] [Accepted: 08/09/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To evaluate the impact of intrathecal baclofen (ITB) on function and quality of life (QOL) and to obtain efficacy and safety data in poststroke spastic hypertonia. DESIGN Prospective open-label multicenter trial with follow-up at 3 and 12 months. SETTING Twenty-four stroke treatment centers in the United States. PARTICIPANTS Ninety-four stroke participants (age range, 24-82 y) with spastic hypertonia. Seventy-four participants underwent ITB pump implantation. INTERVENTION Participants were implanted with an ITB pump. MAIN OUTCOME MEASURES FIM instrument and QOL (Sickness Impact Profile [SIP]) changes, spastic hypertonia (Ashworth Scale), and safety. RESULTS FIM scores improved overall in repeated-measures analysis of variance (ANOVA) (P = .005) and by 3.00 +/- 7.69 (P = .001) at 3 months and by 2.86 +/- 10.13 (P = .017) at 12 months. Significant improvements in SIP scores were noted overall (repeated-measures ANOVA, P < .001) and at 3 (P = .003) and 12 months (P < .001). The combined average Ashworth Scale score of the upper and lower limbs decreased by 1.27 +/- 0.76 (P < .001) at 3 months and by 1.39 +/- 0.73 (P < .001) at 12 months from baseline, which was significant overall (repeated-measures ANOVA, P<.001). Strength in the unaffected side did not change overall (repeated-measures ANOVA, P = .321) or at either 3 (P = .553) or 12 months (P = .462). Minimal adverse events and device complications were reported. CONCLUSIONS There was significant improvement in function, QOL, and spastic hypertonia at 3 and 12 months after implant, without adversely affecting muscle strength of the unaffected limbs. Data suggest that ITB therapy is a safe and efficacious treatment for spastic hypertonia resulting from stroke.
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Affiliation(s)
- Cindy B Ivanhoe
- Brain Injury and Stroke Program, The Institute for Rehabilitation and Research, Houston, TX 77030, USA.
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