To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke

Bilateral upper limb robot-assisted rehabilitation improves upper limb motor function in stroke patients: a study based on quantitative EEG

BACKGROUND

Upper limb dysfunction after stroke seriously affects quality of life. Bilateral training has proven helpful in recovery of upper limb motor function in these patients. However, studies evaluating the effectiveness of bilateral upper limb robot-assisted training on improving motor function and quality of life in stroke patients are lacking. Quantitative electroencephalography (EEG) is non-invasive, simple, and monitors cerebral cortical activity, which can be used to evaluate the effectiveness of interventions. In this study, EEG was used to evaluate the effect of end-drive bilateral upper extremity robot-assisted training on upper extremity functional recovery in stroke patients.

METHODS

24 stroke patients with hemiplegia were randomly divided into a conventional training (CT, n = 12) group or a bilateral upper limb robot-assisted training (BRT, n = 12) group. All patients received 60 min of routine rehabilitation treatment including rolling, transferring, sitting, standing, walking, etc., per day, 6 days a week, for three consecutive weeks. The BRT group added 30 min of bilateral upper limb robot-assisted training per day, while the CT group added 30 min of upper limb training (routine occupational therapy) per day, 6 days a week, for 3  weeks. The primary outcome index to evaluate upper limb motor function was the Fugl-Meyer functional score upper limb component (FMA-UE), with the secondary outcome of activities of daily living (ADL), assessed by the modified Barthel index (MBI) score. Quantitative EEG was used to evaluate functional brain connectivity as well as alpha and beta power current source densities of the brain.

RESULTS

Significant (p < 0.05) within-group differences were found in FMA-UE and MBI scores for both groups after treatment. A between-group comparison indicated the MBI score of the BRT group was significantly different from that of the CT group, whereas the FMA-UE score was not significantly different from that of the CT group after treatment. The differences of FMA-UE and MBI scores before and after treatment in the BRT group were significantly different as compared to the CT group. In addition, beta rhythm power spectrum energy was higher in the BRT group than in the CT group after treatment. Functional connectivity in the BRT group, under alpha and beta rhythms, was significantly increased in both the bilateral frontal and limbic lobes as compared to the CT group.

CONCLUSIONS

BRT outperformed CT in improving ADL in stroke patients within three months, and BRT facilitates the recovery of upper limb function by enhancing functional connectivity of the bilateral cerebral hemispheres.

Effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders: a randomized controlled trial

BACKGROUND

Impaired vision is one of the commonest and most disabling consequence following stroke. Among all visual impairments, eye movement disorders are found in 70% of stroke patients which include nystagmus, strabismus, gaze palsies, disconjugate eye movements and cranial nerve palsies. They have a wide ranging impact on balance and activities of daily livings by creating difficulties in maintaining normal alignment and appropriate movement of eyes. The purpose of this study was to examine the effects of visual scanning exercises in addition to task specific approach on balance and activities of daily livings in post stroke patients with eye movement disorders.

METHODS

This study is a randomized controlled trial and was conducted in the University of Lahore Teaching Hospital from May 2019 to October 2020. A sample of 64 patients was recruited and randomly allocated into experimental and control group. 32 patients in experimental group were treated with visual scanning exercises along with task specific approach and 32 patients in control group were treated with task specific approach alone. Pre and post assessment of balance and activities of daily livings was assessed on BERG BALANCE SCALE and BARTHEL INDEX SCALE at baseline and at 4th week.

RESULTS

Intra-group analysis of BERG BALANCE SCALE in experimental group showed statistically significant result (p < 0.05) in all items except in items 4, 13 and 14 respectively. Intra-group analysis of BERG BALANCE SCALE in control group showed statistically significant result (p < 0.05) in items 3, 5, 8 and 12 respectively, whereas remaining all items showed statistically insignificant result. Intra-group analysis of BARTHEL INDEX SCALE in experimental group showed statistically significant result in all items (p < 0.05) except in items 9 and 10 respectively. Intra-group analysis of BARTHEL INDEX in control group showed statistically significant result (p < 0.05) in items 1, 3, 4 and 8 respectively whereas remaining all items showed statistically insignificant result. Inter-group analysis showed statistically significant result in total scores of BERG BALANCE SCALE (p = 0.000) and BARTHEL INEX SCALE (p = 0.033).

CONCLUSION

Visual scanning exercises along with task specific approach were found to be more effective in comparison to task specific approach alone.

TRIAL REGISTRATION

Trial registration number: [IRCT20190717044237N1], trial registration date: 10/11/2019.

Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: A quasi experimental study

Objective:

To determine the effectiveness of motor relearning program along with electrical stimulation for improving upper limb function in patients with sub-acute stroke.

Methods:

A quasi experimental study was conducted at Physiotherapy Department of SAIDU Group of Teaching Hospitals Swat Khyber Pakhtunkhwa from January to June 2019. Forty four subjects with post stroke duration of 3-9 months (sub-acute) participated in the study. Subjects received electrical stimulations for the effected arm for 15 minutes along with motor relearning programme for an hour five days a week for six weeks. The upper limb sub scales of motor assessment scale were used to collect pre and post treatment data. SPSS version 20 was used to analyze the data.

Results:

The mean age of the participants was 54.95±13.2 years. Out of 44 participants 31(70.5%) were male and 13 (29.5%) were female. Pretreatment upper arm function, hand movement and advance hand activities scores were 1.36 ± 0.49, 1.18 ± 0.39 and 1.04 ± 0.21 respectively while their post treatment scores were 5.18 ± 0.96, 4.77 ± 1.02 and 3.95 ± 1.21 respectively. There was significant differences (P<0.05) between pre and post treatment scores of upper arm function, hand movement and advance hand activities.

Conclusion:

Motor relearning program along with electrical stimulation significantly improves upper limb function in patients with sub-acute stroke.

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

OBJECTIVE:

The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke.

DATA SOURCES:

The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, WanFang, Weipu Information Resources System, Chinese Biomedical Literature Database, PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016.

DATA SELECTION:

We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy (traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis.

OUTCOME MEASURES:

Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index.

RESULTS:

A total of 16 prospective randomized controlled trials (379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm (weighted mean difference (WMD) = 10.822; 95% confidence intervals (95% CI): 7.419–14.226), the action research-arm test (WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement (WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index (WMD = 10.706; 95% CI: 4.417–16.966).

CONCLUSION:

Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.

[Evaluation of a method based on the principle of CI therapy in the correction of walking function in patients with post-stroke hemiparesis syndrome]

AIM

To develop a new, effective, affordable method of neurorehabilitation for the correction of walking functions based on the principle of CI (constraint-induced movement therapy) therapy in patients with the syndrome of hemiparesis of post-stroke origin.

MATERIAL AND METHODS

The study included 100 patients with moderate to marked syndrome of central hemiparesis in the recovery period of stroke. Patients were randomized into two groups. In the main group, the walk recovery was carried out using CI-therapy in complex with traditional methods of neurorehabilitation and in the comparison group, walk correction was performed by generally accepted methods of kinesiotherapy and physical therapy. Both groups were comparable by stage of stroke, the severity of paresis, age.

RESULTS AND CONCLUSION

The risk of fall significantly decreased in both groups of patients. The length and paretic step time significantly decreased in the main group. The effectiveness of the restoration of the function of walking was higher in the main group that allows us to recommend the method of correction of the walk based on the principle of CI therapy in the complex neurorehabilitation.