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Oud T, Bogaards JA, Nollet F, Brehm MA. Preliminary effectiveness and production time and costs of three-dimensional printed orthoses in chronic hand conditions: an interventional feasibility study. J Rehabil Med 2024; 56:jrm39946. [PMID: 38742877 PMCID: PMC11107831 DOI: 10.2340/jrm.v56.39946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE To assess the preliminary effectiveness of three-dimensional printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions on performance of daily activities, hand function, quality of life, satisfaction, and production time and costs. DESIGN Interventional feasibility study. SUBJECTS Chronic hand orthotic users (n = 21). METHODS Participants received a new three-dimensional printed orthosis according to the same type as their current orthosis, which served as the control condition. Primary outcome was performance of daily activities (Patient-Reported Outcomes Measurement Information System-Upper Extremity; Michigan Hand Questionnaire). Secondary outcomes were hand function, quality of life, and satisfaction. Furthermore, production time and costs were recorded. RESULTS At 4 months' follow-up, no significant differences were found between three-dimensional printed orthoses and participants' existing conventional orthoses on activity performance, hand function, and quality of life. Satisfaction with the three-dimensional printed orthosis was significantly higher and the production time and costs for three-dimensional printed orthoses were significantly lower compared with conventional orthoses. The three-dimensional printed orthosis was preferred by 79% of the participants. CONCLUSIONS This feasibility study in chronic hand conditions suggests that three-dimensional printed orthoses are similar to conventional orthoses in terms of activity performance, hand function, and quality of life. Satisfaction, and production time and costs favoured the three-dimensional printed hand orthoses.
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Affiliation(s)
- Tanja Oud
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands.
| | - Johannes A Bogaards
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Public Health, Methodology, Amsterdam, Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, Netherlands
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Du YN, Li Y, Zhang TY, Jiang N, Wei Y, Cheng SH, Li H, Duan HY. Efficacy of botulinum toxin A combined with extracorporeal shockwave therapy in post-stroke spasticity: a systematic review. Front Neurol 2024; 15:1342545. [PMID: 38560731 PMCID: PMC10979702 DOI: 10.3389/fneur.2024.1342545] [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: 11/22/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives In recent years, there has been an increase in the number of randomized clinical trials of BTX-A combined with ESWT for the treatment of post-stroke spasticity. This has made it possible to observe the benefits of combination therapy in clinical practice. Therefore, this paper reviews the effectiveness of BTX-A in combination with ESWT for the treatment of post-stroke spasticity. Methods By October 2023, a systematic review was conducted in the databases PubMed, Cochrane, Embase, Medline, Web of Science, China National Knowledge Infrastructure, Wan Fang Database, China Biology Medicine disc and China Science and Technology Journal Database were systematically searched. We included randomized controlled trials that reported outcome metrics such as MAS, FMA, and MBI score. Studies were excluded if MAS was not reported. The quality of the included studies was assessed by the Cochrane Collaboration's tool for assessing risk of bias, and the AMSTAR quality rating scale was selected for self-assessment. Results A total of 70 articles were included in the initial search, and six were ultimately included. The results of the included studies showed that the combination therapy was effective in reducing MAS scores and improving FMA and MBI scores in patients with spasticity compared to the control group. Combination therapy has also been shown to improve joint mobility and reduce pain in spastic limbs. Conclusion Cumulative evidence from clinical randomized controlled trial studies suggests that the combination therapy is effective in reducing lower limb spasticity and improving mobility after stroke. However, more clinical trials are still needed to corroborate the evidence regarding the efficacy of BTX-A combined with shockwave therapy. Systematic Review Registration The system review can be searched in the PROSPERO database (CRD42023476654).
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Affiliation(s)
- Ya-nan Du
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Yang Li
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Ting-yu Zhang
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Nan Jiang
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun, China
| | - Ying Wei
- Department of radiology, First Hospital of jilin University, Changchun, China
| | - Shi-huan Cheng
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - He Li
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
| | - Hao-yang Duan
- Department of Rehabilitation Medicine, First Hospital of Jilin University, Changchun, China
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Oud T, Tuijtelaars J, Schenk J, Nollet F, Brehm MA. Validity and reliability of the Dutch translation of the OPUS' client satisfaction with device module in chronic users of hand orthoses. Health Qual Life Outcomes 2023; 21:93. [PMID: 37605151 PMCID: PMC10441692 DOI: 10.1186/s12955-023-02181-3] [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: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Orthosis satisfaction is an important outcome in assessing quality of care. However, no measurement specifically assessing orthosis satisfaction is available in the Dutch language. Therefore, the aim of this study was to translate the Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users' Survey (OPUS) into Dutch, and to assess its content validity, structural validity and reliability in persons with chronic hand conditions. METHODS The CSD was translated and cross-cultural adapted according to respective guidelines. To determine content validity, 10 chronic hand orthotic users and two professionals judged the relevance, comprehensibility, and comprehensiveness of the Dutch CSD (D-CSD). Thereafter, in a cross-sectional study, 76 persons were asked to complete the D-CSD twice, with a 2-week interval. Dimensionality of the D-CSD was examined by principal component analysis (PCA), and factor model fit was assessed by confirmatory factor analysis (CFA). Reliability was assessed as internal consistency and test-retest reliability, including the 95% limits of agreement (LoA), the standard error of measurement (SEM) and smallest detectable change (SDC). RESULTS The D-CSD items and response options were deemed relevant and comprehensible. After adding an item on cleaning the orthosis, content validity was judged sufficient. PCA indicated a one-factor model, which was confirmed by CFA. We found good internal consistency (Cronbach's alpha = 0.82; 95%CI 0.75-0.87), and moderate to good test-retest reliability (ICC = 0.81; 95%CI 0.71-0.87). There was no difference between the mean D-CSD score at test (26.8 points) and retest (25.9 points) (mean (SD) difference: 0.86 points (4.00); 95%CI -0.06-1.79; p = 0.07). The 95% LoA were -6.99 to 8.71, and the SEM and SDC were 2.88 and 7.98 points, respectively. CONCLUSIONS Based on sufficient content and structural validity, and good reliability, we consider the D-CSD a useful tool to evaluate orthosis satisfaction in persons with chronic hand conditions on group level. Because of a relatively high SDC, sensitivity to detect changes over time on individual level is limited. STUDY REGISTRATION NUMBER NCT05320211.
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Affiliation(s)
- Tanja Oud
- Amsterdam UMC, Department of Rehabilitation Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
| | - Jana Tuijtelaars
- Amsterdam UMC, Department of Rehabilitation Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jimmy Schenk
- Amsterdam UMC, Department of Epidemiology and Data Science, Amsterdam Public Health, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Department of Intensive Care, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam UMC, Department of Rehabilitation Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, Department of Rehabilitation Medicine, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
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Oud T, Tuijtelaars J, Bogaards H, Nollet F, Brehm MA. Preliminary effectiveness of 3D-printed orthoses in chronic hand conditions: study protocol for a non-randomised interventional feasibility study. BMJ Open 2023; 13:e069424. [PMID: 37024252 PMCID: PMC10083733 DOI: 10.1136/bmjopen-2022-069424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Hand orthoses are often provided to improve performance of activities of daily life (ADL). Yet, the manufacturing process of conventional custom-fabricated hand orthoses is a time-consuming and labour-intensive process. Even though three-dimensional (3D) printing of orthoses is a rapidly growing area that can facilitate the manufacturing process of hand orthoses, evidence on the effectiveness, costs and production time of 3D-printed orthoses in chronic hand conditions is scarce. This study aims to assess (1) the preliminary effectiveness of 3D-printed orthoses compared with conventionally custom-fabricated orthoses in persons with chronic hand conditions, (2) production time and costs of both orthoses and (3) experiences of the participants and orthotists with the manufacturing process of the 3D-printed orthosis. METHODS AND ANALYSIS In this prospective non-randomised interventional feasibility study, 20 adults with various chronic hand conditions using a conventional thumb, wrist or wrist-thumb orthosis will be provided with a 3D-printed corresponding type of orthosis. Assessments will be done 2 weeks prior to the intervention and at baseline for the conventional orthosis, and at 1 month and 4 months follow-up for the 3D-printed orthosis. The primary outcome is change from baseline in ADL performance (custom short form Dutch-Flemish Patient-Reported Outcomes Measurement Information System-Upper Extremity; ADL domain Michigan Hand Outcomes Questionnaire Dutch language version (MHQ-DLV)) at 4 months follow-up. Secondary outcomes include general hand function (MHQ-DLV), satisfaction with the orthosis (Dutch Client Satisfaction with Device; Dutch version of the Quebec User Evaluation of Satisfaction with Assistive Technology), usability (in-house questionnaire) and quality of life (EuroQoL 5-Dimension 5-Level). Costs and production time of the conventional and 3D-printed orthoses will be prospectively recorded. Experiences regarding the manufacturing process will be obtained from participants and orthotists (in-house questionnaire). ETHICS AND DISSEMINATION The Medical Ethics Committee of the Amsterdam UMC, Academic Medical Centre, has waived the requirement for ethical review of this study. Results will be disseminated through peer-reviewed journals, scientific conferences, and media aimed at a broad audience including patients. TRIAL REGISTRATION NUMBER NCT05320211.
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Affiliation(s)
- Tanja Oud
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Jana Tuijtelaars
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Hans Bogaards
- Amsterdam UMC location University of Amsterdam, Department of Epidemiology & Data Science, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
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Park HY, Hwang UJ, Kwon OY. Correlation between trunk rotation and lateral flexion range of motion, peak cough flow, and chest expansion in stroke patients. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1970. [PMID: 35962597 DOI: 10.1002/pri.1970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/28/2022] [Accepted: 07/21/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Stroke patients have problems with voluntary movement and trunk control. Moreover, the respiratory function in stroke patients is affected by neurological impairment, which increases the incidence of respiratory complications. OBJECTIVES To determine the correlation between trunk rotation range of motion (TRROM) and trunk lateral flexion range of motion (TLFROM), peak cough flow (PCF), and chest expansion in stroke patients. METHODS This was an observational study involving 21 patients with a clinical diagnosis of stroke from October 2021 to January 2022. TRROM and TLFROM were assessed using smartphone applications (Compass and Clinometer), respectively, PCF was assessed using a peak flow meter, and chest expansion was assessed using a tape measure. Pearson's correlation was used to analyze the relationships between the variables. RESULTS Statistically significant correlations were found between TRROM and TLFROM (r = 0.91, p < 0.01) and between upper chest expansion and PCF (r = 0.59, p < 0.01). There were significant correlations between lower chest expansion and TRROM (r = 0.50, p < 0.05) and between lower chest expansion and TLFROM (r = 0.51, p < 0.05). CONCLUSION This study demonstrates the relationship between upper chest expansion and PCF. Upper chest expansion exercises should be considered to improve the PCF in stroke patients. In addition, a very strong positive correlation between TRROM and TLFROM was demonstrated. TRROM and TLFROM exercises should be considered to improve the lower chest expansion in stroke patients.
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Affiliation(s)
- Hee-Yong Park
- Department of Physical Therapy, The Graduate School, Yonsei University, Wonju, Korea
| | - Ui-Jae Hwang
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.,Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
| | - Oh-Yun Kwon
- Department of Physical Therapy, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Korea.,Kinetic Ergocise Based on Movement Analysis Laboratory, Wonju, Korea
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Garavaglia L, Pagliano E, LoMauro A, Pittaccio S. Design and custom fabrication of specialized orthoses for the upper-limb stabilization in childhood dyskinesia. Prosthet Orthot Int 2022; 46:625-632. [PMID: 35324551 DOI: 10.1097/pxr.0000000000000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Childhood dyskinesia (CD) is a complex movement disorder with components of dystonic and hyperkinetic nature, characterized by involuntary, sometimes stereotypical postures and gestures that are often impossible to control and hinder the execution of willful motion. The standard orthoses for the treatment of neurological diseases, including CD, are generally poorly differentiated for functional characteristics. The application of similar devices for movement disorders is far less generalized because of the very different symptoms, including the incapacity to control rather than initiate movement. OBJECTIVES This article aims to describe an innovative method to fabricate personalized orthoses for the elbow-wrist joints in CD, taking into account anatomical and functional diversities. It also proposes functional elements to implement the required dynamic postural control. METHODS Wearable custom-made upper-limb orthoses have been fabricated and preliminarily tested on five patients with CD. Optoelectronic stereophotogrammetry was used as an innovative tool for all-in-one-frame acquisition of limb geometry. A new process for the functional personalization of the orthoses has been developed using shape memory alloys. CONCLUSIONS The innovative method presented, encompassing data acquisition, virtual design, fabrication, and assembling, overcomes the problems due to the involuntary movements of the patients, which cannot be avoided during the fitting operations, providing comfortable and useful orthoses with minimal nuisance for the patients. Initial tests show that the orthoses were well tolerated by all the subjects; the promising comments of caregivers, together with improvements, were observed by the clinicians using specific clinical scales.
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Affiliation(s)
- Lorenzo Garavaglia
- Institute of Condensed Matter Chemistry and Technologies for Energy, National Research Council of Italy, Lecco, Italy
| | - Emanuela Pagliano
- Developmental Neurology Unit, IRCCS C. Besta Neurological Institute Foundation, Milan, Italy
| | - Antonella LoMauro
- Politecnico di Milano, Department of Electronics, Information and Bioengineering, Piazza Leonardo Da Vinci, Milano, Italy
| | - Simone Pittaccio
- Institute of Condensed Matter Chemistry and Technologies for Energy, National Research Council of Italy, Lecco, Italy
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Oud T, Kerkum Y, de Groot P, Gijsbers H, Nollet F, Brehm MA. Production Time and User Satisfaction of 3-Dimensional Printed Orthoses For Chronic Hand Conditions Compared With Conventional Orthoses: A Prospective Case Series. JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2021; 4:1000048. [PMID: 33884150 PMCID: PMC8054741 DOI: 10.2340/20030711-1000048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
Objective Hand orthoses are often prescribed for persons with chronic hand and wrist impairments. This study assessed the feasibility, in terms of production time and user satisfaction, of 3-dimensional printed hand orthoses compared with conventional hand orthoses for this population. Methods In this prospective case series, both a conventional hand orthosis and a 3-dimensional printed hand orthosis were manufactured for 10 participants. Production time (in minutes) of each orthosis was recorded. Each orthosis was worn for one week, after which participants completed a self-designed questionnaire on satisfaction, scored on a 5-point Likert scale. Functionality and orthosis preference were also assessed. Results The mean (standard deviation (SD)) production time for the 3-dimensional printed orthoses, of 112 (11.0) min, was significantly shorter compared with 239 (29.2) min for the conventional orthoses (95% confidence interval (95% CI) 71-182 min, p = 0.001). Satisfaction scores were similar for both orthoses, except for comfort item "fitting method", which was rated significantly higher for scanning compared with casting (median [IQR] score: 5 [0.0]; 4 [2.0], p = 0.034). Functionality and orthosis preference were rated similar for both orthoses. CONCLUSION As the production time was halved, user satisfaction similar, and scanning experienced as slightly more comfortable than casting, 3-dimensional printed hand orthoses seem feasible and potentially beneficial for use in people with chronic hand and wrist impairments.
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Affiliation(s)
- Tanja Oud
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Yvette Kerkum
- OIM Orthopedie, Research and Development, Assen, The Netherlands
| | - Peter de Groot
- OIM Orthopedie, Research and Development, Assen, The Netherlands
| | - Harm Gijsbers
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Merel-Anne Brehm
- Amsterdam University Medical Centers, University of Amsterdam, Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Can Pulmonary Function Testing Predict the Functional Outcomes of Poststroke Patients?: An Observational Study. Am J Phys Med Rehabil 2020; 99:1145-1149. [PMID: 32576744 DOI: 10.1097/phm.0000000000001507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with stroke may experience pulmonary dysfunction that reduces movement of the muscles involved in postural control and respiration. This study aimed to evaluate the relationship between postural control and respiratory muscle strength using pulmonary function testing. We sought to identify the respiratory function parameters that predict the functional outcomes patients with stroke at discharge. DESIGN We prospectively recruited 52 patients with first-ever stroke within 6 mos of onset. Peak cough flow, maximal inspired pressure, maximal expired pressure, forced vital capacity, and forced expiratory volume in 1 sec were measured at baseline and after 4 wks of rehabilitation. The primary outcomes were trunk balance measured using the Trunk Impairment Scale and functional outcomes measured using the Berg Balance Scale and functional independence measure. RESULTS The initial peak cough flow, forced vital capacity, and forced expiratory volume in 1 sec values correlated with the Trunk Impairment Scale scores at admission; only the initial peak cough flow and forced vital capacity were predictive factors for the final Trunk Impairment Scale score. Multivariable linear regression analysis showed that the initial peak cough flow was a significant predictive factor for follow-up test scores at discharge: Berg Balance Scale (P < 0.001) and functional independence measure (P < 0.025). CONCLUSION Initial respiratory function was significantly correlated with trunk balance and the functional outcomes.
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Joo S, Lee Y, Song CH. Immediate Effects of Thoracic Spinal Manipulation on Pulmonary Function in Stroke Patients: A Preliminary Study. J Manipulative Physiol Ther 2018; 41:602-608. [PMID: 30121128 DOI: 10.1016/j.jmpt.2017.12.005] [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: 05/01/2017] [Revised: 10/27/2017] [Accepted: 12/15/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the immediate effects of thoracic spinal manipulation (TSM) on pulmonary function in stroke patients. METHODS Thirty-six volunteers with stroke (20 men, 16 women) were recruited and randomized to a TSM group (n = 18) and a sham group (n = 18). All participants underwent initial pulmonary function test and then rested supine for 10 minutes before the intervention. Pulmonary function test was repeated immediately after the intervention. Forced vital capacity, forced expiratory volume at 1 second, maximum voluntary ventilation, and residual volume were measured by a spirometer in preintervention and post-intervention. RESULTS Significant between-group differences were observed in forced vital capacity and forced expiratory volume at 1 second in the TSM group (P < .05). No significant changes in dependent variables were seen in the sham group. CONCLUSION The pulmonary function values for patients in the TSM group were significantly enhanced with no significant improvement in maximum voluntary ventilation and residual volume. Mechanical factors may be responsible for the improved pulmonary function in the TSM group.
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Affiliation(s)
- Sunghee Joo
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
| | - Yongwoo Lee
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea
| | - Chang-Ho Song
- Department of Physical Therapy, Sahmyook University, Seoul, South Korea.
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Effects of Carpal Tunnel Syndrome on Force Coordination and Muscle Coherence during Precision Pinch. J Med Biol Eng 2017; 37:328-335. [PMID: 28824352 DOI: 10.1007/s40846-017-0232-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Carpal tunnel syndrome (CTS), caused by entrapment of the median nerve in the carpal tunnel, impairs hand function including dexterous manipulation. The purpose of this study was to investigate the effects of CTS on force coordination and muscle coherence during low-intensity sustained precision pinch while the wrist assumed different postures. Twenty subjects (10 CTS patients and 10 asymptomatic controls) participated in this study. An instrumented pinch device was used to measure the thumb and index finger forces while simultaneously collecting surface electromyographic activities of the abductor pollicis brevis (APB) and first dorsal interosseous (FDI) muscles. Subjects performed a sustained precision pinch at 10% maximum pinch force for 15 sec with the wrist stabilized at 30° extension, neutral, or 30° flexion using customized splints. The force discrepancy and the force coordination angle between the thumb and index finger forces were calculated, as well as the β-band (15-30 Hz) coherence between APB and FDI. The index finger applied greater force than the thumb (p < 0.05); this force discrepancy was increased with wrist flexion (p < 0.05), but was not affected by CTS (p > 0.05). The directional force coordination was not significantly affected by wrist posture or CTS (p > 0.05). In general, digit force coordination during precision pinch seems to be sensitive to wrist flexion, but is not affected by CTS. The β-band muscular coherence was increased by wrist flexion for CTS patients (p < 0.05), which could be a compensatory mechanism for the flexion-induced exacerbation of CTS symptoms. This study demonstrates that wrist flexion negatively influences muscle and force coordination in CTS patients supporting the avoidance of flexion posture for symptom exacerbation and functional performance.
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Monaghan K, Horgan F, Blake C, Cornall C, Hickey PPM, Lyons BE, Langhorne P. Physical treatment interventions for managing spasticity after stroke. Cochrane Database Syst Rev 2017; 2017:CD009188. [PMCID: PMC6472515 DOI: 10.1002/14651858.cd009188.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
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Affiliation(s)
- Kenneth Monaghan
- St Angela's CollegeSchool of Nursing and Health StudiesLough GillSligoIreland
| | - Frances Horgan
- Royal College of Surgeons in IrelandSchool of Physiotherapy123 St Stephens GreenDublin 2Ireland
| | - Catherine Blake
- University College DublinSchool of Physiotherapy & Performance ScienceUCD Health Sciences CentreBelfieldDublin 4Ireland
| | - Catherine Cornall
- National Rehabilitation HospitalPhysiotherapy DepartmentRochestown AvenueDun LaoghaireIreland
| | - Paula PM Hickey
- Sligo General HospitalDepartment of MedicineThe MallSligoIreland
| | | | - Peter Langhorne
- University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
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Jang SH, Jang WH. Difference in cortical activation during use of volar and dorsal hand splints: a functional magnetic resonance imaging study. Neural Regen Res 2016; 11:1274-7. [PMID: 27651775 PMCID: PMC5020826 DOI: 10.4103/1673-5374.189192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There have been no studies reported on the difference in cortical activation during use of volar and dorsal hand splints. We attempted to investigate the difference in cortical activation in the somatosensory cortical area during use of volar and dorsal hand splints by functional magnetic resonance imaging (fMRI). We recruited eight healthy volunteers. fMRI was performed while subjects who were fitted with volar or dorsal hand splints performed grasp-release movements. Regions of interest were placed on the primary motor cortex (M1), primary somatosensory cortex (S1), posterior parietal cortex (PPC), and secondary somatosensory cortex (S2). Results of group analysis of fMRI data showed that the total numbers of activated voxels in all ROIs were significantly higher during use of volar hand splint (3,376) compared with that (1,416) during use of dorsal hand splint. In each ROI, use of volar hand splint induced greater activation in all ROIs (M1: 1,748, S1: 1,455, PPC: 23, and S2: 150) compared with use of dorsal hand splint (M1: 783, S1: 625, PPC: 0, and S2: 8). The peak activated value was also higher during use of volar hand splint (t-value: 17.29) compared with that during use of dorsal hand splint (t-value: 13.11). Taken together, use of volar hand splint induced greater cortical activation relevant to somatosensory function than use of dorsal hand splint. This result would be important for the physiatrist and therapist to apply appropriate somatosensory input in patients with brain injury.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, South Korea
| | - Woo Hyuk Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, South Korea
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Meca-Lallana JE, Hernández-Clares R, Carreón-Guarnizo E. Spasticity in multiple sclerosis and role of glatiramer acetate treatment. Brain Behav 2015; 5:e00367. [PMID: 26445705 PMCID: PMC4589813 DOI: 10.1002/brb3.367] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/28/2015] [Accepted: 06/07/2015] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Spasticity is one of the most disabling and difficult-to-treat symptoms shown by patients with multiple sclerosis, who often show a suboptimal and unsatisfactory response to classic treatment and new available nonpharmacological alternatives. Due to the progressive nature of this condition, the early management should be essential to improve long-term outcomes. METHODS We performed a narrative literature review of the contribution of spasticity to the burden of multiple sclerosis and the potential role of classic disease-modifying drugs. RESULTS Added to the underlying pathophysiology of spasticity, certain external factors and drugs such as interferon may exacerbate the existing condition, hence their awareness is crucial as part of an effective management of spasticity. Furthermore, the evidence for the effectiveness of glatiramer acetate in preventing spasticity in naïve patients and in those switching from interferon should not be ignored. CONCLUSIONS This literature review proposes the examination of spasticity and the influence of classic disease-modifying agents on the level of existing condition among the variables to be considered when deciding on therapy for multiple sclerosis in clinical practice.
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Affiliation(s)
- Jose Eustasio Meca-Lallana
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
| | - Rocío Hernández-Clares
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
| | - Ester Carreón-Guarnizo
- Department of Neurology, Multiple Sclerosis Unit, Hospital Clínico Universitario Virgen de la Arrixaca Carretera Madrid-Cartagena s/n, 30120, Murcia, Spain ; Cátedra de Neuroinmunología Clínica y Esclerosis Múltiple, UCAM Universidad Católica San Antonio de Murcia Campus de los Jerónimos, Guadalupe, 30107, Murcia, Spain
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Eftekhar P. Clinician's Commentary on Cheung et al.(1). Physiother Can 2015; 67:167-8. [PMID: 25931668 DOI: 10.3138/ptc.2014-07-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)
- Parvin Eftekhar
- University of Toronto; Stroke-Spasticity Clinic, UHN-Toronto Rehab
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Suat E, İbrahim Engin Ş, Nilgün B, Yavuz Y, Fatma U. Short- and Long-Term Effects of an Inhibitor Hand Splint in Poststroke Patients: A Randomized Controlled Trial. Top Stroke Rehabil 2015; 18:231-7. [DOI: 10.1310/tsr1803-231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Basaran A, Emre U, Ikbal Karadavut K, Balbaloglu O, Bulmus N. Hand Splinting for Poststroke Spasticity: A Randomized Controlled Trial. Top Stroke Rehabil 2014; 19:329-37. [DOI: 10.1310/tsr1904-329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Flinn SR, Craven K. Upper limb casting in stroke rehabilitation: rationale, options, and techniques. Top Stroke Rehabil 2014; 21:296-302. [PMID: 25150661 DOI: 10.1310/tsr2104-296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Upper limb casts have been recommended for stroke survivors with moderate to severe spasticity. The objective of this article is to (a) review the rationale of 2 theoretical models that address spasticity and its consequences, (b) describe 4 casting options reported in the literature, (c) present the evidence for each cast type, and (d) suggest techniques that ensure safe and efficient fabrication of casts. This review underscores the critical need for high-evidence research on the efficacy of casting and the potential long-term benefits to this population. Current evidence lacks controlled research designs, robust sample sizes, and sensitive outcome measures. However, selective groups of stroke survivors have benefited from each type of casting. Future studies are required to assess the impact of casting on upper limb function, especially for those persons with wrist and hand spasticity, and to evaluate the efficacy of those casts not widely adopted in current practice such as inhibitory and drop-out casts.
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Affiliation(s)
- Sharon R Flinn
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kimberly Craven
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University Wexner Medical Center, Columbus, Ohio
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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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Abstract
Amyotrophic lateral sclerosis (ALS), the most common adult motor neuron disease, is an acquired disorder that results in loss of function in multiple domains. Although there is no treatment that can halt or reverse this progressive condition, there are many opportunities for interventions that can lead to improved quality of life for the patient and caregiver. Physical and occupational therapy can assist with mobility and activities of daily living. Interventions by speech pathology can optimize nutrition and communication. Respiratory function can be managed noninvasively or invasively. Depression, hopelessness, anxiety, and other mental health issues can and should be aggressively addressed and treated. Many symptoms such as pseudobulbar affect, sialorrhea, constipation, spasticity, and cramps can be treated effectively with medications. Spirituality and religion are important issues to address, as are end-of-life concerns, including advance directives, hospice, and the dying process. In contrast to the discouraging view that "there is nothing we can do," a broad approach to management, through collaboration with a multidisciplinary team, will permit the ALS physician to make a meaningful difference in the lives of individuals living with ALS.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Phadke CP, Robertson CT, Condliffe EG, Patten C. Upper-extremity H-reflex measurement post-stroke: reliability and inter-limb differences. Clin Neurophysiol 2012; 123:1606-15. [PMID: 22277759 DOI: 10.1016/j.clinph.2011.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 11/24/2011] [Accepted: 12/16/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To establish test-retest reliability of flexor carpi radialis (FCR) H-reflexes in non-disabled and stroke participants. We also investigated inter-limb differences and effects of chronicity post-stroke compared to non-disabled group and age-related effects in the non-disabled group. METHODS Sixteen chronic stroke and twenty-two non-disabled participants were recruited. Bilateral FCR H-reflexes were tested on two separate days by stimulating the median nerve and recording surface electromyography responses. FCR recruitment curves were plotted for H-reflex (H) and motor (M) waves and normalized as a percentage of maximal M-wave (ordinate) and motor threshold (abscissa). STATISTICS Intraclass correlation coefficients [two-way mixed model-ICC (1, 2)], one-way ANOVA, Bland-Altman plots, standard error of measurement (SEM), and smallest real difference (SRD). RESULTS ICCs ranged from 0.55 to 0.95 (stroke) and 0.69-0.88 (non-disabled). SEM% (% of the mean) ranged from 9% to 24% (stroke) and 18-38% (non-disabled); SRD% ranged from 18% to 66% (stroke) and 6% to 50% (non-disabled). H-reflex amplitude and slope were greater in the paretic vs. non-paretic arm post-stroke (p=0.07 and 0.01, respectively) and the paretic arm vs. non-disabled participants (p=0.007 and 0.002, respectively). Stroke participants with longer chronicity (mean 9.4 years) revealed a significantly greater Hslp/Mslp on the paretic side compared to shorter chronicity (2.5 years; p=0.05). Mean Hslp/Mslp was significantly greater in the young (mean 29 years) compared to the older group (62 years; p=0.045). CONCLUSIONS These results establish reliability of FCR H-reflexes in stroke and non-disabled participants. SEM and SRD measurements can be used to interpret recovery patterns and longitudinal effects of therapeutic interventions. SIGNIFICANCE FCR H-reflex amplitude and slope can be reliably measured and used to investigate neurophysiological mechanisms of motor recovery post-stroke.
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Affiliation(s)
- Chetan P Phadke
- Neural Control of Movement Laboratory - Brain Rehabilitation Research Center of Excellence, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA
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Kim TG, Bae SH, Kim GY, Kim YE, Kim KY. Analysis of Ultrasonographic Architectural Properties of Muscles of Chronic Stroke Patients during Different Muscle Activities. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tae Gon Kim
- Department of Physical Therapy, Yeosu Chungmu Hospital
| | - Sea Hyun Bae
- Department of Physical Therapy, Gwangju Heemang Hospital
| | - Gye Yeop Kim
- Department of Physical Therapy, College of Health and Welfare, Dongshin University
| | - Young Eok Kim
- Department of Physical Therapy, College of Health and Welfare, Dongshin University
| | - Kyung Yoon Kim
- Department of Physical Therapy, College of Health and Welfare, Dongshin University
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Choi JS, Mun JH, Lee JY, Jeon JH, Jung YJ, Seo CH, Jang KU. Effects of modified dynamic metacarpophalangeal joint flexion orthoses after hand burn. Ann Rehabil Med 2011; 35:880-6. [PMID: 22506218 PMCID: PMC3309381 DOI: 10.5535/arm.2011.35.6.880] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 09/21/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures. METHOD We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks. RESULTS The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05). CONCLUSION The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required.
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Affiliation(s)
- Ji Soo Choi
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Seoul 150-719, Korea
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Monaghan K, Horgan F, Blake C, Cornall C, Hickey PPM, Lyons BE, Langhorne P. Physical treatment interventions for managing spasticity after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.cd009188] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jandt SR, Caballero RMDS, Junior LAF, Dias AS. Correlation between trunk control, respiratory muscle strength and spirometry in patients with stroke: an observational study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2010; 16:218-24. [PMID: 21157882 DOI: 10.1002/pri.495] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 09/15/2010] [Accepted: 09/25/2010] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Stroke is the main cause of chronic disability in adults, and the effect of a stroke on the respiratory system depends on the structures affected by the lesion. OBJECTIVES To evaluate the correlation between trunk control, respiratory muscle strength and pulmonary function in individuals who suffered stroke. METHODS Observational, quantitative and descriptive study. Twenty-three patients who had a clinical diagnosis of ischaemic or haemorrhagic stroke. The trunk control was assessed through the Trunk Impairment Scale (TIS), and the respiratory muscle strength was assessed by manovacuometry by measuring the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). For pulmonary function analysis, we measured forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), peak expiratory flow (PEF) and the Tiffeneau index (TIFF) through spirometry. RESULTS A consistent and statistically significant correlation was found between TIS and PEF (r = 0.489, p = 0.024) and between TIS and EPmax (r = 0.517, p = 0.016). No relation was found between the other variables of pulmonary function and TIS. CONCLUSION This study demonstrated that there is a relation between trunk control and respiratory muscular strength, especially concerning the expiratory muscles. However, there seems to be no relation between trunk control and pulmonary function in this series of individuals who suffered stroke.
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Garros DDSC, Gagliardi RJ, Guzzo RAR. Evaluation of performance and personal satisfaction of the patient with spastic hand after using a volar dorsal orthosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:385-9. [PMID: 20602041 DOI: 10.1590/s0004-282x2010000300011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 10/19/2009] [Indexed: 11/22/2022]
Abstract
The performance and the satisfaction of the patient were quantitatively compared with the use of the volar dorsal orthosis in order to position the spastic hand. Thirty patients wearing the orthosis for eight hours daily were evaluated by the Canadian Occupational Performance Measure and the box and blocks test, for a three-month period. Five activities were selected (among daily life activities, productive activities, and leisure activities) by the patients, which were impaired by spasticity. There was an improvement related to performance after use of orthosis, with an average of 1.4 + or - 0.5 to 6.3 + or - 0.8 (p<0.01). Patient satisfaction average after wearing the orthosis was of 1.7 + or - 0.4 to 6.3 + or - 0.6 (p<0.01). In this casuistic, the use of orthosis for wrist and finger spasticity has shown an improvement in the functional performance and patient satisfaction.
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Affiliation(s)
- Danielle dos Santos Cutrim Garros
- Occupational Therapy Discipline and Neurology Discipline of the Santa Casa de São Paulo, Faculty of Medical Sciences, São Paulo SP, Brazil.
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Abstract
BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
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Affiliation(s)
- Sarah F Tyson
- University of SalfordCentre for Rehabilitation & Human Performance ResearchFrederick Road CampusSalfordUKM6 6PU
| | - Ruth M Kent
- University of LeedsAcademic Department of Rehabilitation Medicine, Faculty of Medicine and HealthLevel D, Martin Wing, Great George StreetLeeds General InfirmaryLeedsUKLS1 3EX
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Abstract
BACKGROUND Post-stroke motor impairments cause difficulty controlling the joints of the affected limbs to produce useful movements. One way to manage this to use an orthosis to control the movement of the affected joints but evidence for their benefit is lacking. OBJECTIVES To determine the effectiveness of upper or lower limb orthoses on activity and impairment in people with stroke and other non-progressive brain lesions. SEARCH STRATEGY In February 2007 we searched the trials registers of the Cochrane Stroke, Movement Disorders and Injuries Groups, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2007), MEDLINE (from 1966), EMBASE (from 1980), CINAHL (from 1983), AMED (from 1985), PsycINFO (from 1967) and RECAL (from 1990), and other databases and trials registers. We screened reference lists, contacted lead authors and other researchers in the field. SELECTION CRITERIA We included randomised controlled trials of orthoses applied to the upper or lower limb in people with stroke and other non-progressive brain lesions. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials, extracted data, and assessed trial quality. Results for continuous outcomes were combined and analysed using mean difference or standardised mean difference, both with 95% confidence intervals and fixed-effect model. MAIN RESULTS We analysed 14 trials with 429 participants. The overall effect of lower limb orthoses on walking disability (speed), walking impairment (step/stride length) and balance impairment (weight distribution in standing) was significant and beneficial. There was no significant effect on postural sway (balance impairment) or mobility disability but the numbers of studies and participants were low. However, these were all cross-over trials that looked at the immediate effect while wearing the orthosis; they did not assess the effects of wearing an orthosis over the long term. Upper limb orthoses showed no effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain. However, this was based on only three trials. AUTHORS' CONCLUSIONS A lower limb orthosis can improve walking and balance but the included studies have only examined the immediate effects while wearing the orthosis; the effects of long-term use have not been investigated. An upper limb orthosis does not effect on upper limb function, range of movement at the wrist, fingers or thumb, nor pain, but this conclusion is based on only three trials.
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Affiliation(s)
- Sarah F Tyson
- Centre for Rehabilitation & Human Performance Research, University of Salford, Frederick Road Campus, Salford, UK, M6 6PU.
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Neutral Functional Realignment Orthosis Prevents Hand Pain in Patients With Subacute Stroke: A Randomized Trial. Arch Phys Med Rehabil 2008; 89:1857-62. [DOI: 10.1016/j.apmr.2008.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 03/16/2008] [Accepted: 03/20/2008] [Indexed: 11/18/2022]
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Birns J, Fitzpatrick M. Management of spasticity: A brief overview of educational and pharmacological therapies. ACTA ACUST UNITED AC 2008. [DOI: 10.12968/bjnn.2008.4.8.30805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan Birns
- Stroke Medicine, Department of Stroke Medicine, Academic Neurosciences Centre, PO41, Institute of Psychiatry, King's College London, Denmark Hill, London SE5 8AF, and
| | - Maria Fitzpatrick
- Department of Stroke Medicine, King's College Hospital, Denmark Hill, London SE5 9RS
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Herbert RD, Lannin NA, McCluskey A, Cusick A. Response to Letter by Shah. Stroke 2007. [DOI: 10.1161/strokeaha.107.489377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert D. Herbert
- School of Physiotherapy, The University of Sydney, New South Wales, Australia
| | - Natasha A. Lannin
- School of Physiotherapy, The University of Sydney, New South Wales, Australia
| | - Annie McCluskey
- School of Physiotherapy, The University of Sydney, New South Wales, Australia
| | - Anne Cusick
- School of Physiotherapy, The University of Sydney, New South Wales, Australia
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Sangole AP, Levin MF. A new perspective in the understanding of hand dysfunction following neurological injury. Top Stroke Rehabil 2007; 14:80-94. [PMID: 17573314 DOI: 10.1310/tsr1403-80] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The human hand is inherently complex and versatile. Its use in everyday activities requires its careful positioning relative to the arm and fine adjustments of the fingers to secure the object in the hand to perform a desired task. Understanding the mechanics of prehension requires an appreciation of the anatomy, biomechanics, kinematics, and control of the hand. This article summarizes these complex mechanisms as well as the central nervous system control of hand movement. We propose a measure to characterize the biomechanics of palmar arch modulation during grasping. We also highlight questions to be investigated in future studies to stimulate further understanding of the motor control of hand function and of the recovery of hand functioning after neurological injury.
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Affiliation(s)
- Archana P Sangole
- School of Physical and Occupational Therapy, McGill University and the Center for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
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Li L, Tong KY, Hu X. The effect of poststroke impairments on brachialis muscle architecture as measured by ultrasound. Arch Phys Med Rehabil 2007; 88:243-50. [PMID: 17270524 DOI: 10.1016/j.apmr.2006.11.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the joint angle dependence of brachialis muscle architecture at rest and changes in brachialis muscle architecture during isometric voluntary contractions in people after stroke. DESIGN The pennation angle and fascicle length of the brachialis muscle were measured in the affected and unaffected sides of people after stroke at 9 different elbow angles ranging from 10 degrees to 90 degrees at the rest condition. Measurements were also carried out at a fixed joint angle of 90 degrees while the subjects were performing isometric muscle contractions at 5 incremental levels of maximal voluntary contraction (MVC) from 20% to 100% of MVC. The data obtained from the affected and unaffected sides of the subjects were compared. SETTING A research laboratory in a rehabilitation center. PARTICIPANTS Seven hemiplegic adults after stroke with passive range of motion in the elbow from 10 degrees to 90 degrees and Modified Ashworth Scale score larger than 1 were recruited. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Ultrasonography was used to measure brachialis muscle pennation angle and fascicle length at the rest condition and during isometric contractions. RESULTS The measured pennation angles and fascicle lengths were found to be joint-angle-dependent in both the affected and unaffected groups at the rest condition. Further comparisons found that the pennation angles of the affected brachialis muscle were significantly larger (P<.05) than the unaffected muscle in the most extended positions (<50 degrees ), whereas the affected fascicle lengths were significantly shorter (P<.05) than the unaffected muscle in most flexed positions (>20 degrees ). As the level of isometric voluntary contraction was increased incrementally from 20% to 100% of MVC, the results showed that pennation angle increased significantly (P<.05) while fascicle length decreased significantly (P<.01) in the unaffected muscle. However, the contraction level has a significant effect only on pennation angle (P<.05) but not on fascicle length in the affected side. In addition, the measured fascicle lengths in the unaffected group were significantly shorter than those in the affected group for isometric contractions above 40% MVC. CONCLUSIONS Our findings suggest that the architectural parameters of the brachialis muscle in people after stroke are elbow-joint-angle-dependent at the rest condition. In the affected side, pennation angle changed the most when the muscle was in an extension position and fascicle length changed the most in a flexed position when compared with the unaffected side. Immobilization and contracture might cause a shortening of the fascicle and an increase in pennation angle in the affected side. Smaller pennation angle and fascicle length changes in the affected side during isometric contraction might be due to weakness in the muscle after the onset of stroke.
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Affiliation(s)
- Le Li
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, China
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