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Chiu YT, Liang CC, Yu Cheng H, Lin CH, Chen JC. Alternating Hot-Cold Water Immersion Facilitates Motor Function Recovery in the Paretic Upper Limb After Stroke: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2024; 105:1642-1648. [PMID: 38734047 DOI: 10.1016/j.apmr.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 04/26/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To assess the effectiveness of alternating hot-cold water immersion (AHCWI) in patients with acute stroke. DESIGN A single-blind pilot randomized controlled trial. SETTING Department of Rehabilitation Medicine of a medical center. PARTICIPANTS Early stroke survivors (N=24) with moderate-to-severe arm paresis. INTERVENTIONS In addition to conventional rehabilitation, eligible patients were randomly assigned to an AHCWI group (n=12, for AHCWI) or a control group (n=12, for upper limb [UL] cycling exercises) 5 times per week for 6 weeks. MAIN OUTCOME MEASURES The Fugl-Meyer Assessment motor-UL (FMA-UL) score, Motricity Index-UL (MI-UL) score, modified Motor Assessment Scale (MMAS; including its UL sections, MMAS-UL) score, Berg Balance Scale score, Barthel Index (BI), and modified Ashworth Scale score were assessed by the same uninvolved physical therapist at baseline and after 4 and 6 weeks of intervention. RESULTS Compared with the control group, the AHCWI group performed better, with significant group effects (P<.05), and exhibited significant improvements in FMA-UL, MI-UL, and MMAS-UL scores at 4 and 6 weeks (P<.05). Although the remaining outcomes were not significantly different, they favored the AHCWI group. Notably, a significant difference was observed in the BI at 4 weeks (P=.032). Significant changes in the muscle tone or adverse effects were not observed in either group after the intervention. CONCLUSIONS AHCWI with stroke rehabilitation is feasible and may facilitate motor function recovery of the paretic UL after a stroke.
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Affiliation(s)
- Yu-Ting Chiu
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chung-Chao Liang
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hung- Yu Cheng
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chun-Hsiang Lin
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jia-Ching Chen
- Department of Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Physical Therapy, College of Medicine, Tzu Chi University, Hualien, Taiwan.
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Prajjwal P, Chandrasekar KK, Battula P, Gaviria E, Awe MO, Inban P, Almutairi AS, Das A, Tekuru Y, Marsool MDM, Reddy MM, Mitra S, Bamba H, Singh G, Jain H, Gadam S, Hussin OA. The efficacy of virtual reality-based rehabilitation in improving motor function in patients with stroke: a systematic review and meta-analysis. Ann Med Surg (Lond) 2024; 86:5425-5438. [PMID: 39238962 PMCID: PMC11374195 DOI: 10.1097/ms9.0000000000002403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/11/2024] [Indexed: 09/07/2024] Open
Abstract
Background Stroke is a major cause of adult disability, prompting the exploration of innovative rehabilitation methods. Virtual rehabilitation (VR), leveraging technological advances, has gained popularity as a treatment for stroke recovery. Methodology The authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published in English within the last decade, adhering to the PRISMA guidelines. The authors searched databases such as Medline/PubMed, and the Cochrane Library using specific search keywords and Medical Subject Headings (MeSH). The methodological quality was assessed using the PEDro scale, focusing on RCTs involving adult stroke patients undergoing VR rehabilitation, with outcomes related to motor function and quality of life. Results The authors included 15 studies in our meta-analysis. VR rehabilitation offers several advantages over traditional therapy, such as enhanced feedback and increased patient motivation. Engaging VR environments helps improve focus during treatment, potentially boosting recovery from post-stroke impairments. VR therapies significantly benefit motor function, which can improve activities of daily living and overall quality of life. Conclusion VR has demonstrated efficacy in improving motor function and quality of life for stroke survivors. Future research should explore patient variability and refine intervention methods. Incorporating VR into rehabilitation programs could optimize stroke recovery outcomes.
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Affiliation(s)
| | | | - Pavani Battula
- Department of Neurology, NTR University of Health Sciences, Hyderabad
| | | | | | | | - Adel S Almutairi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arpan Das
- Department of Neurology, RG Kar Medical College and Hospital, Kolkata
| | - Yogesh Tekuru
- Department of Neurology, RVM Institute of Medical Sciences and Research Center, Laxmakkapally
| | | | | | | | - Hyma Bamba
- Internal Medicine, Government Medical College and Hospital, Chandigarh
| | - Gurmehar Singh
- Internal Medicine, Government Medical College and Hospital, Chandigarh
| | - Hritvik Jain
- Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
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Marques S, Vaughan-Graham J, Costa R, Figueiredo D. The Bobath concept (NDT) in adult neurorehabilitation: a scoping review of conceptual literature. Disabil Rehabil 2024:1-12. [PMID: 38984750 DOI: 10.1080/09638288.2024.2375054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE This scoping review aims to describe how Bobath concept is conceptualized, operationalized, and studied in adult neurorehabilitation. METHODS The Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) guidelines were adopted. Non-scientific and research articles were searched in electronic databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, ScienceDirect, and Physiotherapy Evidence Database (PEDro), with the keywords "Bobath" or "Neurodevelopmental Treatment", published in English, Spanish, and Portuguese, between 2013 and 2023. RESULTS Of the 78 publications identified, 31 articles addressed the conceptual underpinnings of Bobath concept (seven theoretical papers, seven Delphi/surveys/mixed methods studies, four qualitative studies, one scoping review, 10 letters to the editor, and two editorials), comprising five themes: (a) theoretical principles; (b) clinical principles; (c) clinical reasoning; (d) conceptualizing movement; and, current (e) evidence debate. The revised definition and the Model of Bobath Clinical Practice provide a clarification of the unique aspects of Bobath concept. A new clinical skill was identified beyond facilitation - visuospatial kinesthetic perception - as well as how Bobath experts conceptualize movement, which are all integral to clinical reasoning. CONCLUSIONS This review provides an updated Bobath clinical framework that gathers the theoretical foundations and clinical practice principles that require careful consideration in the design of future intervention studies.Implications for rehabilitationThis scoping review consolidates the clinical and theoretical principles of contemporary Bobath practice, providing a clear framework for clinicians.The Model of Bobath Clinical Practice (MBCP) framework enables detailed documentation of movement analysis and movement diagnosis, guiding clinical reasoning and interventions.This review identifies fundamental principles and practices to inform future Bobath intervention studies, ensuring their clinical relevance.A framework with specific recommendations has been developed to guide Bobath intervention studies, enhancing the integration of clinical practice, education, and research.
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Affiliation(s)
- Sofia Marques
- Department of Medical Sciences, CINTESIS@RISE, IbiMED, University of Aveiro, Aveiro, Portugal
| | - Julie Vaughan-Graham
- Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Rui Costa
- IbiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Hernan G, Ingale N, Somayaji S, Veerubhotla A. Virtual Reality-Based Interventions to Improve Balance in Patients with Traumatic Brain Injury: A Scoping Review. Brain Sci 2024; 14:429. [PMID: 38790408 PMCID: PMC11119161 DOI: 10.3390/brainsci14050429] [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: 03/26/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Virtual reality (VR)-based interventions to improve balance and mobility are gaining increasing traction across patient populations. VR-based interventions are believed to be more enjoyable and engaging for patients with traumatic brain injury. This scoping review aims to summarize existing studies from the literature that used VR to improve balance and mobility and determine the gap in VR-based balance literature specific to individuals with traumatic brain injury. METHODS Two authors independently searched the literature using the search terms "Virtual Reality Traumatic Brain Injury Lower Limb", "Virtual Reality Traumatic Brain Injury Balance", and "Virtual Reality Traumatic Brain Injury Gait". RESULTS A total of seventeen studies, specifically, three randomized controlled trials, one one-arm experimental study, two retrospective studies, two case studies, one feasibility/usability study, one cohort study, and seven diagnostic (validation) studies, met the inclusion criteria for this review. The methodological quality of the studies evaluated using the PEDro scale was fair. DISCUSSION Future studies should focus on large-scale clinical trials using validated technology to determine its effectiveness and dose-response characteristics. Additionally, standard assessment tools need to be selected and utilized across interventional studies aimed at improving balance and mobility to help compare results between studies.
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Affiliation(s)
| | | | | | - Akhila Veerubhotla
- Department of Rehabilitation Medicine, Grossman School of Medicine, New York University, New York, NY 10016, USA; (G.H.); (N.I.); (S.S.)
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Li C, Chen Y, Tu S, Lin J, Lin Y, Xu S, Wu M, Xie Y, Jia J. Dual-tDCS combined with sensorimotor training promotes upper limb function in subacute stroke patients: A randomized, double-blinded, sham-controlled study. CNS Neurosci Ther 2024; 30:e14530. [PMID: 37994674 PMCID: PMC11017427 DOI: 10.1111/cns.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Dual transcranial direct current stimulation (tDCS) over the bilateral primary somatosensory cortex (PSC) has potential benefits in stroke. In addition, compared with traditional rehabilitation training, sensorimotor training can significantly improve the sensorimotor function of patients. However, the efficacy of dual-tDCS combined with sensorimotor training in patients with subacute stroke is unknown. OBJECTIVE To assess whether dual-tDCS may enhance the efficacy of sensorimotor training on the upper limb functions in patients with subacute stroke. In addition, this study aims to explore the potential clinical mechanism of this combination therapy. METHODS We randomized 52 individuals with first-ever, unilateral subcortical stroke into the experimental group (n = 26) and the control group (n = 26). Patients in the experimental group received 20 min of dual-tDCS over the PSC and 40 min of sensorimotor training each session, while patients in the control group received sham dual-tDCS. The treatment cycle was a 1-h session of therapy each day, 5 days per week for 4 weeks. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), Box and Block test (BBT), Erasmus MC revised Nottingham sensory assessment scale (Em-NSA), Neurometer sensory nerve quantitative detector (CPT), the Barthel index (BI), and Hospital Anxiety and Depression Scale (HADS) were used to assess upper limb function, activities of daily living (ADL), and mental health before and after the 4-week treatment period. In addition, functional near-infrared spectroscopy (fNIRS) was used to explore potential clinical brain mechanisms. RESULTS Both groups showed significant improvement in all clinical scales (All p < 0.05) after treatment. Compared with sham-tDCS plus sensorimotor training, active dual-tDCS coupled with sensorimotor training can significantly improve the FMA-UE, ARAT, Em-NSA-Stereognosis, and CPT-2K Hz. In addition, dual-tDCS combined with sensorimotor training can significantly activate the left pre-Motor and supplementary motor cortex (PM-SMC) and enhance the functional connection between the left somatosensory association cortex (SAC) and RPM-SMC. Furthermore, the difference of FMA-UE in the experimental group was positively correlated with the functional connectivity of RPM-SMC-LSAC (r = 0.815, p < 0.001). CONCLUSION Dual-tDCS over the PSC combined with sensorimotor training can improve upper limb sensory and motor dysfunction, enhance ADL, and alleviate depression and anxiety for subacute stroke patients. Our results indicated that RPM-SMC-LSAC may be potential therapeutic targets for dual-tDCS in upper limb rehabilitation on stroke.
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Affiliation(s)
- Chong Li
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Yun Chen
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Shuting Tu
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Jiaying Lin
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Yifang Lin
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Shuo Xu
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Maohou Wu
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Yong Xie
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
| | - Jie Jia
- Department of Rehabilitation MedicineFirst Affiliated Hospital of Fujian Medical UniversityFujianChina
- Fujian Branch of Huashan HospitalFudan UniversityFujianChina
- National Clinical Research Center for Aging and Medicine, Huashan HospitalFudan UniversityShanghaiChina
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Jeong T, Chung Y. The effects of visual information deprivation and feedback balance training on balance in patients with stroke. NeuroRehabilitation 2024; 54:435-448. [PMID: 38607770 DOI: 10.3233/nre-230358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Patients with stroke depend on visual information due to balance deficits. Therefore, it is believed that appropriate visual deprivation training could have an impact on improving balance abilities. OBJECTIVE The purpose of this study was to compare the effects of balance training performed in visual deprivation and feedback conditions on balance in stroke survivors. METHODS The 39 participants were randomly assigned to either the Visual Deprivation Group (VDG; n = 13), the Visual Feedback Group (VFG; n = 13), or the Control Group (CG; n = 13). The training sessions were conducted five times a week for three weeks. Participants completed the Berg Balance Scale (BBS), Timed Up and Go test (TUG), Four Square Step Test (FSST), and Limit of Stability (LOS) assessments. RESULTS The VDG showed significant improvements in BBS, FSST, TUG, and LOS. In VFG, significant improvements were observed in BBS and TUG. There were statistically significant differences among the groups in all variables related to balance. CONCLUSION The results of this study suggest that balance training under visual deprivation is effective in improving static and dynamic balance and gait in patients with stroke. In other words, patients with stroke need to reduce their over-reliance on visual information.
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Affiliation(s)
- Taewoong Jeong
- Department of Physical Therapy, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Yijung Chung
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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Villa MC, Geminiani GC, Zettin M, Cicerale A, Ronga I, Duca S, Sacco K. Re-learning mental representation of walking after a brain lesion. Effects of a cognitive-motor training with a robotic orthosis. Front Neurorobot 2023; 17:1177201. [PMID: 37583648 PMCID: PMC10425221 DOI: 10.3389/fnbot.2023.1177201] [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: 03/01/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Stroke-related deficits often include motor impairments and gait dysfunction, leading to a limitation of social activities and consequently affecting the quality of life of stroke survivors. Neurorehabilitation takes advantage of the contribution of different techniques in order to achieve more benefits for patients. Robotic devices help to improve the outcomes of physical rehabilitation. Moreover, motor imagery seems to play a role in neurological rehabilitation since it leads to the activation of the same brain areas as actual movements. This study investigates the use of a combined physical and cognitive protocol for gait rehabilitation in stroke patients. Methods Specifically, we tested the efficacy of a 5-week training program using a robotic orthosis (P.I.G.R.O.) in conjunction with motor imagery training. Twelve chronic stroke patients participated in the study. We evaluated balance and gait performance before and after the training. Six of them underwent fMRI examination before and after the training to assess the effects of the protocol on brain plasticity mechanisms in motor and imagery tasks. Results Our results show that the rehabilitation protocol can effectively improve gait performance and balance and reduce the risk of falls in stroke patients. Furthermore, the fMRI results suggest that rehabilitation is associated with cerebral plastic changes in motor networks. Discussion The present findings, if confirmed by future research, have the potential to advance the development of new, more effective rehabilitation approaches for stroke patients, improving their quality of life and reducing the burden of stroke-related disability.
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Affiliation(s)
- Maria-Chiara Villa
- BraIn Plasticity and Behavior Changes (BIP) at Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
- Clinical Psychology Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giuliano C. Geminiani
- BraIn Plasticity and Behavior Changes (BIP) at Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
- Clinical Psychology Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Marina Zettin
- BraIn Plasticity and Behavior Changes (BIP) at Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
- Centro Puzzle-Rehabilitation of Acquired Brain Damages, Turin, Italy
| | - Alessandro Cicerale
- BraIn Plasticity and Behavior Changes (BIP) at Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
| | - Irene Ronga
- BraIn Plasticity and Behavior Changes (BIP) at Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
| | - Sergio Duca
- Department of Environment, Land and Infrastructure Engineering (DIATI), Polytechnic of Turin, Turin, Italy
- Neuroradiology Unit, Koelliker Hospital, Turin, Italy
| | - Katiuscia Sacco
- BraIn Plasticity and Behavior Changes (BIP) at Department of Psychology and Neuroscience Institute of Turin (NIT), University of Turin, Turin, Italy
- Clinical Psychology Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Centro Puzzle-Rehabilitation of Acquired Brain Damages, Turin, Italy
- Department of Environment, Land and Infrastructure Engineering (DIATI), Polytechnic of Turin, Turin, Italy
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Berger DJ, d'Avella A. Exposure to an incompatible virtual surgery impacts the null space components of the muscle patterns after re-adaptation but not the task performance. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082698 DOI: 10.1109/embc40787.2023.10340277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Under the synergy hypothesis, novel muscle synergies may be required for motor skill learning. We have developed a "virtual surgery" experimental paradigm that alters the mapping of muscle activations onto virtual cursor motion during an isometric reaching task using myoelectric control. By creating virtual surgeries that are "incompatible" with the original synergies, we can investigate learning new muscle synergies in controlled experimental conditions. We have previously shown that participants are able to improve their task performance after an incompatible virtual surgery, using novel muscle patterns to overcome the perturbation. In this work, we investigated whether the activation of novel muscle patterns, that are required after an incompatible virtual surgery, affects task performance or the muscle patterns after re-adaptation to the unperturbed baseline mapping. We found that experiencing an incompatible virtual surgery did not affect the task performance during the baseline mapping. However, the adaptation to the incompatible virtual surgery resulted in changes in the null space components of the muscle patterns used in the unperturbed task.
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Choi W, Lee J, Lee S. Effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with chronic stroke: A randomized pilot study. J Back Musculoskelet Rehabil 2023; 36:79-86. [PMID: 35938238 DOI: 10.3233/bmr-200046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with stroke have hypomobility in the facet joint of affected side. Lumbar joint mobilization could be used to maintain function and mobility of the joints. OBJECTIVE This study aimed to investigate the effects of lumbar joint mobilization on trunk function, postural balance, and gait in patients with stroke. METHODS Thirty patients with stroke were randomly assigned to two groups. Lumbar joint mobilization was provided for 15 min, 5 times a week for 6 weeks to patients who were allocated into the experimental group. Patients who were allocated into the control group received a sham intervention. Trunk function (trunk impairment scale), postural balance (weight distribution, Berg balance scale, and timed up and go test), and walking (10 m walk test, functional gait assessment, step length, and stride length) were evaluated before and after the experiment for all the patients. RESULTS Lumbar joint mobilization significantly improved trunk function, postural balance, and gait compared with pre-test values in the experimental group (P< 0.05). Significant differences were seen in trunk function, postural balance, and walking between the two groups (P< 0.05). CONCLUSION Lumbar joint mobilization might be an effective intervention for trunk function, postural balance, and walking in patients with stroke.
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Affiliation(s)
- Wonjae Choi
- Department of Physical Therapy, Joongbu University, Geumsan-gun, Chungcheongnam-do, Korea
| | - Jieun Lee
- Department of Physical Therapy, Graduate School of Sahmyook University, Seoul, Korea
| | - Seungwon Lee
- Department of Physical Therapy, Joongbu University, Geumsan-gun, Chungcheongnam-do, Korea.,Department of Physical Therapy, Sahmyook University, Seoul, Korea
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Alwhaibi RM, Mahmoud NF, Zakaria HM, Ragab WM, Al Awaji NN, Elserougy HR. Effect of compressive therapy on sensorimotor function of the more affected upper extremity in chronic stroke patients: A randomized clinical trial. Medicine (Baltimore) 2022; 101:e30657. [PMID: 36197197 PMCID: PMC9509044 DOI: 10.1097/md.0000000000030657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Common upper extremity (UE) physical impairments after stroke include paresis, abnormal muscle tone, and somatosensory affection. This study evaluated the effect of passive somatosensory stimulation using compressive therapy on sensorimotor function of the more affected UE in chronic stroke patients. METHODS Forty chronic stroke patients were enrolled in this study. They were randomized into 2 groups: Gr1 and Gr2. Three patients dropped out leaving us with a total of 37 patients completing the study. Gr1 received UE motor program for the more affected UE along with sham electrical stimulation while Gr2 had the same UE motor program along with passive somatosensory stimulation. The session duration in both groups was 85 min. Gr1 and Gr2 received a total of 36 sessions for 6 successive weeks. UE function in Gr1 and Gr2 was examined, before and after treatment using Box and Block test (BBT) and Perdue Pegboard test (PPBT) as measures of motor of both the more affected and less affected UE while the Nottingham sensory assessment (NSA) scale was used as a measure of sensory function of the more affected UE. RESULTS There were significant improvements in motor and sensory function of the more affected UE compared to the less affected UE in both groups, measured by the BBT, PPBT, and NSA scales post-treatment (P < .05). However, the comparison between both groups regarding improvement revealed no significant change (P > .05). CONCLUSION Upper extremity motor and passive somatosensory stimulation techniques are effective in improving sensorimotor function of the more affected UE, but none of them had the advantage over the other, in terms of improving motor and sensory function in chronic stroke patients.
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Affiliation(s)
- Reem M Alwhaibi
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Noha F Mahmoud
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Hoda M Zakaria
- Department of Neuromuscular Disorders and its Surgery, College of Physical Therapy, Cairo University, Cairo 12613, Egypt
| | - Walaa M Ragab
- Department of Neuromuscular Disorders and its Surgery, College of Physical Therapy, Cairo University, Cairo 12613, Egypt
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia
| | - Nisreen N Al Awaji
- Health Communication Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi, Arabia
| | - Hager R Elserougy
- Department of Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza 77, Egypt
- * Correspondence: Hager R. Elserougy, Department of Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza 77, Egypt (e-mail: )
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11
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Jia J. Exploration on neurobiological mechanisms of the central–peripheral–central closed-loop rehabilitation. Front Cell Neurosci 2022; 16:982881. [PMID: 36119128 PMCID: PMC9479450 DOI: 10.3389/fncel.2022.982881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Central and peripheral interventions for brain injury rehabilitation have been widely employed. However, as patients’ requirements and expectations for stroke rehabilitation have gradually increased, the limitations of simple central intervention or peripheral intervention in the rehabilitation application of stroke patients’ function have gradually emerged. Studies have suggested that central intervention promotes the activation of functional brain regions and improves neural plasticity, whereas peripheral intervention enhances the positive feedback and input of sensory and motor control modes to the central nervous system, thereby promoting the remodeling of brain function. Based on the model of a central–peripheral–central (CPC) closed loop, the integration of center and peripheral interventions was effectively completed to form “closed-loop” information feedback, which could be applied to specific brain areas or function-related brain regions of patients. Notably, the closed loop can also be extended to central and peripheral immune systems as well as central and peripheral organs such as the brain–gut axis and lung–brain axis. In this review article, the model of CPC closed-loop rehabilitation and the potential neuroimmunological mechanisms of a closed-loop approach will be discussed. Further, we highlight critical questions about the neuroimmunological aspects of the closed-loop technique that merit future research attention.
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Affiliation(s)
- Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Regional Medical Center, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fujian, China
- *Correspondence: Jie Jia,
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12
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Al-Whaibi RM, Al-Jadid MS, ElSerougy HR, Badawy WM. Effectiveness of virtual reality-based rehabilitation versus conventional therapy on upper limb motor function of chronic stroke patients: a systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract 2021; 38:2402-2416. [PMID: 34315320 DOI: 10.1080/09593985.2021.1941458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To systematically review the available randomized controlled trials in the literature concerning the application of virtual reality (VR) rehabilitation interventions compared to conventional physical therapy, in regaining the upper limb motor function among patients with chronic stroke. Methods: A systematic electronic database search was conducted for related studies published from inauguration and until June 25, 2020 in nine databases. Another new search was done on February 1, 2021 and no new studies were identified. Results: Six studies were included in the analysis. Significant improvement was seen following the VR therapy in patients with chronic stroke, compared to their scores prior to it (SMD = 0.28; 95% CI = 0.03-0.53; p = .03). There was neither heterogeneity (I2 = 0% and P = .5) nor a risk of bias (P = .8) among the included studies. VR interventions produced a comparable effectiveness to that of the conventional rehabilitation, with no statistically significant difference (SMD = 0.15; 95% CI = -0.14-0.44; P = .3). There was neither heterogeneity (I2 = 40% and P = .1) nor a risk of bias (P = .5) among the included studies. Conclusions: The upper limb motor function of patients with chronic stroke who underwent VR-based rehabilitative intervention showed significant improvement as compared to the pre-treatment state. Our analysis also revealed no superiority of VR interventions over conservative therapies; however, the difference observed did not accomplish statistical significance.
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Affiliation(s)
- Reem M Al-Whaibi
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Maher S Al-Jadid
- Rehabilitation Medicine Department, Prince Sultan Military Medical School, Riyadh, Saudi Arabia
| | - Hager R ElSerougy
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Wanees M Badawy
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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13
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Impact of Somatosensory Training on Neural and Functional Recovery of Lower Extremity in Patients with Chronic Stroke: A Single Blind Controlled Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020583. [PMID: 33445588 PMCID: PMC7826555 DOI: 10.3390/ijerph18020583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/23/2022]
Abstract
Recovery of lower extremity (LE) function in chronic stroke patients is considered a barrier to community reintegration. An adequate training program is required to improve neural and functional performance of the affected LE in chronic stroke patients. The current study aimed to evaluate the effect of somatosensory rehabilitation on neural and functional recovery of LE in stroke patients. Thirty male and female patients were recruited and randomized to equal groups: control group (GI) and intervention group (GII). All patients were matched for age, duration of stroke, and degree of motor impairment of the affected LE. Both groups received standard program of physical therapy in addition to somatosensory rehabilitation for GII. The duration of treatment for both groups was eight consecutive weeks. Outcome measures used were Functional Independent Measure (FIM) and Quantitative Electroencephalography (QEEG), obtained pre- and post-treatment. A significant improvement was found in the FIM scores of the intervention group (GII), as compared to the control group (GI) (p < 0.001). Additionally, QEEG scores improved within the intervention group post-treatment. QEEG scores did not improve within the control group post-treatment, except for “Cz-AR”, compared to pretreatment, with no significant difference between groups. Adding somatosensory training to standard physical therapy program results in better improvement of neuromuscular control of LE function in chronic stroke patients.
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14
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Yilmazer C, Boccuni L, Thijs L, Verheyden G. Effectiveness of somatosensory interventions on somatosensory, motor and functional outcomes in the upper limb post-stroke: A systematic review and meta-analysis. NeuroRehabilitation 2019; 44:459-477. [PMID: 31256086 DOI: 10.3233/nre-192687] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research mainly focuses on motor recovery of the upper limb after stroke. Less attention has been paid to somatosensory recovery. OBJECTIVE To review and summarize the effect of upper limb somatosensory interventions on somatosensory impairment, motor impairment, functional activity and participation after stroke. METHODS Biomedical databases Ovid Medline, EMBASE, Web of Science, PEDro, and OTseeker were searched with an update in May 2018. Randomized controlled trials investigating the effect of somatosensory-specific interventions focusing on exteroceptive, proprioceptive or higher cortical somatosensory dysfunction, or any combination were eligible for inclusion. Quality of included studies were assessed using Physiotherapy Evidence Database (PEDro) scale. Standardized Mean Differences and Mean Differences and 95% confidence intervals were calculated and combined in meta-analyses. RESULTS Active somatosensory interventions did not show a significant effect on somatosensation and activity, but demonstrated a significant improvement in motor impairment (SMD = 0.73, 95% CI = 0.14 to 1.32). No study evaluating active somatosensory intervention included participation. Passive somatosensory interventions significantly improved light touch sensation (SMD = 1.13, 95% CI = 0.20 to 2.05). Passive somatosensory interventions did not show significant effects on proprioception and higher cortical somatosensation, motor impairment, activity and participation. CONCLUSIONS To date, there is low quality evidence suggesting active somatosensory interventions having a beneficial effect on upper limb impairment and very low quality evidence suggesting passive somatosensory interventions improving upper limb light touch sensation. There is a need for further well-designed trials of somatosensory rehabilitation post stroke.
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Affiliation(s)
- Cigdem Yilmazer
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Leonardo Boccuni
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Liselot Thijs
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Geert Verheyden
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
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15
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Junior VADS, Santos MDS, Ribeiro NMDS, Maldonado IL. Combining Proprioceptive Neuromuscular Facilitation and Virtual Reality for Improving Sensorimotor Function in Stroke Survivors: A Randomized Clinical Trial. J Cent Nerv Syst Dis 2019; 11:1179573519863826. [PMID: 31384139 PMCID: PMC6659177 DOI: 10.1177/1179573519863826] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 06/23/2019] [Indexed: 12/31/2022] Open
Abstract
Aim: To assess a program combining virtual reality (VR) games and proprioceptive
neuromuscular facilitation (PNF) and to compare it with the standalone
techniques in stroke survivors. Methods: A randomized controlled clinical trial. A total of 48 participants were
recruited in the outpatient clinic of a University Hospital in Salvador,
Brazil. They were randomly assigned to 3 groups (n = 16 each): PNF, VR, and
PNF/VR. Participants attended twice-weekly 50-minute sessions over a 2-month
period. The PNF/VR group performed both PNF and VR exercises employing
Nintendo Wii electronic games. Motor performance was assessed before and
immediately after the treatment using the Fugl-Meyer Assessment scale. Results: An improvement in the mean scores was observed after treatment independent of
the allocation group with significant intragroup changes: 14.5, 10.5, and
10.4 for PNF, VR, and PNF/VR, respectively. Score changes were also observed
in the analyses of specific sections as follows: (1) a significant
improvement in the passive movement and pain score was observed in the PNF
and PNF/VR groups; (2) the same was observed for the motor function of the
upper limb in all groups, for the motor function of the lower limb in the VR
group and for balance in the PNF and PNF/VR groups. Conclusions: The use of a program combining virtual rehabilitation and PNF presented
results that were comparable with those obtained with the isolated
techniques.
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Affiliation(s)
- Vitor Antônio Dos Santos Junior
- Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Matheus de Sales Santos
- Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Nildo Manoel da Silva Ribeiro
- Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil.,Unidade de Reabilitação, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Departamento de Fisioterapia, Instituto de Ciências da Saúde and Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Igor Lima Maldonado
- Divisão de Neurologia e Epidemiologia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.,Unidade Neuro-Músculo-Esquelética, Serviço de Neurocirurgia, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Departamento de Biomorfologia, Instituto de Ciências da Saúde and Unidade Neuro-Músculo-Esquelética, Complexo Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil.,Le Studium Loire Valley Institute for Advanced Studies, Orléans, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
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16
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Lim C. Multi-Sensorimotor Training Improves Proprioception and Balance in Subacute Stroke Patients: A Randomized Controlled Pilot Trial. Front Neurol 2019; 10:157. [PMID: 30881333 PMCID: PMC6407432 DOI: 10.3389/fneur.2019.00157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/07/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction: The objective was to determine whether advanced rehabilitation therapy combined with conventional rehabilitation therapy consisting of sensorimotor exercises would be superior to usual treadmill training for proprioception variation and balance ability in subacute stroke patients. Methods: Thirty subjects (post-stroke time period: 3.96 ± 1.19 months) were randomly assigned to either a multi-sensorimotor training group (n = 19) or a treadmill training group (n = 18). Both groups first performed conventional physical therapy for 30 min, after which the multi-sensorimotor training group performed multi-sensorimotor training for 30 min, and the treadmill training group performed treadmill gait training for 30 min. Both groups performed the therapeutic interventions 5 days per week for 8 weeks. The primary outcome (proprioception variation) was evaluated using an acryl panel and electrogoniometer. The secondary outcome (balance ability) was measured using the Biodex Balance system before intervention and after 8 weeks. Results: The multi-sensorimotor training and treadmill training groups showed significant improvement in proprioception variation and balance (overall, A-P and M-L) (all P < 0.05). In particular, the multi-sensorimotor training group showed more significant differences in proprioception variation (P = 0.002) and anterior-posterior (A-P) balance ability (P = 0.033) than the treadmill training group. Conclusions: The multi-sensorimotor training program performed on multiple types of sensory input had a beneficial effect on proprioception sense in the paretic lower limb and A-P balance. A large-scale randomized controlled study is needed to prove the effect of this training. Clinical Trial Registration:https://cris.nih.go.kr/cris/, identifier KCT0003097.
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Affiliation(s)
- Chaegil Lim
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon, South Korea
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17
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Holt K, Niazi IK, Nedergaard RW, Duehr J, Amjad I, Shafique M, Anwar MN, Ndetan H, Turker KS, Haavik H. The effects of a single session of chiropractic care on strength, cortical drive, and spinal excitability in stroke patients. Sci Rep 2019; 9:2673. [PMID: 30804399 PMCID: PMC6389925 DOI: 10.1038/s41598-019-39577-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/25/2019] [Indexed: 12/11/2022] Open
Abstract
The objective of this study was to investigate whether a single session of chiropractic care could increase strength in weak plantar flexor muscles in chronic stroke patients. Maximum voluntary contractions (strength) of the plantar flexors, soleus evoked V-waves (cortical drive), and H-reflexes were recorded in 12 chronic stroke patients, with plantar flexor muscle weakness, using a randomized controlled crossover design. Outcomes were assessed pre and post a chiropractic care intervention and a passive movement control. Repeated measures ANOVA was used to asses within and between group differences. Significance was set at p < 0.05. Following the chiropractic care intervention there was a significant increase in strength (F (1,11) = 14.49, p = 0.002; avg 64.2 ± 77.7%) and V-wave/Mmax ratio (F(1,11) = 9.67, p = 0.009; avg 54.0 ± 65.2%) compared to the control intervention. There was a significant strength decrease of 26.4 ± 15.5% (p = 0.001) after the control intervention. There were no other significant differences. Plantar flexor muscle strength increased in chronic stroke patients after a single session of chiropractic care. An increase in V-wave amplitude combined with no significant changes in H-reflex parameters suggests this increased strength is likely modulated at a supraspinal level. Further research is required to investigate the longer term and potential functional effects of chiropractic care in stroke recovery.
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Affiliation(s)
- Kelly Holt
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
- Health & Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
- SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Jens Duehr
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Imran Amjad
- Riphah International University, Islamabad, Pakistan
| | | | | | - Harrison Ndetan
- University of North Texas Health Science Center, Tylers, Texas, USA
| | | | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand.
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18
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Khalifeloo M, Naghdi S, Ansari NN, Akbari M, Jalaie S, Jannat D, Hasson S. A study on the immediate effects of plantar vibration on balance dysfunction in patients with stroke. J Exerc Rehabil 2018; 14:259-266. [PMID: 29740561 PMCID: PMC5931163 DOI: 10.12965/jer.1836044.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/14/2018] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to estimate the immediate effects of plantar vibration, applied to the more affected foot, on balance impairment in patients post-stroke. This pretest-posttest clinical study included 18 patients (13 men) poststroke; mean age 56.0±8.9 years (range, 41-71 years). One session of 5-min vibratory stimuli (frequency, 100 Hz) was applied to the plantar region of the more affected foot of all participants. The plantar vibration significantly improved the Timed UP and Go test (P=0.03, Cohen d=0.15), ankle plantar flexor muscle spasticity (P=0.008), and ankle passive range of motion (P<0.001, Cohen d=0.74). The posturography measures and Functional Reach Test did not improve significantly (P>0.05). Vibration stimuli applied to the plantar region of the more affected foot had significant effects on spasticity, ankle passive range of motion and dynamic balance as evaluated by the Timed Up and Go test in patients poststroke. There was no effect on static balance performance. Based on the results, the focal vibratory stimuli applied directly to the plantar region of the more affected foot may be recommended to improve the functional mobility and dynamic balance in patients with stroke.
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Affiliation(s)
- Maede Khalifeloo
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran,
Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran,
Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran,
Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran,
Iran
- Corresponding author: Soofia Naghdi, https://orcid.org/0000-0002-5062-7747, Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences Enghelab Ave, Pich-e-shemiran, Tehran 11489, Iran, Tel: +98-2177535132, Fax: +98-2177727009, E-mail:
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran,
Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran,
Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran,
Iran
| | - Mohammad Akbari
- Department of Physical therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran,
Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran,
Iran
| | - Davood Jannat
- Industrial Engineering, Tarbiat Modares University, Tehran,
Iran
| | - Scott Hasson
- Department of Physical Therapy, Georgia Regents University, Augusta, GA,
USA
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19
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Griffin K, O'Hearn M, Franck CC, Courtney CA. Passive accessory joint mobilization in the multimodal management of chronic dysesthesia following thalamic stroke. Disabil Rehabil 2018; 41:1981-1986. [PMID: 29557687 DOI: 10.1080/09638288.2018.1450453] [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: 10/17/2022]
Abstract
Study design: Case Report. Purpose: Stroke is the most common cause of long-term disability. Dysesthesia, an unpleasant sensory disturbance, is common following thalamic stroke and evidence-based interventions for this impairment are limited. The purpose of this case report was to describe a decrease in dysesthesia following manual therapy intervention in a patient with history of right lacunar thalamic stroke. Case description: A 66-year-old female presented with tingling and dysesthesia in left hemisensory distribution including left trunk and upper/lower extremities, limiting function. Decreased left shoulder active range of motion, positive sensory symptoms but no sensory loss in light touch was found. She denied pain and moderate shoulder muscular weakness was demonstrated. Laterality testing revealed right/left limb discrimination deficits and neglect-like symptoms were reported. Passive accessory joint motion assessment of glenohumeral and thoracic spine revealed hypomobility and provoked dysesthesia. Interventions included passive oscillatory joint mobilization of glenohumeral joint, thoracic spine, ribs and shoulder strengthening. Results: After six sessions, shoulder function, active range of motion, strength improved and dysesthesia decreased. Global Rating of Change Scale was +5 and QuickDASH score decreased from 45% to 22% disability. Laterality testing was unchanged. Conclusion: Manual therapy may be a beneficial intervention in management of thalamic stroke-related dysesthesia. Implications for Rehabilitation While pain is common following thalamic stroke, patients may present with chronic paresthesia or dysesthesia, often in a hemisensory distribution. Passive movement may promote inhibition of hyperexcitable cortical pathways, which may diminish aberrant sensations. Passive oscillatory manual therapy may be an effective way to treat sensory disturbances such as paresthesias or dysesthesia.
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Affiliation(s)
- Kristina Griffin
- a Outpatient Orthopedics , Shirley Ryan Ability Lab , Chicago , IL , USA.,b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Michael O'Hearn
- b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA.,c Outpatient Orthopedics , Lakeland Health , St. Joseph , MI , USA
| | - Carla C Franck
- b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
| | - Carol A Courtney
- b Department of Physical Therapy , University of Illinois at Chicago , Chicago , IL , USA
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20
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Bashir S, Al-Hussain F, Wasay M, Yoo WK. The Effect of Repetitive Arm Cycling Training Priming with Transcranial Direct Current Stimulation on Post-Stroke: Pilot Study. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shahid Bashir
- Neurophysiology department, Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fawaz Al-Hussain
- Department of Neurology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Wasay
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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21
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Mozheiko EY, Prokopenko SV, Alekseevich GV. [The optimization of restoration approaches of advanced hand activity using the sensorial glove and the mCIMT method]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:101-105. [PMID: 29171497 DOI: 10.17116/jnevro2017117101101-105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To reason the choice of methods of restoration of advanced hand activity depending on severity of motor disturbance in the top extremity. MATERIAL AND METHODS Eighty-eight patients were randomized into 3 groups: 1) the mCIMT group, 2) the 'touch glove' group, 3) the control group. For assessment of physical activity of the top extremity Fugl-Meyer Assessment Upper Extremity, Nine-Hole Peg Test, Motor Assessment Scale were used. Assessment of non-use phenomenon was carried out with the Motor Activity Log scale. RESULTS AND CONCLUSION At a stage of severe motor dysfunction, there was a restoration of proximal departments of a hand in all groups, neither method was superior to the other. In case of moderate severity of motor deficiency of the upper extremity the most effective was the method based on the principle of biological feedback - 'a touch glove'. In the group with mild severity of motor dysfunction, the best recovery was achieved in the mCIMT group.
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Affiliation(s)
- E Yu Mozheiko
- Voyno-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health care of the Russian Federation, Krasnoyarsk, Russia; Siberian Clinical Center of Federal Medical Biological Agency of Russia, Krasnoyarsk, Russia
| | - S V Prokopenko
- Voyno-Yasenetsky Krasnoyarsk State Medical University of the Ministry of Health care of the Russian Federation, Krasnoyarsk, Russia; Siberian Clinical Center of Federal Medical Biological Agency of Russia, Krasnoyarsk, Russia
| | - G V Alekseevich
- Siberian Clinical Center of Federal Medical Biological Agency of Russia, Krasnoyarsk, Russia
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22
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Vieira AI, Almeida P, Canário N, Castelo-Branco M, Nunes MV, Castro-Caldas A. Unisensory and multisensory Self-referential stimulation of the lower limb: An exploratory fMRI study on healthy subjects. Physiother Theory Pract 2017; 34:22-40. [PMID: 28862531 DOI: 10.1080/09593985.2017.1368758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The holistic view of the person is the essence of the physiotherapy. Knowledge of approaches that develop the whole person promotes better patient outcomes. Multisensory Self-referential stimulation, more than a unisensory one, seems to produce a holistic experience of the Self ("Core-Self"). OBJECTIVES (1) To analyze the somatotopic brain activation during unisensory and multisensorial Self-referential stimulus; and (2) to understand if the areas activated by multisensorial Self-referential stimulation are the ones responsible for the "Core-Self." METHODS An exploratory functional magnetic resonance imaging (fMRI) study was performed with 10 healthy subjects, under the stimulation of the lower limbs with three Self-referential stimuli: unisensory auditory-verbal, unisensory tactile-manual, and multisensory, applying the unisensory stimuli simultaneously. RESULTS Unisensory stimulation elicits bilateral activations of the temporoparietal junction (TPJ), of the primary somatosensory cortex (S1), of the primary motor cortex (BA4), of the premotor cortex (BA6) and of BA44; multisensory stimulation also elicits activity in TPJ, BA4, and BA6, and when compared with unisensory stimuli, activations were found in: (1) Cortical and subcortical midline structures-BA7 (precuneus), BA9 (medial prefrontal cortex), BA30 (posterior cingulated), superior colliculum and posterior cerebellum; and (2) Posterior lateral cortex-TPJ, posterior BA13 (insula), BA19, and BA37. Bilateral TPJ is the one that showed the biggest activation volume. CONCLUSION This specific multisensory stimulation produces a brain activation map in regions that are responsible for multisensory Self-processing and may represent the Core-Self. We recommend the use of this specific multisensory stimulation as a physiotherapy intervention strategy that might promote the Self-reorganization.
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Affiliation(s)
- Ana Isabel Vieira
- a Department of Physiotherapy, Alcoitão School of Health Sciences , Alcabideche , Portugal.,b Institute of Health Sciences, Catholic University of Portugal , Lisbon , Portugal
| | - Patrícia Almeida
- a Department of Physiotherapy, Alcoitão School of Health Sciences , Alcabideche , Portugal.,b Institute of Health Sciences, Catholic University of Portugal , Lisbon , Portugal
| | - Nádia Canário
- b Institute of Health Sciences, Catholic University of Portugal , Lisbon , Portugal.,c Visual Neuroscience Laboratory, Institute for Biomedical Imaging in Life Sciences (IBILI), ICNAS, Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - Miguel Castelo-Branco
- c Visual Neuroscience Laboratory, Institute for Biomedical Imaging in Life Sciences (IBILI), ICNAS, Faculty of Medicine , University of Coimbra , Coimbra , Portugal
| | - Maria Vânia Nunes
- b Institute of Health Sciences, Catholic University of Portugal , Lisbon , Portugal
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23
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Mikołajewska E. Bobath and traditional approaches in post-stroke gait rehabilitation in adults. BIOMEDICAL HUMAN KINETICS 2017. [DOI: 10.1515/bhk-2017-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
Study aim: The aim of this study was to compare the outcomes of a study of post-stroke gait reeducation using the Bobath neuro‑developmental treatment (NDT-Bobath) method and the traditional approach.
Material and methods: The study included 30 adult patients after ischemic stroke, aged 32-82. Patients were randomly assigned to one of the treatment groups: the study group (treated with the NDT-Bobath method combined with the traditional approach, ten sessions), and a reference group (treated with the traditional method only, ten sessions). The measurements (spatio-temporal gait parameters based on 10 m walking test: gait velocity, normalized gait velocity, cadence, normalized cadence, stride length, and normalized stride length) were administered twice: on admission (before the therapy) and after the last therapy session.
Results: Statistically significant and favorable changes in the gait velocity, cadence and stride length regarding their normalized values were observed. Moderate and high correlations among changes of assessed spatio-temporal gait parameters were observed in both groups.
Conclusions: The NDT-Bobath method may be regarded as a more effective form of gait post-stroke rehabilitation in young adults compared to traditional rehabilitation.
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Affiliation(s)
- Emilia Mikołajewska
- Department of Physiotherapy, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń , Poland
- Neurocognitive Laboratory, Centre for Modern Interdysciplinary Technologies, Nicolaus Copernicus University in Toruń , Poland
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Ham SC, Lim CG. The Effects of Robot-Assisted Gait Training with Visual Feedback on Gait, Balance and Balance Confidence in Chronic Stroke Patients. ACTA ACUST UNITED AC 2016. [DOI: 10.18857/jkpt.2016.28.2.71] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sin-Cheol Ham
- Department of Graduate School of Public Health, College of Health Science, Gachon University
| | - Chae-Gil Lim
- Department of Physical Therapy, College of Health Science, Gachon University
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Colombo R, Sterpi I, Mazzone A, Delconte C, Pisano F. Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study. Neurocase 2016; 22:191-200. [PMID: 26565132 DOI: 10.1080/13554794.2015.1109667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to determine whether a conventional robot-assisted therapy of the upper limb was able to improve proprioception and motor recovery of an individual after stroke who exhibited proprioceptive deficits. After robotic sensorimotor training, significant changes were observed in kinematic performance variables. Two quantitative parameters evaluating position sense improved after training. Range of motion during shoulder and wrist flexion improved, but only wrist flexion remained improved at 3-month follow-up. These preliminary results suggest that intensive robot-aided rehabilitation may play an important role in the recovery of sensory function. However, further studies are required to confirm these data.
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Affiliation(s)
- R Colombo
- a Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Pavia , Italy.,b Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
| | - I Sterpi
- a Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Pavia , Italy
| | - A Mazzone
- b Service of Bioengineering , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
| | - C Delconte
- c Neurologic Rehabilitation Division , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
| | - F Pisano
- c Neurologic Rehabilitation Division , "Salvatore Maugeri" Foundation, IRCCS , Veruno , NO , Italy
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Castel-Lacanal E. Sites of electrical stimulation used in neurology. Ann Phys Rehabil Med 2015; 58:201-207. [PMID: 26183200 DOI: 10.1016/j.rehab.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 11/29/2022]
Abstract
Rehabilitation aims to decrease neurological impairments, in guiding plasticity. Electrical stimulation has been used for many years in rehabilitation treatment of neurological disabilities as a tool for neuromodulation inducing plasticity, although the mechanisms of its action are not well known. The applications vary, encompassing therapeutic and rehabilitative aims. The type and site of stimulation vary depending on the objectives. Some techniques are widely used in clinical practice; others are still in the research stage. They may be invasive, epidural or in direct contact with neurons; they may be noninvasive, applied transcutaneously or indirectly by current vectors. The indications vary: mobility, functionality, pain as well as pharyngeal, respiratory, and perineal function. This paper aims to summarize current data on electrical neuromodulation techniques used in neurorehabilitation, their effects and their mechanisms of action.
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Affiliation(s)
- E Castel-Lacanal
- Inserm U 825, CHU Purpan, Pavillon Baudot, place du Dr-Baylac, 31024 Toulouse cedex 3, France; Service de Médecine Physique et Réadaptation, CHU Rangueil, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France.
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Zheng CJ, Liao WJ, Xia WG. Effect of combined low-frequency repetitive transcranial magnetic stimulation and virtual reality training on upper limb function in subacute stroke: a double-blind randomized controlled trail. ACTA ACUST UNITED AC 2015; 35:248-254. [DOI: 10.1007/s11596-015-1419-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/13/2015] [Indexed: 02/01/2023]
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