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Lee HS, Kim S, Kim H, Baik SM, Kim DH, Chang WH. No Additional Effects of Sequential Facilitatory Cerebral and Cerebellar rTMS in Subacute Stroke Patients. J Pers Med 2024; 14:687. [PMID: 39063941 PMCID: PMC11278256 DOI: 10.3390/jpm14070687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to investigate the additional effects of cerebellar rTMS on the motor recovery of facilitatory rTMS over affected primary motor cortex (M1) in subacute stroke patients. Twenty-eight subacute stroke patients were recruited in this single-blind, randomized, controlled trial. The Cr-Cbll group received Cr-Cbll rTMS stimulation consisting of high-frequency rTMS over affected M1 (10 min), motor training (10 min), and high-frequency rTMS over contralesional Cbll (10 min). The Cr-sham group received sham rTMS instead of high-frequency rTMS over the cerebellum. Ten daily sessions were performed for 2 weeks. A Fugl-Meyer Assessment (FMA) was measured before (T0), immediately after (T1), and 2 months after the intervention (T2). A total of 20 participants (10 in the Cr-Cbll group and 10 in the Cr-sham group) completed the intervention. There was no significant difference in clinical characteristics between the two groups at T0. FMA was significantly improved after the intervention in both Cr-Cbll and Cr-sham groups (p < 0.05). However, there was no significant interaction in FMA between time and group. In conclusion, these results could not demonstrate that rTMS over the contralesional cerebellum has additional effects to facilitatory rTMS over the affected M1 for improving motor function in subacute stroke patients.
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Affiliation(s)
- Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sungwon Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Heegoo Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seung-min Baik
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, Department of Medical Device Management & Research, Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
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Xu J, Chen M, Wang X, Cai Z, Wang Y, Luo X. Global research hotspots and trends in constraint-induced movement therapy in rehabilitation over the past 30 years: a bibliometric and visualization study. Front Neurol 2024; 15:1375855. [PMID: 38948135 PMCID: PMC11211381 DOI: 10.3389/fneur.2024.1375855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Background Stroke is a cerebrovascular disease with high prevalence and mortality, and upper limb hemiparesis is a major factor limiting functional recovery in stroke patients. Improvement of motor function in stroke patients through various forms of constraint-induced movement therapy (CITM) has been recognized as safe and effective in recent years. This research field lacks a comprehensive systematic and clear vein combing analysis, analyzing the literature research of CIMT in the field of rehabilitation in the past three decades, summarizing the research hotspots and cutting-edge trends in this field, in an effort to offer ideas and references for subsequent researchers. Methods Relevant literature on CIMT in rehabilitation was collected from 1996 to 2024 within the Web of Science database's core dataset by using CiteSpace6.1, VOSviewer1.6.18, R-bibliometrix4.6.1, Pajek5.16, Scimago Graphica 1.0.26 software for visualization and analysis. Results There were 970 papers in all United States was ranked first with 401 papers. Alabama Univ was ranked first for institutions with 53 papers. Neurorehabilitation and Neural Repair was ranked first for journals with 78 papers, and Taub E was ranked first for author publications with 64 papers. Research keywords were CIMT, stroke rehabilitation, upper extremity function, lower extremity gait balance, randomized controlled trials, physical therapy techniques (transcranial magnetic stimulation and sensory amplitude electrical stimulation), primary motor cortex plasticity, lateral dominance (spatial behaviors), cerebral vascular accidents, activities of daily living, hand function, disability, functional restoration, bimanual training, aphasia, acquired invalidity, type A Botulinum toxin and joystick riding toys. Conclusion The current state of research shows that CIMT still has a vast potential for development in the field of rehabilitation research. The research hotspots are the clinical efficacy of CIMT combined with other therapies (botulinum toxin type A, transcranial direct current stimulation, virtual reality, mirror therapy, robotic-assisted) to enhance the functionality of upper limb hemiparesis in stroke patients, the mechanism of CIMT to improve the plasticity of the motor cortex through electrophysiological and imaging methods, and improvement of lower limb gait balance function in stroke patients and aphasia applications, the optimal intervention time and dose, and exploration of CIMT in new settings such as robot-assisted, telemedicine, and home rehabilitation.
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Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Xin Wang
- Health Science Center, Peking University, Beijing, China
| | - Zijuan Cai
- College of Physical Education and Health, Geely University of China, Chengdu, China
| | - Yanjie Wang
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
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Weerakkody A, Godecke E, Singer B. Investigating the acceptability of modified constraint-induced movement therapy among stroke survivors and carers: a qualitative study. Disabil Rehabil 2024:1-9. [PMID: 38835171 DOI: 10.1080/09638288.2024.2361808] [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: 12/11/2023] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE To investigate the acceptability of modified constraint-induced movement therapy (mCIMT) among stroke survivors and carers within an early-supported discharge (ESD) service, and to inform further adaptations of the program to enhance acceptability. METHODS Qualitative study within a mixed methods process evaluation of mCIMT implementation. Semi-structured interviews were analysed using reflexive thematic analysis and mapped to the Capability, Opportunity, Motivation- Behaviour (COM-B) model. RESULTS Fifteen stroke survivors and ten carers participated. Five themes were generated and mapped to the COM-B. Participants attributed functional improvements to the program whilst also encountering several challenges with returning home after stroke (Capability- physical); the importance of education (Capability- psychological); the benefits afforded by the structured nature of the program (Opportunity- physical); the challenges for carers to support mCIMT programs whilst navigating new relationship roles (Opportunity- social); the desire to improve (Motivation- automatic); and the influence each of the mCIMT program's components had in facilitating long term upper limb use (Motivation- reflective). CONCLUSION mCIMT was an acceptable intervention for stroke survivors and carers within the ESD service, offering considerable benefits compared to other therapies. The findings suggest that multifaceted education strategies could increase stroke survivor preparedness. Extending the mCIMT program duration may maximise functional improvements.
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Affiliation(s)
- Ashan Weerakkody
- Department of Health, Rehabilitation in the Home, South Metropolitan Health Service, Perth, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
- Department of Health, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, Western Australia, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
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Chavan N, Raghuveer R. Modified Constraint-Induced Movement Therapy for Improving Balance and Gait in a Case of Ganglio-Capsular Infarct: A Single-Case Study. Cureus 2024; 16:e55420. [PMID: 38567214 PMCID: PMC10985558 DOI: 10.7759/cureus.55420] [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: 11/21/2023] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
The ganglio-capsular region consists of the basal ganglia nuclei (caudate nucleus and lentiform nucleus), thalamus, and internal capsule. A disorder of the ganglio-capsular region typically presents with movement disturbance and cognitive impairment. This report presents the case of a 52-year-old male who was diagnosed with acute non-hemorrhagic infarct in the right parietal-occipital-temporal region predominantly involving the cortex and in the right ganglio-capsular region. The patient exhibited typical symptoms, which include impaired reflexes, decreased strength, reduced range of motion, and tone abnormalities. Targeted early physiotherapy intervention (TERI) was initiated from the bedside in the intensive care unit (ICU). Modified constraint-induced movement therapy (mCIMT) along with conventional therapy was selected as the rehabilitation approach for the case as it deals with "forced use" of the affected extremities, which addresses "learned non-use." The case was managed for a duration of six weeks, in which clinical outcomes, including the Berg Balance Scale (BBS), 10-meter walk test (10MWT), functional reach test (FRT), dynamic gait index (DGI), trunk impairment scale (TIS), and fall efficacy test (FET), reported crucial changes in balance, strength, coordination, and tone, which improved the quality of life of the patient.
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Affiliation(s)
- Nitika Chavan
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raghumahanti Raghuveer
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Fujimoto K, Ueno M, Etoh S, Shimodozono M. Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial. Front Neurol 2024; 15:1356732. [PMID: 38456153 PMCID: PMC10919145 DOI: 10.3389/fneur.2024.1356732] [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: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. Methods This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. Results All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. Discussion The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.
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Affiliation(s)
- Koya Fujimoto
- Department of Rehabilitation, Kirishima Sugiyasu Hospital, Kirishima, Kagoshima, Japan
| | - Makoto Ueno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Mishra B, Sudheer P, Agarwal A, Nilima N, Srivastava MVP, Vishnu VY. Minimal Clinically Important Difference of Scales Reported in Stroke Trials: A Review. Brain Sci 2024; 14:80. [PMID: 38248295 PMCID: PMC10813687 DOI: 10.3390/brainsci14010080] [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: 12/15/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
There is a growing awareness of the significance of using minimum clinically important differences (MCIDs) in stroke research. An MCID is the smallest change in an outcome measure that is considered clinically meaningful. This review is the first to provide a comprehensive summary of various scales and patient-reported outcome measures (PROMs) used in stroke research and their MCID values reported in the literature, including a concise overview of the concept of and methods for determining MCIDs in stroke research. Despite the controversies and limitations surrounding the estimation of MCIDs, their importance in modern clinical trials cannot be overstated. Anchor-based and distribution-based methods are recommended for estimating MCIDs, with patient self-evaluation being a crucial component in capturing the patient's perspective on their health. A combination of methods can provide a more comprehensive understanding of the clinical relevance of treatment effects, and incorporating the patient's perspective can enhance the care of stroke patients.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
| | - Nilima Nilima
- Department of Biostatics, All India Institute of Medical Sciences, New Delhi 110029, India;
| | | | - Venugopalan Y. Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India; (B.M.); (P.S.); (A.A.); (M.V.P.S.)
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Weerakkody A, Emmanuel R, White J, Godecke E, Singer B. Unlocking the restraint-Development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation. Aust Occup Ther J 2023; 70:661-677. [PMID: 37424149 DOI: 10.1111/1440-1630.12896] [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: 11/16/2022] [Revised: 06/08/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Strong evidence supports the provision of modified constraint-induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early-supported discharge rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful 'education only' attempt. This paper aims to systematically document the steps undertaken and to provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, rehabilitation intervention. METHODS This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (n = 3). Data collection methods included informal discussions with clinicians and an online survey (n = 35). The staged process included reflection on why the first attempt did not improve the provision of mCIMT (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide the behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5). RESULTS Reflection among the working group identified the need for upskilling in mCIMT delivery and the use of a behaviour change framework to guide the implementation program. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context-specific mCIMT protocol, the BCW guided the behaviour change intervention, which included education, training, persuasion, environmental restructuring, and modelling. CONCLUSION This paper provides an example of using the TDF and BCW to support the implementation of mCIMT in a large early-supported discharge service. It outlines the suite of behaviour change techniques used to influence clinician behaviour. The success of this behaviour change intervention will be explored in future research.
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Affiliation(s)
- Ashan Weerakkody
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Robyn Emmanuel
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
- Neurotherapy Occupational Therapy Services, Perth, Australia
| | - Jocelyn White
- Rehabilitation in the Home, South Metropolitan Health Service, Department of Health, Fremantle, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- Sir Charles Gairdner Hospital, North Metropolitan Health Service, Department of Health, Nedlands, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- TRAining Centre in Subacute Care (TRACSWA), Department of Health, Fremantle, Australia
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8
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Psychouli P, Mamais I, Anastasiou C. An Exploration of the Effectiveness of Different Intensity Protocols of Modified Constraint-Induced Therapy in Stroke: A Systematic Review. Rehabil Res Pract 2023; 2023:6636987. [PMID: 37854484 PMCID: PMC10581859 DOI: 10.1155/2023/6636987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose To examine the effectiveness of different modified Constraint-Inuced Therapy (mCIMT) protocol intensities on upper extremity motor function in adults with hemiplegia. Methods A search was conducted in PubMed, Scopus, EBSCO, and Cochrane Library for articles published between April 2010 and December 2021. Only randomized controlled trials (RCTs) were included. Studies were excluded if they used a sample of less than five, mCIMT in combination with other therapy, and/or if they were not written in English. Methodologic quality was assessed using the Cochrane collaboration risk of bias tool-2. Results Thirty-six RCTs with a total of 721 participants were included. Most researchers followed a moderate to low protocol intensity in terms of total treatment time and moderate to high intensity with regard to restriction time. Almost all of the upper limb motor function measures showed statistically significant improvements (p < .05) after mCIMT, irrespective of the protocol's intensity, but there was lack of high-quality studies. Statistically significant improvements did not always translate to clinical importance. Conclusions Low-intensity CIMT protocols may result in comparable improvements to more intensive ones but caution has to be taken when drawing conclusions due to high risk of bias studies.
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Affiliation(s)
- Pavlina Psychouli
- Occupational Therapy Program, Department of Health Sciences, European University Cyprus, Cyprus
| | - Ioannis Mamais
- Occupational Therapy Program, Department of Health Sciences, European University Cyprus, Cyprus
| | - Charalambos Anastasiou
- Occupational Therapy Program, Department of Health Sciences, European University Cyprus, Cyprus
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Sylaja PN, Nair JPR, Kate MP, Dhasan A, Nambiar V, Narayan S, Renjith V, Arora D, Verma SJ, Sharma M, Dhaliwal R, Khatter H, Sarma PS, Pandian JD. Ayurvedic Treatment in the Rehabilitation of Ischemic Stroke Patients in India: A Randomized Controlled Trial Study Protocol. Cerebrovasc Dis 2023; 52:609-615. [PMID: 37023741 DOI: 10.1159/000530546] [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: 02/26/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
In patients with ischemic stroke, motor and sensory impairments are common and are associated with functional disability. Conventional physiotherapy (CP) is the primary modality of rehabilitation for post-stroke sensorimotor dysfunction. Ayurveda is a commonly practiced alternative system of medicine that offers unique rehabilitative measures for post-stroke recovery. We hypothesize that Ayurvedic rehabilitative treatment (ART) is superior to similar duration CP in improving the sensorimotor recovery of patients with ischemic stroke at 90 days after enrollment. AyuRvedic TrEatment in the Rehabilitation of Ischemic STrOke Patients in India: A Randomized controllEd trial (RESTORE) is an investigator-initiated, multicenter, prospective, randomized, controlled, parallel-arm, blinded outcome assessment trial being conducted under the Indian Stroke Clinical Trial (INSTRuCT) Network across the four comprehensive stroke centers in India. Consecutive hemodynamically stable adult patients with their first acute ischemic stroke between 1 and 3 months from stroke onset are being randomized (1:1) into two treatment groups to receive either 1 month of ART or 1 month of CP. The primary outcome measure is the Fugl Meyer Assessment-upper extremity for physical performance at 90 days. The secondary outcomes are the modified Rankin Scale, Barthel Index, Berg Balance, and SF-36 at 90 days. The safety outcomes include a composite of irreversible morbidity and mortality. A sample size of 140 (70 in each group) patients with ischemic stroke will allow us to detect a minimal clinical important difference of 9.4 (standard deviation) with superiority margin of 5, an attrition rate of 10%, alpha of 5%, and power of 80%. This randomized trial will systematically assess the efficacy and safety of traditional ART compared to CP. The trial has been registered in the Clinical Trial Registry India (CTRI/2018/04/013379).
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Affiliation(s)
- Padmavathy Narayana Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | - Aneesh Dhasan
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Vivek Nambiar
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India
| | - Sunil Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vishnu Renjith
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Deepti Arora
- Department of Neurology, Christian Medical College, Ludhiana, India
| | | | - Meenakshi Sharma
- Non-Communicable Diseases Section, Indian Council of Medical Research, New Delhi, India
| | - Rupinder Dhaliwal
- Non-Communicable Diseases Section, Indian Council of Medical Research, New Delhi, India
| | - Himani Khatter
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
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10
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Yang FA, Lee TH, Huang SW, Liou TH, Escorpizo R, Chen HC. Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:516-533. [PMID: 36330696 DOI: 10.1177/02692155221137698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand-arm bimanual intensive training, hand-arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. DATA SOURCES We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. REVIEW METHODS To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. RESULTS We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand-arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand-arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( - 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. CONCLUSION We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.
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Affiliation(s)
- Fu-An Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Hsuan Lee
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
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11
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Timing and Dose of Constraint-Induced Movement Therapy after Stroke: A Systematic Review and Meta-Regression. J Clin Med 2023; 12:jcm12062267. [PMID: 36983266 PMCID: PMC10058952 DOI: 10.3390/jcm12062267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/23/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
The aim of this study is to investigate the effects of constraint-induced movement therapy on stroke patients who had intact cognition and some voluntary finger extension and to identify optimal protocols to apply this therapy method. We searched PubMed, Cochrane Library, and Embase for randomized controlled trials conducted prior to January 2022. The outcomes included the Motor Activity Log, Fugl-Meyer Assessment, and Wolf Motor Function Test. The inverse variance method fixed-effect model as well as the DerSimonian and Laird estimator random-effects model were applied, and the mean difference was calculated with 95% confidence interval to measure continuous outcomes. Six randomized controlled trials involving a total of 169 patients with stroke were enrolled. Compared with conventional rehabilitation methods, there was no significant effect of constraint-induced movement therapy when evaluated by the Motor Activity Log, including the amount of use (random-effect, standardized mean difference 0.65; 95%, confidence interval: −0.23–1.52) and quality of movement (random-effect, standardized mean difference 0.60; 95% confidence interval: −0.19–1.39). However, among patients with chronic stroke symptoms, meta-regression analyses showed better performance with a constraint time of at least 6 h per day and 6 h training per week when assessing the amount of use (p = 0.0035) and quality of movement (p = 0.0031). Daily intervention time did not lead to a significant difference in functional upper limb performance. An efficient protocol of constraint-induced movement therapy designed as 6 h of training per week with 6 h constraint per day could bring significant stroke symptom improvement to patients with chronic stroke.
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Donnellan-Fernandez K, Ioakim A, Hordacre B. Revisiting dose and intensity of training: Opportunities to enhance recovery following stroke. J Stroke Cerebrovasc Dis 2022; 31:106789. [PMID: 36162377 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106789] [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: 07/28/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Stroke is a global leading cause of adult disability with survivors often enduring persistent impairments and loss of function. Both intensity and dosage of training appear to be important factors to help restore behavior. However, current practice fails to achieve sufficient intensity and dose of training to promote meaningful recovery. The purpose of this review is to propose therapeutic solutions that can help achieve a higher dose and/or intensity of therapy. Raising awareness of these intensive, high-dose, treatment strategies might encourage clinicians to re-evaluate current practice and optimize delivery of stroke rehabilitation for maximal recovery. METHODS Literature that tested and evaluated solutions to increase dose or intensity of training was reviewed. For each therapeutic strategy, we outline evidence of clinical benefit, supporting neurophysiological data (where available) and discuss feasibility of clinical implementation. RESULTS Possible therapeutic solutions included constraint induced movement therapy, robotics, circuit therapy, bursts of training, gaming technologies, goal-oriented instructions, and cardiovascular exercise. CONCLUSION Our view is that clinicians should evaluate current practice to determine how intensive high-dose training can be implemented to promote greater recovery after stroke.
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Affiliation(s)
| | - Andrew Ioakim
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, Adelaide, Australia.
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Seo NJ, Ramakrishnan V, Woodbury ML, Bonilha L, Finetto C, Schranz C, Scronce G, Coupland K, Blaschke J, Baker A, Howard K, Meinzer C, Velozo CA, Adams RJ. Concomitant sensory stimulation during therapy to enhance hand functional recovery post stroke. Trials 2022; 23:262. [PMID: 35382902 PMCID: PMC8981199 DOI: 10.1186/s13063-022-06241-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background Post-stroke hand impairment is prevalent and persistent even after a full course of rehabilitation. Hand diminishes stroke survivors’ abilities for activities of daily living and independence. One way to improve treatment efficacy is to augment therapy with peripheral sensory stimulation. Recently, a novel sensory stimulation, TheraBracelet, has been developed in which imperceptible vibration is applied during task practice through a wrist-worn device. The objective of this trial is to determine if combining TheraBracelet with hand task practice is superior to hand task practice alone. Methods A double-blind randomized controlled trial will be used. Chronic stroke survivors will undergo a standardized hand task practice therapy program (3 days/week for 6 weeks) while wearing a device on the paretic wrist. The device will deliver TheraBracelet vibration for the treatment group and no vibration for the control group. The primary outcome is hand function measured by the Wolf Motor Function Test. Other outcomes include the Box and Block Test, Action Research Arm Test, upper extremity use in daily living, biomechanical measure of the sensorimotor grip control, and EEG-based neural communication. Discussion This research will determine clinical utility of TheraBracelet to guide future translation. The TheraBracelet stimulation is delivered via a wrist-worn device, does not interfere with hand motion, and can be easily integrated into clinical practice. Enhancing hand function should substantially increase stroke survivors' independence and quality of life and reduce caregiver burden. Trial registration NCT04569123. Registered on September 29, 2020
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Affiliation(s)
- Na Jin Seo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA. .,Ralph H. Johnson VA Medical Center, Charleston, SC, USA. .,Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA.
| | - Viswanathan Ramakrishnan
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Michelle L Woodbury
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
| | - Christian Finetto
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Christian Schranz
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Gabrielle Scronce
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Kristen Coupland
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Jenna Blaschke
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Adam Baker
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Keith Howard
- Department of Health Science and Research, Medical University of South Carolina, 77 President St, MSC 700, Charleston, SC, 29425, USA
| | - Caitlyn Meinzer
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon St, Charleston, SC, 29425, USA
| | - Craig A Velozo
- Department of Rehabilitation Sciences, Department of Health Science and Research, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, USA
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 606, Charleston, SC, 29425, USA
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McEnerney Edmondson AE, Cancio JM, Yancosek KE. Modified Constraint-Induced Movement Therapy for persons with unilateral upper extremity amputation: A case report. J Hand Ther 2021; 33:587-592. [PMID: 30352767 DOI: 10.1016/j.jht.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/28/2018] [Accepted: 09/08/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Pretest/posttest case series design. INTRODUCTION Rates of prosthetic device abandonment are highest among persons with upper extremity (UE) amputation. Modified Constraint-Induced Movement Therapy (mCIMT), which has been extensively studied in patients with chronic, subacute, and acute stroke, is an under-utilized approach to treat persons with UE amputation. PURPOSE OF THE STUDY To present an mCIMT intervention for prosthetic device training after a unilateral UE amputation. METHODS The two cases from an advanced rehabilitation center herein described followed a standard UE amputation rehabilitation program used in conjunction with a home training program using mCIMT 3 hours a day, 5 days a week, for 3 weeks. Progress was evaluated weekly using the Activities Measure for Upper Limb Amputees (AM-ULA); Disabilities of the Arm, Shoulder, and Hand; Trinity Amputation and Prosthesis Experience Scales-Revised. RESULTS Both the cases exhibited an increase in observable and objective functional use with a UE prosthetic device, as indicated by the AM-ULA. CONCLUSIONS To our knowledge, this is the first description of mCIMT as part of a unilateral UE amputee rehabilitation program. The AM-ULA results show meaningful change, whereas Disabilities of the Arm, Shoulder, and Hand and Trinity Amputation and Prosthesis Experience Scales-Revised show mixed results.
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Affiliation(s)
- Anne E McEnerney Edmondson
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX, USA.
| | - Jill M Cancio
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX, USA; Extremity Trauma and Amputation Center of Excellence, JBSA Ft. Sam Houston, TX, USA
| | - Kathleen E Yancosek
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, JBSA Ft. Sam Houston, TX, USA
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Rocha LSO, Gama GCB, Rocha RSB, Rocha LDB, Dias CP, Santos LLS, Santos MCDS, Montebelo MIDL, Teodori RM. Constraint Induced Movement Therapy Increases Functionality and Quality of Life after Stroke. J Stroke Cerebrovasc Dis 2021; 30:105774. [PMID: 33848906 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105774] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/15/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022] Open
Abstract
This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided into two groups: Control (CG) and CIMT (CIMTG); evaluated before and after 12 and 24 intervention sessions. The scales used were: adapted Fugl-Meyer Motor Assessment (FMA), Modified Ashworth, Stroke Specific Quality Of Life (SS-QOL) and the Functional Reach Test (FRT). The scores for all FMA variables in the CIMTG increased until the 24th session, differing from the pre-treatment. In the CG, the scores increased for pain, coordination/ speed and sensitivity. In the FRT there was an increase in the scores in both groups; after the 12th and 24th sessions, the result of the CIMTG was superior to the CG. For the SS-QOL in the CIMTG, the general score and most of the variables increased, as well as in the CG. Muscle tone in CIMTG was lower compared to CG after 24 sessions. Both protocols used in the study were effective, the CIMT protocol showed benefits in recovering the functionality of the paretic upper limb, in the functional range and in reducing muscle tone, with a consequent improvement in quality of life.
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Affiliation(s)
- Larissa Salgado Oliveira Rocha
- Physiotherapy Course at the State University of Pará; Belém, Brazil; Postgraduate in Human Movement Sciences at the Methodist University of Piracicaba; Piracicaba, Brazil.
| | | | - Rodrigo Santiago Barbosa Rocha
- Physiotherapy Course at the State University of Pará; Belém, Brazil; Postgraduate in Human Movement Sciences at the Methodist University of Piracicaba; Piracicaba, Brazil
| | | | | | - Luciane Lobato Sobral Santos
- Physiotherapy Course at the State University of Pará; Belém, Brazil; Postgraduate in Human Movement Sciences at the Methodist University of Piracicaba; Piracicaba, Brazil
| | | | | | - Rosana Macher Teodori
- Postgraduate in Human Movement Sciences at the Methodist University of Piracicaba; Piracicaba, Brazil
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Galvão FR, Silvestre MC, Gomes CL, Pereira NK, Nóbrega VT, Lima WS, Gondim AL, Cacho EW, Cacho RO. Group-based constraint-induced movement therapy in the rehabilitation of chronic poststroke patients. Medicine (Baltimore) 2021; 100:e24864. [PMID: 33663110 PMCID: PMC7909176 DOI: 10.1097/md.0000000000024864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to describe the effects of a 90-minute group-based constraint-induced movement therapy protocol (CIMT) on upper extremity (UE) rehabilitation in poststroke patients. METHOD The study was a case series clinical study with 6 patients with chronic stroke admitted to the institutional integrated clinic. Ten 90-minute CIMT sessions were administered, based on the principles of the original therapy. On completion of the protocol, participants underwent group care once a week, for 1 hour a day. For comparison purposes, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM) were applied on admission, shortly after completing the protocol, and 3 months after completion. In addition, the MAL and shaping tasks were applied daily. RESULTS There was a statistically significant difference only in the MAL Amount of Use Scale applied daily between the 2nd (3.56) and 9th (3.31) and 2nd and 10th days (4.49) (P = .004), with a moderate effect size (d' = 0.46), and in the average value of shaping repetitions between the 1st (16.10) and 2nd (6.00) and 1st and 10th tasks (7.00) (P = .014), with a moderate effect size (d' = 0.35). CONCLUSION The 90-minute CIMT protocol resulted in significant improvements in use of the more affected arm in activities of daily living during the 2-week protocol. Additional research with a larger sample and a control group is needed to confirm its effectiveness.
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Schowalter S, Katz DI, Lin DJ. Clinical Reasoning: A 33-Year-Old Patient With Left-Sided Hemiparesis and Anarthria. Neurology 2020; 96:128-133. [PMID: 32913028 DOI: 10.1212/wnl.0000000000010809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sean Schowalter
- From the Beth Israel Deaconess Medical Center (S.S.), Boston; Boston University School of Medicine (D.I.K.); and Massachusetts General Hospital (D.J.L.), Boston.
| | - Douglas I Katz
- From the Beth Israel Deaconess Medical Center (S.S.), Boston; Boston University School of Medicine (D.I.K.); and Massachusetts General Hospital (D.J.L.), Boston
| | - David J Lin
- From the Beth Israel Deaconess Medical Center (S.S.), Boston; Boston University School of Medicine (D.I.K.); and Massachusetts General Hospital (D.J.L.), Boston
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Exploring the relationship between visuospatial function and age-related deficits in motor skill transfer. Aging Clin Exp Res 2020; 32:1451-1458. [PMID: 31520336 DOI: 10.1007/s40520-019-01345-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/31/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Generalizing learned information from one motor task to another is critical for effective motor rehabilitation. A recent study demonstrated age-related declines in motor skill transfer, yet findings from other motor learning studies suggest that visuospatial impairments may explain such aging effects. AIMS The purpose of this secondary analysis was to test whether age-related deficits in motor skill transfer were related to low visuospatial ability. METHODS Forty-two participants (mean ± SD age: 72.1 ± 9.9 years) were tested on an upper extremity dexterity task before and after 3 days of training on an upper extremity reaching task. Training and control data have been published previously. Prior to training, global cognitive status and specific cognitive domains (visuospatial/executive, attention, and delayed memory) were evaluated using the Montreal Cognitive Assessment. RESULTS Backward-stepwise linear regression indicated that the Visuospatial/Executive subtest was related to motor skill transfer (i.e., the amount of change in performance on the untrained motor task), such that participants with higher visuospatial scores improved more on the untrained dexterity task than those with lower scores. Global cognitive status was unrelated to motor skill transfer. DISCUSSION Consistent with previous studies showing a positive relationship between visuospatial function and other aspects of motor learning, this secondary analysis indicates that less motor skill transfer among older adults may indeed be due to declines in visuospatial function. CONCLUSIONS The present study highlights the potential utility of assessing older patients' visuospatial ability within motor rehabilitation to provide valuable insight into the extent to which they may learn and generalize motor skills through training.
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Smith MA, Tomita MR. Combined effects of Telehealth and Modified Constraint-Induced Movement Therapy for Individuals with Chronic Hemiparesis. Int J Telerehabil 2020; 12:51-62. [PMID: 32983368 PMCID: PMC7502810 DOI: 10.5195/ijt.2020.6300] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Telehealth use allows improved access to services and results in potential cost savings. The purpose of this study was to examine the effectiveness of a combined modified Constrained Induced Movement Therapy (mCIMT) program using telehealth and in-person sessions, for participants with higher (Group 1) and lower (Group 2) functional ability of the hemiparetic upper extremity. Using a pre-experimental design with a 6-week intervention, 28 participants were assessed twice on use of upper extremity via subjective and objective measures. For the Motor Activity Log, the amount of use and quality of use were significant for Groups 1 and 2. Significant improvements were shown on the Wolf Motor Function Test (WMFT), the Fugl-Meyer UE, and the Functional Independence Measure (FIM) for both groups except for the strength subtest on the WMFT and the timed portion for Group 1. Percentages of attendance for telehealth and in-person sessions were also compared. Telehealth sessions had a higher attendance rate (84.5%) than in-person sessions (75.3%) (p=.004). The combined mCIMT program of telerehabilitation and in-person group sessions was effective in improving functional ability after a stroke.
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Affiliation(s)
- Mary Ann Smith
- University of St. Augustine for Health Sciences, Austin, TX, USA
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Ekechukwu END, Olowoyo P, Nwankwo KO, Olaleye OA, Ogbodo VE, Hamzat TK, Owolabi MO. Pragmatic Solutions for Stroke Recovery and Improved Quality of Life in Low- and Middle-Income Countries-A Systematic Review. Front Neurol 2020; 11:337. [PMID: 32695058 PMCID: PMC7336355 DOI: 10.3389/fneur.2020.00337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Given the limited healthcare resources in low and middle income countries (LMICs), effective rehabilitation strategies that can be realistically adopted in such settings are required. Objective: A systematic review of literature was conducted to identify pragmatic solutions and outcomes capable of enhancing stroke recovery and quality of life of stroke survivors for low- and middle- income countries. Methods: PubMed, HINARI, and Directory of Open Access Journals databases were searched for published Randomized Controlled Trials (RCTs) till November 2018. Only completed trials published in English with non-pharmacological interventions on adult stroke survivors were included in the review while published protocols, pilot studies and feasibility analysis of trials were excluded. Obtained data were synthesized thematically and descriptively analyzed. Results: One thousand nine hundred and ninety six studies were identified while 347 (65.22% high quality) RCTs were found to be eligible for the review. The most commonly assessed variables (and outcome measure utility) were activities of daily living [75.79% of the studies, with Barthel Index (37.02%)], motor function [66.57%; with Fugl Meyer scale (71.88%)], and gait [31.12%; with 6 min walk test (38.67%)]. Majority of the innovatively high technology interventions such as robot therapy (95.24%), virtual reality (94.44%), transcranial direct current stimulation (78.95%), transcranial magnetic stimulation (88.0%) and functional electrical stimulation (85.00%) were conducted in high income countries. Several traditional and low-cost interventions such as constraint-induced movement therapy (CIMT), resistant and aerobic exercises (R&AE), task oriented therapy (TOT), body weight supported treadmill training (BWSTT) were reported to significantly contribute to the recovery of motor function, activity, participation, and improvement of quality of life after stroke. Conclusion: Several pragmatic, in terms of affordability, accessibility and utility, stroke rehabilitation solutions, and outcome measures that can be used in resource-limited settings were found to be effective in facilitating and enhancing post-stroke recovery and quality of life.
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Affiliation(s)
- Echezona Nelson Dominic Ekechukwu
- Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu, Nigeria
- LANCET Physiotherapy and Wellness and Research Centre, Enugu, Nigeria
| | - Paul Olowoyo
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti, Nigeria
- College of Medicine and Health Sciences, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kingsley Obumneme Nwankwo
- Stroke Control Innovations Initiative of Nigeria, Abuja, Nigeria
- Fitness Global Consult Physiotherapy Clinic, Abuja, Nigeria
| | - Olubukola A Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Ojo Owolabi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
- Blossom Specialist Medical Centre, Ibadan, Nigeria
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Bani-Ahmed AA. Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review. J Phys Ther Sci 2019; 31:950-959. [PMID: 31871384 PMCID: PMC6879401 DOI: 10.1589/jpts.31.950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This review synthesizes findings from studies on two forms of Constraint-Induced Movement Therapies: the original Constraint-Induced Movement Therapy and the modified Constraint-Induced Movement Therapy, in adult stroke patients including the evidence, current limitations and future directions. [Methods] We critically reviewed studies evaluating the effectiveness of Constraint-Induced Movement Therapies in chronic stoke focusing on the functional (i.e. motor recovery) and the neural (i.e. cortical organization) levels. [Results] Constraint-Induced Movement Therapies seemed to improve the upper limb functional usage in chronic stoke with no reliable neurophysiological underlying mechanisms. The Motor Activity Log was the common outcome measuring motor recovery. The work that has been done on modified Constraint-Induced Movement Therapy was far less than the work done on the original Constraint-Induced Movement Therapy. [Conclusion] Evident lack of understanding of the association between changes in motor recovery and the underlying neural mechanisms in-terms of measures of assessing and defining functional recovery (i.e Motor Activity Log) that lacks sufficient sensitivity to characterize changes in movement strategies and thereby lack of distinction between recovery and behavioral compensation. Future studies should employ using kinematic metrics to quantify and explain the training-related changes in behavior following Constraint-Induced Movement Therapies in chronic stroke.
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Affiliation(s)
- Ali Ahmed Bani-Ahmed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk: 71491 Tabuk, KSA
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Alashram AR, Annino G, Mercuri NB. Task-oriented Motor Learning in Upper Extremity Rehabilitation Post Stroke. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/2516608519864760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Upper extremity deficits are the most popular symptoms following stroke. Task-oriented training has the ability to increase motor area excitability in the brain, which can stimulate the recovery of motor control.Objective: This study was aimed to examine the efficiency of the task-oriented approach on paretic upper extremity following a stroke, and to identify efficient treatment dosage in those populations.Method: We searched through PubMed, Scopus, Physiotherapy Evidence Database (PEDro), National Rehabilitation Information (REHABDATA), and Web of Science databases. Randomized clinical trials (RCTs) and pseudo-RCTs those investigating upper extremity in patients with stroke published in English language were selected. Different scales and measurement methods to assess range of motion, strength, spasticity, and upper extremity function were considered. The quality assessment of included articles was evaluated utilizing the PEDro scale. Effect sizes were calculated.Results: Six RCTs were included in the present study. The quality assessment for included studies ranged from 6 to 8 with 6.5 as a median. A total of 456 post-stroke patients, 41.66% of which were women, were included in all studies. The included studies demonstrated a meaningful influence of task-oriented training intervention on the hemiplegic upper limb motor functions but not spasticity post-stroke.Conclusion: Task-oriented training does not produce a superior effect than other conventional physical therapy interventions in treating upper extremity in patients with stroke. There is no evidence supporting the beneficial effect of task-oriented on spasticity. Task-oriented training with the following dosage 30 to 90 minutes/session, 2 to 3 sessions weekly for 6 to 10 weeks may improve motor function and strength of paretic upper extremity post-stroke.
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Affiliation(s)
- Anas R. Alashram
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata,” Italy
- Department of Medicine Systems, University of Rome “Tor Vergata,” Italy
| | - Giuseppe Annino
- Department of Medicine Systems, University of Rome “Tor Vergata,” Italy
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Nicola Biagio Mercuri
- Faculty of Medicine and Surgery, University of Rome “Tor Vergata,” Italy
- Department of Medicine Systems, University of Rome “Tor Vergata,” Italy
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Mugler EM, Tomic G, Singh A, Hameed S, Lindberg EW, Gaide J, Alqadi M, Robinson E, Dalzotto K, Limoli C, Jacobson T, Lee J, Slutzky MW. Myoelectric Computer Interface Training for Reducing Co-Activation and Enhancing Arm Movement in Chronic Stroke Survivors: A Randomized Trial. Neurorehabil Neural Repair 2019; 33:284-295. [PMID: 30888251 DOI: 10.1177/1545968319834903] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Abnormal muscle co-activation contributes to impairment after stroke. We developed a myoelectric computer interface (MyoCI) training paradigm to reduce abnormal co-activation. MyoCI provides intuitive feedback about muscle activation patterns, enabling decoupling of these muscles. OBJECTIVE To investigate tolerability and effects of MyoCI training of 3 muscle pairs on arm motor recovery after stroke, including effects of training dose and isometric versus movement-based training. METHODS We randomized chronic stroke survivors with moderate-to-severe arm impairment to 3 groups. Two groups tested different doses of isometric MyoCI (60 vs 90 minutes), and one group tested MyoCI without arm restraint (90 minutes), over 6 weeks. Primary outcome was arm impairment (Fugl-Meyer Assessment). Secondary outcomes included function, spasticity, and elbow range-of-motion at weeks 6 and 10. RESULTS Over all 32 subjects, MyoCI training of 3 muscle pairs significantly reduced impairment (Fugl-Meyer Assessment) by 3.3 ± 0.6 and 3.1 ± 0.7 ( P < 10-4) at weeks 6 and 10, respectively. Each group improved significantly from baseline; no significant differences were seen between groups. Participants' lab-based and home-based function also improved at weeks 6 and 10 ( P ≤ .01). Spasticity also decreased over all subjects, and elbow range-of-motion improved. Both moderately and severely impaired patients showed significant improvement. No participants had training-related adverse events. MyoCI reduced abnormal co-activation, which appeared to transfer to reaching in the movement group. CONCLUSIONS MyoCI is a well-tolerated, novel rehabilitation tool that enables stroke survivors to reduce abnormal co-activation. It may reduce impairment and spasticity and improve arm function, even in severely impaired patients.
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Affiliation(s)
| | | | | | | | | | - Jon Gaide
- 1 Northwestern University, Chicago, IL, USA
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Seo NJ, Woodbury ML, Bonilha L, Ramakrishnan V, Kautz SA, Downey RJ, Dellenbach BHS, Lauer AW, Roark CM, Landers LE, Phillips SK, Vatinno AA. TheraBracelet Stimulation During Task-Practice Therapy to Improve Upper Extremity Function After Stroke: A Pilot Randomized Controlled Study. Phys Ther 2019; 99:319-328. [PMID: 30690609 PMCID: PMC6383710 DOI: 10.1093/ptj/pzy143] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/13/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Peripheral sensory stimulation has been used in conjunction with upper extremity movement therapy to increase therapy-induced motor gains in patients with stroke. The limitation is that existing sensory stimulation methods typically interfere with natural hand tasks and thus are administered prior to therapy, requiring patients' time commitment. To address this limitation, we developed TheraBracelet. This novel stimulation method provides subthreshold (ie, imperceptible) vibratory stimulation to the wrist and can be used during hand tasks/therapy without interfering with natural hand tasks. OBJECTIVE The objective was to determine the feasibility of using TheraBracelet during therapy to augment motor recovery after stroke. DESIGN The design was a triple-blinded pilot randomized controlled trial. METHODS Twelve chronic stroke survivors were assigned to the treatment or control group. All participants completed 2-hour task practice therapy sessions thrice weekly for 2 weeks. Both groups wore a small vibrator on the paretic wrist, which was turned on to provide TheraBracelet stimulation for the treatment group and turned off for the control group to provide sham stimulation. Outcome measures (Box and Block Test [BBT] and Wolf Motor Function Test [WMFT]) were obtained at baseline, 6 days after therapy, and at follow-up 19 days after therapy. RESULTS The intervention was feasible with no adverse events. The treatment group significantly improved their BBT scores after therapy and at follow-up compared with baseline, whereas the control group did not. For WMFT, the group × time interaction was short of achieving significance. Large effect sizes were obtained (BBT d = 1.43, WMFT d = 0.87). No indication of desensitization to TheraBracelet stimulation was observed. LIMITATIONS The limitation was a small sample size. CONCLUSIONS TheraBracelet could be a promising therapy adjuvant for upper extremity recovery after stroke.
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Affiliation(s)
- Na J Seo
- Division of Occupation Therapy, Department of Health Professions, Department of Health Sciences and Research, Medical University of South Carolina, 151B Rutledge Ave, Charleston, SC 29425 (USA)
| | - Michelle L Woodbury
- Department of Health Sciences and Research, Medical University of South Carolina
| | | | | | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina
| | - Ryan J Downey
- Department of Health Professions, Medical University of South Carolina
| | - Blair H S Dellenbach
- Department of Health Sciences and Research, Medical University of South Carolina
| | - Abigail W Lauer
- Department of Public Health Sciences, Medical University of South Carolina
| | - Caroline M Roark
- Division of Occupational Therapy, Medical University of South Carolina
| | - Lauren E Landers
- Division of Occupational Therapy, Medical University of South Carolina
| | - Sarah K Phillips
- Division of Occupational Therapy, Medical University of South Carolina
| | - Amanda A Vatinno
- College of Health Professions, Medical University of South Carolina
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Christie LJ, McCluskey A, Lovarini M. Constraint-induced movement therapy for upper limb recovery in adult neurorehabilitation: An international survey of current knowledge and experience. Aust Occup Ther J 2019; 66:401-412. [PMID: 30714621 DOI: 10.1111/1440-1630.12567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Constraint-induced movement therapy (CIMT) is an effective intervention for upper limb recovery following stroke and traumatic brain injury. Despite strong evidence, the use of CIMT in practice is limited. The aim of this study was to investigate clinician knowledge and experience of delivering CIMT protocols internationally in neurorehabilitation. METHODS A cross-sectional survey was conducted online. The survey was distributed through occupational therapy and physiotherapy associations, neurological interest groups and list serves in 11 countries. Passive snowball sampling was used to recruit participants. Descriptive and inferential statistics were used for analysis. RESULTS Complete surveys were returned by 169 respondents (64.5% occupational therapists; 34.3% physiotherapists; 1.2% other). Most respondents were from the United Kingdom (36.1%), Australia (28.4%) and Denmark (7.7%). Most participants delivered CIMT to individuals (79.3%) rather than in groups. A modified version of CIMT was used most often (74.6%), with one hour sessions per day (30.2%), provided to stroke survivors (96.4%) and people with traumatic brain injury (37.3%). Most respondents (88.8%) used intensive graded practice as a component of a CIMT program, but only 43.2% reported using a mitt restraint for most waking hours, and only 38.5% used a transfer package. CONCLUSION These findings suggest that CIMT is being used globally but not always with fidelity to the original trials. A range of strategies are needed for improving clinicians' knowledge and skills to increase the frequency of program delivery and enhance program delivery with fidelity.
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Affiliation(s)
- Lauren J Christie
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,Liverpool Hospital Brain Injury Rehabilitation Unit, South Western Sydney Local Health District (SWSLHD), Liverpool, NSW, Australia.,Brain Injury Rehabilitation Research Group (BIRRG), The Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.,The StrokeEd Collaboration, Sydney, NSW, Australia
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
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Welsby E, Ridding M, Hillier S, Hordacre B. Connectivity as a Predictor of Responsiveness to Transcranial Direct Current Stimulation in People with Stroke: Protocol for a Double-Blind Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10848. [PMID: 30341044 PMCID: PMC6231838 DOI: 10.2196/10848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/24/2023] Open
Abstract
Background Stroke can have devastating consequences for an individual’s quality of life. Interventions capable of enhancing response to therapy would be highly valuable to the field of neurological rehabilitation. One approach is to use noninvasive brain stimulation techniques, such as transcranial direct current stimulation, to induce a neuroplastic response. When delivered in combination with rehabilitation exercises, there is some evidence that transcranial direct current stimulation is beneficial. However, responses to stimulation are highly variable. Therefore biomarkers predictive of response to stimulation would be valuable to help select appropriate people for this potentially beneficial treatment. Objective The objective of this study is to investigate connectivity of the stimulation target, the ipsilesional motor cortex, as a biomarker predictive of response to anodal transcranial direct current stimulation in people with stroke. Methods This study is a double blind, randomized controlled trial (RCT), with two parallel groups. A total of 68 participants with first ever ischemic stroke with motor impairment will undertake a two week (14 session) treatment for upper limb function (Graded Repetitive Arm Supplementary Program; GRASP). Participants will be randomized 2:1 to active:sham treatment groups. Those in the active treatment group will receive anodal transcranial direct current stimulation to the ipsilesional motor cortex at the start of each GRASP session. Those allocated to the sham treatment group will receive sham transcranial direct current stimulation. Behavioural assessments of upper limb function will be performed at baseline, post treatment, 1 month follow-up and 3 months follow-up. Neurophysiological assessments will include magnetic resonance imaging (MRI), electroencephalography (EEG) and transcranial magnetic stimulation (TMS) and will be performed at baseline, post treatment, 1 month follow-up (EEG and TMS only) and 3 months follow-up (EEG and TMS only). Results Participants will be recruited between March 2018 and December 2018, with experimental testing concluding in March 2019. Conclusions Identifying a biomarker predictive of response to transcranial direct current stimulation would greatly assist clinical utility of this novel treatment approach. Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12618000443291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000443291 (Archived by WebCite at http://www.webcitation.org/737QOXXxt) Registered Report Identifier RR1-10.2196/10848
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Affiliation(s)
- Ellana Welsby
- The Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Michael Ridding
- Neuromotor Plasticity and Development Group, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Susan Hillier
- The Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Brenton Hordacre
- The Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia
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27
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Tabernig CB, Lopez CA, Carrere LC, Spaich EG, Ballario CH. Neurorehabilitation therapy of patients with severe stroke based on functional electrical stimulation commanded by a brain computer interface. J Rehabil Assist Technol Eng 2018; 5:2055668318789280. [PMID: 31191948 PMCID: PMC6453036 DOI: 10.1177/2055668318789280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction Brain computer interface is an emerging technology to treat the sequelae of stroke. The purpose of this study was to explore the motor imagery related desynchronization of sensorimotor rhythms of stroke patients and to assess the efficacy of an upper limb neurorehabilitation therapy based on functional electrical stimulation controlled by a brain computer interface. Methods Eight severe chronic stroke patients were recruited. The study consisted of two stages: screening and therapy. During screening, the ability of patients to desynchronize the contralateral oscillatory sensorimotor rhythms by motor imagery of the most affected hand was assessed. In the second stage, a therapeutic intervention was performed. It involved 20 sessions where an electrical stimulator was activated when the patient's cerebral activity related to motor imagery was detected. The upper limb was assessed, before and after the intervention, by the Fugl-Meyer score (primary outcome). Spasticity, motor activity, range of movement and quality of life were also evaluated (secondary outcomes). Results Desynchronization was identified in all screened patients. Significant post-treatment improvement (p < 0.05) was detected in the primary outcome measure and in the majority of secondary outcome scores. Conclusions The results suggest that the proposed therapy could be beneficial in the neurorehabilitation of stroke individuals.
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Affiliation(s)
- Carolina B Tabernig
- Laboratorio de Ingeniería en Rehabilitación e Investigaciones Neuromusculares y Sensoriales (LIRINS), Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Oro Verde, Argentina
| | - Camila A Lopez
- Fundación Rosarina de Neuro-rehabilitación, Rosario, Argentina
| | - Lucía C Carrere
- Laboratorio de Ingeniería en Rehabilitación e Investigaciones Neuromusculares y Sensoriales (LIRINS), Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Oro Verde, Argentina
| | - Erika G Spaich
- SMI®, Department of Health Science and Technology, Aalborg University, Denmark
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Seo NJ, Arun Kumar J, Hur P, Crocher V, Motawar B, Lakshminarayanan K. Usability evaluation of low-cost virtual reality hand and arm rehabilitation games. ACTA ACUST UNITED AC 2018; 53:321-34. [PMID: 27271199 DOI: 10.1682/jrrd.2015.03.0045] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 08/26/2015] [Indexed: 11/05/2022]
Abstract
The emergence of lower-cost motion tracking devices enables home-based virtual reality rehabilitation activities and increased accessibility to patients. Currently, little documentation on patients' expectations for virtual reality rehabilitation is available. This study surveyed 10 people with stroke for their expectations of virtual reality rehabilitation games. This study also evaluated the usability of three lower-cost virtual reality rehabilitation games using a survey and House of Quality analysis. The games (kitchen, archery, and puzzle) were developed in the laboratory to encourage coordinated finger and arm movements. Lower-cost motion tracking devices, the P5 Glove and Microsoft Kinect, were used to record the movements. People with stroke were found to desire motivating and easy-to-use games with clinical insights and encouragement from therapists. The House of Quality analysis revealed that the games should be improved by obtaining evidence for clinical effectiveness, including clinical feedback regarding improving functional abilities, adapting the games to the user's changing functional ability, and improving usability of the motion-tracking devices. This study reports the expectations of people with stroke for rehabilitation games and usability analysis that can help guide development of future games.
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Affiliation(s)
- Na Jin Seo
- Division of Occupational Therapy, Department of Health Professions, Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
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29
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Esfahlani SS, Thompson T, Parsa AD, Brown I, Cirstea S. ReHabgame: A non-immersive virtual reality rehabilitation system with applications in neuroscience. Heliyon 2018; 4:e00526. [PMID: 29560446 PMCID: PMC5857620 DOI: 10.1016/j.heliyon.2018.e00526] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/24/2017] [Accepted: 01/23/2018] [Indexed: 12/04/2022] Open
Abstract
This paper proposes the use of a non-immersive virtual reality rehabilitation system “ReHabgame” developed using Microsoft Kinect™ and the Thalmic™ Labs Myo gesture control armband. The ReHabgame was developed based on two third-person video games that provide a feasible possibility of assessing postural control and functional reach tests. It accurately quantifies specific postural control mechanisms including timed standing balance, functional reach tests using real-time anatomical landmark orientation, joint velocity, and acceleration while end trajectories were calculated using an inverse kinematics algorithm. The game was designed to help patients with neurological impairment to be subjected to physiotherapy activity and practice postures of daily activities. The subjective experience of the ReHabgame was studied through the development of an Engagement Questionnaire (EQ) for qualitative, quantitative and Rasch model. The Monte-Carlo Tree Search (MCTS) and Random object (ROG) generator algorithms were used to adapt the physical and gameplay intensity in the ReHabgame based on the Motor Assessment Scale (MAS) and Hierarchical Scoring System (HSS). Rasch analysis was conducted to assess the psychometric characteristics of the ReHabgame and to identify if these are any misfitting items in the game. Rasch rating scale model (RSM) was used to assess the engagement of players in the ReHabgame and evaluate the effectiveness and attractiveness of the game. The results showed that the scales assessing the rehabilitation process met Rasch expectations of reliability, and unidimensionality. Infit and outfit mean squares values are in the range of (0.68–1.52) for all considered 16 items. The Root Mean Square Residual (RMSR) and the person separation reliability were acceptable. The item/person map showed that the persons and items were clustered symmetrically.
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Affiliation(s)
- Shabnam Sadeghi Esfahlani
- Anglia Ruskin University, Department of Computing and Technology, CB5 8DZ, Cambridge, United Kingdom
| | - Tommy Thompson
- Anglia Ruskin University, Department of Computing and Technology, CB5 8DZ, Cambridge, United Kingdom
| | - Ali Davod Parsa
- Anglia Ruskin University, Department of Medical Science, CB5 8DZ, Cambridge, United Kingdom
| | - Ian Brown
- Anglia Ruskin University, Department of Computing and Technology, CB5 8DZ, Cambridge, United Kingdom
| | - Silvia Cirstea
- Anglia Ruskin University, Department of Computing and Technology, CB5 8DZ, Cambridge, United Kingdom
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30
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Llorens R, Noé E, Alcañiz M, Deutsch JE. Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke. Brain Inj 2017; 32:303-309. [PMID: 29278927 DOI: 10.1080/02699052.2017.1418905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the influence of time since injury on the efficacy and maintenance of gains of rehabilitation of balance after stroke. METHOD Forty-seven participants were assigned to a least (6-12 months), a moderate (12-24 months), or a most chronic (>24 months) group. Participants trained for 20 one-hour sessions, administered three to five times a week, combining conventional physical therapy and visual feedback-based exercises that trained the ankle and hip strategies. Participants were assessed before, after the intervention, and one month later with a posturography test (Sway Speed and Limits of Stability) and clinical scales. RESULTS In contrast to other subjects, the most chronic participants failed to improve their sway and to maintain the benefits detected in the Limits of Stability after the intervention. Although all the participants improved in those clinical tests that better matched the trained skills, time since injury limited the improvement, and over all, the maintenance of gains. CONCLUSION Time since injury limits but does not prevent improvement in chronic stages post-stroke, and this effect appears to be more pronounced with maintaining gains. These findings support that training duration and intensity as well as type of therapy may need to be adjusted based on time post-stroke.
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Affiliation(s)
- Roberto Llorens
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain.,b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Enrique Noé
- b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Mariano Alcañiz
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain
| | - Judith E Deutsch
- c Rivers Lab, Department of Movement and Rehabilitation Sciences , Rutgers University-School of Professions , Newark , USA
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31
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Hsu CJ, Kim J, Roth EJ, Rymer WZ, Wu M. Forced Use of the Paretic Leg Induced by a Constraint Force Applied to the Nonparetic Leg in Individuals Poststroke During Walking. Neurorehabil Neural Repair 2017; 31:1042-1052. [PMID: 29145773 DOI: 10.1177/1545968317740972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Individuals with stroke usually show reduced muscle activities of the paretic leg and asymmetrical gait pattern during walking. OBJECTIVE To determine whether applying a resistance force to the nonparetic leg would enhance the muscle activities of the paretic leg and improve the symmetry of spatiotemporal gait parameters in individuals with poststroke hemiparesis. METHODS Fifteen individuals with chronic poststroke hemiparesis participated in this study. A controlled resistance force was applied to the nonparetic leg using a customized cable-driven robotic system while subjects walked on a treadmill. Subjects completed 2 test sections with the resistance force applied at different phases of gait (ie, early and late swing phases) and different magnitudes (10%, 20%, and 30% of maximum voluntary contraction [MVC] of nonparetic leg hip flexors). Electromyographic (EMG) activity of the muscles of the paretic leg and spatiotemporal gait parameters were collected. RESULTS Significant increases in integrated EMG of medial gastrocnemius, medial hamstrings, vastus medialis, and tibialis anterior of the paretic leg were observed when the resistance was applied during the early swing phase of the nonparetic leg, compared with baseline. Additionally, resistance with 30% of MVC induced the greatest level of muscle activity than that with 10% or 20% of MVC. The symmetry index of gait parameters also improved with resistance applied during the early swing phase. CONCLUSION Applying a controlled resistance force to the nonparetic leg during early swing phase may induce forced use on the paretic leg and improve the spatiotemporal symmetry of gait in individuals with poststroke hemiparesis.
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Affiliation(s)
| | - Janis Kim
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Elliot J Roth
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
| | - Ming Wu
- 1 Shirley Ryan AbilityLab, Chicago, IL, USA.,2 Northwestern University, Chicago, IL, USA
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32
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van Lieshout ECC, Visser-Meily JMA, Neggers SFW, van der Worp HB, Dijkhuizen RM. Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients. BMJ Open 2017; 7:e016566. [PMID: 28851789 PMCID: PMC5629737 DOI: 10.1136/bmjopen-2017-016566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Many patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking. METHODS AND ANALYSIS In a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7-14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences. TRIAL REGISTRATION NUMBER NTR6133.
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Affiliation(s)
- Eline C C van Lieshout
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center, Utrecht, The Netherlands
| | - Sebastiaan F W Neggers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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Chang WH, Park E, Lee J, Lee A, Kim YH. Association Between Brain-Derived Neurotrophic Factor Genotype and Upper Extremity Motor Outcome After Stroke. Stroke 2017; 48:1457-1462. [DOI: 10.1161/strokeaha.116.015264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/24/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke.
Methods—
A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor.
Results—
The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of
Met
alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke.
Conclusions—
Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement.
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Affiliation(s)
- Won Hyuk Chang
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.H.C., E.P., J.L., A.L., Y.-H.K.); and Department of Health Science and Technology (Y.-H.K.) and Department of Medical Device Management and Research (Y.-H.K.), Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Eunhee Park
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.H.C., E.P., J.L., A.L., Y.-H.K.); and Department of Health Science and Technology (Y.-H.K.) and Department of Medical Device Management and Research (Y.-H.K.), Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Jungsoo Lee
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.H.C., E.P., J.L., A.L., Y.-H.K.); and Department of Health Science and Technology (Y.-H.K.) and Department of Medical Device Management and Research (Y.-H.K.), Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Ahee Lee
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.H.C., E.P., J.L., A.L., Y.-H.K.); and Department of Health Science and Technology (Y.-H.K.) and Department of Medical Device Management and Research (Y.-H.K.), Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Yun-Hee Kim
- From the Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (W.H.C., E.P., J.L., A.L., Y.-H.K.); and Department of Health Science and Technology (Y.-H.K.) and Department of Medical Device Management and Research (Y.-H.K.), Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Bundy DT, Souders L, Baranyai K, Leonard L, Schalk G, Coker R, Moran DW, Huskey T, Leuthardt EC. Contralesional Brain-Computer Interface Control of a Powered Exoskeleton for Motor Recovery in Chronic Stroke Survivors. Stroke 2017; 48:1908-1915. [PMID: 28550098 PMCID: PMC5482564 DOI: 10.1161/strokeaha.116.016304] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 03/22/2017] [Accepted: 04/18/2017] [Indexed: 12/27/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— There are few effective therapies to achieve functional recovery from motor-related disabilities affecting the upper limb after stroke. This feasibility study tested whether a powered exoskeleton driven by a brain–computer interface (BCI), using neural activity from the unaffected cortical hemisphere, could affect motor recovery in chronic hemiparetic stroke survivors. This novel system was designed and configured for a home-based setting to test the feasibility of BCI-driven neurorehabilitation in outpatient environments. Methods— Ten chronic hemiparetic stroke survivors with moderate-to-severe upper-limb motor impairment (mean Action Research Arm Test=13.4) used a powered exoskeleton that opened and closed the affected hand using spectral power from electroencephalographic signals from the unaffected hemisphere associated with imagined hand movements of the paretic limb. Patients used the system at home for 12 weeks. Motor function was evaluated before, during, and after the treatment. Results— Across patients, our BCI-driven approach resulted in a statistically significant average increase of 6.2 points in the Action Research Arm Test. This behavioral improvement significantly correlated with improvements in BCI control. Secondary outcomes of grasp strength, Motricity Index, and the Canadian Occupational Performance Measure also significantly improved. Conclusions— The findings demonstrate the therapeutic potential of a BCI-driven neurorehabilitation approach using the unaffected hemisphere in this uncontrolled sample of chronic stroke survivors. They also demonstrate that BCI-driven neurorehabilitation can be effectively delivered in the home environment, thus increasing the probability of future clinical translation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02552368.
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Affiliation(s)
- David T Bundy
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Lauren Souders
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Kelly Baranyai
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Laura Leonard
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Gerwin Schalk
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Robert Coker
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Daniel W Moran
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Thy Huskey
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.)
| | - Eric C Leuthardt
- From the Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City (D.T.B.); Departments of Biomedical Engineering (D.T.B., R.C., D.W.M., E.C.L.), Neurology (L.S., K.B., L.L., T.H.), Neurological Surgery (E.C.L.), Mechanical Engineering and Material Sciences (E.C.L.), and Neuroscience (E.C.L.), Washington University, St. Louis, MO; and National Center for Adaptive Neurotechnologies, Wadsworth Center, NYS Department of Health, Albany, NY (G.S.).
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Doussoulin A, Arancibia M, Saiz J, Silva A, Luengo M, Salazar A. Recovering functional independence after a stroke through Modified Constraint-Induced Therapy. NeuroRehabilitation 2017; 40:243-249. [DOI: 10.3233/nre-161409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Doussoulin
- Department of Pediatrics and Child Surgery, Universidad de La Frontera, Temuco, Chile
| | - M. Arancibia
- Department of Pediatrics and Child Surgery, Universidad de La Frontera, Temuco, Chile
| | - J. Saiz
- Department of Psychology, Universidad de La Frontera, Temuco, Chile
| | - A. Silva
- Graduate Program of Health Sciences, Federal University of Porto Alegre, Brazil
| | - M. Luengo
- Domiciliary Hospitalization Program, Hospital Villarrica, Chile
| | - A.P. Salazar
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
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Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res 2017; 39:197-210. [PMID: 27123790 DOI: 10.1097/mrr.0000000000000169] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique designed to improve upper extremity motor functions after stroke. This review aimed to investigate evidence of the effect of CIMT on upper extremity in stroke patients and to identify optimal methods to apply CIMT. Four databases (MEDLINE, EMBASE, CINHAL, and PEDro) and reference lists of relevant articles and reviews were searched. Randomized clinical trials that studied the effect of CIMT on upper extremity outcomes in stroke patients compared with other rehabilitative techniques, usual care, or no intervention were included. Methodological quality was assessed using the PEDro score. The following data were extracted for each trial: patients' characteristics, sample size, eligibility criteria, protocols of CIMT and control groups, outcome measurements, and the PEDro score. A total of 38 trials were identified according to the inclusion criteria. The trials included were heterogeneous in CIMT protocols, time since stroke, and duration and frequency of treatment. The pooled meta-analysis of 36 trials found a heterogeneous significant effect of CIMT on upper extremity. There was no significant effect of CIMT at different durations of follow-up. The majority of included articles did not fulfill powered sample size and quality criteria. The effect of CIMT changed in terms of sample size and quality features of the articles included. These meta-analysis findings indicate that evidence for the superiority of CIMT in comparison with other rehabilitative interventions is weak. Information on the optimal dose of CIMT and optimal time to start CIMT is still limited.
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Yadav RK, Sharma R, Borah D, Kothari SY. Efficacy of Modified Constraint Induced Movement Therapy in the Treatment of Hemiparetic Upper Limb in Stroke Patients: A Randomized Controlled Trial. J Clin Diagn Res 2016; 10:YC01-YC05. [PMID: 28050492 DOI: 10.7860/jcdr/2016/23468.8899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Paretic upper limb in stroke patients has a significant impact on the quality of life. Modified Constraint Induced Movement Therapy (mCIMT) is one of the treatment options used for the improvement of the function of the paretic limb. AIM To investigate the efficacy of four week duration mCIMT in the management of upper extremity weakness in hemiparetic patients due to stroke. MATERIALS AND METHODS Prospective single blind, parallel randomized controlled trial in which 30 patients received conventional rehabilitation programme (control group) and 30 patients participated in a mCIMT programme in addition to the conventional rehabilitation programme (study group). The mCIMT included three hours therapy sessions emphasizing the affected arm use in general functional tasks, three times a week for four weeks. Their normal arm was also constrained for five hours per day over five days per week. All the patients were assessed at baseline, one month and three months after completion of therapy using Fugl-Meyer Assessment (FMA) score for upper extremity and Motor Activity Log (MAL) scale comprising of Amount of Use (AOU) score and Quality of Use (QOU) score. RESULTS All the 3 scores improved significantly in both the groups at each follow-up. Post-hoc analysis revealed that compared to conventional rehabilitation group, mCIMT group showed significantly better scores at 1 month {FMA1 (p-value <0.0001, es0.2870), AOU1 (p-value 0.0007, es0.1830), QOU1 (p-value 0.0015, es0.1640)} and 3 months {FMA3 (p-value <.0001, es0.4240), AOU3 (p-value 0.0003, es 0.2030), QOU3 (p-value 0.0008, es 0.1790)}. CONCLUSION Four weeks duration for mCIMT is effective in improving the motor function in paretic upper limb of stroke patients.
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Affiliation(s)
- Raj Kumar Yadav
- Senior Resident, Department of Physical Medicine & Rehabilitation, VMMC & Safdarjung Hospital , New Delhi, India
| | | | - Diganta Borah
- Professor, Department of Physical Medicine & Rehabilitation, VMMC & Safdarjung Hospital , New Delhi, India
| | - S Y Kothari
- Retired Special DGHS and Professor, Department of Physical Medicine & Rehabilitation, VMMC & Safdarjung Hospital , New Delhi, India
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Chang WH, Uhm KE, Shin YI, Pascual-Leone A, Kim YH. Factors influencing the response to high-frequency repetitive transcranial magnetic stimulation in patients with subacute stroke. Restor Neurol Neurosci 2016; 34:747-55. [PMID: 27372515 DOI: 10.3233/rnn-150634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE High-frequency repetitive transcranial magnetic stimulation (rTMS) aids motor recovery in patients with subacute stroke. However, the response to high-frequency rTMS is highly variable between patients. The aim of this study was to identify the factors associated with improved motor function in response to high-frequency rTMS in subacute stroke patients with moderate to severe upper extremity motor involvement. METHODS Sixty-two patients with subacute stroke were enrolled. rTMS was applied over the primary motor cortex of the affected hemisphere at 10 Hz with 1,000 pulses/day for 10 days. Upper limb motor function was scored with the upper limb of Fugl-Meyer Assessment (FMA-UL) score before intervention and immediately after intervention. All FMA-UL changes greater than or equal to 5 points were considered clinically significant. Potential influencing factors considered included patient characteristics, motor function, corticospinal tract (CST) integrity assessments, and genetics. Multivariate logistic regression analysis was used to identify the significance of each of these factors. RESULTS We found that the two factors with the greatest impact on the improvement in FMA-UL score were: 1) the functional integrity of the CST, and 2) the brain-derived neurotrophic factor (BDNF) genotype (p < 0.05). Age tended to influence clinically significant changes in the FMA-UL score, although this effect was not significant. CONCLUSION Our findings suggest that high-frequency rTMS interventions aimed at improving upper extremity motor function in patients with subacute stroke with moderate to severe motor involvement should be individually tailored according to functional CST status and BDNF genotype.
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Affiliation(s)
- Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyeong Eun Uhm
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan, Korea
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Korea
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Sun Y, Boots J, Zehr EP. The lingering effects of a busted myth--false time limits in stroke rehabilitation. Appl Physiol Nutr Metab 2016; 40:858-61. [PMID: 26244605 DOI: 10.1139/apnm-2014-0523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
It was once falsely believed that neurological and functional recovery after stroke occurred only in the first 6 months after lesion. The perception of this "6-month myth" continues to negatively impact the attitudes of patients towards their rehabilitation and on the clinicians and therapists making optimal training plans. Here we briefly outline some evidence that debunked the 6-month myth, where the concept of this temporal limit may have originated, and the lingering misunderstanding that individuals with stroke reach a plateau of recovery after 6 months even with rehabilitation training. We present evidence that significant functional improvement can occur years after stroke when rehabilitation training is applied. We frame the concepts of active and passive neurological recovery and that active neurological recovery continues far beyond any temporal limit. Because the effects of this busted 6-month myth persist, we aim to remind active physicians, therapists, exercise professionals, and those with stroke to continuously seek opportunities for active rehabilitation training. Meanwhile, trained and certified exercise professionals can play critical roles in facilitating rehabilitative training for community-dwelling stroke survivors.
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Affiliation(s)
- Yao Sun
- a Rehabilitation Neuroscience Laboratory, PO Box 3010 STN CSC, University of Victoria, Victoria, BC V8W 3P1, Canada.,b Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.,c Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.,d School of Exercise Science, Physical, and Health Education University of Victoria, Victoria, BC, Canada
| | - Joanne Boots
- e Island Medical Program, University of British Columbia and University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - E Paul Zehr
- a Rehabilitation Neuroscience Laboratory, PO Box 3010 STN CSC, University of Victoria, Victoria, BC V8W 3P1, Canada.,b Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, BC V5Z 1M9, Canada.,c Centre for Biomedical Research, University of Victoria, Victoria, BC V8W 2Y2, Canada.,d School of Exercise Science, Physical, and Health Education University of Victoria, Victoria, BC, Canada
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Koski L, Mernar TJ, Dobkin BH. Immediate and Long-Term Changes in Corticomotor Output in Response to Rehabilitation: Correlation with Functional Improvements in Chronic Stroke. Neurorehabil Neural Repair 2016; 18:230-49. [PMID: 15537994 DOI: 10.1177/1545968304269210] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The goal of this study was to determine whether transcranial magnetic stimulation (TMS) measures of the corticomotor pathways might reflect and predict functional improvements during rehabilitation of a hemiparetic upper extremity. Ten patients with variable levels of functional impairment in upper extremity use were enrolled at least 3 months after a stroke. TMS was used to obtain serial measures of motor thresholds and motor-evoked potential (MEP) size for a muscle from both hands before and after each session of an intervention aimed at improving functional motor control. Functional ability and cortical map area and volume were measured before each therapy session. At intake, all TMS measures from the affected side were impaired compared with the unaffected side but they did not reliably predict the level of functional improvement. Motor thresholds decreased, whereas MEP amplitude and map size increased with treatment. The amount of change in affected side measures was correlated with the amount of improvement in hand/arm function. Normalization of MEP amplitude asymmetry in response to the 1st 2 therapy sessions predicted long-term improvement in Fugl-Meyer motor score. Within limits, TMS appears to be useful in both moderate and more impaired patients as a physiological assay of treatment-induced plasticity and behavioral gains. Methodological differences in the literature, however, currently obscure a full understanding of the potential contributions of TMS to rehabilitation research.
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Affiliation(s)
- Lisa Koski
- Ahmanson-Lovelace Brain Mapping Center, Neuropsychiatric Institute and Department of Neurology, University of California at Los Angeles, USA.
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Brogårdh C, Sjölund BH. Constraint-induced movement therapy in patients with stroke: a pilot study on effects of small group training and of extended mitt use. Clin Rehabil 2016; 20:218-27. [PMID: 16634340 DOI: 10.1191/0269215506cr937oa] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: (1) To evaluate constraint-induced movement therapy for chronic stroke patients modified into group practice to limit the demand on therapist resources. (2) To explore whether extended mitt use alone may enhance outcome. Design: A combined case-control and randomized controlled study with pre- and post-treatment measures by blinded observers. Setting: A university hospital rehabilitation department. Participants: Sixteen stroke patients (nine men and seven women; mean age 56.7 years; on average 28.9 months post stroke, five of whom were 6-9 months post stroke) with moderate motor impairments in the contralateral upper limb. Intervention: Constraint-induced therapy (mitt on the less affected hand 90% of waking hours for 12 days) with 2-3 patients per therapist and 6 h of group training per day. After the training period, the patients were randomized either to using the mitt at home every other day for two-week periods for another three months (in total 21 days) or to no further treatment. Outcome measures: Modified Motor Assessment Scale, Sollerman Hand Function Test, Two-Point Discrimination test and Motor Activity Log. Results: The mean motor performance improved significantly after two weeks of constraint-induced group therapy on Motor Assessment Scale (1.44 (95% confidence interval (95% CI) 0.59-2.28) points; P = 0.003) and on Sollerman Hand Function Test (3.81 (95% CI 0.26-7.36) points; P = 0.037) but showed no sensory change in the Two-Point Discrimination Test (P = 0.283). The median difference in self-reported motor ability (Motor Activity Log) also improved (P B=0.001). However, no additional effect was seen from wearing a mitt for another three months. Conclusion: Constraint-induced group therapy, allowing several patients per therapist, seems to be a feasible alternative to improve upper limb motor function. The restraint alone, extended in time, did not enhance the treatment effect.
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Affiliation(s)
- Christina Brogårdh
- Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
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Does the use of a constraint mitten to encourage use of the hemiplegic upper limb improve arm function in adults with subacute stroke? Clin Rehabil 2016; 21:895-904. [DOI: 10.1177/0269215507079144] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effect of a constraint mitten, worn on the unaffected upper limb, on the arm and hand function of participants with hemiplegia. To estimate the sample size for a future trial. Design: An A-B-A design. Setting: Inpatient, outpatient and domiciliary setting. Subjects Ten participants with mild to moderate residual upper limb hemiparesis, between 1 and 12 months post stroke. Intervention: Following a two-week baseline period, 10 participants were advised to wear the constraint mitten on the unaffected upper limb for 9 waking hours/day for two weeks to encourage use of the hemiplegic arm. Existing levels of therapy continued during the whole study. Main measures: The primary outcome measure was the Action Research Arm Test. At the end of the intervention phase participants completed a questionnaire. Participants also recorded their daily use of the constraint mitten during the intervention phase. Results: A mean improvement in the Action Research Arm Test score of 4.0 points (95% confidence interval 1.7 to 6.2; P=00.016) was found during the intervention phase after correcting for background recovery. Mean compliance was 6.7 hours/day (74%), 90% of participants were positive about the intervention and would recommend the treatment to other stroke survivors, although 50% were relieved to stop the mitten-wearing phase. Conclusions: The use of a constraint mitten in upper limb stroke rehabilitation may be a useful adjunct to enhance functional recovery with minimal additional resources. The positive findings from this preliminary study warrant a larger randomized controlled trial of 200 participants in total.
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1538] [Impact Index Per Article: 192.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Kim SH, Park JH, Jung MY, Yoo EY. Effects of Task-Oriented Training as an Added Treatment to Electromyogram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients. Occup Ther Int 2016; 23:165-74. [DOI: 10.1002/oti.1421] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/30/2015] [Accepted: 11/10/2015] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sun-Ho Kim
- Department of Occupational Therapy; Young Kwang Rehabilitation Hospital; Wonju-si Gangwon-do Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy; Yonsei University; 1 Yonseidae-gil Wonju Gangwon-do Korea
| | - Min-Ye Jung
- Department of Occupational Therapy; Yonsei University; 1 Yonseidae-gil Wonju Gangwon-do Korea
| | - Eun-Young Yoo
- Department of Occupational Therapy; Yonsei University; 1 Yonseidae-gil Wonju Gangwon-do Korea
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Winstein CJ, Wolf SL, Dromerick AW, Lane CJ, Nelsen MA, Lewthwaite R, Cen SY, Azen SP. Effect of a Task-Oriented Rehabilitation Program on Upper Extremity Recovery Following Motor Stroke: The ICARE Randomized Clinical Trial. JAMA 2016; 315:571-81. [PMID: 26864411 PMCID: PMC4795962 DOI: 10.1001/jama.2016.0276] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program [ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC: 0.14; 95% CI, -0.05 to 0.33; P = .16; ASAP vs UCC: -0.01; 95% CI, -0.22 to 0.21; P = .94; and DEUCC vs UCC: -0.14; 95% CI, -0.32 to 0.05; P = .15). Secondary outcomes for the ASAP group were WMFT change score, -8.8 seconds, and improved SIS, 73%; DEUCC group, WMFT, -8.1 seconds, and SIS, 72%; and UCC group, WMFT, -7.2 seconds, and SIS, 69%, with no significant pairwise between-group differences (ASAP vs DEUCC: WMFT, 1.8 seconds; 95% CI, -0.8 to 4.5 seconds; P = .18; improved SIS, 1%; 95% CI, -12% to 13%; P = .54; ASAP vs UCC: WMFT, -0.6 seconds, 95% CI, -3.8 to 2.6 seconds; P = .72; improved SIS, 4%; 95% CI, -9% to 16%; P = .48; and DEUCC vs UCC: WMFT, -2.1 seconds; 95% CI, -4.5 to 0.3 seconds; P = .08; improved SIS, 3%; 95% CI, -9% to 15%; P = .22). A total of 168 serious adverse events occurred in 109 participants, resulting in 8 patients withdrawing from the study. CONCLUSIONS AND RELEVANCE Among patients with motor stroke and primarily moderate upper extremity impairment, use of a structured, task-oriented rehabilitation program did not significantly improve motor function or recovery beyond either an equivalent or a lower dose of UCC upper extremity rehabilitation. These findings do not support superiority of this program among patients with motor stroke and primarily moderate upper extremity impairment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00871715.
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Corbetta D, Sirtori V, Castellini G, Moja L, Gatti R. Constraint-induced movement therapy for upper extremities in people with stroke. Cochrane Database Syst Rev 2015; 2015:CD004433. [PMID: 26446577 PMCID: PMC6465192 DOI: 10.1002/14651858.cd004433.pub3] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND In people who have had a stroke, upper limb paresis affects many activities of daily life. Reducing disability is therefore a major aim of rehabilitative interventions. Despite preserving or recovering movement ability after stroke, sometimes people do not fully realise this ability in their everyday activities. Constraint-induced movement therapy (CIMT) is an approach to stroke rehabilitation that involves the forced use and massed practice of the affected arm by restraining the unaffected arm. This has been proposed as a useful tool for recovering abilities in everyday activities. OBJECTIVES To assess the efficacy of CIMT, modified CIMT (mCIMT), or forced use (FU) for arm management in people with hemiparesis after stroke. SEARCH METHODS We searched the Cochrane Stroke Group trials register (last searched June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library Issue 1, 2015), MEDLINE (1966 to January 2015), EMBASE (1980 to January 2015), CINAHL (1982 to January 2015), and the Physiotherapy Evidence Database (PEDro; January 2015). SELECTION CRITERIA Randomised control trials (RCTs) and quasi-RCTs comparing CIMT, mCIMT or FU with other rehabilitative techniques, or none. DATA COLLECTION AND ANALYSIS One author identified trials from the results of the electronic searches according to the inclusion and exclusion criteria, three review authors independently assessed methodological quality and risk of bias, and extracted data. The primary outcome was disability. MAIN RESULTS We included 42 studies involving 1453 participants. The trials included participants who had some residual motor power of the paretic arm, the potential for further motor recovery and with limited pain or spasticity, but tended to use the limb little, if at all. The majority of studies were underpowered (median number of included participants was 29) and we cannot rule out small-trial bias. Eleven trials (344 participants) assessed disability immediately after the intervention, indicating a non-significant standard mean difference (SMD) 0.24 (95% confidence interval (CI) -0.05 to 0.52) favouring CIMT compared with conventional treatment. For the most frequently reported outcome, arm motor function (28 studies involving 858 participants), the SMD was 0.34 (95% CI 0.12 to 0.55) showing a significant effect (P value 0.004) in favour of CIMT. Three studies involving 125 participants explored disability after a few months of follow-up and found no significant difference, SMD -0.20 (95% CI -0.57 to 0.16) in favour of conventional treatment. AUTHORS' CONCLUSIONS CIMT is a multi-faceted intervention where restriction of the less affected limb is accompanied by increased exercise tailored to the person's capacity. We found that CIMT was associated with limited improvements in motor impairment and motor function, but that these benefits did not convincingly reduce disability. This differs from the result of our previous meta-analysis where there was a suggestion that CIMT might be superior to traditional rehabilitation. Information about the long-term effects of CIMT is scarce. Further trials studying the relationship between participant characteristics and improved outcomes are required.
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Affiliation(s)
- Davide Corbetta
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Valeria Sirtori
- San Raffaele HospitalUnit of Functional RecoveryVia Olgettina, 48MilanItaly20132
| | - Greta Castellini
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
| | - Lorenzo Moja
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanItaly20133
| | - Roberto Gatti
- University Vita‐Salute San RaffaeleSchool of PhysiotherapyVia Olgettina, 58MilanItaly20132
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Bang DH, Shin WS, Choi HS. Effects of modified constraint-induced movement therapy combined with trunk restraint in chronic stroke: A double-blinded randomized controlled pilot trial. NeuroRehabilitation 2015; 37:131-7. [PMID: 26409698 DOI: 10.3233/nre-151245] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reducing the compensatory mechanism by restraining the unnecessary movement may be helpful in relearning the upper-limb movement. OBJECTIVE To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint (TR) in chronic stroke patients with moderate impairment. METHODS Eighteen participants with hemiparesis were randomly assigned to mCIMT + TR or mCIMT. Each group underwent 20 (1 h/d) intervention session (5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer assessment upper extremity (FMA-UE), the modified Barthel index (MBI), and the motor activity log (MAL-AOU and MAL-QOM). RESULTS The mCIMT combined with trunk restraint group exhibited greater changes in the ARAT, FMA, MBI, and MAL (MAL-AOU and MAL-QOM) compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (Z = -2.17, P = 0.03), FMA-UE (Z = -2.49, P = 0.01), MBI (Z = -2.44, P = 0.02), MAL-AOU (Z = -2.17, P = 0.03), and MAL-QOM (Z = -2.17, P = 0.03) between groups. CONCLUSION These finding suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in patient with chronic stroke.
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Affiliation(s)
- Dae-Hyouk Bang
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
| | - Won-Seob Shin
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea.,Department of Physical Therapy, College of Health and Medical Science, Daejeon University, Daejeon, Republic of Korea
| | - Ho-Suk Choi
- Department of Physical Therapy, Graduate School of Daejeon University, Daejeon, Republic of Korea
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Kwakkel G, Veerbeek JM, van Wegen EEH, Wolf SL. Constraint-induced movement therapy after stroke. Lancet Neurol 2015; 14:224-34. [PMID: 25772900 DOI: 10.1016/s1474-4422(14)70160-7] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Constraint-induced movement therapy (CIMT) was developed to overcome upper limb impairments after stroke and is the most investigated intervention for the rehabilitation of patients. Original CIMT includes constraining of the non-paretic arm and task-oriented training. Modified versions also apply constraining of the non-paretic arm, but not as intensive as original CIMT. Behavioural strategies are mostly absent for both modified and original CIMT. With forced use therapy, only constraining of the non-paretic arm is applied. The original and modified types of CIMT have beneficial effects on motor function, arm-hand activities, and self-reported arm-hand functioning in daily life, immediately after treatment and at long-term follow-up, whereas there is no evidence for the efficacy of constraint alone (as used in forced use therapy). The type of CIMT, timing, or intensity of practice do not seem to affect patient outcomes. Although the underlying mechanisms that drive modified and original CIMT are still poorly understood, findings from kinematic studies suggest that improvements are mainly based on adaptations through learning to optimise the use of intact end-effectors in patients with some voluntary motor control of wrist and finger extensors after stroke.
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Affiliation(s)
- Gert Kwakkel
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands; Amsterdam Rehabilitation Research Center, Reade Centre for Rehabilitation and Rheumatology, Amsterdam, Netherlands.
| | - Janne M Veerbeek
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Erwin E H van Wegen
- Department of Rehabilitation Medicine, MOVE Research Institute Amsterdam, VU University Medical Center, Amsterdam, Netherlands
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical Therapy, Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta, GA, USA
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Rocha S, Silva E, Foerster Á, Wiesiolek C, Chagas AP, Machado G, Baltar A, Monte-Silva K. The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial. Disabil Rehabil 2015; 38:653-60. [DOI: 10.3109/09638288.2015.1055382] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Urbin MA, Waddell KJ, Lang CE. Acceleration metrics are responsive to change in upper extremity function of stroke survivors. Arch Phys Med Rehabil 2015; 96:854-61. [PMID: 25497517 PMCID: PMC4410063 DOI: 10.1016/j.apmr.2014.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/14/2014] [Accepted: 11/23/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (1) determine whether acceleration metrics derived from monitoring outside of treatment are responsive to change in upper extremity (UE) function; and secondarily to (2) compare metric values during task-specific training and while in the free-living environment, and (3) establish metric associations with an in-clinic measure of movement capabilities. DESIGN Before-after observational study. SETTING Inpatient hospital (primary purpose); outpatient hospital (secondary purpose). PARTICIPANTS Individuals (n=8) with UE hemiparesis <30 days poststroke (primary purpose); individuals (n=27) with UE hemiparesis ≥6 months poststroke (secondary purpose). INTERVENTION The inpatient sample was evaluated for UE movement capabilities and monitored with wrist-worn accelerometers for 22 hours outside of treatment before and after multiple sessions of task-specific training. The outpatient sample was evaluated for UE movement capabilities and monitored during a single session of task-specific training and the subsequent 22 hours outside clinical settings. MAIN OUTCOME MEASURES Action Research Arm Test (ARAT) and acceleration metrics quantified from accelerometer recordings. RESULTS Five metrics improved in the inpatient sample, along with UE function as measured on the ARAT: use ratio, magnitude ratio, variation ratio, median paretic UE acceleration magnitude, and paretic UE acceleration variability. Metric values were greater during task-specific training than in the free-living environment, and each metric was strongly associated with ARAT score. CONCLUSIONS Multiple metrics that characterize different aspects of UE movement are responsive to change in function. Metric values are different during training than in the free-living environment, providing further evidence that what the paretic UE does in the clinic may not generalize to what it does in everyday life.
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Affiliation(s)
- M A Urbin
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO.
| | - Kimberly J Waddell
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO
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