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Choi JB, Cho KI. Effects of virtual reality-based robot therapy combined with task-oriented therapy on upper limb function and cerebral cortex activation in patients with stroke. Medicine (Baltimore) 2024; 103:e38723. [PMID: 38968539 PMCID: PMC11224869 DOI: 10.1097/md.0000000000038723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 06/06/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND This study aimed to investigate the effects of virtual reality (VR)-based robot therapy combined with task-oriented therapy on cerebral cortex activation and upper limb function in patients with stroke. METHODS This study included 46 patients with hemiplegia within 1 year of stroke onset. Patients were divided into an experimental group (n = 23) and a control group (n = 23) using a computer randomization program. The experimental group received VR-based robot and task-oriented therapies, whereas the control group received only task-oriented therapy. All participants received interventions for 40 minutes per session, 5 times a week, for 8 weeks. For the pre- and post-evaluation of all participants, the Fugl-Meyer Assessment for the upper extremity, manual function test, motor activity log, and Jebsen-Taylor Hand Function Test were used to evaluate changes in upper limb function and motor-evoked potential amplitudes were measured to compare cerebral cortex activation. RESULTS In comparison to the control group, experimental group demonstrated an improvement in the function of the upper limb (P < .01) and activation of the cerebral cortex (P < .01). CONCLUSION The combined intervention of VR-based robot and task-oriented therapies is valuable for improving upper limb function and cerebral cortex activation in patients with stroke.
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Affiliation(s)
- Jong-Bae Choi
- Department of Occupational Therapy, Chosun University, Gwangju, Republic of Korea
| | - Kyung-In Cho
- Department of Occupational Therapy, Dongnam Health University, Suwon-si, Gyeonggi-do, Republic of Korea
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Fujimoto K, Ueno M, Etoh S, Shimodozono M. Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial. Front Neurol 2024; 15:1356732. [PMID: 38456153 PMCID: PMC10919145 DOI: 10.3389/fneur.2024.1356732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. Methods This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. Results All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. Discussion The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.
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Affiliation(s)
- Koya Fujimoto
- Department of Rehabilitation, Kirishima Sugiyasu Hospital, Kirishima, Kagoshima, Japan
| | - Makoto Ueno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Senda J, Ito K, Kotake T, Mizuno M, Kishimoto H, Yasui K, Katsuno M, Nishida Y, Sobue G. Investigation of inpatient convalescent rehabilitation outcomes in branch atheromatous disease. J Stroke Cerebrovasc Dis 2023; 32:106937. [PMID: 36621120 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106937] [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: 09/14/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We investigated inpatient convalescent rehabilitation outcomes of Branch atheromatous disease (BAD). SUBJECTS AND METHODS The subjects were 116 patients with lenticulostriate artery territory - BAD (LSA-BAD) and 29 with paramedian pontine artery territory - BAD (PPA-BAD). For all patients, the National Institutes of Health Stroke Scale (NIHSS), Functional Independence Measure (FIM) scores, and Brunnstrom recovery stages (BRS) of the upper limb, fingers, and lower limb were measured on admission and at discharge. RESULTS There were no significant differences in clinical characteristics on admission between the LSA-BAD and PPA-BAD groups. The neurological severity of PPA-BAD, as measured by the NIHSS, was significantly milder compared with that of LSA-BAD upon admission (p = 0.015) and at discharge (p = 0.001). Patients with LSA-BAD had significantly less improvement in the BRS of the upper limb (p = 0.001), fingers (p < 0.001), and lower limb (p = 0.007) at discharge. Furthermore, they had significantly smaller changes in BRS between admission and discharge for the upper limb (p = 0.033) and fingers (p = 0.014) compared with patients with PPA-BAD. The improvement in BRS for patients with LSA-BAD tended to be limited to two stages; however, both patients with LSA-BAD and PPA-BAD saw sufficient gains in FIM at discharge. CONCLUSION Rehabilitation outcomes following BAD in the convalescent period should be assessed in terms of improvements in pure-motor hemiparesis and activities of daily living. Furthermore, the disturbance patterns in the corticospinal tract by ischemic stroke lesions may be different between LSA-BAD and PPA-BAD.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Komaki, Japan; Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan.
| | - Keiichi Ito
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Tomomitsu Kotake
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan; Department of Physiology, Graduate School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Masanori Mizuno
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Hideo Kishimoto
- Division of Rehabilitation, Kami-iida Rehabilitation Hospital, Nagoya, Japan
| | - Keizo Yasui
- Department of Neurology, Japanese Red Cross Aichi Medical Center Nagoya Second Hospital, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihiro Nishida
- Division of Rehabilitation, Nagoya University Hospital, Nagoya, Japan; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Graduate School of Medicine, Aichi Medical School, Nagakute, Japan
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Wang T, Liu Z, Gu J, Tan J, Hu T. Effectiveness of soft robotic glove versus repetitive transcranial magnetic stimulation in post-stroke patients with severe upper limb dysfunction: A randomised controlled trial. Front Neurol 2023; 13:887205. [PMID: 36712422 PMCID: PMC9874667 DOI: 10.3389/fneur.2022.887205] [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: 03/02/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To explore the difference in rehabilitation effect between soft robot gloves and repetitive transcranial magnetic stimulation (rTMS) in patients with severe upper limb motor dysfunction after a stroke. Methods A total of 69 post-stroke patients with severe upper limb dysfunction were randomly assigned to a repetitive transcranial magnetic group, a soft robotic glove group, and a conventional treatment group. The primary outcomes were the Fugl-Meyer Upper Extremity Assessment (FMA-UE) and the Modified Barthel Index (MBI). The secondary endpoints were the amplitude surface electromyogram of the extensor wrist muscle (sEMG) and the cerebral hemispheric resting motor threshold (RMT). Results The change of FMA-UE score in the soft robotic glove group was significantly better than that in the conventional treatment group (median difference: 2 points; 95% confidence interval [1, 3]; P < 0.05), but there was no significant difference compared with the repetitive transcranial magnetic stimulation group (median difference: 0 points; 95% confidence interval [-1, 2]; P [0.547] > 0.05). There was no significant difference in the change of MBI score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [F = 2.458, P [0.093] > 0.05]. There was no significant difference in the change of sEMG score between the soft robotic glove group and the conventional treatment and repetitive transcranial magnetic treatment groups [H = 0.042, P [0.980] > 0.05]. Additionally, the change of RMT score in the soft robotic glove group was significantly inferior to that in the repetitive transcranial magnetic treatment group [difference: -1.09; 95% confidence interval [-2.048, 0.048]; P < 0.05], but there was no significant difference compared with the conventional treatment group [difference: 0.31 points; 95% confidence interval [-0.879, 0.358]; P [0.495] > 0.05]. Conclusion For patients with severe dyskinesia after a stroke, soft robotic gloves are as effective as repetitive transcranial magnetic stimulation and may be a good choice for home rehabilitation. In addition, conventional treatment combined with repetitive transcranial magnetic stimulation (rTMS) or a soft robotic glove produced better rehabilitation outcomes than conventional treatment alone.
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Affiliation(s)
- Taotao Wang
- Zhongshan People's Hospital, Zhongshan, China,*Correspondence: Taotao Wang ✉
| | | | - Jianxiong Gu
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, China,Jianxiong Gu ✉
| | - Jizhi Tan
- Guangdong Medical University, Zhanjiang, China
| | - Tian Hu
- Guangdong Medical University, Zhanjiang, China
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Lee KE, Choi M, Jeoung B. Effectiveness of Rehabilitation Exercise in Improving Physical Function of Stroke Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12739. [PMID: 36232038 PMCID: PMC9566624 DOI: 10.3390/ijerph191912739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/24/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Rehabilitation is a crucial part of recovery for stroke survivors, and numerous studies have examined various exercises and treatments of stroke. In addition, it is very important for patients to choose the timing of rehabilitation and what kind of rehabilitation they will proceed with. The purpose of the current study is to examine research investigating the effects of rehabilitation exercise programs in recovery of physical function in patients with stroke, based on aspects of their physical function, physical strength, and daily activities, and systematically examine their effects. Therefore, through systematic review, we have investigated the effects of interventions in rehabilitation exercise programs for recovery of physical function in patients with stroke. We collected relevant publications through the databases MEDLINE/PubMed and Google scholar. Twenty-one articles were ultimately selected for the analysis. We classified the rehabilitation programs and identified the trends of treatment for stroke survivors. Our review indicated that task-oriented therapy is still dominant, but various types of combined rehabilitations have been attempted. In addition, it was identified that physical and active rehabilitation were required rather than unconditional rest, even at an early stage. Home-based treatment was used for rapid recovery and adaptation to daily life during the mid-term period.
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Affiliation(s)
- Kyung Eun Lee
- Department Sport Industry Studies, Yonsei University, Seoul 03722, Korea
| | - Muncheong Choi
- Department Exercise Rehabilitation, Gachon University, Incheon 21936, Korea
| | - Bogja Jeoung
- Department Exercise Rehabilitation, Gachon University, Incheon 21936, Korea
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Effectiveness of Repetitive Facilitative Exercise Combined with Electrical Stimulation Therapy to Improve Very Severe Paretic Upper Limbs in with Stroke Patients: A Randomized Controlled Trial. Occup Ther Int 2022; 2022:4847363. [PMID: 35572164 PMCID: PMC9068343 DOI: 10.1155/2022/4847363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background The difference in the effects of combined therapy with repetitive facilitative exercise (RFE) and neuromuscular electrical stimulation (NMES) on stroke upper limb paralysis was only reported by a pilot study; it has not been investigated in many patients. Objective We investigated the effect of combined therapy with RFE and NMES on stroke patients with severe upper paresis. Methods This study included 99 of the very severe paresis stroke patients with scores of zero or 1a in the Finger-Function test of the Stroke Impairment Assessment Set (SIAS). We randomly divided the patients into four groups, namely, NMES, RFE, RFE under NMES, and conventional training (CT) groups. A total of 20 min of group-specific training in addition to 40 min of conventional exercise per day, seven times a week for 4 weeks after admission, was performed. The upper extremity items of the Fugl-Meyer Assessment (FMA) were evaluated before and after the training period. Results The total score gains of the FMA, FMA wrist item, and FMA finger item were significantly larger in the RFE under NMES group than those in the CT group (p < 0.05). Conclusion The combination of voluntary movement and electrical stimulation may promote the activation of paralyzed muscles and improve distal function for very severe paralyzed upper limbs.
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Hoei T, Kawahira K, Shimodozono M, Fukuda H, Shigenobu K, Ogura T, Matsumoto S. Repetitive facilitative exercise under continuous electrical stimulation for recovery of pure motor isolated hand palsy after infarction of the "hand knob" area: A case report. Physiother Theory Pract 2022:1-8. [PMID: 35188445 DOI: 10.1080/09593985.2022.2042633] [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: 10/19/2022]
Abstract
PURPOSE Pure motor isolated hand palsy (PMIHP) following infarction of the "hand knob" area is a rare entity in stroke. PMIHP usually recovers within the first few days, but there are rare cases where patients do not recover rapidly. Herein, we report a case of residual PMIHP in which repetitive facilitative exercise under concurrent low-amplitude continuous neuromuscular electrical stimulation ("RFE-under-cNMES") was introduced to improve hand function. CASE DESCRIPTION A 65-year-old man with PMIHP (30 days after onset) participated in a rehabilitation program involving RFE-under-cNMES. This protocol followed an A1-B1-A2-B2 schedule, where the "A"-period consisted of RFE-under-cNMES ("A1," 2 weeks; "A2," 1 week), and the "B"-period consisted of 1-week conventional rehabilitation. OUTCOMES The 5-week intervention promoted not only recovery from paralysis (8 points by the Fugl-Meyer Assessment), but also the ability to manipulate objects (13 points by the Action Research Arm test) and increased the subjective use of the affected upper limb during activities of daily living (2.88 points by the Motor Activity Log). Changes that exceeded the minimal clinically important difference occurred only in the RFE-under-cNMES period. CONCLUSIONS The patient had improved outcomes. Further studies are required to determine the possibility of RFE-under-cNMES relieving motor paralysis in patients with PMIHP who do not recover rapidly.
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Affiliation(s)
| | - Kazumi Kawahira
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | | | | | | | - Shuji Matsumoto
- Center of Medical Education, Faculty of Health Sciences, Ryotokuji University, Chiba, Japan
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Stage 2: Who Are the Best Candidates for Robotic Gait Training Rehabilitation in Hemiparetic Stroke? J Clin Med 2021; 10:jcm10235715. [PMID: 34884417 PMCID: PMC8658177 DOI: 10.3390/jcm10235715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to compare the effects of robotic-assisted gait training (RAGT) in patients with FAC < 2 (low initial functional ambulation category [LFAC]) and FAC ≥ 2 (high initial functional ambulation category [HFAC]) on sensorimotor and spasticity, balance and trunk stability, the number of steps and walking distance in subacute hemiparetic stroke. Fifty-seven patients with subacute hemiparetic stroke (mean age, 63.86 ± 12.72 years; 23 women) were assigned to two groups. All patients received a 30-min Walkbot-assisted gait training session, 3 times/week, for 6 weeks. Clinical outcomes included scores obtained on the Fugl-Meyer Assessment (FMA) scale, Modified Ashworth Scale (MAS), Berg Balance Scale (BBS), trunk impairment scale (TIS), and the number of walking steps and walking distance. Analysis of covariance and analysis of variance were conducted at p < 0.05. Significant main effects of time in both groups on number of walking steps and distance (p < 0.05) were observed, but not in MAS (p> 0.05). Significant changes in FMA, BBS, and TIS scores between groups (p < 0.05) were observed. Significant main effects of time on BBS and TIS were demonstrated (p < 0.05). Our study shows that RAGT can maximize improvement in the functional score of FMA, BBS, TIS, steps, and distance during neurorehabilitation of subacute stroke patients regardless of their FAC level.
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Kurobe M, Matsubara H, Suzuki T. Excitability of anterior horn cells after periodic or discrete repetitive movements. Muscle Nerve 2021; 64:606-610. [PMID: 34368978 DOI: 10.1002/mus.27390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS It has been well established that spasticity interferes with smooth joint movements. Although the degree of spasticity is related to the excitability of anterior horn cells and is thought to improve after repetitive movements, the effect of the rhythm of repetitive movements on the excitability of anterior horn cells remains unknown. Therefore, we investigated the excitability of anterior horn cells after periodic and discrete repetitive movements using F waves. METHODS Right-handed, healthy subjects were recruited for this study. Subjects then performed periodic or discrete repetitive thumb abduction movements for 10 seconds, measuring the F waves before, immediately after, and then 2 and 4 minutes after performing these movements. Specifically, the F waves were recorded from the abductor pollicis brevis muscle, after median nerve stimulation at the wrist. Next, the F/M amplitude ratio, which was used to evaluate the excitability of anterior horn cells, was compared before, immediately after, and 2 and 4 minutes after each task. RESULTS A total of 12 subjects participated in this study. In the periodic task, the F/M amplitude ratio was found to be significantly decreased immediately after the task compared with before the task, but there was no significant difference between the other trials. Conversely, in the discrete task, there was no significant difference in the F/M amplitude ratio between trials. DISCUSSION Periodic repetitive movements were found to temporarily reduce the excitability of anterior horn cells.
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Affiliation(s)
- Masataka Kurobe
- Department of Clinical Rehabilitation Research, Tanabe Central Hospital, Wakayama, Japan.,Graduate School of Health Sciences, Graduate School of Kansai University of Health Sciences, Osaka, Japan
| | - Hiroyuki Matsubara
- Department of Clinical Rehabilitation Research, Tanabe Central Hospital, Wakayama, Japan.,Graduate School of Health Sciences, Graduate School of Kansai University of Health Sciences, Osaka, Japan.,Department of Rehabilitation, Geriatric Health Services Facility Tanabe Sumire-En, Wakayama, Japan.,Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Toshiaki Suzuki
- Graduate School of Health Sciences, Graduate School of Kansai University of Health Sciences, Osaka, Japan
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Liu J, Wang J, Tan G, Sheng Y, Chang H, Xie Q, Liu H. Correlation Evaluation of Functional Corticomuscular Coupling With Abnormal Muscle Synergy After Stroke. IEEE Trans Biomed Eng 2021; 68:3261-3272. [PMID: 33764872 DOI: 10.1109/tbme.2021.3068997] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE While neuroplasticity and functional reorganization during motor recovery can be indirectly reflected and evaluated by functional corticomuscular coupling (fCMC), little work has been published regarding the cortical origin of abnormal muscle synergy and compensatory mechanism in the separation movement of stroke patients. METHODS In this study, we proposed to use extended partial directed coherence (ePDC) combined with an optimal spatial filtering approach to estimate fCMC in stroke patients and healthy controls, and further established muscle synergy model (MSM) to jointly explore the modulation mechanism between cortex and muscles. RESULTS Compared to healthy controls, stroke patients had significantly reduced coupling strength in both descending and ascending pathway. Moreover, the MSM were abnormal with high variability and low similarity in the separation stage of stroke patients. Further exploration of the positive relationship between fCMC characteristics and MSM parameters proved the possibility of using fCMC-MSM-based correlation indicator to evaluate abnormality of the cortical related synergy movement as well as the rehabilitation level of stroke patients. CONCLUSION We developed a computational procedure to evaluate the correlation between fCMC and MSM in stroke patients. SIGNIFICANCE This article provides a quantitative evaluation metrics based on fCMC to reveal the deficits during poststroke motor restoration and a promising approach to help patients correct abnormal movement habits, paving the way for neurophysiological assessment of neuromuscular control in conjunction with clinical scores.
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Hokazono A, Etoh S, Jonoshita Y, Kawahira K, Shimodozono M. Combination therapy with repetitive facilitative exercise program and botulinum toxin type A to improve motor function for the upper-limb spastic paresis in chronic stroke: A randomized controlled trial. J Hand Ther 2021; 35:507-515. [PMID: 33820711 DOI: 10.1016/j.jht.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN An open-label, randomized, controlled, observer-blinded trial. INTRODUCTION Repetitive facilitative exercise (RFE) is a movement therapy to recover from hemiparesis after stroke. However, improvement is inhibited by spasticity. Recently, botulinum toxin type A (BoNT-A) injection has been shown to reduce spasticity. PURPOSE To examine the combined effect of an RFE program and BoNT-A treatment on upper-limb spastic paresis in chronic stroke. METHODS Forty chronic stroke inpatients with upper-limb spastic paresis (Brunnstrom stage ≥III and Modified Ashworth Scale [MAS] score ≥1) were enrolled. Subjects were randomized into 2 groups of 20 each and received 4 weeks of treatment. The intervention group received RFE and BoNT-A injection; the control group underwent RFE only. Assessments were performed at baseline and at study conclusion. The primary outcome was change in Fugl-Meyer Assessment score for the upper extremity (FMA). The Action Research Arm Test (ARAT), active range of motion, Box and Block Test, and MAS were also evaluated. RESULTS All participants completed this study. After 4 weeks, the intervention group evidenced a significantly greater increase in FMA score (median 11.0 [range 4-20]) than the control group (median 3.0 [range 0-9]) (P < .01, r = 0.79); as well as improvements in the other measures such as ARAT (median 12.5 [range 4-22] vs 7 [0-13]) (P < .01, r = 0.6), and MAS in the elbow flexors (median -1.5 [range -2 to 0] vs -1 [-2 to 0]) (P < .01, r = 0.45). DISCUSSION A high degree of repetitive volitional movement induced by the facilitative technique with concomitant control of spasticity by BoNT-A injection might increase efficiency of motor learning with continuous movement of the affected upper-limb. CONCLUSIONS The combination of RFE and BoNT-A for spastic paresis might be more effective than RFE alone to improve upper-limb motor function and to lessen impairment in chronic stroke.
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Affiliation(s)
- Akihiko Hokazono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yuiko Jonoshita
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Kagoshima, Japan
| | - Kazumi Kawahira
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Kang MG, Yun SJ, Lee SY, Oh BM, Lee HH, Lee SU, Seo HG. Effects of Upper-Extremity Rehabilitation Using Smart Glove in Patients With Subacute Stroke: Results of a Prematurely Terminated Multicenter Randomized Controlled Trial. Front Neurol 2020; 11:580393. [PMID: 33240205 PMCID: PMC7680863 DOI: 10.3389/fneur.2020.580393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background: Although there have been many trials and interventions for reducing upper-extremity impairment in stroke survivors, it remains a challenge. A novel intervention is needed to provide high-repetition task-specific training early after stroke. Objective: This study aimed to investigate the effect of smart glove training (SGT) for upper-extremity rehabilitation in patients with subacute stroke. Methods: A prospective, multicenter, randomized, controlled study was conducted in patients with upper-extremity hemiparesis with Brunnstrom stage for arm 2–5 in the subacute phase after stroke. Eligible participants were randomly allocated to the SGT group or the control group. The SGT group underwent 30 min of standard occupational therapy plus 30 min of upper-extremity training with smart glove. The control group underwent standard occupational therapy for 30 min plus upper-extremity self-training (homework tasks at bedside) for 30 min. All participants underwent each intervention 5 days/week for 2 consecutive weeks. They were evaluated before, immediately after, and 4 weeks after the intervention. The primary outcome measure was the change in the score of the Fugl-Meyer assessment of the upper extremity (FMA-UE). Results: Twenty-three patients were enrolled. Repeated-measures analysis of covariance after controlling for age and disease duration showed significant time × group interaction effects in the FMA-UE, FMA-distal, and FMA-coordination/speed (p = 0.018, p = 0.002, p = 0.006). Repeated-measures analysis of variance showed significant time × group interaction effects in the FMA-UE, FMA-distal, and Box and Block Test (p = 0.034, p = 0.010, p = 0.046). Mann-Whitney U-test showed a statistically higher increase in the FMA-UE and FMA-distal in the SGT group than in the control group (p = 0.023, p = 0.032). Conclusion: Upper-extremity rehabilitation with a smart glove may reduce upper-extremity impairment in patients with subacute stroke. Clinical Trial Registration: ClinicalTrials.gov (NCT02592759).
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Affiliation(s)
- Min-Gu Kang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Yoon Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyun Haeng Lee
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Shi-Uk Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Paci M, Prestera C, Ferrarello F. Generalizability of Results from Randomized Controlled Trials in Post-Stroke Physiotherapy. Physiother Can 2020; 72:382-393. [PMID: 35110812 PMCID: PMC8781507 DOI: 10.3138/ptc-2018-0117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose: The randomized controlled trial (RCT) is considered a reliable experimental design, able to detect the effect of an intervention. However, a criticism frequently levelled at RCTs by clinicians is their lack of generalizability. This study aimed to evaluate the generalizability of findings from RCTs of physiotherapy interventions for individuals with stroke. Method: A sample of RCTs of physiotherapy interventions after stroke indexed in the PEDro database was selected, and the reported inclusion and exclusion criteria were analyzed. Results: We reviewed 100 articles, which included 7,366 participants (41.6% women, with a mean weighted age of 65.5 years). The most frequent criteria for exclusion were comorbidity (83%), cognitive impairments (69%), communication skills (55%), recurrent stroke (53%), low functional level (47%) and being elderly (25%). Conclusions: A variety of cohorts of individuals who have had a stroke are excluded from RCTs published in the field of physiotherapy. Because they represent a substantial proportion of the real-world population with stroke, and consequently treated in clinical practice, more vulnerable cohorts of participants should be included in RCTs.
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Affiliation(s)
- Matteo Paci
- Unit of Functional Recovery, Azienda USL Toscana Centro, Florence
| | - Claudia Prestera
- Rehabilitation Center, Fondazione Filippo Turati Onlus, Gavinana, Pistoia, Italy
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14
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Lee HS, Lim JH, Jeon BH, Song CS. Non-immersive Virtual Reality Rehabilitation Applied to a Task-oriented Approach for Stroke Patients: A Randomized Controlled Trial. Restor Neurol Neurosci 2020; 38:165-172. [DOI: 10.3233/rnn-190975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hye-Sun Lee
- Department of Occupational Therapy, Gwang-ju Women's University, Gwangju, Republic of Korea
| | - Jae-Heon Lim
- Department of Physical Therapy, Wonkwang Health Science University, Jeollabuk-do, Republic of Korea
| | - Byeong-Hyeon Jeon
- Department of Physical Therapy, Graduate school, Honam University, Gwangju, Republic of Korea
| | - Chiang-Soon Song
- Deparment of Occupational Therapy, College of Health Science, Chosun University, Gwangju, Republic of Korea
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Amano Y, Noma T, Etoh S, Miyata R, Kawamura K, Shimodozono M. Reaching exercise for chronic paretic upper extremity after stroke using a novel rehabilitation robot with arm-weight support and concomitant electrical stimulation and vibration: before-and-after feasibility trial. Biomed Eng Online 2020; 19:28. [PMID: 32375788 PMCID: PMC7203976 DOI: 10.1186/s12938-020-00774-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Our group developed a rehabilitation robot to assist with repetitive, active reaching movement of a paretic upper extremity. The robot is equipped with a servo motor-controlled arm-weight support and works in conjunction with neuromuscular electrical stimulation and vibratory stimulation to facilitate agonist-muscle contraction. In this before-and-after pilot study, we assessed the feasibility of applying the robot to improve motor control and function of the hemiparetic upper extremity in patients who suffered chronic stroke. Methods We enrolled 6 patients with chronic stroke and hemiparesis who, while sitting and without assistance, could reach 10 cm both sagitally and vertically (from a starting position located 10 cm forward from the patient’s navel level) with the affected upper extremity. The patients were assigned to receive reaching exercise intervention with the robot (Yaskawa Electric Co., Ltd. Fukuoka, Japan) for 2 weeks at 15 min/day in addition to regular occupational therapy for 40 min/day. Outcomes assessed before and after 2 weeks of intervention included the upper extremity component of the Fugl-Meyer Assessment (UE-FMA), the Action Research Arm Test (ARAT), and, during reaching movement, kinematic analysis. Results None of the patients experienced adverse events. The mean score of UE-FMA increased from 44.8 [SD 14.4] to 48.0 [SD 14.4] (p = 0.026, r = 0.91), and both the shoulder–elbow and wrist–hand scores increased after 2-week intervention. An increase was also observed in ARAT score, from mean 29.8 [SD 16.3] to 36.2 [SD 18.1] (p = 0.042, r = 0.83). Kinematic analysis during the reaching movement revealed a significant increase in active range of motion (AROM) at the elbow, and movement time tended to decrease. Furthermore, trajectory length for the wrist (“hand path”) and the acromion (“trunk compensatory movement”) showed a decreasing trend. Conclusions This robot-assisted modality is feasible and our preliminary findings suggest it improved motor control and motor function of the hemiparetic upper extremity in patients with chronic stroke. Training with this robot might induce greater AROM for the elbow and decrease compensatory trunk movement, thus contributing to movement efficacy and efficiency. Trial registration UMIN Clinical Trial Registry, as UMIN000018132, on June 30, 2015. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000020398
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Affiliation(s)
- Yumeko Amano
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Tomokazu Noma
- Kagoshima University Hospital Kirishima Rehabilitation Center, Kagoshima, Japan.,Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Higashi-nukumi-cho 26-2, Handa, Aichi, 475-0012, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Ryuji Miyata
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
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16
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Etoh S, Kawamura K, Tomonaga K, Miura S, Harada S, Noma T, Kikuno S, Ueno M, Miyata R, Shimodozono M. Effects of concomitant neuromuscular electrical stimulation during repetitive transcranial magnetic stimulation before repetitive facilitation exercise on the hemiparetic hand. NeuroRehabilitation 2020; 45:323-329. [PMID: 31796693 DOI: 10.3233/nre-192800] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. OBJECTIVE To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. METHODS This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1 Hz rTMS for the unaffected motor cortex for 10 min and performed RFE for 60 min. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. RESULTS FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. CONCLUSIONS NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.
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Affiliation(s)
- Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kentaro Kawamura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kei Tomonaga
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Miura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shizuyo Harada
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomokazu Noma
- Department of Rehabilitation, Faculty of Health Science, Nihon Fukushi University, Aichi, Japan
| | - Satomi Kikuno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Makoto Ueno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryuji Miyata
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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17
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Kim E, Meinhold W, Shinohara M, Ueda J. Statistical Inter-stimulus Interval Window Estimation for Transient Neuromodulation via Paired Mechanical and Brain Stimulation. Front Neurorobot 2020; 14:1. [PMID: 32116633 PMCID: PMC7010981 DOI: 10.3389/fnbot.2020.00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
For achieving motor recovery in individuals with sensorimotor deficits, augmented activation of the appropriate sensorimotor system, and facilitated induction of neural plasticity are essential. An emerging procedure that combines peripheral nerve stimulation and its associative stimulation with central brain stimulation is known to enhance the excitability of the motor cortex. In order to effectively apply this paired stimulation technique, timing between central and peripheral stimuli must be individually adjusted. There is a small range of effective timings between two stimuli, or the inter-stimulus interval window (ISI-W). Properties of ISI-W from neuromodulation in response to mechanical stimulation (Mstim) of muscles have been understudied because of the absence of a versatile and reliable mechanical stimulator. This paper adopted a combination of transcranial magnetic stimulation (TMS) and Mstim by using a high-precision robotic mechanical stimulator. A pneumatically operated robotic tendon tapping device was applied. A low-friction linear cylinder achieved high stimulation precision in time and low electromagnetic artifacts in physiological measurements. This paper describes a procedure to effectively estimate an individual ISI-W from the transiently enhanced motor evoked potential (MEP) with a reduced number of paired Mstim and sub-threshold TMS trials by applying statistical sampling and regression technique. This paper applied a total of four parametric and non-parametric statistical regression methods for ISI-W estimation. The developed procedure helps to reduce time for individually adjusting effective ISI, reducing physical burden on the subject.
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Affiliation(s)
- Euisun Kim
- Bio-Robotics and Human Modeling Laboratory, G.W.W. School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Waiman Meinhold
- Bio-Robotics and Human Modeling Laboratory, G.W.W. School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Minoru Shinohara
- Human Neuromuscular Physiology Laboratory, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Jun Ueda
- Bio-Robotics and Human Modeling Laboratory, G.W.W. School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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18
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Miura S, Miyata R, Matsumoto S, Higashi T, Wakisaka Y, Ago T, Kitazono T, Iihara K, Shimodozono M. Quality Management Program of Stroke Rehabilitation Using Adherence to Guidelines: A Nationwide Initiative in Japan. J Stroke Cerebrovasc Dis 2019; 28:2434-2441. [PMID: 31301984 DOI: 10.1016/j.jstrokecerebrovasdis.2019.06.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/02/2019] [Accepted: 06/22/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND AIM In recent years, interest in the quality of medical care has rapidly increased worldwide. However, quality indicators that contribute to establishing standard treatment in stroke medicine, especially rehabilitation, are not well-developed in Japan. Japan has established Kaifukuki (convalescent) rehabilitation wards, and the development of quality indicators for stroke rehabilitation in the convalescent phase is an urgent issue. METHODS We first reviewed the literature regarding quality indicators for stroke rehabilitation. Next, we extracted candidate indicators from identified reports and guidelines and surveyed educational hospitals certified by the Japanese Association of Rehabilitation Medicine. On the basis of the survey results, we reevaluated the suitability of the proposed indicators in discussions with an expert panel. RESULTS The questionnaire survey highlighted several important items that revealed there is room for improvement in adherence. For stroke rehabilitation in the convalescent phase, we adopted 15 indicators that were feasible as indicators to be used for comparisons between facilities, based on scoring by and opinions of the expert panel. These indicators measured structure (2 indicators), process (5 indicators), and outcome (8 indicators). CONCLUSION This is the first study to establish quality indicators to standardize stroke rehabilitation in Japan. We developed this set of 15 indicators using an evidence-based approach. However, many tasks remain for continuous quality improvement.
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Affiliation(s)
- Seiji Miura
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryuji Miyata
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan; Department of Rehabilitation and Physical Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahiro Higashi
- Division of Health Services Research, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Yoshinobu Wakisaka
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Iihara
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Mizuno K, Abe T, Ushiba J, Kawakami M, Ohwa T, Hagimura K, Ogura M, Okuyama K, Fujiwara T, Liu M. Evaluating the Effectiveness and Safety of the Electroencephalogram-Based Brain-Machine Interface Rehabilitation System for Patients With Severe Hemiparetic Stroke: Protocol for a Randomized Controlled Trial (BEST-BRAIN Trial). JMIR Res Protoc 2018; 7:e12339. [PMID: 30522993 PMCID: PMC6302229 DOI: 10.2196/12339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/07/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND We developed a brain-machine interface (BMI) system for poststroke patients with severe hemiplegia to detect event-related desynchronization (ERD) on scalp electroencephalogram (EEG) and to operate a motor-driven hand orthosis combined with neuromuscular electrical stimulation. ERD arises when the excitability of the ipsi-lesional sensorimotor cortex increases. OBJECTIVE The aim of this study was to evaluate our hypothesis that motor training using this BMI system could improve severe hemiparesis that is resistant to improvement by conventional rehabilitation. We, therefore, planned and implemented a randomized controlled clinical trial (RCT) to evaluate the effectiveness and safety of intensive rehabilitation using the BMI system. METHODS We conducted a single blind, multicenter RCT and recruited chronic poststroke patients with severe hemiparesis more than 90 days after onset (N=40). Participants were randomly allocated to the BMI group (n=20) or the control group (n=20). Patients in the BMI group repeated 10-second motor attempts to operate EEG-BMI 40 min every day followed by 40 min of conventional occupational therapy. The interventions were repeated 10 times in 2 weeks. Control participants performed a simple motor imagery without servo-action of the orthosis, and electrostimulation was given for 10 seconds for 40 min, similar to the BMI intervention. Overall, 40 min of conventional occupational therapy was also given every day after the control intervention, which was also repeated 10 times in 2 weeks. Motor functions and electrophysiological phenotypes of the paretic hands were characterized before (baseline), immediately after (post), and 4 weeks after (follow-up) the intervention. Improvement in the upper extremity score of the Fugl-Meyer assessment between baseline and follow-up was the main outcome of this study. RESULTS Recruitment started in March 2017 and ended in July 2018. This trial is currently in the data correcting phase. This RCT is expected to be completed by October 31, 2018. CONCLUSIONS No widely accepted intervention has been established to improve finger function of chronic poststroke patients with severe hemiparesis. The results of this study will provide clinical data for regulatory approval and novel, important understanding of the role of sensory-motor feedback based on BMI to induce neural plasticity and motor recovery. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000026372; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000030299 (Archived by WebCite at http://www.webcitation.org/743zBJj3D). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12339.
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Affiliation(s)
- Katsuhiro Mizuno
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Abe
- School of Data Science, Yokohama City University, Yokohama, Japan.,Keio University School of Medicine, Tokyo, Japan
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Yokohama, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomomi Ohwa
- Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Kazuto Hagimura
- Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Miho Ogura
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohei Okuyama
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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20
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Hwang J, Shin Y, Park JH, Cha YJ, You JSH. Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia. NeuroRehabilitation 2018; 42:481-489. [PMID: 29660947 DOI: 10.3233/nre-172226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. OBJECTIVE The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. METHODS Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. RESULTS Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P < 0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. CONCLUSIONS These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.
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Affiliation(s)
- Jongseok Hwang
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Yongil Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea
| | - Ji-Ho Park
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Young Joo Cha
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
| | - Joshua Sung H You
- Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea
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Effects of Repetitive Facilitative Exercise on Spasticity in the Upper Paretic Limb After Subacute Stroke. J Stroke Cerebrovasc Dis 2018; 27:2863-2868. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 06/01/2018] [Accepted: 06/14/2018] [Indexed: 11/19/2022] Open
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22
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Park JH, Shin YI, You JSH, Park MS. Comparative effects of robotic-assisted gait training combined with conventional physical therapy on paretic hip joint stiffness and kinematics between subacute and chronic hemiparetic stroke. NeuroRehabilitation 2018; 42:181-190. [PMID: 29562554 DOI: 10.3233/nre-172234] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Robotic-assisted gait training (RAGT) has been proposed as a novel, promising intervention paradigm to improve gait function in subacute or chronic stroke neurorehabilitation. However, the benefits of RAGT combined with conventional physical therapy for gait recovery in patients with subacute and chronic hemiparetic stroke remain unclear. OBJECTIVES The aim of the present study was to compare the effect of RAGT combine with conventional physical therapy on hip joint kinetics, kinematics, and clinical function characteristics between subacute and chronic hemiparetic stroke. METHODS Seventeen patients with hemiparetic stroke (nine subacute and eight chronic patients) performed progressive RAGT (session 1, 40 min) combined with conventional physical therapy (session 1, 40 min) 5 days per week, for an average of 86 sessions over 8 weeks. The clinical outcomes included the Functional Ambulation Category (FAC), modified Rankin scale (mRS), Korean version of the modified Barthel index (K-MBI), and modified Ashworth scale, in addition to hip joint kinetics and kinematics before and after intervention. RESULTS The mean change in active torque, resistive torque, and stiffness in the paretic hip joint did not differ significantly between the two groups. However, Cohen's effect size suggested a moderate difference between the groups in the hip flexion phase (d = 0.58, d = 0.70, and d = 0.70). The mean change in maximal hip flexion kinematics in the chronic group was significantly greater than that in the subacute group (p = 0.04, d = -0.70). The mean change in the clinical function test results between the groups was not statistically significant. However, both groups showed significantly improved FAC, mRS, and K-MBI scores. CONCLUSIONS RAGT combine with conventional physical therapy may be useful when selecting therapeutic interventions to improve the active torque, resistive torque, and stiffness in the paretic hip flexion phase in patients with chronic hemiparetic stroke who reached a plateau in the maximum locomotor recovery after conventional locomotor training.
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Affiliation(s)
- Ji-Ho Park
- Department of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Yonsei University, Wonju, Republic of Korea.,Brain Korea 21 PLUS Project for Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Joshua Sung H You
- Department of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Yonsei University, Wonju, Republic of Korea.,Brain Korea 21 PLUS Project for Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Min Su Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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23
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Liu W, Wu W, Lin G, Cheng J, Zeng Y, Shi Y. Physical exercise promotes proliferation and differentiation of endogenous neural stem cells via ERK in rats with cerebral infarction. Mol Med Rep 2018; 18:1455-1464. [PMID: 29901080 PMCID: PMC6072171 DOI: 10.3892/mmr.2018.9147] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 05/14/2018] [Indexed: 01/25/2023] Open
Abstract
Physical exercise is beneficial for the functional recovery of neurons after stroke. It has been suggested that exercise regulates proliferation and differentiation of endogenous neural stem cells (NSCs); however, the underlying molecular mechanisms are still largely unknown. In the present study, the aim was to investigate whether physical exercise activates the extracellular signal-regulated kinase (ERK) signaling pathway to promote proliferation and differentiation of NSCs in rats with cerebral infarction, thereby improving neurological function. Following middle cerebral artery occlusion, rats underwent physical exercise and neurological behavior was analyzed at various time points. Immunofluorescence staining was performed to detect proliferation and differentiation of NSCs, and western blotting was used to analyze cyclin-dependent kinase 4 (CDK4), Cyclin D1, retinoblastoma protein (p-Rb), P-16, phosphorylated (p)-ERK1/2 and c-Fos expression. The results indicated that physical exercise promoted proliferation and differentiation of NSCs, and led to improved neural function. In addition, the expression levels of CDK4, Cyclin D1, p-Rb, p-ERK1/2 and c-Fos were upregulated, whereas the expression of P-16 was downregulated following exercise. U0126, an inhibitor of ERK signaling, reversed the beneficial effects of exercise. Therefore, it may be hypothesized that physical exercise enhances proliferation and differentiation of endogenous NSCs in the hippocampus of rats with cerebral infarction via the ERK signaling pathway.
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Affiliation(s)
- Wei Liu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Wen Wu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Guangyong Lin
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Jian Cheng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Yanyan Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
| | - Yu Shi
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510280, P.R. China
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Miura S, Takazawa J, Kobayashi Y, Fujie MG. Accuracy to detection timing for assisting repetitive facilitation exercise system using MRCP and SVM. ROBOTICS AND BIOMIMETICS 2017; 4:12. [PMID: 29170726 PMCID: PMC5676804 DOI: 10.1186/s40638-017-0071-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Abstract
This paper presents a feasibility study of a brain–machine interface system to assist repetitive facilitation exercise. Repetitive facilitation exercise is an effective rehabilitation method for patients with hemiplegia. In repetitive facilitation exercise, a therapist stimulates the paralyzed part of the patient while motor commands run along the nerve pathway. However, successful repetitive facilitation exercise is difficult to achieve and even a skilled practitioner cannot detect when a motor command occurs in patient’s brain. We proposed a brain–machine interface system for automatically detecting motor commands and stimulating the paralyzed part of a patient. To determine motor commands from patient electroencephalogram (EEG) data, we measured the movement-related cortical potential (MRCP) and constructed a support vector machine system. In this paper, we validated the prediction timing of the system at the highest accuracy by the system using EEG and MRCP. In the experiments, we measured the EEG when the participant bent their elbow when prompted to do so. We analyzed the EEG data using a cross-validation method. We found that the average accuracy was 72.9% and the highest at the prediction timing 280 ms. We conclude that 280 ms is the most suitable to predict the judgment that a patient intends to exercise or not.
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Affiliation(s)
- Satoshi Miura
- Faculty of Science and Engineering, Waseda University, 3-4-1, Okubo, Shinjuku-ku, 169-8555 Tokyo, Japan
| | - Junichi Takazawa
- Graduate School of Science and Engineering, Waseda University, 3-4-1, Okubo, Shinjuku-ku, 169-8555 Tokyo, Japan
| | - Yo Kobayashi
- Healthcare Robotics Institute, Future Robotics Organization, Waseda University, 3-4-1, Okubo, Shinjuku-ku, 169-8555 Tokyo, Japan
| | - Masakatsu G Fujie
- Healthcare Robotics Institute, Future Robotics Organization, Waseda University, 3-4-1, Okubo, Shinjuku-ku, 169-8555 Tokyo, Japan
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Shinohara M, Ueda J. Optimal inter-stimulus interval for paired associative stimulation with mechanical stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:1134-1137. [PMID: 29060075 DOI: 10.1109/embc.2017.8037029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this paper, inter-stimulus interval (ISI) of paired associative stimulation (PAS) with mechanical stimulation was analyzed. PAS is a prominent therapeutic intervention for individuals after stroke and helps to improve limb function by strengthening excitatory synapses and inducing neural plasticity. This intervention involves repeated application of transcranial magnetic stimulation (TMS) followed by peripheral stimulation. When responses to both stimulations are overlapped in the brain at the same time, this successful PAS is expected to induce long term potentiation (LTP) which leads to a neural plasticity phenomenon. Therefore ISI between these two stimulations is very crucial in this treatment. Instead of electrical stimulation in general PAS, mechanical stimulation was used in this study due to some promising aspects of mechanical stimulation. Long latency stretch response (LLSR) was observed in electromyography (EMG) during the PAS with mechanical stimulation, since LLSR reflects successful overlapping of two stimulations. Each subject had specific range of ISIs, or a time window, that leads to successful overlapping of paired stimulations. These time window lengths varied between 5ms and 105 ms, and within this range it can be guaranteed to obtain LLSR in EMG at least 40% among the all PAS trials. In addition, normally distributed responses within time window suggests that the optimal ISI which results in the highest number of LLSRs is the average of the time window. This result suggests that PAS with mechanical stimulation could lead to a rehabilitation effect by regaining motor functionality when the two stimulations are paired with the optimal ISI and it could provide a significant advancement in neuromodulation.
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Improvement and Neuroplasticity after Combined Rehabilitation to Forced Grasping. Case Rep Neurol Med 2017; 2017:1028390. [PMID: 28265475 PMCID: PMC5317149 DOI: 10.1155/2017/1028390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/31/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022] Open
Abstract
The grasp reflex is a distressing symptom but the need to treat or suppress it has rarely been discussed in the literature. We report the case of a 17-year-old man who had suffered cerebral infarction of the right putamen and temporal lobe 10 years previously. Forced grasping of the hemiparetic left upper limb was improved after a unique combined treatment. Botulinum toxin type A (BTX-A) was first injected into the left biceps, wrist flexor muscles, and finger flexor muscles. Forced grasping was reduced along with spasticity of the upper limb. In addition, repetitive facilitative exercise and object-related training were performed under low-amplitude continuous neuromuscular electrical stimulation. Since this 2-week treatment improved upper limb function, we compared brain activities, as measured by near-infrared spectroscopy during finger pinching, before and after the combined treatment. Brain activities in the ipsilesional sensorimotor cortex (SMC) and medial frontal cortex (MFC) during pinching under electrical stimulation after treatment were greater than those before. The results suggest that training under electrical stimulation after BTX-A treatment may modulate the activities of the ipsilesional SMC and MFC and lead to functional improvement of the affected upper limb with forced grasping.
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Tomioka K, Matsumoto S, Ikeda K, Uema T, Sameshima JI, Sakashita Y, Kaji T, Shimodozono M. Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients. J Phys Ther Sci 2017; 29:212-215. [PMID: 28265141 PMCID: PMC5332972 DOI: 10.1589/jpts.29.212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 10/27/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the short-term effects of a combination therapy
consisting of repetitive facilitative exercises and orthotic treatment. [Subjects and
Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females;
59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and
motor function. Each subject received combination therapy consisting of repetitive
facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot
orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke
Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test,
and the 10-m walk test as a measure of functional ambulation were evaluated before and
after the combination therapy intervention. [Results] The findings of the Fugl-Meyer
assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test
significantly improved after the intervention. Moreover, the results of the 10-m walk test
at a fast speed reached the minimal detectible change threshold (0.13 m/s). [Conclusion]
Short-term physiotherapy combining repetitive facilitative exercises and orthotic
treatment may be more effective than the conventional neurofacilitation therapy, to
improve the lower-limb motor performance and functional ambulation of chronic post-stroke
patients.
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Affiliation(s)
- Kazutoshi Tomioka
- Department of Rehabilitation, Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Japan
| | - Shuji Matsumoto
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | - Keiko Ikeda
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Japan
| | - Tomohiro Uema
- Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital, Japan
| | - Jun-Ichi Sameshima
- Department of Rehabilitation, Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Japan
| | - Yuji Sakashita
- Department of Rehabilitation, Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Japan
| | - Tomokazu Kaji
- Department of Rehabilitation, Tarumizu Municipal Medical Center Tarumizu Chuo Hospital, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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Hoei T, Kawahira K, Fukuda H, Sihgenobu K, Shimodozono M, Ogura T. Use of an arm weight-bearing combined with upper-limb reaching apparatus to facilitate motor paralysis recovery in an incomplete spinal cord injury patient: a single case report. J Phys Ther Sci 2017; 29:176-180. [PMID: 28210068 PMCID: PMC5300834 DOI: 10.1589/jpts.29.176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/11/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Training using an arm weight-bearing device combined with upper-limb reaching
apparatus to facilitate motor paralysis recovery, named the “Reaching Robot”, as well as
Repetitive Facilitation Exercise were applied to a patient with severe impairment of the
shoulder and elbow due to incomplete spinal cord injury and the effects were examined.
[Subjects and Methods] A 66-year-old man with incomplete spinal cord injury participated
in an upper extremity rehabilitation program involving a Reaching Robot. The program was
comprised of active motor suspension, continuous low amplitude neuromuscular electrical
stimulation and functional vibratory stimulation, as well as Repetitive Facilitation
Exercise combined with continuous low amplitude neuromuscular electrical stimulation. This
protocol used a crossover design following an
A1-B1-A2-B2. “A” consisted of 2 weeks of
Repetitive Facilitation Exercise, and “B” consisted of 2 weeks of Reaching Robot training.
[Results] Improvements were observed after all sessions. Active range of motion for
shoulder flexion improved after 2 weeks of Reaching Robot sessions only. There were no
adverse events. [Conclusion] Reaching Robot training for severe paretic upper-extremity
after incomplete spinal cord injury was a safe and effective treatment. Reaching Robot
training may be useful for rehabilitation of paretic upper-extremity after incomplete
spinal cord injury.
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Affiliation(s)
| | - Kazumi Kawahira
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
| | | | | | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan
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Matsumoto S, Shimodozono M, Noma T, Uema T, Horio S, Tomioka K, Sameshima JI, Yunoki N, Kawahira K. Outcomes of repetitive facilitation exercises in convalescent patients after stroke with impaired health status. Brain Inj 2016; 30:1722-1730. [PMID: 27996326 DOI: 10.1080/02699052.2016.1205754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the impact of stroke on health status and the effects of repetitive facilitation exercises (RFEs) for convalescent patients after stroke. METHODS The study was a prospective observational study of patients enrolled in an RFE programme. Between April 2008 and March 2012, 468 patients with stroke were enrolled in an intensive, comprehensive RFE programme. Patients participated in this interdisciplinary programme for 12 weeks, for an average of 5 hours per week. Before and immediately after the programme, several measures of rehabilitation outcomes and health-related quality-of-life were evaluated. RESULTS At baseline, most patients (95.4%) had modified Rankin scale scores of 3-5. Their health-related quality-of-life was significantly impaired, with physical and mental component summary scores on the Short Form 36-item questionnaire (SF-36) of 30.7 and 35.8, respectively. After the RFE programme, all outcome measures improved significantly. CONCLUSIONS The results demonstrate that convalescent patients after stroke may benefit substantially from RFE programmes in stroke rehabilitation centres, even when patients have impaired health status or high levels of healthcare utilization. Thus, an RFE programme is a simple yet highly effective means to improve rehabilitation outcomes and health-related quality-of-life, with a relatively low dropout rate.
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Affiliation(s)
- Shuji Matsumoto
- a Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences , Kagoshima University , Kagoshima , Japan
| | - Megumi Shimodozono
- a Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences , Kagoshima University , Kagoshima , Japan
| | - Tomokazu Noma
- b Department of Rehabilitation , Kirishima Rehabilitation Center of Kagoshima University Hospital , Kagoshima , Japan
| | - Tomohiro Uema
- b Department of Rehabilitation , Kirishima Rehabilitation Center of Kagoshima University Hospital , Kagoshima , Japan
| | - Shinya Horio
- c Department of Rehabilitation, Kumamoto-Takumadai Rehabilitation Hospital , Kumamoto , Japan
| | - Kazutoshi Tomioka
- d Department of Rehabilitation, Tarumizu Municipal Medical Center, Tarumizu Central Hospital , Kagoshima , Japan
| | - Jun-Ichi Sameshima
- d Department of Rehabilitation, Tarumizu Municipal Medical Center, Tarumizu Central Hospital , Kagoshima , Japan
| | - Naoya Yunoki
- e Department of Rehabilitation, Miyanaga Hospital , Miyazaki , Japan
| | - Kazumi Kawahira
- a Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences , Kagoshima University , Kagoshima , Japan
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French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, Sutton CJ, Tishkovskaya S, Watkins CL. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev 2016; 11:CD006073. [PMID: 27841442 PMCID: PMC6464929 DOI: 10.1002/14651858.cd006073.pub3] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Repetitive task training (RTT) involves the active practice of task-specific motor activities and is a component of current therapy approaches in stroke rehabilitation. OBJECTIVES Primary objective: To determine if RTT improves upper limb function/reach and lower limb function/balance in adults after stroke. Secondary objectives: 1) To determine the effect of RTT on secondary outcome measures including activities of daily living, global motor function, quality of life/health status and adverse events. 2) To determine the factors that could influence primary and secondary outcome measures, including the effect of 'dose' of task practice; type of task (whole therapy, mixed or single task); timing of the intervention and type of intervention. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (4 March 2016); the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 5: 1 October 2006 to 24 June 2016); MEDLINE (1 October 2006 to 8 March 2016); Embase (1 October 2006 to 8 March 2016); CINAHL (2006 to 23 June 2016); AMED (2006 to 21 June 2016) and SPORTSDiscus (2006 to 21 June 2016). SELECTION CRITERIA Randomised/quasi-randomised trials in adults after stroke, where the intervention was an active motor sequence performed repetitively within a single training session, aimed towards a clear functional goal. DATA COLLECTION AND ANALYSIS Two review authors independently screened abstracts, extracted data and appraised trials. We determined the quality of evidence within each study and outcome group using the Cochrane 'Risk of bias' tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria. We did not assess follow-up outcome data using GRADE. We contacted trial authors for additional information. MAIN RESULTS We included 33 trials with 36 intervention-control pairs and 1853 participants. The risk of bias present in many studies was unclear due to poor reporting; the evidence has therefore been rated 'moderate' or 'low' when using the GRADE system. There is low-quality evidence that RTT improves arm function (standardised mean difference (SMD) 0.25, 95% confidence interval (CI) 0.01 to 0.49; 11 studies, number of participants analysed = 749), hand function (SMD 0.25, 95% CI 0.00 to 0.51; eight studies, number of participants analysed = 619), and lower limb functional measures (SMD 0.29, 95% CI 0.10 to 0.48; five trials, number of participants analysed = 419). There is moderate-quality evidence that RTT improves walking distance (mean difference (MD) 34.80, 95% CI 18.19 to 51.41; nine studies, number of participants analysed = 610) and functional ambulation (SMD 0.35, 95% CI 0.04 to 0.66; eight studies, number of participants analysed = 525). We found significant differences between groups for both upper-limb (SMD 0.92, 95% CI 0.58 to 1.26; three studies, number of participants analysed = 153) and lower-limb (SMD 0.34, 95% CI 0.16 to 0.52; eight studies, number of participants analysed = 471) outcomes up to six months post treatment but not after six months. Effects were not modified by intervention type, dosage of task practice or time since stroke for upper or lower limb. There was insufficient evidence to be certain about the risk of adverse events. AUTHORS' CONCLUSIONS There is low- to moderate-quality evidence that RTT improves upper and lower limb function; improvements were sustained up to six months post treatment. Further research should focus on the type and amount of training, including ways of measuring the number of repetitions actually performed by participants. The definition of RTT will need revisiting prior to further updates of this review in order to ensure it remains clinically meaningful and distinguishable from other interventions.
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Affiliation(s)
- Beverley French
- University of Central LancashireDepartment of Nursing and Caring SciencesRoom 434Brook BuildingPrestonLancashireUKPR1 2HE
| | - Lois H Thomas
- University of Central LancashireCollege of Health and WellbeingRoom 326Brook BuildingPrestonLancashireUKPR1 2HE
| | - Jacqueline Coupe
- University of Central LancashireCollege of Health and WellbeingRoom 326Brook BuildingPrestonLancashireUKPR1 2HE
| | - Naoimh E McMahon
- University of Central LancashireCollege of Health and WellbeingRoom 326Brook BuildingPrestonLancashireUKPR1 2HE
| | - Louise Connell
- University of Central LancashireCollege of Health and WellbeingRoom 326Brook BuildingPrestonLancashireUKPR1 2HE
| | - Joanna Harrison
- University of Central LancashireDepartment of NursingPrestonLancashireUKPR1 2HE
| | - Christopher J Sutton
- University of Central LancashireCollege of Health and WellbeingRoom 326Brook BuildingPrestonLancashireUKPR1 2HE
| | | | - Caroline L Watkins
- University of Central LancashireCollege of Health and WellbeingRoom 326Brook BuildingPrestonLancashireUKPR1 2HE
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Kim E, Kovalenko I, Lacey L, Shinohara M, Ueda J. Timing Analysis of Robotic Neuromodulatory Rehabilitation System for Paired Associative Stimulation. IEEE Robot Autom Lett 2016. [DOI: 10.1109/lra.2016.2530866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Saunders DH, Sanderson M, Hayes S, Kilrane M, Greig CA, Brazzelli M, Mead GE. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2016; 3:CD003316. [PMID: 27010219 PMCID: PMC6464717 DOI: 10.1002/14651858.cd003316.pub6] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability and to assess the effects of training with regard to adverse events, risk factors, physical fitness, mobility, physical function, quality of life, mood, and cognitive function. Interventions to improve cognitive function have attracted increased attention after being identified as the highest rated research priority for life after stroke. Therefore we have added this class of outcomes to this updated review. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 1: searched February 2015), MEDLINE (1966 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), SPORTDiscus (1949 to February 2015), and five additional databases (February 2015). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 58 trials, involving 2797 participants, which comprised cardiorespiratory interventions (28 trials, 1408 participants), resistance interventions (13 trials, 432 participants), and mixed training interventions (17 trials, 957 participants). Thirteen deaths occurred before the end of the intervention and a further nine before the end of follow-up. No dependence data were reported. Diverse outcome measures restricted pooling of data. Global indices of disability show moderate improvement after cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% confidence interval (CI) 0.19 to 0.84; P value = 0.002) and by a small amount after mixed training (SMD 0.26, 95% CI 0.04 to 0.49; P value = 0.02); benefits at follow-up (i.e. after training had stopped) were unclear. There were too few data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 6.71 metres per minute, 95% CI 2.73 to 10.69), preferred gait speed (MD 4.28 metres per minute, 95% CI 1.71 to 6.84), and walking capacity (MD 30.29 metres in six minutes, 95% CI 16.19 to 44.39) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), and walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95). Balance scores improved slightly after mixed training (SMD 0.27, 95% CI 0.07 to 0.47). Some mobility benefits also persisted at the end of follow-up. The variability, quality of the included trials, and lack of data prevents conclusions about other outcomes and limits generalisability of the observed results. AUTHORS' CONCLUSIONS Cardiorespiratory training and, to a lesser extent, mixed training reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve the speed and tolerance of walking; some improvement in balance could also occur. There is insufficient evidence to support the use of resistance training. The effects of training on death and dependence after stroke are still unclear but these outcomes are rarely observed in physical fitness training trials. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Institute for Sport, Physical Education and Health Sciences (SPEHS), University of EdinburghMoray House School of EducationSt Leonards LandHolyrood RoadEdinburghUKEH8 2AZ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickDepartment of Clinical TherapiesLimerickIreland
| | - Maeve Kilrane
- Royal Infirmary of EdinburghDepartment of Stroke MedicineWard 201 ‐ Stroke UnitLittle FranceEdinburghUKEH16 4SA
| | - Carolyn A Greig
- University of BirminghamSchool of Sport, Exercise and Rehabilitation Sciences, MRC‐ARUK Centre for Musculoskeletal Ageing ResearchEdgbastonBirminghamUKB15 2TT
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
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Zhang Y, Cao RY, Jia X, Li Q, Qiao L, Yan G, Yang J. Treadmill exercise promotes neuroprotection against cerebral ischemia-reperfusion injury via downregulation of pro-inflammatory mediators. Neuropsychiatr Dis Treat 2016; 12:3161-3173. [PMID: 28003752 PMCID: PMC5161395 DOI: 10.2147/ndt.s121779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Stroke is one of the major causes of morbidity and mortality worldwide, which is associated with serious physical deficits that affect daily living and quality of life and produces immense public health and economic burdens. Both clinical and experimental data suggest that early physical training after ischemic brain injury may reduce the extent of motor dysfunction. However, the exact mechanisms have not been fully elucidated. The aim of this study was to investigate the effects of aerobic exercise on neuroprotection and understand the underlying mechanisms. MATERIALS AND METHODS Middle cerebral artery occlusion (MCAO) was conducted to establish a rat model of cerebral ischemia-reperfusion injury to mimic ischemic stroke. Experimental animals were divided into the following three groups: sham (n=34), MCAO (n=39), and MCAO plus treadmill exercise (n=28). The effects of aerobic exercise intervention on ischemic brain injury were evaluated using functional scoring, histological analysis, and Bio-Plex Protein Assays. RESULTS Early aerobic exercise intervention was found to improve motor function, prevent death of neuronal cells, and suppress the activation of microglial cells and astrocytes. Furthermore, it was observed that aerobic exercise downregulated the expression of the cytokine interleukin-1β and the chemokine monocyte chemotactic protein-1 after transient MCAO in experimental rats. CONCLUSION This study demonstrates that treadmill exercise rehabilitation promotes neuroprotection against cerebral ischemia-reperfusion injury via the downregulation of proinflammatory mediators.
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Affiliation(s)
| | - Richard Y Cao
- Laboratory of Immunology, Shanghai Xuhui Central Hospital, Shanghai Clinical Research Center, Chinese Academy of Sciences
| | - Xinling Jia
- School of Life sciences, Shanghai University
| | - Qing Li
- Department of Rehabilitation
| | | | - Guofeng Yan
- School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Etoh S, Noma T, Takiyoshi Y, Arima M, Ohama R, Yokoyama K, Hokazono A, Amano Y, Shimodozono M, Kawahira K. Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients. Int J Neurosci 2015; 126:1007-12. [PMID: 26473535 DOI: 10.3109/00207454.2015.1094473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients. SUBJECTS AND METHODS Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks. RESULT There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group. DISCUSSION RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.
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Affiliation(s)
- Seiji Etoh
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Tomokazu Noma
- b 2 Department of Rehabilitation, Kirishima Rehabilitation Center of Kagoshima University Hospital , Kagoshima , Japan
| | | | - Michiko Arima
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Rintaro Ohama
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Katsuya Yokoyama
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Akihiko Hokazono
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Yumeko Amano
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Megumi Shimodozono
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Kazumi Kawahira
- a 1 Department of Rehabilitation and Physical Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
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Neuroprotection of Early Locomotor Exercise Poststroke: Evidence From Animal Studies. Can J Neurol Sci 2015; 42:213-20. [PMID: 26041314 DOI: 10.1017/cjn.2015.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Early locomotor exercise after stroke has attracted a great deal of attention in clinical and animal research in recent years. A series of animal studies showed that early locomotor exercise poststroke could protect against ischemic brain injury and improve functional outcomes through the promotion of angiogenesis, inhibition of acute inflammatory response and neuron apoptosis, and protection of the blood-brain barrier. However, to date, the clinical application of early locomotor exercise poststroke was limited because some clinicians have little confidence in its effectiveness. Here we review the current progress of early locomotor exercise poststroke in animal models. We hope that a comprehensive awareness of the early locomotor exercise poststroke may help to implement early locomotor exercise more appropriately in treatment for ischemic stroke.
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Shimodozono M. [Repetitive facilitative exercise: recent evidence and development for combination therapy]. Rinsho Shinkeigaku 2015; 23:1267-9. [PMID: 24291952 DOI: 10.5692/clinicalneurol.53.1267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Repetitive facilitative exercise (RFE), a combination of high-dose (high frequency) of repetitions and neurofacilitation, is a recently developed approach to the rehabilitation of stroke-related limb impairment. We conducted a randomized controlled evaluation of RFE compared with a duration-matched conventional rehabilitation program in the treatment of subacute stroke-related upper extremity impairment (Shimodozono et al. 2013). RFE demonstrated both statistically and clinically significant benefits over conventional rehabilitation both on the Action Research Arm Test, which is designed to measure dexterity and function, and on the Fugl-Meyer Arm scores, which was chosen as measure of motor control. In the case-series study, the beneficial effect of RFE is also reported in the treatment of chronic phase of stroke. More research is needed, but RFE could conceivably be integrated with other approaches such as vibration, neuromuscular electrical stimulation, repetitive transcranial magnetic stimulation, botulinum toxin, and robotics to achieve further improvement in its capabilities.
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Affiliation(s)
- Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
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Novel neuromuscular electrical stimulation system for the upper limbs in chronic stroke patients: a feasibility study. Am J Phys Med Rehabil 2014; 93:503-10. [PMID: 24508928 DOI: 10.1097/phm.0000000000000056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to assess the feasibility of applying a novel neuromuscular electrical stimulation system, targeting shoulder flexion, elbow extension, wrist extension, and individual finger extensions, to improve motor control and function of the hemiparetic upper limbs in chronic stroke patients. DESIGN Fifteen participants with chronic (>1 yr after cerebrovascular accident) upper limb hemiparesis were enrolled. The subjects underwent upper limb training for 60 mins per day, 6 days per week, for 2 wks, using both a shoulder-and-elbow stimulation device and a wrist-and-finger stimulation device developed by the study investigators. Outcomes were assessed using the upper extremity component of the Fugl-Meyer assessment, the action research arm test, and the modified Ashworth scale before and after intervention. RESULTS All patients completed the training successfully using the neuromuscular electrical stimulation system without any safety incidents or other complications reported. Nonparametric statistical analyses indicated significant improvements in the upper extremity component of the Fugl-Meyer assessment and action research arm test scores, both at P < 0.01. There were also significant reductions in modified Ashworth scale scores for the elbow and the wrist flexor, both at P < 0.01. CONCLUSIONS The multimuscle stimulation approach and method presented in this study seem feasible, and the improvements of upper limb motor control and functional test in chronic stroke patients justify further controlled investigation.
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Zheng HQ, Zhang LY, Luo J, Li LL, Li M, Zhang Q, Hu XQ. Physical exercise promotes recovery of neurological function after ischemic stroke in rats. Int J Mol Sci 2014; 15:10974-88. [PMID: 24945308 PMCID: PMC4100192 DOI: 10.3390/ijms150610974] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 01/05/2023] Open
Abstract
Although physical exercise is an effective strategy for treatment of ischemic stroke, the underlying protective mechanisms are still not well understood. It has been recently demonstrated that neural progenitor cells play a vital role in the recovery of neurological function (NF) through differentiation into mature neurons. In the current study, we observed that physical exercise significantly reduced the infarct size and improved damaged neural functional recovery after an ischemic stroke. Furthermore, we found that the treatment not only exhibited a significant increase in the number of neural progenitor cells and neurons but also decreased the apoptotic cells in the peri-infarct region, compared to a control in the absence of exercise. Importantly, the insulin-like growth factor-1 (IGF-1)/Akt signaling pathway was dramatically activated in the peri-infarct region of rats after physical exercise training. Therefore, our findings suggest that physical exercise directly influences the NF recovery process by increasing neural progenitor cell count via activation of the IGF-1/Akt signaling pathway.
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Affiliation(s)
- Hai-Qing Zheng
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Li-Ying Zhang
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Jing Luo
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Li-Li Li
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Menglin Li
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Qingjie Zhang
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| | - Xi-Quan Hu
- Department of Rehabilitation Medicine Science, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
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Shimodozono M, Noma T, Matsumoto S, Miyata R, Etoh S, Kawahira K. Repetitive facilitative exercise under continuous electrical stimulation for severe arm impairment after sub-acute stroke: A randomized controlled pilot study. Brain Inj 2013; 28:203-10. [DOI: 10.3109/02699052.2013.860472] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Levels of physical fitness are low after stroke. It is unknown whether improving physical fitness after stroke reduces disability. OBJECTIVES To determine whether fitness training after stroke reduces death, dependence, and disability. The secondary aims were to determine the effects of training on physical fitness, mobility, physical function, quality of life, mood, and incidence of adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched January 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12: searched January 2013), MEDLINE (1966 to January 2013), EMBASE (1980 to January 2013), CINAHL (1982 to January 2013), SPORTDiscus (1949 to January 2013), and five additional databases (January 2013). We also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a non-exercise intervention, or usual care in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed quality, and extracted data. We analysed data using random-effects meta-analyses. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 45 trials, involving 2188 participants, which comprised cardiorespiratory (22 trials, 995 participants), resistance (eight trials, 275 participants), and mixed training interventions (15 trials, 918 participants). Nine deaths occurred before the end of the intervention and a further seven at the end of follow-up. No dependence data were reported. Diverse outcome measures made data pooling difficult. Global indices of disability show a tendency to improve after cardiorespiratory training (standardised mean difference (SMD) 0.37, 95% confidence interval (CI) 0.10 to 0.64; P = 0.007); benefits at follow-up and after mixed training were unclear. There were insufficient data to assess the effects of resistance training.Cardiorespiratory training involving walking improved maximum walking speed (mean difference (MD) 7.37 metres per minute, 95% CI 3.70 to 11.03), preferred gait speed (MD 4.63 metres per minute, 95% CI 1.84 to 7.43), walking capacity (MD 26.99 metres per six minutes, 95% CI 9.13 to 44.84), and Berg Balance scores (MD 3.14, 95% CI 0.56 to 5.73) at the end of the intervention. Mixed training, involving walking, increased preferred walking speed (MD 4.54 metres per minute, 95% CI 0.95 to 8.14), walking capacity (MD 41.60 metres per six minutes, 95% CI 25.25 to 57.95), and also pooled balance scores but the evidence is weaker (SMD 0.26 95% CI 0.04 to, 0.49). Some mobility benefits also persisted at the end of follow-up. The variability and trial quality hampered the assessment of the reliability and generalisability of the observed results. AUTHORS' CONCLUSIONS The effects of training on death and dependence after stroke are unclear. Cardiorespiratory training reduces disability after stroke and this may be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programs to improve the speed and tolerance of walking; improvement in balance may also occur. There is insufficient evidence to support the use of resistance training. Further well-designed trials are needed to determine the optimal content of the exercise prescription and identify long-term benefits.
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Affiliation(s)
- David H Saunders
- Moray House School of Education, Institute for Sport, Physical Education and Health Sciences (SPEHS), University of Edinburgh, St Leonards Land, Holyrood Road, Edinburgh, Midlothian, UK, EH8 2AZ
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Zhang P, Zhang Y, Zhang J, Wu Y, Jia J, Wu J, Hu Y. Early Exercise Protects against Cerebral Ischemic Injury through Inhibiting Neuron Apoptosis in Cortex in Rats. Int J Mol Sci 2013; 14:6074-89. [PMID: 23502470 PMCID: PMC3634421 DOI: 10.3390/ijms14036074] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 02/03/2013] [Accepted: 02/28/2013] [Indexed: 12/31/2022] Open
Abstract
Early exercise is an effective strategy for stroke treatment, but the underlying mechanism remains poorly understood. Apoptosis plays a critical role after stroke. However, it is unclear whether early exercise inhibits apoptosis after stroke. The present study investigated the effect of early exercise on apoptosis induced by ischemia. Adult SD rats were subjected to transient focal cerebral ischemia by middle cerebral artery occlusion model (MCAO) and were randomly divided into early exercise group, non-exercise group and sham group. Early exercise group received forced treadmill training initiated at 24 h after operation. Fourteen days later, the cell apoptosis were detected by TdT-mediated dUTP-biotin nick-end labeling (TUNEL) and Fluoro-Jade-B staining (F-J-B). Caspase-3, cleaved caspase-3 and Bcl-2 were determined by western blotting. Cerebral infarct volume and motor function were evaluated by cresyl violet staining and foot fault test respectively. The results showed that early exercise decreased the number of apoptotic cells (118.74 ± 6.15 vs. 169.65 ± 8.47, p < 0.05, n = 5), inhibited the expression of caspase-3 and cleaved caspase-3 (p < 0.05, n = 5), and increased the expression of Bcl-2 (p < 0.05, n = 5). These data were consistent with reduced infarct volume and improved motor function. These results suggested that early exercise could provide neuroprotection through inhibiting neuron apoptosis.
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Affiliation(s)
- Pengyue Zhang
- Medical Faculty, Kunming University of Science and Technology, Kunming 650500, China; E-Mail: (J.Z.)
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China; E-Mails: (Y.Z.); (Y.W.); (J.J.); (J.W.)
| | - Yuling Zhang
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China; E-Mails: (Y.Z.); (Y.W.); (J.J.); (J.W.)
| | - Jie Zhang
- Medical Faculty, Kunming University of Science and Technology, Kunming 650500, China; E-Mail: (J.Z.)
- Yunnan Provincial Key Laboratory for Birth Defects and Genetic Diseases, Genetic Diagnosis Center, the First People’s Hospital of Yunnan Province, Kunming 650032, China
| | - Yi Wu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China; E-Mails: (Y.Z.); (Y.W.); (J.J.); (J.W.)
- The Yonghe Branch of Huashan Hospital, Fudan University, Shanghai 200436, China
| | - Jie Jia
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China; E-Mails: (Y.Z.); (Y.W.); (J.J.); (J.W.)
| | - Junfa Wu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China; E-Mails: (Y.Z.); (Y.W.); (J.J.); (J.W.)
| | - Yongshan Hu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai 200040, China; E-Mails: (Y.Z.); (Y.W.); (J.J.); (J.W.)
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