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Zhang J, Mao H, Gao F, Li Y, Yang Y. Comparative study of ultrasonic-guided betamethasone local injection and extracorporeal shock wave therapy in post-stroke hemiplegic shoulder pain: a randomized clinical trial. Front Neurol 2023; 14:1158500. [PMID: 37538259 PMCID: PMC10395831 DOI: 10.3389/fneur.2023.1158500] [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: 02/04/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023] Open
Abstract
Objective This study aimed to compare the efficacy and safety of ultrasound-guided local injection (UGLI) of betamethasone around the shoulder and extracorporeal shock wave therapy (ESWT) in patients with hemiplegic shoulder pain. Method Forty-two patients with hemiplegic shoulder pain were randomly divided into the UGLI group (N = 21) and the ESWT group (N = 21). In the UGLI group, betamethasone was injected at the pain point around the shoulder under ultrasonic localization. In the ESWT group, an extracorporeal shock wave was performed at the pain points around the shoulder for 20 min of time, once a week, for 4 consecutive weeks. Both groups received rehabilitation training. The visual analog scale (VAS) evaluation was performed at baseline, 1 h, 1 week, and 1 month after treatment. Furthermore, Neer shoulder joint function scores, upper limb Fugl-Meyer assessment (FMA), modified Barthel index (MBI), Hamilton Depression Scale (HAMD), the MOS-item short-form health survey (SF-36) scores, and serum expression level of cytokine were evaluated at baseline and 1 month after treatment. Results After 1-h treatment, the UGLI group showed a greater effect on the degree of pain than the ESWT group (P = 0.017). After 4 consecutive weeks of intervention, the UGLI group showed a significant improvement in the serum level of cytokine expression compared with the ESWT group (P < 0.05). The range of motion (ROM) of the hemiplegic shoulder (P < 0.05) has no difference between the two groups (P > 0.05). Conclusion The ultrasonic-guided betamethasone local injection and extracorporeal shock wave both can improve hemiplegic shoulder pain. However, the UGLI can induce a more cytokine expression level.
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Effects of Repetitive Peripheral Magnetic Stimulation through Hand Splint Materials on Induced Movement and Corticospinal Excitability in Healthy Participants. Brain Sci 2022; 12:brainsci12020280. [PMID: 35204043 PMCID: PMC8869939 DOI: 10.3390/brainsci12020280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 01/27/2023] Open
Abstract
Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive neuromodulation technique. Magnetic fields induced by rPMS pass through almost all materials, and it has clinical applications for neurorehabilitation. However, the effects of rPMS through clothing and orthosis on induced movement and corticospinal excitability remain unclear. The aim of this study was to determine whether rPMS induces movement and enhances corticospinal excitability through hand splint materials. rPMS was applied directly to the skin (L0) and through one (L1) or two (L2) layers of splint material in 14 healthy participants at 25-Hz, 2-s train per 6 s for a total of 20 min. rPMS was delivered to the forearm with the stimulus intensity set to 1.5-times the train intensity-induced muscle contractions under the L0 condition. We recorded induced wrist movements during rPMS and motor-evoked potentials of the extensor carpi radialis pre- and post-application. The results showed that rPMS induced wrist movements in L0 and L1, and it facilitated corticospinal excitability in L0 but not in L1 and L2. This suggests that rPMS can make electromagnetic induction on periphery even when applied over clothing and orthosis and demonstrates the potential clinical applications of this technique for neurorehabilitation.
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Thomann G, de Carvalho VA. Personalized upper limb orthosis necessitates variety of tools during the development process: hemiplegic child case study. Disabil Rehabil Assist Technol 2019; 16:188-195. [PMID: 31361170 DOI: 10.1080/17483107.2019.1646820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE A design methodology for the creation of an upper-limb dynamic orthosis for children was developed in this article. For a non-negligible numerous of cases, orthoses are abandoned for many reasons: they are expensive, heavy, complicated to use, uncomfortable, non-customized, and so on. Three-dimensional (3D) printing technologies are a way to answer a lot of these issues. Moreover, virtual reality and serious games are more and more used in rehabilitation for users' motivation and sometimes for disability evaluation. MATERIALS AND METHODS Microsoft Kinect and Leap Motion technologies combined with games were manipulated to identify the user abilities. Meetings with specialists were made to develop the technical specifications of the orthosis. 3D printer was used with an iterative process for the development of the personalized orthosis. It allowed to progressively focus on the final product thanks to successive prototypes. A Polylactic Acid material was validated with specialists to verify the product reliability. RESULTS Thirteen prototypes were printed. Technical adjustments were done regarding the 3D printer technology and the molding procedure during the first development cycles. User and physiotherapists were more involved during the 4 final cycles. CONCLUSIONS A combination of design process, technological tools and technical material allowed a 67 g dynamic upper-limb orthosis to be produced, satisfying all technical specifications.Implications for rehabilitationAn iterative design process allows to quickly manufacture and test numerous physical prototypes with design team and final user.Moulding material can be used with 3D printer technologies for facilitating the personalization of the orthosis.Virtual reality and serious game are used as engineering tools to clarify the patient's abilities and needs.
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Affiliation(s)
- Guillaume Thomann
- Institute of Engineering, University of Grenoble Alpes, Grenoble, France
| | - Vinicius A de Carvalho
- Institute of Engineering, University of Grenoble Alpes, Grenoble, France.,Engenharia de Produção, UNICAMP, Limeira, Brazil
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Yao J, Sullivan JE, Dewald J. A Novel EMG-driven Functional Electrical Stimulator for Post- Stroke Individuals to Practice Activities of Daily Living. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1436-1439. [PMID: 30440662 DOI: 10.1109/embc.2018.8512543] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prior research has demonstrated that hand function can be recovered in individuals with mild stroke through an intervention that is both 'intense' and 'functional'. However, in individuals with moderate to severe post stroke hand paresis, current evidence for an effective intervention to regain hand function is almost absent. A possible contributor to such poor recovery in these individuals may be the inability to intensively practice with the paretic hand during activities of daily living (ADLs). Many ADLs require use of the paretic arm and hand. Due to post-stroke abnormal muscle synergies, functional arm movements, such as lifting or reaching, often result in unwanted activity in the wrist/finger flexors. This makes voluntary hand opening more difficult. A possible solution to enable these individuals to practice with their paretic hand in a functional context is using devices to assist hand opening. Unfortunately, most of currently available hand rehabilitation devices do not sufficiently address hand opening with the appearance of abnormal muscle synergies. We, therefore, developed a synergy resistant, electromyographic (EMG)-driven electrical stimulation device that allows for $\mathbf {Re}$liable and $\mathbf {In}$tuitive control of the hand (ReIn-Hand) opening while using the paretic arm during lifting and reaching.
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Doucet BM, Mettler JA. Pilot Study Combining Electrical Stimulation and a Dynamic Hand Orthosis for Functional Recovery in Chronic Stroke. Am J Occup Ther 2018; 72:7202345030p1-7202345030p6. [PMID: 29426393 DOI: 10.5014/ajot.2018.025007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We investigated the effect of a combined neuromuscular electrical stimulation (ES) and dynamic hand orthosis (DHO) regimen with a group of people with chronic stroke to improve performance on specific daily tasks. METHOD Four people with chronic stroke participated in an ES-DHO regimen using the affected upper extremity 5×/wk for 6 wk. Outcome measures included grip strength, range of motion (ROM), and analysis of muscle activation-deactivation during release of grasp through electromyography. Ability to perform specific daily living tasks was assessed using the Assessment of Motor and Process Skills (AMPS). RESULTS Results suggested that improvements in strength, ROM, and grasp deactivation are possible with the combined ES-DHO regimen. All participants' AMPS motor scores improved. CONCLUSIONS An ES-DHO regimen may improve motor skills needed for functional task performance in people with chronic stroke. Results should be interpreted cautiously because of the pilot nature of the study and the small sample size.
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Affiliation(s)
- Barbara M Doucet
- Barbara M. Doucet, PhD, LOTR, is Associate Professor, Department of Occupational Therapy, Health Sciences Center, School of Allied Health Professions, Louisiana State University, New Orleans;
| | - Joni A Mettler
- Joni A. Mettler, PhD, is Assistant Professor, Division of Exercise and Sport Science, Department of Health and Human Performance, Texas State University, San Marcos
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Cui BJ, Wang DQ, Qiu JQ, Huang LG, Zeng FS, Zhang Q, Sun M, Liu BL, Sun QS. Effects of a 12-hour neuromuscular electrical stimulation treatment program on the recovery of upper extremity function in sub-acute stroke patients: a randomized controlled pilot trial. J Phys Ther Sci 2015; 27:2327-31. [PMID: 26311975 PMCID: PMC4540873 DOI: 10.1589/jpts.27.2327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/16/2015] [Indexed: 11/29/2022] Open
Abstract
[Purpose] This study investigated the effects of a 12-hour neuromuscular electrical
stimulation program in the evening hours on upper extremity function in sub-acute stroke
patients. [Subjects and Methods] Forty-five subjects were randomized to one of three
groups: 12-hour neuromuscular electrical stimulation group (n=15), which received 12 hours
of neuromuscular electrical stimulation and conventional rehabilitation for the affected
upper extremity; neuromuscular electrical stimulation group (n=15), which received 30 min
of neuromuscular electrical stimulation and conventional rehabilitation; and control group
(n=15), which received conventional rehabilitation only. The Fugl-Meyer assessment, Action
Research Arm Test, and modified Ashworth scale were used to evaluate the effects before
and after intervention, and 4 weeks later. [Results] The improvement in the distal
(wrist-hand) components of the Fugl-Meyer assessment and Action Research Arm Test in the
12-hour neuromuscular electrical stimulation group was more significant than that in the
neuromuscular electrical stimulation group. No significant difference was found between
the two groups in the proximal component (shoulder-elbow) of the Fugl-Meyer assessment.
[Conclusion] The 12-hour neuromuscular electrical stimulation group achieved better
improvement in upper extremity motor function, especially in the wrist-hand function. This
alternative therapeutic approach is easily applicable and can be used in stroke patients
during rest or sleep.
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Affiliation(s)
- Bao-Juan Cui
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Dao-Qing Wang
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Jian-Qing Qiu
- Department of Obstetrics and Gynecology, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Lai-Gang Huang
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Fan-Shuo Zeng
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Qi Zhang
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Min Sun
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Ben-Ling Liu
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
| | - Qiang-San Sun
- Department of Rehabilitation, The Second Hospital of Shandong University, Shandong Univeristy, China
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Khadilkar A, Phillips K, Jean N, Lamothe C, Milne S, Sarnecka J. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Post-Stroke Rehabilitation. Top Stroke Rehabil 2015; 13:1-269. [PMID: 16939981 DOI: 10.1310/3tkx-7xec-2dtg-xqkh] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this project was to create guidelines for 13 types of physical rehabilitation interventions used in the management of adult patients (>18 years of age) presenting with hemiplegia or hemiparesis following a single clinically identifiable ischemic or hemorrhagic cerebrovascular accident (CVA). METHOD Using Cochrane Collaboration methods, the Ottawa Methods Group identified and synthesized evidence from comparative controlled trials. The group then formed an expert panel, which developed a set of criteria for grading the strength of the evidence and the recommendation. Patient-important outcomes were determined through consensus, provided that these outcomes were assessed with a validated and reliable scale. RESULTS The Ottawa Panel developed 147 positive recommendations of clinical benefit concerning the use of different types of physical rehabilitation interventions involved in post-stroke rehabilitation. DISCUSSION AND CONCLUSION The Ottawa Panel recommends the use of therapeutic exercise, task-oriented training, biofeedback, gait training, balance training, constraint-induced movement therapy, treatment of shoulder subluxation, electrical stimulation, transcutaneous electrical nerve stimulation, therapeutic ultrasound, acupuncture, and intensity and organization of rehabilitation in the management of post stroke.
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Basaran A, Emre U, Ikbal Karadavut K, Balbaloglu O, Bulmus N. Hand Splinting for Poststroke Spasticity: A Randomized Controlled Trial. Top Stroke Rehabil 2014; 19:329-37. [DOI: 10.1310/tsr1904-329] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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IJzerman MJ, Renzenbrink GJ, Geurts ACH. Neuromuscular stimulation after stroke: from technology to clinical deployment. Expert Rev Neurother 2014; 9:541-52. [DOI: 10.1586/ern.09.6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Krabben T, Buurke JH, Prange GB, Rietman JS. A feasibility study of the effect of multichannel electrical stimulation and gravity compensation on hand function in stroke patients: a pilot study. IEEE Int Conf Rehabil Robot 2013; 2013:6650370. [PMID: 24187189 DOI: 10.1109/icorr.2013.6650370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Many stroke patients have to cope with impaired arm and hand function. As a feasibility study, gravity compensation (GC) and multichannel electrical stimulation (ES) were applied to the forearm of eight stroke patients to study potential effects on dexterity. ES was triggered by positional data of the subject's hand relative to the objects that had to be grasped. Dexterity was evaluated by means of the Box and Blocks Test (BBT). The BBT was performed with four combinations of support; with and without GC and with and without ES. In all patients, it was possible to induce sufficient hand opening for grasping a block of the BBT by means of ES. There was no significant increase in dexterity as measured with the BBT. GC and/or ES did not improve instantaneous dexterity in a small sample of stroke patients although sufficient hand opening was reached in all patients. More research in a larger sample of stroke patients with more specific and more sophisticated control algorithms is needed to explore beneficial effects of GC and ES on hand function in post stroke rehabilitation.
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Neutral Functional Realignment Orthosis Prevents Hand Pain in Patients With Subacute Stroke: A Randomized Trial. Arch Phys Med Rehabil 2008; 89:1857-62. [DOI: 10.1016/j.apmr.2008.03.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 03/16/2008] [Accepted: 03/20/2008] [Indexed: 11/18/2022]
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Hu XL, Song R, Tong KY, Tsang SF, Leung OY, Li L. Coactivations of elbow and shoulder muscles in hemiplegic persons with chronic stroke during robot-assisted training. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2007; 2006:4933-5. [PMID: 17945868 DOI: 10.1109/iembs.2006.259575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The motor recovery procedure of chronic stroke during robot-assisted training has not been well studied previously. In this work, we analyzed the variations in the coactivating patterns of elbow and shoulder muscles (biceps, triceps lateral, anterior deltoid, and posterior deltoid) in hemiplegic persons with chronic stroke (n=4) during a 20-session's interactive robot-assisted treatment. Significant decreases in muscle cocontractions (P<0.05) for all muscle pairs started from the 8th session of the training. Improvements were also observed in motor scores of Fugl-Meyer and modified Ashworth scale after the treatment. The results suggested an increased dexterity and selective control on individual muscles for both elbow and shoulder joints in a designed task after the robot-assisted training.
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Affiliation(s)
- X L Hu
- Dept. of Health Technol. & Informatics, Hong Kong Polytech. Univ., China.
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