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Egger M, Bergmann J, Krewer C, Jahn K, Müller F. Sensory Stimulation and Robot-Assisted Arm Training after Stroke: A Randomized Controlled Trial. J Neurol Phys Ther 2024:01253086-990000000-00068. [PMID: 38912852 DOI: 10.1097/npt.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND PURPOSE Functional recovery after stroke is often limited, despite various treatment methods such as robot-assisted therapy. Repetitive sensory stimulation (RSS) might be a promising add-on therapy that is thought to directly drive plasticity processes. First positive effects on sensorimotor function have been shown. However, clinical studies are scarce, and the effect of RSS combined with robot-assisted training has not been evaluated yet. Therefore, our objective was to investigate the feasibility and sensorimotor effects of RSS (compared to a control group receiving sham stimulation) followed by robot-assisted arm therapy. METHODS Forty participants in the subacute phase (4.4-23.9 weeks) after stroke with a moderate to severe arm paresis were randomized to RSS or control group. Participants received 12 sessions of (sham-) stimulation within 3 weeks. Stimulation of the fingertips and the robot-assisted therapy were each applied in 45-min sessions. Motor and sensory outcome assessments (e.g. Fugl-Meyer-Assessment, grip strength) were measured at baseline, post intervention and at a 3-week follow-up. RESULTS Participants in both groups improved their sensorimotor function from baseline to post and follow-up measurements, as illustrated by most motor and sensory outcome assessments. However, no significant group effects were found for any measures at any time (P > 0.058). Stimulations were well accepted, no safety issues arose. DISCUSSION AND CONCLUSIONS Feasibility of robot-assisted therapy with preceding RSS in persons with moderate to severe paresis was demonstrated. However, RSS preceding robot-assisted training failed to show a preliminary effect compared to the control intervention. Participants might have been too severely affected to identify changes driven by the RSS, or these might have been diluted or more difficult to identify because of the additional robotic training and neurorehabilitation. VIDEO ABSTRACT AVAILABLE for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A478).
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Affiliation(s)
- Marion Egger
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Jeannine Bergmann
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Carmen Krewer
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Klaus Jahn
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
| | - Friedemann Müller
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany (M.E., J.B., C.K., K.J., F.M.)
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany (M.E.); German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilians-Universität in Munich, Munich, Germany (J.B., K.J.); and Chair of Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany (C.K.)
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Ma HI, Liao WW, Lin CH, Chen IC, Wu CY. Indirect causal path from motor function to quality of life through daily use of the affected arm poststroke after task-specific training: a longitudinal mediation analysis. Disabil Rehabil 2024; 46:2089-2096. [PMID: 37243526 DOI: 10.1080/09638288.2023.2216948] [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: 08/19/2022] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Task-specific training generally targets motor function, with the ultimate goal of improving quality of life (QoL). This study aimed to determine whether motor function indirectly affects QoL through daily use of the affected arm and activities of daily living (ADL) in patients with chronic stroke. METHODS This was a retrospective cohort study of 155 patients who received training for 90-120 min/session, 3-5 sessions/week, for 4-6 weeks. The training involved specific mirror or robot-assisted therapy, followed by functional task practice for 15-30 min in each session. Patients were assessed before and after the intervention. RESULTS At both pre-test and post-test, significant indirect effects of motor function on QoL through daily use of the affect arm and ADL were observed (β = 0.087-0.124). When the change scores of the measures between the pre-test and post-test were used, significant mediating effects of daily arm use on the relationship between motor function and QoL were identified (β = 0.094-0.103). CONCLUSIONS Enhanced motor function after intervention may lead to an increase in arm use for daily activities and subsequently result in an improvement in QoL. These results highlight the critical role of daily arm use in task-specific training aimed at improving QoL.
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Affiliation(s)
- Hui-Ing Ma
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wan-Wen Liao
- Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Chen Chen
- Department of Occupational Therapy, College of Nursing and Health Sciences, Da-Yeh University, Changhua, Taiwan
| | - Ching-Yi Wu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Pan H, Liu TW, Ng SSM, Chen PM, Chung RCK, Lam SSL, Li CSK, Chan CCC, Lai CWK, Ng WWL, Tang MWS, Hui E, Woo J. Effects of mirror therapy with electrical stimulation for upper limb recovery in people with stroke: a systematic review and meta-analysis. Disabil Rehabil 2024:1-16. [PMID: 38334111 DOI: 10.1080/09638288.2024.2310757] [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: 06/21/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. METHODS Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. RESULTS A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52-2.26]) and ES alone (SMD, 0.42 [0.11-0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04-0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92-11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. CONCLUSION MT with ES may be effective in improving upper limb motor recovery in people with stroke.
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Affiliation(s)
- Hong Pan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Tai Wa Liu
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China (SAR)
| | - Shamay S M Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Pei Ming Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Stefanie S L Lam
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Carol S K Li
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Charles C C Chan
- Department of Physiotherapy, Shatin Hospital, Hong Kong, China (SAR)
| | - Charles W K Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Winnie W L Ng
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China (SAR)
| | - Maria W S Tang
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China (SAR)
| | - Elsie Hui
- Department of Medicine and Geriatrics, Shatin Hospital, Hong Kong, China (SAR)
| | - Jean Woo
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China (SAR)
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Wang R, Zhang S, Zhang J, Tong Q, Ye X, Wang K, Li J. Electromyographic biofeedback therapy for improving limb function after stroke: A systematic review and meta-analysis. PLoS One 2024; 19:e0289572. [PMID: 38206927 PMCID: PMC10783731 DOI: 10.1371/journal.pone.0289572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/21/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Upper and lower limb impairment is common after stroke. Electromyographic biofeedback therapy is a non-invasive treatment, and its effectiveness in functional rehabilitation of the limb after stroke still remains uncertain. OBJECTIVE The objective of this study was to evaluate whether electromyographic biofeedback can improve upper and lower limb dysfunction in stroke patients. METHODS PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database (PEDro) were searched from inception to 1st May 2022. Inclusion criteria were randomized controlled clinical trials of electromyographic biofeedback therapy interventions reporting changes in upper and lower limb function in post-stroke patients. Data were extracted by two independent reviewers and pooled in random-effects models using Review manager (RevMan) software. RESULTS Our analyses included 10 studies enrolling a total of 303 participants. Electromyographic biofeedback therapy can effectively improve limb function after stroke (standardized mean difference [SMD], 0.44; 95% confidence interval [CI], 0.12-0.77; P = 0.008) and in subgroup analyses, the effect sizes of short-term effect (SMD, 0.33; 95% CI, 0.02-0.64; P = 0.04) was significant, but the long-term was not (SMD, 0.61; 95% CI, -0.11-1.33; P = 0.10). In addition, Electromyographic biofeedback therapy can improve the active range of motion of shoulder (SMD, 1.49; 95% CI, 2.22; P<0.0001) and wrist joints (SMD, 0.77; 95% CI, 0.13-1.42; P = 0.02) after stroke. CONCLUSION In this meta-analysis, electromyographic biofeedback therapy intervention can improve upper and lower limb function in patients with stroke. Short-term (less than one month) improvement after electromyographic biofeedback therapy was supported, while evidence for long-term (more than one month) benefits was lacking. Range of motion in the glenohumeral and wrist joints were improved. Stronger evidence for individualized parameters, such as optimal treatment parameters and intervention period, is needed in the future. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?recordID=267596], identifier [CRD42022354363].
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Affiliation(s)
- Rui Wang
- Department of The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shuangshuang Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jie Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qifeng Tong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
- College of Rehabilitation, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Kai Wang
- Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Juebao Li
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
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Muscle Tonus Evaluation in Patients with Neurological Disorders: A Scoping Review. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Lee YC, Li YC, Lin KC, Yao G, Chang YJ, Lee YY, Liu CT, Hsu WL, Wu YH, Chu HT, Liu TX, Yeh YP, Chang C. Effects of robotic priming of bilateral arm training, mirror therapy, and impairment-oriented training on sensorimotor and daily functions in patients with chronic stroke: study protocol of a single-blind, randomized controlled trial. Trials 2022; 23:566. [PMID: 35841056 PMCID: PMC9287972 DOI: 10.1186/s13063-022-06498-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Combining robotic therapy (RT) with task-oriented therapy is an emerging strategy to facilitate motor relearning in stroke rehabilitation. This study protocol will compare novel rehabilitation regimens that use bilateral RT as a priming technique to augment two task-oriented therapies: mirror therapy (MT) and bilateral arm training (BAT) with a control intervention: RT combined with impairment-oriented training (IOT). METHODS This single-blind, randomized, comparative efficacy study will involve 96 participants with chronic stroke. Participants will be randomized into bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT groups and receive 18 intervention sessions (90 min/day, 3 d/week for 6 weeks). The outcomes will include the Fugl-Meyer Assessment, Stroke Impact Scale version 3.0, Medical Research Council scale, Revised Nottingham Sensory Assessment, ABILHAND Questionnaire, and accelerometer and will be assessed at baseline, after treatment, and at the 3-month follow-up. Analysis of covariance and the chi-square automatic interaction detector method will be used to examine the comparative efficacy and predictors of outcome, respectively, after bilateral RT+MT, bilateral RT+BAT, and bilateral RT+IOT. DISCUSSION The findings are expected to contribute to the research and development of robotic devices, to update the evidence-based protocols in postacute stroke care programs, and to investigate the use of accelerometers for monitoring activity level in real-life situations, which may in turn promote home-based practice by the patients and their caregivers. Directions for further studies and empirical implications for clinical practice will be further discussed in upper-extremity rehabilitation after stroke. TRIAL REGISTRATION This trial was registered December 12, 2018, at www. CLINICALTRIALS gov ( NCT03773653 ).
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Affiliation(s)
- Yi-Chen Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yi-Chun Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan. .,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
| | - Grace Yao
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ya-Ju Chang
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chien-Ting Liu
- Department of Rehabilitation, Taipei Tzu Chi Hospital, the Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
| | - Wan-Ling Hsu
- Department of Rehabilitation, Taipei Tzu Chi Hospital, the Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan
| | - Yi-Hsuan Wu
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ho-Ta Chu
- Rehabilitation Department, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Ting-Xuan Liu
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Yi-Ping Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
| | - Chieh Chang
- School of Occupational Therapy, College of Medicine, National Taiwan University, 17, F4, Xu Zhou Road, Taipei, Taiwan
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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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Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities. Rehabil Res Pract 2022; 2021:9487319. [PMID: 35003808 PMCID: PMC8741383 DOI: 10.1155/2021/9487319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background Mirror therapy (MT) has been used as a treatment for various neurological disorders. Recent application of electroencephalogram (EEG) to the MT study allows researchers to gain insight into the changes in brain activity during the therapy. Objective This scoping review is aimed at mapping existing evidence and identifying knowledge gaps about the effects of MT on upper limb recovery and its application for individuals with chronic stroke. Methods and Materials A scoping review through a systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. Twenty articles published between 2010 and 2020 met the inclusion criteria. The efficacy of MT on upper limb recovery and brain activity during MT were discussed according to the International Classification of Functioning, Disability and Health (ICF). Results A majority of the studies indicated positive effects of MT on upper limb recovery from the body structure/functional domain. All studies used EEG to indicate brain activation during MT. Conclusion MT is a promising intervention for improving upper limb function for individuals with chronic stroke. This review also highlights the need to incorporate EEG into the MT study to capture brain activity and understand the mechanism underlying the therapy.
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Feldhacker DR, Lucas Molitor W, Jensen L, Lohman H, Lampe AM. Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions. Am J Occup Ther 2022; 76:23147. [PMID: 35019969 DOI: 10.5014/ajot.2022.049324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. OBJECTIVE In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. DATA SOURCES We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. FINDINGS We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.
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Affiliation(s)
- Diana R Feldhacker
- Diana R. Feldhacker, OTD, OTR/L, BCPR, is Department Chair and Assistant Professor in Occupational Therapy, Department of Occupational Therapy, Des Moines University, Des Moines, IA;
| | - Whitney Lucas Molitor
- Whitney Lucas Molitor, PhD, OTD, OTR/L, BCG, is Assistant Professor, Department of Occupational Therapy, and Undergraduate Public Health Program Director, University of South Dakota, Vermillion
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Helene Lohman
- Helene Lohman, OTD, OTR/L, is Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
| | - Angela M Lampe
- Angela M. Lampe, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, Creighton University, Omaha, NE
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Stoykov ME, Heidle C, Kang S, Lodesky L, Maccary LE, Madhavan S. Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2021; 42:65-78. [PMID: 34311607 DOI: 10.1177/15394492211032606] [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: 11/15/2022]
Abstract
Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.
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Affiliation(s)
- Mary E Stoykov
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Northwestern University, Chicago, IL, USA
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Gil-Martínez A, Lerma-Lara S, Hernando-Jorge A, Campos-Vegas A, Aceval A, Pagés-Scasso R, Morán-Burgos F, Beltran-Alacreu H. Influence of Mirror Therapy (Specular Face Software) on Electromyographic Behavior of the Facial Muscles for Facial Palsy. Brain Sci 2021; 11:930. [PMID: 34356164 PMCID: PMC8308022 DOI: 10.3390/brainsci11070930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Facial paralysis (FP) is a neuromuscular disorder caused by facial nerve injury. There are two main types of FP (which can be either primary or secondary): central and peripheral; Procedure of cases: This case series presents five patients with facial paralysis with different etiologies. In all cases, we assessed the facial disability index and a clinical test registering the electromyographic activity, with and without biofeedback generated by Specular Face, a new software program; Discussion: After performing the appropriate tests, we checked the patients' ability to change certain expressions when the Specular Face program was added. We can confirm that the mirror visual feedback therapy changes the behavior of synkinesis and the muscle function in these patients; Conclusion: The use of mirror therapy using a computerized treatment system of facial images yields promising results in modulating the muscle activity of patients with FP.
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Affiliation(s)
- Alfonso Gil-Martínez
- Centro Superior de Estudios Universitarios La Salle, Department of Physiotherapy, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.L.-L.); (A.H.-J.); (A.C.-V.); (A.A.)
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain;
- Unit of Physiotherapy, Hospital La Paz Institute for Health Research, IdiPAZ, 28046 Madrid, Spain
| | - Sergio Lerma-Lara
- Centro Superior de Estudios Universitarios La Salle, Department of Physiotherapy, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.L.-L.); (A.H.-J.); (A.C.-V.); (A.A.)
- Motion in Brains, Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
| | - Alfredo Hernando-Jorge
- Centro Superior de Estudios Universitarios La Salle, Department of Physiotherapy, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.L.-L.); (A.H.-J.); (A.C.-V.); (A.A.)
| | - Ana Campos-Vegas
- Centro Superior de Estudios Universitarios La Salle, Department of Physiotherapy, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.L.-L.); (A.H.-J.); (A.C.-V.); (A.A.)
| | - Audrey Aceval
- Centro Superior de Estudios Universitarios La Salle, Department of Physiotherapy, Universidad Autónoma de Madrid, 28023 Madrid, Spain; (S.L.-L.); (A.H.-J.); (A.C.-V.); (A.A.)
| | | | - Francisco Morán-Burgos
- Grupo de Tratamiento de Imágenes (GTI), Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Hector Beltran-Alacreu
- CranioSPain Research Group, Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain;
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physical Therapy and Nursing, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
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Chrastina J, Svízelová H. Mirror therapy in adult stroke patients: a review of possible applications and effectiveness with an emphasis on activities of daily living. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2020.11.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Luo Z, Zhou Y, He H, Lin S, Zhu R, Liu Z, Liu J, Liu X, Chen S, Zou J, Zeng Q. Synergistic Effect of Combined Mirror Therapy on Upper Extremity in Patients With Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:155. [PMID: 32300326 PMCID: PMC7144801 DOI: 10.3389/fneur.2020.00155] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023] Open
Abstract
Background: There is an increasing trend for researchers to combine mirror therapy with another rehabilitation therapy when treating the upper extremity of patients with stroke. Objective: To evaluate the synergistic effect of combined mirror therapy (MT) on the upper extremity in patients with stroke and to judge efficacies of four combined mirror therapy subgroups [EMGBF group: electromyographic biofeedback (EMGBF) + MT; MG group: mesh glove (MG) + MT; AT group: acupuncture (AT) + MT; ES group: EMG-triggered electrical stimulation (ES) + MT]. Methods: CNKI, Wan Fang, VIP, Web of Science, ScienceDirect, PubMed, OVID LWW, and Cochrane were used. We searched these databases for randomized controlled trials published from January 2013 to August 2019, which presented results of combining mirror therapy with other rehabilitation therapies. Quality assessments were performed using the Cochrane Handbook criteria in order to accurately review interventions. The primary outcomes were measured by the Fugl–Meyer Assessment—upper extremity (FMA-UE). Results: Ten trials, with a total of 444 patients whose upper limb functions were damaged after stroke, were included in the meta-analysis. Compared with the control group, a remarkable effect of combined mirror therapy [all: weight mean difference in random effects model (WMD): 8.07, 95% confidence interval (CI) 5.87, 10.26] on functional recovery of the upper limb was detected. However, a high value of heterogeneity (χ2 = 20.09, df = 9; I2 = 55%) was found. The subgroup analysis (EMGBF group: WMD = 8.95, 95% CI 6.33, 11.58; ES group: WMD = 10.14, 95% CI: 5.67, 15.01) showed moderate improvement in functional recovery of the upper extremity in patients with stroke when mirror therapy was combined with conventional therapy. Furthermore, no difference in efficacy on upper extremity in patients with stroke was observed between the EMGBF group and the ES group. Conclusion: Despite the heterogeneity, the results indicate that combining mirror therapy with another rehabilitation therapy on the upper extremity in patients with stroke is better than single rehabilitation therapy. However, more randomized controlled clinical trials and larger sample sizes are required for an in-depth meta-analysis.
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Affiliation(s)
- Zhonghua Luo
- First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yuqing Zhou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - He He
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shanshan Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen Liu
- Department of Rehabilitation Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoli Liu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuping Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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The Priming Effects of Mirror Visual Feedback on Bilateral Task Practice: A Randomized Controlled Study. Occup Ther Int 2019; 2019:3180306. [PMID: 31824233 PMCID: PMC6899317 DOI: 10.1155/2019/3180306] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022] Open
Abstract
The priming effect of mirror visual feedback can be simply provided by inexpensive mirror therapy (MT), which exhibits beneficial effects on sensorimotor recovery in stroke. The present study was a single-blind pretest-posttest study that examined whether the priming effect of mirror visual feedback on bilateral task practice would render better outcomes. Twenty-three patients with chronic stroke were randomized to receive hospital-based task-oriented MT or bilateral arm training (BAT) for 4 weeks at 90 minutes/day, 3 days/week and a home practice for 30-40 minutes/day, 5 days/week. There was the potential trend for MT to improve temperature sense as measured by the revised Nottingham Sensory Assessment (Cohen's d = 1.00; 95% confidence interval, -0.09 to 2.09), and MT increased the Stroke Impact Scale 3.0 total score (d = 0.89; 0.003 to 1.71). MT also showed a trend for greater improvements in the Motor Activity Log (amount of use: d = 0.62; -0.24 to 1.44; quality of movement: d = 0.50; -0.35 to 1.31). MT involving bilateral movement practice with the priming effect of mirror visual feedback may render beneficial effects. The unilateral approach or MT augmented by extra feedback might be appropriate modifications.
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Carvalho S, French M, Thibaut A, Lima W, Simis M, Leite J, Fregni F. Median nerve stimulation induced motor learning in healthy adults: A study of timing of stimulation and type of learning. Eur J Neurosci 2018; 48:1667-1679. [PMID: 29885268 DOI: 10.1111/ejn.13990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 05/23/2018] [Accepted: 05/29/2018] [Indexed: 01/08/2023]
Abstract
Median nerve stimulation (MNS) has been shown to change brain metaplasticity over the somatosensory networks, based on a bottom-up mechanism and may improve motor learning. This exploratory study aimed to test the effects of MNS on implicit and explicit motor learning as measured by the serial reaction time task (SRTT) using a double-blind, sham-controlled, randomized trial, in which participants were allocated to one of three groups: (a) online active MNS during acquisition, (b) offline active MNS during early consolidation and (c) sham MNS. SRTT was performed at baseline, during the training phase (acquisition period), and 30 min after training. We assessed the effects of MNS on explicit and implicit motor learning at the end of the training/acquisition period and at retest. The group receiving online MNS (during acquisition) showed a significantly higher learning index for the explicit sequences compared to the offline group (MNS during early consolidation) and the sham group. The offline group also showed a higher learning index as compared to sham. Additionally, participants receiving online MNS recalled the explicit sentence significantly more than the offline MNS and sham groups. MNS effects on motor learning have a specific effect on type of learning (explicit vs. implicit) and are dependent on timing of stimulation (during acquisition vs. early consolidation). More research is needed to understand and optimize the effects of peripheral electrical stimulation on motor learning. Taken together, our results show that MNS, especially when applied during the acquisition phase, is a promising tool to modulate motor leaning.
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Affiliation(s)
- Sandra Carvalho
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Neurotherapeutics and Experimental Psychopatology Group, Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Melanie French
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aurore Thibaut
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Coma Science Group, GIGA-Consciousness, University and University Hospital of Liege, Liege, Belgium
| | - Wilrama Lima
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marcel Simis
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Jorge Leite
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Neurotherapeutics and Experimental Psychopatology Group, Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
- Univ Portucalense, Portucalense Institute for Human Development - INPP, Oporto, Portugal
| | - Felipe Fregni
- Spaulding Neuromodulation Center, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Grant VM, Gibson A, Shields N. Somatosensory stimulation to improve hand and upper limb function after stroke—a systematic review with meta-analyses. Top Stroke Rehabil 2017; 25:150-160. [DOI: 10.1080/10749357.2017.1389054] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | - Alison Gibson
- Department of Allied Health, Northern Health, Epping, Australia
| | - Nora Shields
- Department of Allied Health, Northern Health, Epping, Australia
- School of Allied Health, La Trobe University, Melbourne, Australia
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Chen HL, Lin KC, Hsieh YW, Wu CY, Liing RJ, Chen CL. A study of predictive validity, responsiveness, and minimal clinically important difference of arm accelerometer in real-world activity of patients with chronic stroke. Clin Rehabil 2017; 32:75-83. [DOI: 10.1177/0269215517712042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hao-ling Chen
- 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
| | - 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
| | - Yu-wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Rong-jiuan Liing
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hartman K, Altschuler EL. Mirror Therapy for Hemiparesis Following Stroke: A Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0131-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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