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Vanoglio F, Comini L, Gaiani M, Bonometti GP, Luisa A, Bernocchi P. A Sensor-Based Upper Limb Treatment in Hemiplegic Patients: Results from a Randomized Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:2574. [PMID: 38676190 PMCID: PMC11054364 DOI: 10.3390/s24082574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
In post-stroke patients, the disabling motor deficit mainly affects the upper limb. The focus of rehabilitation is improving upper limb function and reducing long-term disability. This study aims to evaluate the feasibility of using the Gloreha Aria (R-Lead), a sensor-based upper limb in-hospital rehabilitation, compared with conventional physiotherapist-led training in subacute hemiplegic patients. Twenty-one patients were recruited and randomised 1:1 to a sensor-based group (treatment group TG) or a conventional group (control group, CG). All patients performed 30 sessions of 30 min each of dedicated upper limb rehabilitation. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary evaluation., both as a motor score and as individual items. Secondary evaluations were Functional Independence Measure; global disability assessed with the Modified Barthel Index; Motor Evaluation Scale for UE in stroke; power grip; and arm, shoulder, and hand disability. All the enrolled patients, 10 in the TG and 11 in the CG, completed all hand rehabilitation sessions during their hospital stay without experiencing any adverse events. FMA-UE scores in upper limb motor function improved in both groups [delta change CG (11.8 ± 9.2) vs. TG (12.7 ± 8.6)]. The score at T1 for FMA joint pain (21.8 vs. 24 best score) suggests the use of the Gloreha Aria (R-Lead) as feasible in improving arm function abilities in post-stroke patients.
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Affiliation(s)
- Fabio Vanoglio
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Laura Comini
- Scientific Direction of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy;
| | - Marta Gaiani
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Gian Pietro Bonometti
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Alberto Luisa
- Neuromotor Rehabilitation Unit of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy; (F.V.); (M.G.); (G.P.B.); (A.L.)
| | - Palmira Bernocchi
- Continuity of Care Service of Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, 25065 Lumezzane, Italy
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Al Battat MM, Etoom M, Alghwiri AA. Relationship between Sleep Quality and Shoulder Disorders in People with Stroke. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2010. [PMID: 38004059 PMCID: PMC10672844 DOI: 10.3390/medicina59112010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
Background and objective: The primary aim of the study was to investigate the relationship between sleep quality (SQ) and shoulder disorders in people after a stroke. The secondary aim was to explore the relationship between SQ and stroke outcomes, including the impact of stroke, fatigue, and quality of life (QOL). Material and Methods: A sample of 94 stroke patients was included. The Pittsburgh Sleep Quality Index (PSQI) was used to assess SQ, whereas the Shoulder Pain and Disability Index (SPADI) was utilized to assess shoulder pain and disability. The Stroke Impact Scale 16, the Modified Fatigue Impact Scale, and the Medical Outcomes Study Short Form 12 were also used as secondary measures. Results: The prevalence of poor SQ, shoulder pain, and shoulder disability in our sample was 60%, 78%, and 85%, respectively. The global PSQI score had a significant association with the SPADI pain subscale. There were some significant correlations between the PSQI subscales and shoulder pain and disability. The PSQI significantly correlated with stroke recovery, fatigue, and QOL. The daytime dysfunction PSQI subscale was significantly correlated with all shoulder and stroke outcomes and their subscale. Conclusion: SQ was associated more with the non-motor outcomes of stroke, including pain, cognitive fatigue, and mental status, than the motor outcomes. Considering SQ during upper extremity rehabilitation and care processes is essential.
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Affiliation(s)
| | - Mohammad Etoom
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Alia A. Alghwiri
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
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Pereira TA, de Oliveira MPB, Serrão PRMDS, Tsen C, Coutinho NB, Letieri RV, Santos ATS, Reis LMD. Effect of lower limb resistance training on ICF components in chronic stroke: A systematic review and meta-analysis of RCTs. Ann Phys Rehabil Med 2023; 66:101766. [PMID: 37883831 DOI: 10.1016/j.rehab.2023.101766] [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: 11/13/2022] [Revised: 03/02/2023] [Accepted: 04/23/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Resistance training (RT) effectively promotes functional independence after stroke. OBJECTIVES To investigate the effect of lower limb RT on body structure and function (muscle strength, postural balance), activity (mobility, gait) and participation (quality of life, impact of stroke on self-perceived health) outcomes in individuals with chronic stroke. METHODS Six databases were searched from inception until September 2022 for randomized controlled trials comparing lower limb RT to a control intervention. The random-effects model was used in the meta-analyses. Effect sizes were reported as standardized mean differences (SMD). Quality of evidence was assessed using the GRADE approach. RESULTS Fourteen studies were included. Significant improvements were found in body structure and function after lower limb RT: knee extensors (paretic side - SMD: 1.27; very low evidence), knee flexors (paretic side - SMD: 0.51; very low evidence; non-paretic side - SMD: 0.52; low evidence), leg press (paretic side - SMD: 0.83; very low evidence) and global lower limb muscle strength (SMD: -1.47; low evidence). No improvement was found for knee extensors (p = 0.05) or leg press (p = 0.58) on the non-paretic side. No improvements were found in the activity domain after lower limb RT: mobility (p = 0.16) and gait (walking speed-usual: p = 0.17; walking speed-fast: p = 0.74). No improvements were found in the participation domain after lower limb RT: quality of life (p > 0.05), except the bodily pain dimension (SMD: 1.02; low evidence) or the impact of stroke on self-perceived health (p = 0.38). CONCLUSION Lower limb RT led to significant improvements in the body structure and function domain (knee extensors and flexors, leg press, global lower limb muscle strength) in individuals with chronic stroke. No improvements were found in the activity (mobility, gait [walking speed]) or participation (quality of life, impact of stroke on self-perceived health) domains. PROSPERO REGISTRATION NUMBER CRD42021272645.
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Affiliation(s)
- Tales Andrade Pereira
- Department of Physical Therapy, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Marcos Paulo Braz de Oliveira
- Healthy Aging Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - Paula Regina Mendes da Silva Serrão
- Rheumatology and Hand Rehabilitation Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - Carolina Tsen
- Healthy Aging Research Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | | | - Rubens Vinícius Letieri
- Department of Physical Education, Federal University of North Tocantins, Araguaia, Tocantins, Brazil
| | | | - Luciana Maria Dos Reis
- Department of Physical Therapy, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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Tosun OC, Keser I, Dayican DK, Yavuz O, Tosun G, Kurt S. Does multiple-component intensive pelvic floor muscle training decrease muscle fatigue and symptoms in women with urinary incontinence? Int Urogynecol J 2023; 34:2067-2080. [PMID: 36951973 DOI: 10.1007/s00192-023-05499-0] [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: 11/18/2022] [Accepted: 01/29/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS A multiple-component intensive pelvic floor muscle training (MCI-PFMT) protocol was developed as a neurophysiological-based rehabilitation model to improve neuroplasticity. This study aimed to investigate the effects of the MCI-PFMT protocol on muscle fatigue and symptoms in women with urinary incontinence. METHODS This randomized controlled trial included 49 female patients with mixed urinary incontinence. Participants were divided into the MCI-PFMT group and the control group. The MCI-PFMT group performed supervised intensive pelvic floor muscle training, while the control group received bladder training and standard pelvic floor muscle training as a home program. Both training sessions were conducted 5 days a week for a single week. Participants' symptoms were evaluated with questionnaires, bladder diary, and pad tests. Superficial electromyography, ultrasonography, and the PERFECT scale were used to evaluate pelvic floor and abdominal muscle functions. RESULTS In the post-treatment evaluation, symptoms were decreased in both groups, with a significant decrease in the MCI-PFMT group (p < 0.05). While average and peak work values of pelvic floor muscles, transversus abdominus, and internal oblique muscles increased in both groups, maximum voluntary contraction values of these muscles decreased (p < 0.05). A 12.7% decrease was observed in the maximum voluntary contraction values of pelvic floor muscles in the control group, while a 9.6% decrease was observed in the MCI-PFMT group. CONCLUSIONS The MCI-PFMT protocol can lead to pelvic floor and abdominal muscle fatigue. However, it may be effective at decreasing symptoms in women with urinary incontinence. Additional studies on this issue are needed.
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Affiliation(s)
- Ozge Celiker Tosun
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.
| | - Irem Keser
- Dokuz Eylül University, Institute of Health Sciences, Izmir, Turkey
| | - Damla Korkmaz Dayican
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Istanbul, Turkey
| | - Onur Yavuz
- Department of Obstetrics and Gynecology, Dokuz Eylül University, Izmir, Turkey
| | - Gokhan Tosun
- Department of Obstetrics and Gynecology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Dokuz Eylül University, Izmir, Turkey
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Abdullahi A, Wong TWL, Ng SSM. Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice. Front Neurol 2023; 14:1225924. [PMID: 37602245 PMCID: PMC10435271 DOI: 10.3389/fneur.2023.1225924] [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: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice. Method We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature. Result The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter. Conclusion We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.
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Chang WK, Lim H, Park SH, Lim C, Paik NJ, Kim WS, Ku J. Effect of immersive virtual mirror visual feedback on Mu suppression and coherence in motor and parietal cortex in stroke. Sci Rep 2023; 13:12514. [PMID: 37532803 PMCID: PMC10397282 DOI: 10.1038/s41598-023-38749-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023] Open
Abstract
We investigated the activation pattern of the motor cortex (M1) and parietal cortex during immersive virtual reality (VR)-based mirror visual feedback (MVF) of the upper limb in 14 patients with chronic stroke and severe upper limb hemiparesis and in 21 healthy controls. Participants performed wrist extension with unaffected wrists (dominant side in controls). In the MVF condition, movement of the affected hand was synchronized with that of the unaffected hand. In the no-MVF condition, only the movement of unaffected hand was shown. Mu suppression in bilateral M1 and parietal cortex and mu coherence were analyzed. In patients with stroke, MVF induced significant mu suppression in both the ipsilesional M1 and parietal lobes (p = 0.006 and p = 0.009, respectively), while mu suppression was observed in the bilateral M1 (p = 0.003 for ipsilesional and p = 0.041 for contralesional M1, respectively) and contralesional parietal lobes in the controls (p = 0.036). The ipsilesional mu coherence between the M1 and parietal cortex in patients with stroke was stronger than controls, regardless of MVF condition (p < 0.001), while mu coherence between interhemispheric M1 cortices was significantly weaker in patients with stroke (p = 0.032). Our findings provide evidence of the neural mechanism of MVF using immersive VR in patients with stroke.
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Affiliation(s)
- Won Kee Chang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyunmi Lim
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea
| | - Seo Hyun Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chaiyoung Lim
- Bundang Rusk Rehabilitation Speciality Hospital, Seongnam, Republic of Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
| | - Jeonghun Ku
- Department of Biomedical Engineering, College of Medicine, Keimyung University, 1095, Dalgubeol-daero, Dalseo-gu, Daegu, Republic of Korea.
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea.
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Pereira ND, Lixandrão MC, Morris D, Michaelsen SM, Camargo PR. Shoulder complex and trunk coordination of individuals with severe hemiparesis following a constraint-induced movement therapy protocol: A case series. J Bodyw Mov Ther 2023; 35:91-98. [PMID: 37330809 DOI: 10.1016/j.jbmt.2023.04.072] [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: 10/25/2021] [Revised: 03/07/2023] [Accepted: 04/15/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Constraint Induced Movement Therapy (CIMT) has been shown to be an effective rehabilitation technique in individuals with mild and moderate upper limb (UL) hemiparesis. The aim was to evaluate the effect the CIMT for improving paretic UL use and interjoint coordination with individuals in severe hemiparesis. METHODS Six individuals with severe chronic hemiparesis (mean age = 55 ± 16 years) received a UL CIMT intervention for 2 weeks. UL clinical assessments were conducted five times: two assessments at pre-intervention and then, one assessment at post-intervention and 1- and 3-month follow-up using the Graded Motor Activity Log GMAL) and the Graded Wolf Motor Function Test (GWMFT). Scapula, humerus and trunk coordination variability were assessed using the 3-D kinematics during arm elevation, combing hair, turning on the switch and grasp a washcloth. A paired t-test was used to check differences between coordination variability and a one-way ANOVA repeated measures was used to check differences between GMAL and GWMFT scores. RESULTS There were no differences in GMAL and GWMFT between the patient screening and the baseline data collection (p > 0.05). GMAL scores increased at post-intervention and at follow-ups (p < 0.02). GWMFT performance time score decreased at post-intervention and at 1-month follow-up (p < 0.04). Improvements in kinematic variability of the paretic UL at pre and post-intervention were observed in all tasks, except in the activity of turn on the light switch. CONCLUSION Following the CIMT protocol, improvements in GMAL and GWMFT scores may reflect improvements in paretic UL performance, in real-life environment. Improvements in kinematic variability may reflect an improving of UL interjoint coordination for individuals with chronic severe hemiparesis.
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Yang SW, Ma SR, Choi JB. The Effect of Kinesio Taping Combined with Virtual-Reality-Based Upper Extremity Training on Upper Extremity Function and Self-Esteem in Stroke Patients. Healthcare (Basel) 2023; 11:1813. [PMID: 37444646 DOI: 10.3390/healthcare11131813] [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: 05/25/2023] [Revised: 06/17/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
(1) Background: The purpose of this study is to investigate the effect of virtual-reality-based hand motion training (VRT) in parallel with the Kinesio Taping (KT) technique on upper extremity function in stroke patients and to present a more effective therapeutic basis for virtual reality training intervention. (2) Methods: First, 43 stroke patients were randomly assigned to two groups: 21 experimental subjects and 22 controls. The experimental group performed Kinesio Taping (KT) on the dorsal part of the hand along with virtual-reality-based hand motion training, and the control group performed only virtual-reality-based hand motion training. The intervention was conducted for a total of 30 sessions over 6 weeks. To evaluate changes in upper extremity function, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL) (including amount of use (AOU) and quality of movement (QOM)) were evaluated. In addition, the Self-Efficacy Scale (SEF) was evaluated to examine the change in the self-esteem of the study subjects. (3) Results: The experimental group who participated in the virtual reality training in parallel with the KT technique showed statistically significant improvement (** p < 0.01) in the FMA-UE, WMFT, and MAL evaluations that investigate changes in upper extremity function. SEF evaluation also showed a statistically significant improvement (** p < 0.01). A statistically significant difference between the two groups was observed in the evaluation of FMA-UE, WMFT, MAL-QOM, and SEF (†p < 0.05), showing that that combined intervention was more effective at improving upper extremity function than the existing VRT intervention. There was no statistical difference between the two groups in the MAL-AOU item, which is an evaluation of upper extremity function (p > 0.05). There was a statistically significant difference between the two groups in the amount of change in upper limb function (††p < 0.01). (4) Conclusions: It was confirmed that virtual-reality-based hand motion training performed in parallel with the KT technique had a positive effect on the recovery of upper extremity function of stroke patients. The fact that the KT technique provided stability to the wrist by assisting the wrist extensor muscles appears to have improved the upper extremity function more effectively than VRT alone.
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Affiliation(s)
- Seo-Won Yang
- Department of Occupational Therapy, Sangji University, 83 Sangjidae-gil, Wonju-si 26339, Republic of Korea
| | - Sung-Ryong Ma
- Department of Occupational Therapy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
| | - Jong-Bae Choi
- Department of Occupational Therapy, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Republic of Korea
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Abdullahi A, Wong TWL, Ng SSM. Effects of constraint induced movement therapy in patients with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2023; 71:104569. [PMID: 36848838 DOI: 10.1016/j.msard.2023.104569] [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: 11/09/2022] [Revised: 01/09/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurodegenerative disorder of the central nervous system (CNS) that commonly affects young and middle-aged adults. Neurodegeneration of the CNS affects its functions such as sensorimotor, autonomic and cognitive functions. Affectation of motor function can result in disability in performance of daily life activities. Thus, effective rehabilitation interventions are needed to help prevent disability in patients with MS. One of these interventions is the constraint induced movement therapy (CIMT). The CIMT is used to improve motor function in patients with stroke and other neurological conditions. Recently, its use in patients with MS is gaining ground. The aim of this study is to carry out a systematic review and meta-analysis to determine from the literature, the effects of CIMT on upper limb function in patients with MS. METHODS PubMED, Embase, Web of Science (WoS), PEDro, and CENTRAL were searched until October 2022. Randomized controlled trials in patients with MS who were 18 years and above were included. Data on the characteristics of the study participants such as disease duration, type of MS, the mean scores of the outcomes of interest such as motor function and use of the arm in daily activities, and white matter integrity were extracted. Methodological quality and risks of bias of the included studies were assessed using PEDro scale and Cochrane risks of bias tool. The data was analysed using both narrative and quantitative syntheses. In the quantitative synthesis, random effect model meta-analysis of the mean and standard deviation of the scores on the outcomes of interest and the study sample size (for both the CIMT and the control group) post intervention was carried out. In addition, percentage of variation across the studies due to heterogeneity (I2) was considered significant when it is between 50% and 90% at p < 0.05. RESULTS Two studies comprising of 4 published articles with good methodological quality were included in the study. The results showed that, CIMT is safe and improved white matter integrity, motor function, muscle strength, dexterity, real-world arm use and biomechanical parameters post intervention. However, although there was a trend towards better improvement in the CIMT group in all the outcomes, there was no statistically significant difference between groups in motor function (SMD=0.44, 95% CI=-0.20 to 1.07, p = 0.18) and quality of movement (SMD=0.96, -1.15 to 3.07, p = 0.37). CONCLUSION CIMT can be used in patients with MS since it is safe as well as effective at improving functional outcomes. However, more studies are required to confirm its safety and effectiveness.
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Affiliation(s)
- Auwal Abdullahi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Thomson Wai-Lung Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Shamay Sheung-Mei Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China.
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Türkmen C, Konca M, Yetim B. Prioritization of neurologic rehabilitation interventions by ELECTRE-III analysis in subacute stroke patients. Acta Neurol Belg 2023; 123:181-189. [PMID: 35639258 DOI: 10.1007/s13760-022-01982-5] [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: 04/04/2022] [Accepted: 05/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elimination and Choice Translating Reality (ELECTRE) III is a commonly used multicriteria decision-making (MCDM) method when alternatives are being prioritized in health sciences. The selection of the rehabilitation approach is the key factor to improve the upper extremity functions of stroke patients. Thus, choosing a reasonably good treatment approach will directly reduce the patient's cost to the government and caregivers, while also improving quality of life. The aim of our study was to prioritize the six different methods used in the rehabilitation of stroke patients with mild or moderate upper extremity dysfunction, using one of the MCDM methods based on experts' opinions. METHODS A three-stage face-to-face interview across Turkey, based on the ELECTRE-III method, was conducted with 18 physiotherapists specializing in the rehabilitation of mild or moderate stroke-induced upper extremity disorders. RESULTS According to ELECTRE-III, Circuit Class Therapy (CCT) is the best choice for treating upper extremity functional loss in general. It is also the best alternative in both the ascending and descending distillation processes of ELECTRE-III. On the other hand, Bobath neurodevelopmental treatment (NDT) has a similar success level according to ascending distillation. Mirror therapy and constraint-induced movement therapy are the third-best methods in the analysis. However, robotic rehabilitation is the least preferable treatment method according to the experts' judgments. CONCLUSIONS The results showed that rehabilitation interventions such as Bobath-NDT and proprioceptive neuromuscular facilitation, which are frequently used in developing countries, are still useful, and CCT is the most appropriate intervention for the transition from conventional methods to innovative models in these countries.
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Affiliation(s)
- Ceyhun Türkmen
- Faculty of Health Sciences, Çankırı Karatekin University, 18200 Sıhhiye st, Çankırı, Turkey.
| | - Murat Konca
- Faculty of Health Sciences, Çankırı Karatekin University, 18200 Sıhhiye st, Çankırı, Turkey
| | - Birol Yetim
- Faculty of Economics and Administrative Sciences, Hacettepe University, Beytepe, 06800, Ankara, Turkey
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Abdullahi A, Wong TW, Van Criekinge T, Ng SS. Combination of noninvasive brain stimulation and constraint-induced movement therapy in patients with stroke: a systematic review and meta-analysis. Expert Rev Neurother 2023; 23:187-203. [PMID: 36745928 DOI: 10.1080/14737175.2023.2177154] [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: 02/08/2023]
Abstract
INTRODUCTION Constraint-induced movement therapy (CIMT) and noninvasive brain stimulation (NIBS) are used to counteract learned nonuse phenomenon and imbalance in interhemispheric inhibition following stroke. The aim of this study is to summarize the available evidence on the effects of combining NIBS with CIMT in patients with stroke. METHOD PubMed, Embase, Web of Science (WoS), PEDro, OTSeeker, and CENTRAL were searched for randomized controlled trials comparing the use of NIBS+CIMT with sham NIBS+CIMT. Data on variables such as time since stroke and mean scores and standard deviations on outcomes assessed such as motor function were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risk of bias and methodological quality of the included studies. RESULTS The results showed that both NIBS+CIMT and sham NIBS+CIMT improved all outcomes post-intervention and at follow-up. However, NIBS+CIMT is superior to sham NIBS+CIMT at improving level of motor impairment (SMD = 1.75, 95% CI = 0.49 to 3.01, P = 0.007) post-intervention and hand function (SMD = 1.21, 95% CI = 0.07 to 2.35, P = 0.04) at follow-up. CONCLUSIONS The addition of NIBS to CIMT seems to provide additional benefits to the recovery of function following stroke.
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Affiliation(s)
- Auwal Abdullahi
- The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong
| | - Thomson Wl Wong
- The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong
| | | | - Shamay Sm Ng
- The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong
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Zhang J, Xiao X, Jin Q, Li J, Zhong D, Li Y, Qin Y, Zhang H, Liu X, Xue C, Zheng Z, Jin R. The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis. Front Neurol 2023; 14:1137320. [PMID: 37144004 PMCID: PMC10151521 DOI: 10.3389/fneur.2023.1137320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 05/06/2023] Open
Abstract
Background Due to motor function insufficiency, patients with post-stroke motor dysfunction (PSMD) have limitations in performing an activity, feel restricted during social participation, and feel impaired in their quality of life. Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique, but its effectiveness on PSMD after stroke still remains controversial. Objective This meta-analysis and trial sequential analysis (TSA) aimed to comprehensively evaluate the effect and safety of CIMT for PSMD. Methods Four electronic databases were searched from their inception to 1 January 2023 to identify randomized controlled trials (RCTs) investigating the effectiveness of CIMT for PSMD. Two reviewers independently extracted the data and assessed the risk of bias and reporting quality. The primary outcome was a motor activity log for the amount of use (MAL-AOU) and the quality of movement (MAL-QOM). RevMan 5.4, Statistical Package for Social Sciences (SPSS) 25.0, and STATA 13.0 software were used for statistical analysis. The certainty of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. We also performed the TSA to assess the reliability of the evidence. Results A total of 44 eligible RCTs were included. Our results showed that CIMT combined with conventional rehabilitation (CR) was superior to CR in improving MAL-AOU and MAL-QOM scores. The results of TSA indicated that the above evidence was reliable. Subgroup analysis demonstrated that CIMT (≥6 h per day or duration ≤ 20 days) combined with CR was more effective than CR. Meanwhile, both CIMT and modified CIMT (mCIMT) combined with CR were more efficient than CR at all stages of stroke. No severe CIMT-related adverse events occurred. Conclusion CIMT may be an optional and safe rehabilitation therapy to improve PSMD. However, due to limited studies, the optimal protocol of CIMT for PSMD was undetermined, and more RCTs are required for further exploration. Clinical trial registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143490, identifier: CRD42019143490.
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Affiliation(s)
- Jiaming Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qizu Jin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Qin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Hong Zhang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chen Xue
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhong Zheng
- Center for Neurobiological Detection, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Zhong Zheng
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Rongjiang Jin
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Wang D, Li L, Pan H, Huang L, Sun X, He C, Wei Q. Comparison of the Effects of Constraint-Induced Movement Therapy and Unconstraint Exercise on Oxidative Stress and Limb Function-A Study on Human Patients and Rats with Cerebral Infarction. Brain Sci 2022; 13:brainsci13010004. [PMID: 36671986 PMCID: PMC9856592 DOI: 10.3390/brainsci13010004] [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: 10/29/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Most conventional post-stroke rehabilitation treatments do not involve imposed constraints of the unaffected limb. In contrast, Constraint-Induced Movement Therapy (CIMT) is comprised of massed task practice with the affected limb and constraint of the unaffected limb. CIMT is a promising rehabilitation technique used for motor recovery of affected limbs after stroke, but its effectiveness and mechanism are not fully understood. We compared the effects of the two exercise modes on limb function post-stroke in animal models and human subjects, and investigated whether oxidative stress response was involved in regulating the effects. We first conducted a randomized controlled trial (RCT), in which 84 subjects with cerebral infarction were assigned to dose-matched constraint-induced movement therapy (CIMT), or unconstraint exercise (UE), or conventional rehabilitation treatment. Motor functions of the limb are primary outcomes of the RCT measured using Brief Fugl-Meyer upper extremity score (FMA-UE), Ashworth score, and Barthel scale. Psychological influence of CIMT and UE was also examined using Self-Rating Depression Scale (SDS). Next, we investigated the effects of CIMT and UE in rats undergoing middle cerebral artery occlusion and reperfusion (MCAO/R). Motor function, infarct volume, and pathohistological changes were investigated by mNSS, MRI, and histological studies. The role of Keap1-Nrf2-ARE was investigated using qRT-PCR, Western blot, immunochemistry, immunofluorescence, and ELISA experiments. In RCT, patients taking CIMT had a higher score in FMA-UE, Barthel index, and SDS, and a lower score in modified Ashworth, compared to those taking UE. In rats receiving CIMT, motor function was increased, and infarct volume was decreased compared to those receiving UE. The expression of Keap1 protein and mRNA in the peri-infarct tissue was decreased, and Nrf2 and ARE protein and mRNA were increased in rats receiving CIMT compared with UE. Nrf2 agonist t-BHQ increased the benefits of CIMT. In conclusion, CIMT is more effective than UE in improving upper limb motor function, reducing muscle spasm in patients with cerebral infarction compared to UE, but patients receiving CIMT may feel depressed. Moreover, both CIMT and UE are beneficial to limb function recovery and limit the infarct expansion in MCAO/R rats, but CIMT was more effective than UE. Oxidative stress reaction has an essential role in regulating the CIMT induced benefits.
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Affiliation(s)
- Dong Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Correspondence: ; Tel.: +86-2885422847
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Abdullahi A, Sabo B, Badaru UM, Saeys W, Truijen S. Factors influencing recovery of upper limb motor function during constraint-induced movement therapy for people with stroke. Transl Neurosci 2022; 13:453-459. [PMID: 36561290 PMCID: PMC9743202 DOI: 10.1515/tnsci-2022-0260] [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: 07/06/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of this study is to determine the personal and clinical factors that can predict recovery of motor function in people with stroke. Methods Characteristics of the study participants such as age, sex, time since stroke and type of stroke, motor function, shoulder pain, amount and quality of use of the affected limb in the real world, wrist and elbow spasticity, handedness, central post-stroke pain and dose of massed practice were recorded. The data obtained were analyzed using descriptive statistics and multiple regression. Results A total of 144 patients with stroke with mean age, 58.71 ± 19.90 years participated in the study. The result showed that, the whole model significantly explained the total variance by 88.4%, F(14, 144) = 32.870, R 2 = 0. 0.781, p < 0.001. However, in the final model, only four independent variables in the order of degree of predictability, amount of use of the limb in the real world (Beta = 0.455, p = 0.003), intensity of practice during rehabilitation session (Beta = 0.321, p < 0.001), wrist spasticity (Beta = 0.148, p = 0.004) and side affected (Beta = 0.093, p = 0.033) significantly predicted recovery of motor function. Conclusion Encouraging the use of the limb in the real world may be more important than practice during rehabilitation session in the clinic or in the laboratory.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
| | - Bishir Sabo
- Department of Physiotherapy, Bayero University Kano, Kano, Nigeria,Department of Physiotherapy, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
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EEG Correlation Coefficient Change with Motor Task Activation Can Be a Predictor of Functional Recovery after Hemiparetic Stroke. Neurol Int 2022; 14:738-747. [PMID: 36135997 PMCID: PMC9503013 DOI: 10.3390/neurolint14030062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recently, it was reported that the extent of cortico-cortical functional connections can be estimated by the correlation coefficient based on electroencephalography (EEG) monitoring. We aimed to investigate whether the EEG correlation coefficient change with motor task activation can predict the functional outcomes of hemiparetic stroke patients. METHODS Sixteen post-stroke hemiparetic patients admitted to our rehabilitation ward were studied. On admission, EEG recording to calculate the correlation coefficient was performed at rest and during motor task activation. For the analysis of the EEG data, the program software FOCUS (NIHON KOHDEN, Japan) was used. The motor function of paretic limbs was evaluated with the Fugl-Meyer Assessment (FMA) on admission and 4 weeks after admission. RESULTS Significant increases in the correlation coefficient with motor task activation were noted in C3-F3 or C4-F4, C3-F7 or C4-F8, and F3-F7 or F4-F8 of the lesional hemisphere. Among them, the rate of the correlation coefficient change in F3-F7 or F4-F8 in the lesional hemisphere was significantly correlated with the rate of the upper-limb FMA score change. CONCLUSION The extent of the EEG correlation coefficient change with motor task activation in F3-F7 or F4-F8 of the lesional hemisphere may help predict the motor functional outcomes of hemiparetic upper limbs after stroke.
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Aloraini SM. Effects of constraint-induced movement therapy for the lower extremity among individuals post-stroke: A randomized controlled clinical trial. NeuroRehabilitation 2022; 51:421-431. [DOI: 10.3233/nre-220139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Stroke often leads to lower extremity impairments that significantly hinders functional recovery. OBJECTIVE: To investigate the effectiveness of constraint-induced movement therapy for the lower extremity (CIMT-LE) for improving balance and ambulation among people post-stroke. METHODS: A randomized controlled, single-blinded clinical trial was conducted. Participants were recruited and randomized into one of two groups: CIMT-LE group and control. Outcome measures were the Fugl-Meyer assessment of lower extremity, Berg balance scale, ten-meter walk test and six-minute walk test. Outcome measures were collected at baseline, following the conclusion of the therapeutic programs and after three months. RESULTS: 38 participants were enrolled in the study (19 in each group). No significant differences were found between groups at baseline. At the conclusion of therapeutic programs, both groups showed significant changes compared to baseline. However, changes seen in the CIMT-LE were clinically significant. Further, at three months following the conclusion of the program, the recorded improvements were retained by participants. CONCLUSION: A CIMT-LE program compared to an intensity-matched conventional program yielded significant clinical improvements among people post-stroke. These improvements were seen in lower extremity motor recovery, postural balance and gait speed. Furthermore, these improvements were retained three months following the conclusion of the therapeutic program.
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Affiliation(s)
- Saleh M. Aloraini
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah 51452, Saudi Arabia
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17
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Xie YL, Yang YX, Jiang H, Duan XY, Gu LJ, Qing W, Zhang B, Wang YX. Brain-machine interface-based training for improving upper extremity function after stroke: A meta-analysis of randomized controlled trials. Front Neurosci 2022; 16:949575. [PMID: 35992923 PMCID: PMC9381818 DOI: 10.3389/fnins.2022.949575] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Upper extremity dysfunction after stroke is an urgent clinical problem that greatly affects patients' daily life and reduces their quality of life. As an emerging rehabilitation method, brain-machine interface (BMI)-based training can extract brain signals and provide feedback to form a closed-loop rehabilitation, which is currently being studied for functional restoration after stroke. However, there is no reliable medical evidence to support the effect of BMI-based training on upper extremity function after stroke. This review aimed to evaluate the efficacy and safety of BMI-based training for improving upper extremity function after stroke, as well as potential differences in efficacy of different external devices. Methods English-language literature published before April 1, 2022, was searched in five electronic databases using search terms including “brain-computer/machine interface”, “stroke” and “upper extremity.” The identified articles were screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.4.1 software. The GRADE method was used to assess the quality of the evidence. Results A total of 17 studies with 410 post-stroke patients were included. Meta-analysis showed that BMI-based training significantly improved upper extremity motor function [standardized mean difference (SMD) = 0.62; 95% confidence interval (CI) (0.34, 0.90); I2 = 38%; p < 0.0001; n = 385; random-effects model; moderate-quality evidence]. Subgroup meta-analysis indicated that BMI-based training significantly improves upper extremity motor function in both chronic [SMD = 0.68; 95% CI (0.32, 1.03), I2 = 46%; p = 0.0002, random-effects model] and subacute [SMD = 1.11; 95%CI (0.22, 1.99); I2 = 76%; p = 0.01; random-effects model] stroke patients compared with control interventions, and using functional electrical stimulation (FES) [SMD = 1.11; 95% CI (0.67, 1.54); I2 = 11%; p < 0.00001; random-effects model]or visual feedback [SMD = 0.66; 95% CI (0.2, 1.12); I2 = 4%; p = 0.005; random-effects model;] as the feedback devices in BMI training was more effective than using robot. In addition, BMI-based training was more effective in improving patients' activities of daily living (ADL) than control interventions [SMD = 1.12; 95% CI (0.65, 1.60); I2 = 0%; p < 0.00001; n = 80; random-effects model]. There was no statistical difference in the dropout rate and adverse effects between the BMI-based training group and the control group. Conclusion BMI-based training improved upper limb motor function and ADL in post-stroke patients. BMI combined with FES or visual feedback may be a better combination for functional recovery than robot. BMI-based trainings are well-tolerated and associated with mild adverse effects.
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Affiliation(s)
- Yu-lei Xie
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Yu-xuan Yang
- Department of Rehabilitation Medicine, The Second Clinical Hospital of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
| | - Hong Jiang
- Department of Rehabilitation Medicine, Xichong County People's Hospital, Nanchong Central Hospital, Nanchong, China
| | - Xing-Yu Duan
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Li-jing Gu
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Wu Qing
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Bo Zhang
- Department of Rehabilitation Medicine, The Second Clinical Hospital of North Sichuan Medical College, Nanchong Central Hospital, Nanchong, China
- Bo Zhang
| | - Yin-xu Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- *Correspondence: Yin-xu Wang
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Frost SB, Chen D, Barbay S, Friel KM, Plautz EJ, Nudo RJ. Reorganization of Ventral Premotor Cortex After Ischemic Brain Injury: Effects of Forced Use. Neurorehabil Neural Repair 2022; 36:514-524. [PMID: 35559809 PMCID: PMC9378490 DOI: 10.1177/15459683221101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical use of the affected upper extremity can have a beneficial effect on motor recovery in people after stroke. Few studies have examined neurological mechanisms underlying the effects of forced use in non-human primates. In particular, the ventral premotor cortex (PMV) has been previously implicated in recovery after injury. OBJECTIVE To examine changes in motor maps in PMV after a period of forced use following ischemic infarct in primary motor cortex (M1). METHODS Intracortical microstimulation (ICMS) techniques were used to derive motor maps in PMV of four adult squirrel monkeys before and after an experimentally induced ischemic infarct in the M1 distal forelimb area (DFL) in the dominant hemisphere. Monkeys wore a sleeved jacket (generally 24 hrs/day) that forced limb use contralateral to the infarct in tasks requiring skilled digit use. No specific rehabilitative training was provided. RESULTS At 3 mos post-infarct, ICMS maps revealed a significant expansion of the DFL representation in PMV relative to pre-infarct baseline (mean = +77.3%; n = 3). Regression analysis revealed that the magnitude of PMV changes was largely driven by M1 lesion size, with a modest effect of forced use. One additional monkey examined after ∼18 months of forced use demonstrated a 201.7% increase, unprecedented in non-human primate studies. CONCLUSIONS Functional reorganization in PMV following an ischemic infarct in the M1 DFL is primarily driven by M1 lesion size. Additional expansion occurs in PMV with extremely long periods of forced use but such extended constraint is not considered clinically feasible.
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Affiliation(s)
- Shawn B. Frost
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Daofen Chen
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Physical Therapy & Rehabilitation Science; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Scott Barbay
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Kathleen M. Friel
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Erik J. Plautz
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Randolph J. Nudo
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
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Ramos-Castaneda JA, Barreto-Cortes CF, Losada-Floriano D, Sanabria-Barrera SM, Silva-Sieger FA, Garcia RG. Efficacy and Safety of Vagus Nerve Stimulation on Upper Limb Motor Recovery After Stroke. A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:889953. [PMID: 35847207 PMCID: PMC9283777 DOI: 10.3389/fneur.2022.889953] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Background Upper limb motor impairment is one of the main complications of stroke, affecting quality of life both for the patient and their family. The aim of this systematic review was to summarize the scientific evidence on the safety and efficacy of Vagus Nerve Stimulation (VNS) on upper limb motor recovery after stroke. Methods A systematic review and meta-analysis of studies that have evaluated the efficacy or safety of VNS in stroke patients was performed. The primary outcome was upper limb motor recovery. A search of articles published on MEDLINE, CENTRAL, EBSCO and LILACS up to December 2021 was performed, and a meta-analysis was developed to calculate the overall effects. Results Eight studies evaluating VNS effects on motor function in stroke patients were included, of which 4 used implanted and 4 transcutaneous VNS. It was demonstrated that VNS, together with physical rehabilitation, increased upper limb motor function on average 7.06 points (95%CI 4.96; 9.16) as assessed by the Fugl-Meyer scale. Likewise, this improvement was significantly greater when compared to a control intervention (mean difference 2.48, 95%CI 0.98; 3.98). No deaths or serious adverse events related to the intervention were reported. The most frequent adverse events were dysphonia, dysphagia, nausea, skin redness, dysgeusia and pain related to device implantation. Conclusion VNS, together with physical rehabilitation, improves upper limb motor function in stroke patients. Additionally, VNS is a safe intervention.
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Affiliation(s)
- Jorge A. Ramos-Castaneda
- Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
- Research Group Innovación y Cuidado, Faculty of Nursing, Universidad Antonio Nariño, Neiva, Colombia
- *Correspondence: Jorge A. Ramos-Castaneda
| | | | | | | | | | - Ronald G. Garcia
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- School of Medicine, Universidad de Santander, Bucaramanga, Colombia
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20
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Wu X, Zhang Q, Qiao J, Chen N, Wu X. Calligraphy-based rehabilitation exercise for improving the upper limb function of stroke patients: protocol for an evaluator-blinded randomised controlled trial. BMJ Open 2022; 12:e052046. [PMID: 35568494 PMCID: PMC9109027 DOI: 10.1136/bmjopen-2021-052046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 04/29/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A common complication of stroke is upper limb dysfunction. Chinese calligraphy handwriting (CCH) is an aesthetical exercise developed from the traditional way of writing in China and holds potential to become a rehabilitation method to improve upper limb functions in patients with stroke. This study aims to design a randomised controlled trial to assess the effect of a customised CCH-based exercise for poststroke rehabilitation of upper limb dysfunction. METHODS AND ANALYSIS A single-blinded randomised controlled trial will be conducted on 60 stroke patients. The patients will be randomly allocated into three groups: (1) conventional occupational therapy (COT) group, (2) COT+CCH group, (3) COT+Graded Repetitive Arm Supplementary Program (GRASP) group. For the COT group, patients will receive COT treatment of 1 hour/day. For the COT+CCH group, patients will receive 30 mins COT treatment and 30 mins CCH training. For the COT+GRASP group, patients will receive 30 mins COT treatment and 30 mins GRASP training. All the interventions will be performed 5 days per week for a total of 3 weeks. The upper limb functions will be assessed before and after the interventions using a series of rating scales. ETHICS AND DISSEMINATION This study has been approved by the Research Ethics Committees of the Second Rehabilitation Hospital of Shanghai (study ID: 2020-32-01) and the Shanghai University of Sport (study ID: 102772021RT043). Results will be directly disseminated to the patients at the end of the study and to the public via publications in peer-reviewed journals and presentations in conferences. TRIAL REGISTRATION NUMBER ChiCTR 2100043036; Chinese Clinical Trials Registry.
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Affiliation(s)
- Xiaodi Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
| | - Qiang Zhang
- Institute for Biomechanics, ETH Zürich, Zurich, Switzerland
| | - Jun Qiao
- Department of Treatment, The Second Rehabilitation Hospital of Shanghai, Shanghai, People's Republic of China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Afliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
- Department of Rehabilitation, Xinhua Hospital Chongming Branch, Shanghai, People's Republic of China
| | - Xie Wu
- School of Kinesiology, Shanghai University of Sport, Shanghai, People's Republic of China
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21
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Tedla JS, Gular K, Reddy RS, de Sá Ferreira A, Rodrigues EC, Kakaraparthi VN, Gyer G, Sangadala DR, Qasheesh M, Kovela RK, Nambi G. Effectiveness of Constraint-Induced Movement Therapy (CIMT) on Balance and Functional Mobility in the Stroke Population: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10030495. [PMID: 35326973 PMCID: PMC8949312 DOI: 10.3390/healthcare10030495] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/01/2023] Open
Abstract
Constraint-induced movement therapy (CIMT) is one of the most popular treatments for enhancing upper and lower extremity motor activities and participation in patients following a stroke. However, the effect of CIMT on balance is unclear and needs further clarification. The aim of this research was to estimate the effect of CIMT on balance and functional mobility in patients after stroke. After reviewing 161 studies from search engines including Google Scholar, EBSCO, PubMed, PEDro, Science Direct, Scopus, and Web of Science, we included eight randomized controlled trials (RCT) in this study. The methodological quality of the included RCTs was verified using PEDro scoring. This systematic review showed positive effects of CIMT on balance in three studies and similar effects in five studies when compared to the control interventions such as neuro developmental treatment, modified forced-use therapy and conventional physical therapy. Furthermore, a meta-analysis indicated a statistically significant effect size by a standardized mean difference of 0.51 (P = 0.01), showing that the groups who received CIMT had improved more than the control groups. However, the meta-analysis results for functional mobility were statistically insignificant, with an effect size of −4.18 (P = 0.16), indicating that the functional mobility improvements in the investigated groups were not greater than the control group. This study’s findings demonstrated the superior effects of CIMT on balance; however, the effect size analysis of functional mobility was statistically insignificant. These findings indicate that CIMT interventions can improve balance-related motor function better than neuro developmental treatment, modified forced-use therapy and conventional physical therapy in patients after a stroke.
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Affiliation(s)
- Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (J.S.T.); (K.G.); (V.N.K.); (D.R.S.)
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (J.S.T.); (K.G.); (V.N.K.); (D.R.S.)
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (J.S.T.); (K.G.); (V.N.K.); (D.R.S.)
- Correspondence:
| | - Arthur de Sá Ferreira
- Postgraduate Program in Rehabilitation Science, University Center Augusto Motta UNISUAM, Rio de Janeiro 21032-060, Brazil; (A.d.S.F.); (E.C.R.)
| | - Erika Carvalho Rodrigues
- Postgraduate Program in Rehabilitation Science, University Center Augusto Motta UNISUAM, Rio de Janeiro 21032-060, Brazil; (A.d.S.F.); (E.C.R.)
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (J.S.T.); (K.G.); (V.N.K.); (D.R.S.)
| | - Giles Gyer
- The London College of Osteopathic Medicine, London NW1 6QH, UK;
| | - Devika Rani Sangadala
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61413, Saudi Arabia; (J.S.T.); (K.G.); (V.N.K.); (D.R.S.)
| | - Mohammed Qasheesh
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
| | - Rakesh Krishna Kovela
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha 442001, Maharastra, India;
| | - Gopal Nambi
- Gopal Nambi, Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 16278, Saudi Arabia;
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22
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Pandian S, Arya KN, Kumar V, Joshi AK. Synergy-Based Motor Therapy Inducing Favorable Changes in Motor Function Components among Poststroke Subjects: A Single-Group Study. J Neurosci Rural Pract 2022; 13:261-269. [PMID: 35694074 PMCID: PMC9187400 DOI: 10.1055/s-0042-1743458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Synergy is an outcome of multiple muscles acting in a synchronized pattern, controlled by the central nervous system. After brain insult, a set of deviated movement pattern emerges in the affected limb. The methods to train synchronization of muscles may diminish the deviated movement augmenting neuromotor control. The purpose of this investigation was to develop a synergy-based motor therapy (SBMT) protocol for the paretic upper limb in poststroke subjects. Further, the feasibility and effectiveness of the program was evaluated. .
Methods
The design was Pretest–posttest single-group assessor-blinded trial. Department of occupational therapy of a national institute for persons with physical disabilities was the study site. There were 40 study subjects (23 men, ranging from 40 to 60 years, 18 subjects with hemorrhagic cerebrovascular accident, and > 6 months after the accident) exhibiting motor paresis of half side of the body. SBMT is a stage-specific regime based on the linkage between the deviated and usual muscle action. SBMT items were selected considering the strength and magnitude of the deviated motor components. The movement linkages were utilized to dissociate strong coupled components; for instance, forearm pronation-supination with elbow 90-degree flexion. Fugl-Meyer Assessment (upper extremity) (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI) were applied to quantify the motor status, motor functional ability of the upper extremity, and self-care activities, respectively.
Results
All the enrolled subjects could perform their corresponding SBMT sessions. Posttreatment, FMA-UE improved significantly (
p
< 0.001) from mean of 26.30 (standard deviation [SD] 15.02) to 35.20 (SD 17.64). Similarly, the WMFT both time (in seconds) and quality also positively improved significantly (
p
< .001) from mean of 76.77 (SD 54.73) to 64.07 (SD 56.99) and 1.34 (SD 1.06) to 1.87 (SD 1.34), respectively. BI improved from 79.88 (SD 17.07) to 92.62 (SD 21.2) after the intervention (
p
< 0.001).
Conclusion
SBMT protocol was a feasible and effective intervention to facilitate motor function components in chronic hemiparetic subjects. The regime could be considered as a potential intervention for stroke rehabilitation. Further trials and use of sophisticated measures are recommended to authenticate the outcome of this investigation.
Clinical Trial Registration
Clinical Trial Registry of India as CTRI/2017/10/010162 on October 23, 2017 (retrospectively).
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Affiliation(s)
- Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Akshay Kumar Joshi
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
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23
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Jo S, Kim H, Song C. A Novel Approach to Increase Attention during Mirror Therapy among Stroke Patients: A Video-Based Behavioral Analysis. Brain Sci 2022; 12:brainsci12030297. [PMID: 35326254 PMCID: PMC8946785 DOI: 10.3390/brainsci12030297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Stroke is a major cause of disability and an evident rehabilitation strategy is crucial. Mirror therapy (MT) is one of the popular rehabilitation methods that is known to be effective as the patients benefit from the mirror illusion. However, the patient’s attention to the mirror illusion during treatment is unclear. Therefore, the present study assesses the duration and frequency of the mirror gaze, distraction, and preparation of sixteen stroke patients during two MT methods using a behavioral coding software. During the 30 min treatment, the total mirror gaze duration during conventional bilateral MT (BMT) was 564.04 s, while it was 1482.45 s in unilateral MT using a screen (UMT). The total distracted time was 945.61 s in BMT, while it was only 162.03 s in UMT. The total preparatory duration was 290.35 s in BMT and 155.53 s in UMT. The total number of distracted bouts were 136.45 in BMT, while it was 73.38 in UMT. The total number of preparatory bouts were 18.42 in BMT and 9.56 in UMT. The average times of gaze duration per bout were 5.52 s in BMT and 21.81 s in UMT. The average times of distraction per bout were 9.22 s in BMT and 3.00 s in UMT. The total number of mirror gaze bouts and average time of preparation per bout did not present a statistical significance in the comparisons of the two methods. This study assesses two methods of MT using observational coding software to evaluate the duration and frequency of the mirror gaze during treatment. The results suggest that UMT may be an alternative option to provide MT for stroke patients to increase their attention towards the mirror.
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24
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Sicari M, Longhi M, D'Angelo G, Boetto V, Lavorato A, Cocchini L, Beatrici M, Battiston B, Garbossa D, Massazza G, Titolo P. Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review. Eur J Phys Rehabil Med 2022; 58:43-50. [PMID: 34747579 PMCID: PMC9980490 DOI: 10.23736/s1973-9087.21.06886-6] [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: 11/08/2022]
Abstract
INTRODUCTION Obstetric brachial plexus palsy (OBPP) is a flaccid paralysis occurring in the upper limb during birth. The OBPP includes mild lesions with complete spontaneous recovery and severe injuries with no regain of arm function. Among the most promising rehabilitation treatments aimed at improving upper extremity motor activities in individuals with neurological dysfunctions, there is the modified constraint-induced movement therapy (mCIMT). The aim of this systematic review is to assess and synthesize the critical aspects of the use of mCIMT in children with OBPP. EVIDENCE ACQUISITION This systematic review has been carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). A comprehensive search of the literature was conducted using PubMed, MEDLINE and Evidence Based Medicine Reviews, databases. We enclosed experimental and original articles, case reports and book chapters. Four articles were finally included. EVIDENCE SYNTHESIS One case report tested the feasibility of mCIMT to encourage use of the affected arm in a child with Erb-Duchenne palsy and documented the clinical changes observed. A case series had the purpose to determine if mCIMT in combination with botulinum toxin (BTX-A) improved arm function in 2 children with OBPP. A cohort study compared the use of mCIMT in 19 OBPP and 18 unilateral Cerebral Palsy. A prospective single-blind RCT described mCIMT versus conventional therapy in a group of 39 children with OBPP. CONCLUSIONS This systematic review on the use of mCIMT in children with OBPP shows that there is unanimous agreement that a program should last 2 weeks at least. However, there is no scientific evidence supporting a single common mCIMT protocol in the management of OBPP because of a considerable heterogeneity. Further high methodological studies regarding the application of mCIMT for OBPP and based on larger patients' sample should have the potential to optimize the appropriateness of care provided to infants with OBPP and, therefore, their quality of life.
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Affiliation(s)
- Monica Sicari
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maria Longhi
- Unit of Rehabilitation Medicine, Department of Neuroscience, University Hospital of Modena, Modena, Italy -
| | - Giulia D'Angelo
- Division of Physical Medicine and Rehabilitation, ASLTO3, Turin, Italy
| | - Valentina Boetto
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Lavorato
- Unit of Neurosurgery, Department of Neuroscience "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Lorella Cocchini
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Maurizio Beatrici
- Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Bruno Battiston
- Unit of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, Department of Neuroscience "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Titolo
- Unit of Hand and Upper Limb Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
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25
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Sabo B, Abdullahi A, Badaru UM, Saeys W, Truijen S. Predictors of high dose of massed practice following stroke. Transl Neurosci 2022; 13:181-190. [PMID: 35903752 PMCID: PMC9285765 DOI: 10.1515/tnsci-2022-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of this study is to determine the factors that affect patients' ability to carry out high dose of massed practice. Methods Patients with stroke were included in the study if they had no severe impairment in motor and cognitive functions. Dose of massed practice, motor function, perceived amount and quality of use of the arm in the real world, wrist and elbow flexors spasticity, dominant hand stroke, presence of shoulder pain, and central post-stroke pain were assessed on the first day. Dose of massed practice was assessed again on the second day. The data were analyzed using descriptive statistics and linear multiple regression. Results Only motor function (β = -0.310, r = 0.787, P < 0.001), perceived amount of use (β = 0.300, r = 0.823; 95% CI = 0.34-107.224, P = 0.049), severity of shoulder pain (β = -0.155, r = -0.472, P = 0.019), wrist flexors spasticity (β = -0.154, r = -0.421, P = 0.002), age (β = -0.129, r = -0.366, P = 0.018), dominant hand stroke (β = -0.091, r = -0.075, P = 0.041), and sex (β = -0.090, r = -0.161, P = 0.036) significantly influenced patients' ability to carry out high dose of massed practice. Conclusion Many factors affect patients' ability to carry out high dose of massed practice. Understanding these factors can help in designing appropriate rehabilitation.
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Affiliation(s)
- Bishir Sabo
- Department of Physiotherapy, Bayero University Kano, 70001 Kano, Nigeria.,Department of Physiotherapy, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Auwal Abdullahi
- Department of Physiotherapy, Bayero University Kano, 70001 Kano, Nigeria.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
| | | | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Movant, Wilrijk, Belgium
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26
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Angerhöfer C, Colucci A, Vermehren M, Hömberg V, Soekadar SR. Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany - Toward Long-Term Treatment With Brain-Computer Interfaces. Front Neurol 2021; 12:772199. [PMID: 34867760 PMCID: PMC8637332 DOI: 10.3389/fneur.2021.772199] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.
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Affiliation(s)
- Cornelius Angerhöfer
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Annalisa Colucci
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mareike Vermehren
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Volker Hömberg
- Department of Neurology, SRH Gesundheitszentrum Bad Wimpfen GmbH, Bad Wimpfen, Germany
| | - Surjo R Soekadar
- Clinical Neurotechnology Lab, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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27
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The Effects of Auditory Feedback Gait Training Using Smart Insole on Stroke Patients. Brain Sci 2021; 11:brainsci11111377. [PMID: 34827376 PMCID: PMC8615866 DOI: 10.3390/brainsci11111377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 12/02/2022] Open
Abstract
This study aimed to assess the effect of the auditory feedback gait training (AFGT) using smart insole on the gait variables, dynamic balance, and activities of daily living (ADL) of stroke patients. In this case, 45 chronic stroke patients who were diagnosed with a stroke before 6 months and could walk more than 10 m were included in this study. Participants were randomly allocated to the smart insole training group (n = 23), in which the AFGT system was used, or to the general gait training group (GGTG) (n = 22). Both groups completed conventional rehabilitation, including conventional physiotherapy and gait training, lasting 60 min per session, five times per week for 4 weeks. Instead of gait training, the smart insole training group received smart insole training twice per week for 4 weeks. Participants were assessed using the GAITRite for gait variables and Timed Up and Go test (TUG), Berg Balance Scale (BBS) for dynamic balance, and Modified Barthel Index (MBI) for ADL. The spatiotemporal gait parameters, symmetry of gait, TUG, BBS, and MBI in the smart insole training group were significantly improved compared to those in the GGTG (p < 0.05). The AFGT system approach is a helpful method for improving gait variables, dynamic balance, and ADL in chronic stroke patients.
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28
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Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial. J Hand Ther 2021; 33:418-425. [PMID: 32151503 DOI: 10.1016/j.jht.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/29/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective single-blind, randomized controlled study. INTRODUCTION Children with perinatal brachial plexus palsy (PBPP) have motion limitations in the affected upper extremity. Modified constraint-induced movement therapy (mCIMT) is one of the treatment options used for the improvement of the function of the affected limb. PURPOSE OF THE STUDY The purpose of this study was to compare the effect of mCIMT and conventional therapy in improving active range of motion (ROM) and functional use of the affected upper extremity in children with PBPP with injuries to upper and middle trunks in the hospital environment. MATERIALS 26 patients received conventional rehabilitation program (control group) and 13 patients participated in a mCIMT program (study group). Children had a mean age 56.3 months (range 4-10 years). The mCIMT included 1 hour therapy sessions emphasizing the affected arm use for 14 consecutive days during hospitalization. Their normal arm was also constrained for 6 hour per day. All the patients were assessed at the baseline, one day, one month, and three months after completion of therapy using active ROM, active movement scale, hand dynamometer, box and blocks test. RESULTS The mCIMT group improved more than the control group in shoulder internal rotation, forearm supination, elbow flexion active ROMs, hand grip strength, and in upper extremity function. CONCLUSION mCIMT has a potential to promote functional gains for children with PBPP; this approach should be widely applied within routine clinical practice.
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29
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Parmar ST, Kanitkar A, Sepehri N, Bhairannawar S, Szturm T. Computer Game-Based Telerehabilitation Platform Targeting Manual Dexterity: Exercise Is Fun. "You Are Kidding-Right?". SENSORS (BASEL, SWITZERLAND) 2021; 21:5766. [PMID: 34502656 PMCID: PMC8434447 DOI: 10.3390/s21175766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
There is a need for innovation to improve the engagement and accessibility of rehabilitation programs for children and adults with upper extremity motor impairments due to neurodevelopmental disorders, acquired brain injuries, or spinal cord injuries. For this purpose, a computer game-based telerehabilitation platform (GTP) was developed to address this need. Through the application of a miniature inertial-based computer mouse and the wide variety of commercial computer games, the developed GTP can provide engaging task-specific exercises for the rehabilitation of manual dexterity (object handling and manipulation). A purpose-built repetitive task practice software (RTP) was also developed to gather event data and synchronize it with patient movements during gameplays. This provides automated monitoring and quantification of patients' motor skills, while they practice a range of game-based exercises with their hand and/or arm. The GTP would initially be used in a supervised clinical setting followed by a transition to function at home and be monitored by clinician specialists. Clinical support for home and rural communities, with protocols that can be easily updated, will help increase accessibility to targeted and personalized solutions for patients and achieve the desired training effect.
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Affiliation(s)
| | - Anuprita Kanitkar
- College of Rehabilitation Science, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Nariman Sepehri
- Department of Mechanical Engineering, Price Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Satish Bhairannawar
- Department of Electronics and Communication Engineering, SDM College of Engineering and Technology, Dharwad 580009, Karnataka, India;
| | - Tony Szturm
- College of Rehabilitation Science, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
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30
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Abdullahi A, Candan SA, Soysal Tomruk M, Yakasai AM, Truijen S, Saeys W. Constraint-induced movement therapy protocols using the number of repetitions of task practice: a systematic review of feasibility and effects. Neurol Sci 2021; 42:2695-2703. [PMID: 33884528 DOI: 10.1007/s10072-021-05267-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND High repetitions of task practice is required for the recovery of the motor function during constraint-induced movement therapy (CIMT). This can be achieved into ways: when the task practice is measured in hours of practice or when the number of repetitions is counted. However, it has been argued that using hours of task practice as a measure of practice does not provide a clear instruction on the dose of practice. AIM The aim of this study is to determine the feasibility and effects of the CIMT protocol that uses the number of repetitions of task practice. MATERIALS/METHOD The study was a systematic review registered in PROSPERO (CRD42020142140). Five databases, PubMED, CENTRAL, PEDro, OTSeeker and Web of Science, were searched. Studies of any designs in adults with stroke were included if they used the number of repetitions of task practice as a measure of dose. The methodological quality of the included studies was assessed using Modified McMaster critical review form. The results were analysed using qualitative synthesis. RESULTS Eight studies (n = 205) were included in the study. The number of task repetitions in the studies ranges between 45 and 1280 per day. The results showed that CIMT protocol using the number of repetitions of task practice was feasible and improved outcomes such as motor function, quality of life, functional mobility and spasticity. CONCLUSION The number of repetitions of task practice as a measure of CIMT dose can be used in place of the existing protocol that uses the number of hours of task practice.
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Affiliation(s)
- Auwal Abdullahi
- Neurological Rehabilitation Unit, Department of Physiotherapy, Bayero University Kano, PMB 3011, Gwarzo road, Kano, Nigeria. .,Department of Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, D.R.312, Wilrijk, 2610, Belgium.
| | - Sevim Acaroz Candan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ordu University, 52100, Ordu, Turkey
| | - Melda Soysal Tomruk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mehmet Akif University, Burdur, Turkey
| | | | - Steven Truijen
- Department of Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, D.R.312, Wilrijk, 2610, Belgium
| | - Wim Saeys
- Department of Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, D.R.312, Wilrijk, 2610, Belgium
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31
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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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32
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Lansberg MG, Legault C, MacLellan A, Parikh A, Muccini J, Mlynash M, Kemp S, Buckwalter MS, Flavin K. Home-based virtual reality therapy for hand recovery after stroke. PM R 2021; 14:320-328. [PMID: 33773059 DOI: 10.1002/pmrj.12598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many stroke survivors experience arm and hand weakness, but there are only limited efficacious options for arm therapy available. OBJECTIVE To assess the feasibility of unsupervised home-based use of a virtual reality device (Smart Glove) for hand rehabilitation post stroke. DESIGN Prospective single-arm study consisting of a 2-week run-in phase with no device use followed by an 8-week intervention period. SETTING Participants were recruited at the Stanford Neuroscience Outpatient Clinic. PARTICIPANTS Twenty chronic stroke patients with upper extremity impairment. INTERVENTIONS Participants were instructed to use the Smart Glove 50 minutes per day, 5 days per week for 8 weeks. MAIN OUTCOME MEASURES The following outcomes were measured: (1) compliance, (2) patients' impression of the intervention, and (3) efficacy using the upper extremity Fugl-Meyer (UE-FM), the Jebsen-Taylor hand function test (JTHFT), and the Stroke Impact Scale (SIS). RESULTS Of 20 participants, seven (35%) met target compliance of 40 days use, and six (30%) used the device for 20-39 days. Eighty-five percent of participants were satisfied with the therapy, with 80% reporting improvement in hand function. During the run-in phase there were no improvements in hand function. During the intervention, patients improved by a mean of 26.6 ± 48.8 seconds on the JTHFT (P = .03), by 16.1 ± 15.3 points on the hand-domain of the SIS (P < .01) and there was a trend toward improvement on the UE-FM (2.2 ± 5.5 points, P = .10). CONCLUSIONS Unsupervised use of the Smart Glove in the home environment may improve hand/arm function in subacute/chronic stroke patients. A randomized controlled trial is needed to confirm these results.
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Affiliation(s)
- Maarten G Lansberg
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Catherine Legault
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Adam MacLellan
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Alay Parikh
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Julie Muccini
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA.,Outpatient Neurologic Rehabilitation Program, Stanford Health Care, Stanford, California, USA
| | - Michael Mlynash
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Stephanie Kemp
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Marion S Buckwalter
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kara Flavin
- Stanford Stroke Center, Stanford University School of Medicine, Stanford, California, USA.,Outpatient Neurologic Rehabilitation Program, Stanford Health Care, Stanford, California, USA.,Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, Stanford, California, USA
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Abdullahi A, Truijen S, Umar NA, Useh U, Egwuonwu VA, Van Criekinge T, Saeys W. Effects of Lower Limb Constraint Induced Movement Therapy in People With Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:638904. [PMID: 33833730 PMCID: PMC8021771 DOI: 10.3389/fneur.2021.638904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Constraint induced movement therapy (CIMT) is effective at improving upper limb outcomes after stroke. Aim: The aim of this study was to carry out a systematic review and meta-analysis of the effects of lower limb CIMT studies of any design in people with stroke. Materials/ Method: PubMED, PEDro, OTSeeker, CENTRAL, and Web of Science were searched from their earliest dates to February 2021. Lower limbs CIMT studies that measured outcomes at baseline and post-intervention were selected. Sample size, mean, and standard deviation on the outcomes of interest and the protocols of both the experimental and control groups were extracted. McMaster Critical Review Form was used to assess the methodological quality of the studies. Result: Sixteen studies with different designs were included in this review. The result showed that lower limb CIMT improves functional, physiological and person's reported outcomes including motor function, balance, mobility, gait speed, oxygen uptake, exertion before and after commencement of activities, knee extensor spasticity, weight bearing, lower limb kinematics and quality of life in people with stroke post intervention. However, there were only significant differences in quality of life in favor of CIMT post-intervention [mean difference (MD) = 16.20, 95% CI = 3.30–29.10, p = 0.01]; and at follow-up [mean difference (MD) = 14.10, 95% CI = 2.07–26.13, p = 0.02] between CIMT and the control group. Even for the quality of life, there was significant heterogeneity in the studies post intervention (I2 = 84%, p = 0.01). Conclusion: Lower limb CIMT improves motor function, balance, functional mobility, gait speed, oxygen uptake, weigh bearing, lower limb kinematics, and quality of life. However, it is only superior to the control at improving quality of life after stroke based on the current literature.
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Affiliation(s)
- Auwal Abdullahi
- Neurological Rehabilitation Unit, Department of Physiotherapy, Bayero University Kano, Kano, Nigeria.,Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Steven Truijen
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Naima A Umar
- Department of Physiotherapy, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
| | - Ushotanefe Useh
- Lifestyle Diseases Research Entity, Faculty of Health Sciences, North-West University, Mmabatho, South Africa
| | - Victor A Egwuonwu
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Tamaya Van Criekinge
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Wilrijk, Belgium
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Effect of constraint-induced movement therapy on persons-reported outcomes of health status after stroke: a systematic review and meta-analysis. Int J Rehabil Res 2021; 44:15-23. [PMID: 33234842 DOI: 10.1097/mrr.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. The aim of this review was to investigate its effect on persons-reported outcomes of health status (PROsHS) compared with conventional therapy. The study was a systematic review and meta-analysis registered in PROSPERO (CRD42019142279). Five databases PubMED, PEDro, OTSeeker, CENTRAL and Web of Science were searched. Randomized controlled trials were included if they assessed PROsHS. Mean scores of PROsHS, sample size and dose of CIMT and control groups interventions were extracted. The result was analyzed using qualitative and quantitative syntheses. Nine studies (n = 558) were included in the review. From the result, CIMT significantly improved PROsHS postintervention. However, postintervention, there was no statistically significant difference between groups for the upper limb [Mean difference (MD) = 6.67, 95% confidence interval (CI) = -2.09 to 15.44, P = 0.14] and the lower limb (MD = -1.86, 95% CI = -16.29 to 12.57, P = 0.80). Similarly, there was no statistically significant percentage of variation across studies, upper limb (I2 = 0%, P = 0.92) and lower limb (I2 = 0%, P = 0.86). For the lower limb at follow-up, there was no statistically significant difference between groups (MD = 0.97, 95% CI = -13.59 to 15.53, P = 0.90). When upper and lower limbs studies were pooled, there was no statistically significant difference between groups postintervention (MD = 0.22, 95% CI = -0.15 to 0.58, P = 0.24) and at follow-up (MD = 0.03, 95% CI = -0.43 to 0.49, P = 0.90). CIMT improves PROsHS after stroke. However, it is not superior to conventional therapy based on the current literature.
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Comparing Two Different Modes of Task Practice during Lower Limb Constraint-Induced Movement Therapy in People with Stroke: A Randomized Clinical Trial. Neural Plast 2021; 2021:6664058. [PMID: 33603778 PMCID: PMC7870299 DOI: 10.1155/2021/6664058] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/16/2020] [Accepted: 01/19/2021] [Indexed: 12/30/2022] Open
Abstract
Background Constraint-induced movement therapy (CIMT) is used for the rehabilitation of motor function after stroke. Objectives The aim of this study was to compare the effects of lower limb CIMT that uses number of repetition of tasks with the one that uses number of hours of practice. Method The study was a randomized clinical trial approved by the Ethics Committee of Kano State Ministry of Health. Fifty-eight people with stroke participated in the study. Groups 1 and 2 performed daily 600 repetitions and 3 hours of task practice, respectively, 5 times weekly for 4 weeks. Motor impairment (primary outcome), balance, functional mobility, knee extensor spasticity, walking speed and endurance, and exertion before and after commencement of activities were assessed at baseline and postintervention. The data was analyzed using Friedmann and Mann-Whitney U tests. Result The results showed that there was only significant difference (p < 0.05) in knee extensor spasticity (group 1 (median = 0(0), mean rank = 27.50); group 2 (median = 0(0), mean rank = 31.64)), exertion before commencement of activities (group 1 (median = 0(0.5), mean rank = 21.90); group 2 (median = 1(0.5), mean rank = 37.64)), and exertion after commencement of activities (group 1 (median = 1(1), mean rank = 20.07); group 2 (median = 1(0), mean rank = 39.61) postintervention in favour of the experimental group (group 1)). Conclusion The group 1 protocol is more effective at improving outcomes after stroke.
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ÇEKMECE Ç, SADE I. İnmeli Hastalarda Robotik Rehabilitasyonun El Fonksiyonları ve Günlük Yaşam Aktiviteleri Üzerine Etkisi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.756705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sawant N, Bose M, Parab S. Dexteria app. therapy versus conventional hand therapy in stroke. JOURNAL OF ENABLING TECHNOLOGIES 2020. [DOI: 10.1108/jet-05-2020-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Hand impairment post-stroke is a very common and important rehabilitation goal for functional independence. Advanced therapy options such as an app. therapy provides repetitive training, which may be beneficial for improving fine motor function. This study aims to evaluate the effect of app-based therapy compared to conventional hand therapy in improving dexterity in individuals with stroke.
Methodology
In total, 39 individuals within the first year of stroke with Brunnstrom stage of hand recovery IV to VI were randomly divided into three groups. All three groups received 60 min of therapy for 21 sessions over a period of 30 days. Group A received conventional hand therapy; Group B received app. therapy, while Group C received conventional therapy along with the app. therapy. All participants were assessed on the Nine-Hole Peg Test and Jebsen–Taylor Hand Function Test at the beginning and after completion of 21 sessions of intervention. Kruskal–Wallis (H) test and Wilcoxon test were used for statistical analysis.
Results
All three groups improved on hand function post-treatment. However, Group C demonstrated significant improvement with 16%–58% increase in hand function performance on outcome measures (p < 0.05).
Findings
Findings of the present study demonstrate improvement in dexterity with the app. therapy and combination therapy, in comparison to conventional therapy alone in individuals with stroke.
Originality
This experimental study focuses the first time on a structured protocol using an enabling technology adjunct to conventional physical therapy to improve hand function in individuals with stroke, which opens up the further scope in Neurorehabilitation.
Peer review
The peer review history for this article is available at: https://publons.com/publon/10.1108/ILT-04-2020-0144/
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Sweeney G, Barber M, Kerr A. Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke: Use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland. Br J Occup Ther 2020. [DOI: 10.1177/0308022620909023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice. Methods A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention. Findings The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation. Conclusion Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake.
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Affiliation(s)
- Gillian Sweeney
- Occupational Therapist, NHS Lanarkshire, Bothwell, UK
- School of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Mark Barber
- University Department of Stroke Care, NHS Lanarkshire, Bothwell, UK
| | - Andrew Kerr
- School of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Egan M, Kessler D, Duong P, Gurgel-Juarez N, Linkewich E, Sikora L, Montgomery P, Chopra A. Participation-focused interventions for stroke rehabilitation: a scoping review protocol. JBI Evid Synth 2020; 18:2666-2672. [PMID: 32813422 DOI: 10.11124/jbisrir-d-19-00387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objectives of this scoping review are to i) identify adaptive stroke rehabilitation interventions using metacognitive or self-management approaches targeting participation as an outcome; ii) determine the explicit and implicit theories underlying these interventions; and iii) ascertain the elements in each intervention. This review will develop a catalogue of these interventions, improving the understanding of how these interventions work, thereby facilitating efficient development and testing of participation-focused interventions. INTRODUCTION Stroke rehabilitation interventions can be categorized as those aiming to correct impairment and those seeking participation improvement despite impairment. Impairment-focused interventions include a relatively small number of well-defined elements, generally based on motor learning or other types of learning theory. Participation-focused interventions span a large group of diverse interventions. The underlying theory is typically varied and often implicit, but many of these interventions are based on metacognitive or self-management approaches. An examination of the underlying theory and elements of participation-focused interventions would allow researchers to more effectively advance the science of these approaches. INCLUSION CRITERIA The review will include published papers describing rehabilitation interventions using metacognitive or self-management approaches to improve participation among adults who have experienced a stroke. METHODS The search will include JBI Evidence-Based Practice Database, MEDLINE, Embase, CINAHL, PsycINFO, OTSeeker, and PEDro databases. Studies will be selected according to a three-step process, including i) managing search results and removing duplicates, ii) title and abstract screening, and iii) full text screening. The extracted data will be presented in table form and narrative summary, aligning with the objectives and scope of this review.
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Affiliation(s)
- Mary Egan
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Dorothy Kessler
- Bruyère Research Institute, Ottawa, ON, Canada.,School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Patrick Duong
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Nalia Gurgel-Juarez
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Linkewich
- Regional Stroke Center, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, ON, Canada
| | | | - Anchal Chopra
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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Neurobiology of Recovery of Motor Function after Stroke: The Central Nervous System Biomarker Effects of Constraint-Induced Movement Therapy. Neural Plast 2020; 2020:9484298. [PMID: 32617098 PMCID: PMC7312560 DOI: 10.1155/2020/9484298] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/25/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022] Open
Abstract
Recovery of motor function after stroke involves many biomarkers. This review attempts to identify the biomarker effects responsible for recovery of motor function following the use of Constraint-Induced Movement Therapy (CIMT) and discuss their implications for research and practice. From the studies reviewed, the biomarker effects identified include improved perfusion of motor areas and brain glucose metabolism; increased expression of proteins, namely, Brain-Derived Neurotrophic Factor (BDNF), Vascular Endothelial Growth Factor (VEGF), and Growth-Associated Protein 43 (GAP-43); and decreased level of Gamma-Aminobutyric Acid (GABA). Others include increased cortical activation, increased motor map size, and decreased interhemispheric inhibition of the ipsilesional hemisphere by the contralesional hemisphere. Interestingly, the biomarker effects correlated well with improved motor function. However, some of the biomarker effects have not yet been investigated in humans, and they require that CIMT starts early on poststroke. In addition, one study seems to suggest the combined use of CIMT with other rehabilitation techniques such as Transcortical Direct Stimulation (tDCs) in patients with chronic stroke to achieve the biomarker effects. Unfortunately, there are few studies in humans that implemented CIMT during early poststroke. Thus, it is important that more studies in humans are carried out to determine the biomarker effects of CIMT especially early on poststroke, when there is a greater opportunity for recovery. Furthermore, it should be noted that these effects are mainly in ischaemic stroke.
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Szturm T, Imran Z, Pooyania S, Kanitkar A, Mahana B. Evaluation of a Game Based Tele Rehabilitation Platform for In-Home Therapy of Hand-Arm Function Post Stroke: Feasibility Study. PM R 2020; 13:45-54. [PMID: 32107868 DOI: 10.1002/pmrj.12354] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2020] [Accepted: 02/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a need for innovation to improve compliance and accessibility of rehabilitation programs for individuals with acquired brain injuries. A computer game-assisted tele-rehabilitation platform (GTP) has been developed to address this need. With the novel application of a miniature inertial computer mouse and taking advantage of the wide variety of computer games, the GTP can provide engaging exercises for rehabilitation of upper extremity motor skills. OBJECTIVE To determine the feasibility and acceptability of the game-assisted home exercise program for upper extremity rehabilitation for people with stroke. The treatment effect was also measured after 16 weeks of intervention. DESIGN A feasibility study. SETTING College of Rehabilitation Science, University of Manitoba. PARTICIPANTS Ten stroke clients. INTERVENTION Participants received three to four initial clinically supervised therapy sessions for training with the game assisted therapy program. Once trained, participants continued the program at the home for 16 weeks, four times per week. MAIN OUTCOME MEASURES Feasibility was evaluated based on retention rate and compliance. Semistructured interviews after the completion of the program were done to assess acceptability of the program. Quantitative analysis included (1) the Wolf Motor Function Test A and B and (2) a computerized performance-based assessment of specific object manipulation tasks that required a combination of finger, wrist, elbow and shoulder motion. RESULTS Findings demonstrated the feasibility and acceptability of the home tele-rehab program. Eight of the 10 participants fully complied with the 16-week exercise program. Two participants had difficulty with computer operations and did not complete the program. For the eight participants who completed the program, there was a substantial improvement from pre- to postintervention. CONCLUSION Although some difficulties with the technology were reported, the findings demonstrate feasible trial procedures, acceptable game-assisted task-oriented home training with a high compliance rate and positive outcomes. These findings and the theoretical evidence direct the next phase of a full-scale randomized controlled trial.
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Affiliation(s)
- Tony Szturm
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Zoya Imran
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Sepideh Pooyania
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Attending Physician Stroke Rehabilitation Unit, Riverview Health Centre, Winnipeg, Canada
| | - Anuprita Kanitkar
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Bhuvan Mahana
- Department of Physical Therapy, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
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The influence of sleep quality and circadian preferences on upper extremity rehabilitation in stroke patients after constraint-induced movement therapy. Int J Rehabil Res 2020; 43:20-27. [DOI: 10.1097/mrr.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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D'Anci KE, Uhl S, Oristaglio J, Sullivan N, Tsou AY. Treatments for Poststroke Motor Deficits and Mood Disorders: A Systematic Review for the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Stroke Rehabilitation. Ann Intern Med 2019; 171:906-915. [PMID: 31739315 DOI: 10.7326/m19-2414] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early rehabilitation after stroke is essential to help reduce disability. PURPOSE To summarize evidence on the benefits and harms of nonpharmacologic and pharmacologic treatments for motor deficits and mood disorders in adults who have had stroke. DATA SOURCES English-language searches of multiple electronic databases from April 2009 through July 2018; targeted searches to December 2018 for studies of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors. STUDY SELECTION 19 systematic reviews and 37 randomized controlled trials addressing therapies for motor deficits or mood disorders in adults with stroke. DATA EXTRACTION One investigator abstracted the data, and quality and GRADE assessment were checked by a second investigator. DATA SYNTHESIS Most interventions (for example, SSRIs, mental practice, mirror therapy) did not improve motor function. High-quality evidence did not support use of fluoxetine to improve motor function. Moderate-quality evidence supported use of cardiorespiratory training to improve maximum walking speed and repetitive task training or transcranial direct current stimulation to improve activities of daily living (ADLs). Low-quality evidence supported use of robotic arm training to improve ADLs. Low-quality evidence indicated that antidepressants may reduce depression, whereas the frequency and severity of antidepressant-related adverse effects was unclear. Low-quality evidence suggested that cognitive behavioral therapy and exercise, including mind-body exercise, may reduce symptoms of depression and anxiety. LIMITATION Studies were of poor quality, interventions and comparators were heterogeneous, and evidence on harms was scarce. CONCLUSION Cardiorespiratory training, repetitive task training, and transcranial direct current stimulation may improve ADLs in adults with stroke. Cognitive behavioral therapy, exercise, and SSRIs may reduce symptoms of poststroke depression, but use of SSRIs to prevent depression or improve motor function was not supported. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs, Veterans Health Administration.
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Affiliation(s)
- Kristen E D'Anci
- ECRI Institute, Plymouth Meeting, Pennsylvania (K.E.D., S.U., J.O., N.S., A.Y.T.)
| | - Stacey Uhl
- ECRI Institute, Plymouth Meeting, Pennsylvania (K.E.D., S.U., J.O., N.S., A.Y.T.)
| | - Jeffrey Oristaglio
- ECRI Institute, Plymouth Meeting, Pennsylvania (K.E.D., S.U., J.O., N.S., A.Y.T.)
| | - Nancy Sullivan
- ECRI Institute, Plymouth Meeting, Pennsylvania (K.E.D., S.U., J.O., N.S., A.Y.T.)
| | - Amy Y Tsou
- ECRI Institute, Plymouth Meeting, Pennsylvania (K.E.D., S.U., J.O., N.S., A.Y.T.)
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Arya KN, Pandian S, Sharma A, Kumar V, Kashyap VK. Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial. Top Stroke Rehabil 2019; 27:272-289. [PMID: 31707972 DOI: 10.1080/10749357.2019.1682368] [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] [Indexed: 12/24/2022]
Abstract
Background: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 - 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 - 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.
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Affiliation(s)
- Kamal Narayan Arya
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Abhishek Sharma
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Department of Occupational Therapy, Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
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Wang H, Arceo R, Chen S, Ding L, Jia J, Yao J. Effectiveness of interventions to improve hand motor function in individuals with moderate to severe stroke: a systematic review protocol. BMJ Open 2019; 9:e032413. [PMID: 31562163 PMCID: PMC6773351 DOI: 10.1136/bmjopen-2019-032413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The human hand is extremely involved in our daily lives. However, the rehabilitation of hand function after stroke can be rather difficult due to the complexity of hand structure and function, as well as neural basis that supports hand function. Specifically, in individuals with moderate to severe impairment following a stroke, previous evidence for effective treatments that recover hand function in this population is limited, and thus has never been reviewed. With the progress of rehabilitation science and tool development, results from more and more clinical trials are now available, thereby justifying conducting a systematic review. METHODS AND ANALYSIS This systematic review protocol is consistent with the methodology recommended by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane handbook for systematic reviews of interventions. Electronic searches will be carried out in the PubMed, CINAHL, Physiotherapy Evidence Database and Cochrane Library databases, along with manual searches in the reference lists from included studies and published systematic reviews. The date range parameters used in searching all databases is between January 1999 and January 2019. Randomised controlled trials (RCTs) published in English, with the primary outcome focusing on hand motor function, will be included. Two reviewers will screen all retrieved titles, abstracts and full texts, perform the evaluation of the risk bias and extract all data independently. The risk of bias of the included RCTs will be evaluated by the Cochrane Collaboration's tool. A qualitative synthesis will be provided in text and table, to summarise the main results of the selected publications. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. The quality of the included publications will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation system from the Cochrane Handbook for Systematic Reviews of Interventions. ETHICS AND DISSEMINATION No ethical approval is needed, and the results of this review will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER CRD42019128285.
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Affiliation(s)
- Hewei Wang
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Ray Arceo
- Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Shugeng Chen
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Yao
- Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
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Hung CS, Lin KC, Chang WY, Huang WC, Chang YJ, Chen CL, Grace Yao K, Lee YY. Unilateral vs Bilateral Hybrid Approaches for Upper Limb Rehabilitation in Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2019; 100:2225-2232. [PMID: 31421096 DOI: 10.1016/j.apmr.2019.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effects of unilateral hybrid therapy (UHT) and bilateral hybrid therapy (BHT) compared with robot-assisted therapy (RT) alone in patients with chronic stroke. DESIGN A single-blind, randomized controlled trial. SETTING Four hospitals. PARTICIPANTS Outpatients with chronic stroke and mild to moderate motor impairment (N=44). INTERVENTION UHT combined unilateral RT (URT) and modified constraint-induced therapy. BHT combined bilateral RT (BRT) and bilateral arm training. The RT group received URT and BRT. The intervention frequency for the 3 groups was 90 min/d 3 d/wk for 6 weeks. MAIN OUTCOME MEASURES Fugl-Meyer Assessment (FMA, divided into the proximal and distal subscale) and Stroke Impact Scale (SIS) version 3.0 scores before, immediately after, and 3 months after treatment and Wolf Motor Function Test (WMFT) and Nottingham Extended Activities of Daily Living (NEADL) scale scores before and immediately after treatment. RESULTS The results favored BHT over UHT on the FMA total score and distal score at the posttest (P=.03 and .04) and follow-up (P=.01 and .047) assessment and BHT over RT on the follow-up FMA distal scores (P=.03). At the posttest assessment, the WMFT and SIS scores of the 3 groups improved significantly without between-group differences, and the RT group showed significantly greater improvement in the mobility domain of NEADL compared with the BHT group (P<.01). CONCLUSIONS BHT was more effective for improving upper extremity motor function, particularly distal motor function at follow-up, and individuals in the RT group demonstrated improved functional ambulation post intervention.
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Affiliation(s)
- Chung-Shan Hung
- Department of Community and Aging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wan-Ying Chang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Wen-Chih Huang
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, Miaoli General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan
| | - Ya-Ju Chang
- Physical Therapy Department and Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan; Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kaiping Grace Yao
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- 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, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Effects of Number of Repetitions and Number of Hours of Shaping Practice during Constraint-Induced Movement Therapy: A Randomized Controlled Trial. Neurol Res Int 2018; 2018:5496408. [PMID: 29808120 PMCID: PMC5902054 DOI: 10.1155/2018/5496408] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 02/10/2018] [Accepted: 02/28/2018] [Indexed: 11/25/2022] Open
Abstract
Background Constraint-induced movement therapy (CIMT) is effective in improving motor outcomes after stroke. However, its existing protocols are resource-intensive and difficult to implement. The aim of this study is to design an easier CIMT protocol using number of repetitions of shaping practice. Method The study design was randomized controlled trial. Participants within 4 weeks after stroke were recruited at Murtala Muhammad Specialist Hospital. They were randomly assigned to groups A, B, C, and D. Group A received 3 hours of traditional therapy. Groups B, C, and D received modified CIMT consisting of 3 hours of shaping practice per session, 300 repetitions of shaping practice in 3 sessions, and 600 repetitions of shaping practice in 3 sessions per day, respectively, and constraint for 90% of the waking hours. All treatment protocols were administered 5 times per week for 4 weeks. The primary outcome was measured using upper limb Fugl-Meyer assessment, while the secondary outcome was measured using motor activity log, Wolf Motor Function Test, and upper limb self-efficacy test at baseline, 2 weeks, and 4 weeks after intervention. Result There were 48 participants 4 weeks after intervention. The result showed that there was no significant difference between groups at baseline (p > 0.05). Within-group improvements attained minimal clinically important difference (MCID) in modified CIMT and 300 repetitions and 600 repetitions groups. Conclusion Number of repetitions of shaping practice significantly improved motor function, real-world arm use, and upper limb self-efficacy after stroke. Therefore, it seems to be a simple alternative for the use of number of hours. Trial Registration This trial is registered with Pan African Clinical Trial Registry (registration number: PACTR201610001828172) (date of registration: 21/10/2016).
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Abdullahi A. Neurophysiological effects of constraint-induced movement therapy and motor function: A systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.4.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: There is a claim that improvements in motor function in people with stroke following constraint-induced movement therapy (CIMT) is due to compensation but not actually neurorestoration. However, few studies have demonstrated improvements in neurophysiological outcomes such as increased motor map size and activation of primary cortex, or their positive correlations with motor function, following CIMT. The aim of this study was to carry out a systematic review of CIMT trials using neurophysiological outcomes, and a meta-analysis of the relationship between the neurophysiological outcomes and motor function. Methods: The PubMed, PEDro and CENTRAL databases, as well as the reference lists of the included studies, were searched. The included studies were randomised controlled trials comparing the effect of CIMT on neurophysiological outcomes compared with other rehabilitation techniques, conventional therapy, or another variant of CIMT. Methodological quality was assessed using the PEDro scale. The data extracted from the studies were sample size, eligibility criteria, dose of intervention and control, outcome measurements, and time since stroke. Findings: A total of 10 articles (n=219) fulfilled the study inclusion criteria, all of which were used for narrative synthesis, and four studies were used in the meta-analysis. The methodological quality of the studies ranged from low to high. Strong, positive, and significant correlations were found between the neurophysiological and motor function outcomes in fixed effects (z=3.268, p=0.001; r=0.52, 95% confidence interval (CI) 0.227–0.994) and random-effects (z=2.106, p=0.035; r=0.54, 95% CI 0.0424–0.827) models. Conclusions: Randomised controlled trials evaluating the effects of CIMT on neurophysiological outcomes are few in number. Additionally, these studies used diverse outcomes, which makes it difficult to draw any meaningful conclusion. However, there is a strong positive correlation between neurophysiological and motor function outcomes in these studies.
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Affiliation(s)
- Auwal Abdullahi
- Lecturer, Department of Physiotherapy, Bayero University Kano, Nigeria
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Abstract
Rehabilitation of hand movements after stroke aims at skills that can be well retained and transferred to novel conditions. These functions may be altered by training schedules such as constant and variable practice. A total of 36 participants with hemiparesis completed one of these schedules counterbalanced. Precise isometric hand grip force production was practiced for 4 days with a target force of 25% maximum voluntary contraction. The constant group practiced only the target force, whereas the variable group practiced the same amount including ±5 and 10% maximum voluntary contraction. Target force presentation and feedback were provided visually. Results indicated that both practice schedule led to learning. Variable practice resulted in a superior performance in retention and transfer tests, suggesting that it may be effective not only in the healthy population but also in stroke rehabilitation.
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