[Box and block test of manual dexterity in normal subjects and in patients with multiple sclerosis]

Brain-computer interface combined with mental practice and occupational therapy enhances upper limb motor recovery, activities of daily living, and participation in subacute stroke

Background

We investigated the effects of brain-computer interface (BCI) combined with mental practice (MP) and occupational therapy (OT) on performance in activities of daily living (ADL) in stroke survivors.

Methods

Participants were randomized into two groups: experimental (n = 23, BCI controlling a hand exoskeleton combined with MP and OT) and control (n = 21, OT). Subjects were assessed with the functional independence measure (FIM), motor activity log (MAL), amount of use (MAL-AOM), and quality of movement (MAL-QOM). The box and blocks test (BBT) and the Jebsen hand functional test (JHFT) were used for the primary outcome of performance in ADL, while the Fugl-Meyer Assessment was used for the secondary outcome. Exoskeleton activation and the degree of motor imagery (measured as event-related desynchronization) were assessed in the experimental group. For the BCI, the EEG electrodes were placed on the regions of FC3, C3, CP3, FC4, C4, and CP4, according to the international 10-20 EEG system. The exoskeleton was placed on the affected hand. MP was based on functional tasks. OT consisted of ADL training, muscle mobilization, reaching tasks, manipulation and prehension, mirror therapy, and high-frequency therapeutic vibration. The protocol lasted 1 h, five times a week, for 2 weeks.

Results

There was a difference between baseline and post-intervention analysis for the experimental group in all evaluations: FIM (p = 0.001, d = 0.56), MAL-AOM (p = 0.001, d = 0.83), MAL-QOM (p = 0.006, d = 0.84), BBT (p = 0.004, d = 0.40), and JHFT (p = 0.001, d = 0.45). Within the experimental group, post-intervention improvements were detected in the degree of motor imagery (p < 0.001) and the amount of exoskeleton activations (p < 0.001). For the control group, differences were detected for MAL-AOM (p = 0.001, d = 0.72), MAL-QOM (p = 0.013, d = 0.50), and BBT (p = 0.005, d = 0.23). Notably, the effect sizes were larger for the experimental group. No differences were detected between groups at post-intervention.

Conclusion

BCI combined with MP and OT is a promising tool for promoting sensorimotor recovery of the upper limb and functional independence in subacute post-stroke survivors.

Feasibility of a mobility programme for people with dementia in the respite care setting: results of the DESKK study

BACKGROUND

Caring for people with dementia (PwD) is often challenging for caregiving relatives. Respite care (RC) is a commonly used short-term inpatient service. The provision of RC can serve as a link between home care and institutional care and can help to stabilize the care provided at home. During RC, the everyday functional skills of PwD can be improved or stabilized through systematic mobility training. However, no specific mobility programme exists for this setting. The aim of the DESKK study was to develop and test a mobility training programme for PwD in the RC setting in Germany.

METHODS

A quasi-experimental pilot study was conducted in a specialized RC centre for PwD. Qualitative and quantitative data were collected and analysed using a mixed methods design.

RESULTS

The DESKK mobility programme may be introduced in the RC setting depending on the required time and professional resources. The mobility programme had a high acceptance rate among the staff involved. Ongoing documentation of the mobility exercises were challenging. During their stay (2-4 weeks), the physical function level of the included PwD (n = 20) increased regarding leg strength, gross motor coordination, fine coordination of the fingers and hand strength.

CONCLUSIONS

The DESKK mobility programme showed a high acceptance rate by the staff and was usable in daily care routine for the most part. These aspects indicate that the programme has the potential to be successfully implemented in the RC setting. The DESKK concept is described in the form of a practice-friendly website to facilitate its use in clinical practice after its successful evaluation.

Low-cost equipment for the evaluation of reach and grasp in post-stroke individuals: a pilot study

Background

Reach–grasp movements are motor components commonly affected after stroke and directly related to the independence of these individuals. Evaluations of these activities can be performed using clinical instruments and assessed by detailed and costly kinematic analyses. The aim of this study was to develop an analysis of reach–grasp movements in post-stroke patients using a simple, inexpensive, and manageable instrument.

Results

A Mann–Whitney test was used to compare paretic and non-paretic limb motor performance. A statistically significant difference was found between the variables of total time (p = 0.02) and speed to reach target 3 (p = 0.04) for task 1, while in task 2 significance was found only in the aspect of speed to reach target 2 (p = 0.04). The correlation between clinical tests and variables of tasks was then performed using Spearman’s rank correlation coefficient. At task 1, when compared with the REACH instrument, the close target sub-item; there was a high positive correlation between the parameters of total time (p = 0.028), target velocity 3 (p = 0.028), and target acceleration 3 (p = 0.028). Another instrument that showed a high positive correlation with the target time 3 (p = 0.01) and target acceleration 3 (p = 0.028) variables was the Box and Block Test. When correlated, the data between the task 2 variables and clinical instruments did not present statistically significant data.

Conclusion

Our instrument—the Temporal Data Acquisition Instrument—TDAI—fulfilled the expected objectives and can be used as an option to evaluate the movements of reach and grasp of upper limb post-stroke, using an easy and fast application, without the need for calibration.

Trial registration Trial Registration: Research Ethics Committee of the Trairi School of Health Sciences—Number 2.625.609, approved on April 13, 2018; Brazilian Registry of Clinical Trials—RBR-4995cr approved on July 4, 2019 retrospectively registered (http://www.ensaiosclinicos.gov.br/rg/RBR-4995cr/)

DESKK Study - Development and testing of a dementia-specific respite care concept with a mobility and counselling programme: study protocol

INTRODUCTION

Specific mobility programmes can delay functional decline in people with dementia (PwD). Family caregivers (FCs) can be relieved from care-related burden by counselling services. Respite care is a short-term inpatient care service (1-8 weeks of stay). Respite care centres (RCCs) can function as support structures for dementia care arrangements through caring-based mobility training of PwD and counselling sessions for their FCs. However, no systematic mobility or counselling programmes exist in this setting in Germany or the rest of the world. The aim of the development and testing of a dementia-specific respite care concept (DESKK) study is the development and testing of an evidence-based mobility and counselling programme for PwD and their FCs that is suitable for the respite care setting.

METHODS AND ANALYSIS

A pilot-based, quasi-experimental evaluation study will be conducted in a specialised RCC for PwD. To evaluate the acceptance and usability of the development and testing of a DESKK concept, qualitative data will be collected from the RCC staff and FCs via semistandardised interviews. Quantitative data will be collected using instruments to assess effect tendencies of the concept related to mobility (PwD) and burden (FCs). Furthermore, a mixed-methods triangulation approach will be conducted.

ETHICS AND DISSEMINATION

The protocol, informed consent and accompanying material given to patients were submitted by the investigator to the Ethical Review Committee of the German Society of Nursing Science. The project was examined and finally approved on 31 January 2017 (Number: 16-27). Prior to obtaining written consent for study participation, information must be given to all of the study participants in verbal and written form. The results of the study will be presented at national and international conferences and published in peer-reviewed journals. After the concept is finalised, a practice-friendly manual will be developed in which implementation components are described for other RCCs.

TRIAL REGISTRATION NUMBER

NCT03578861.

Upper Extremity Capability Tests in Multiple Sclerosis

Multiple sclerosis is a chronic demyelinating disease. Since attacks are accompanied by psychiatric and physical disabilities, additional symptoms such as withdrawal from the social environment and psychiatric disorders are also observed. It is very important to evaluate patients adequately and correctly, to determine the disability, and treat them with appropriate clinical approach. For this reason, Expanded Disability Status Scale score and upper extremity capacity measurement tests are used in many studies by investigators. These tests provide detailed examination on the patient's upper limbs, and indirectly provide information about their cognitive function. A multi-disciplinary approach for multiple sclerosis patients is the most crucial factor in clinical follow-up and treatment success.

The use of Virtual Reality for upper limb rehabilitation of hemiparetic Stroke patients

Introduction The Stroke is a neurologic disturbs that leads to a serious impact to the functionality and the quality of life of the survivors. It is necessary to develop new tools with rehabilitation objectives, where the Virtual Reality (VR) is introduced as a useful therapeutic resource to the motor recovery, in an attractive and efficient way, restoring functions through adapted games. Objective Analyzing the therapeutic effects of the Virtual Reality (Serious Game) in the recovery of the upper limb in hemiparetic Stroke patients. Methods Quasi-experimental research type time series, there are three pre and three post-tests already accomplished around 20 VR sessions. In the assessments the following measurement instruments were used: Fugl-Meyer Scale – session of the upper limb (FMS - UL); Range of Motion (ROM) for flexion and abduction shoulder; Box and Block Test (BBT); Nine Holes and Peg Test (9HPT); the Nottingham Health Profile (NHP); and the Modified Ashworth Scale (MAS). Results Significant gains were observed in the FMS-UL tests, with increase of 25.6%; increase ROM of shoulder with 34.0% for abduction and 19% for flexion; BBT 25.0%; also reported improvement in quality of life by NHP; it did not occurred significant alterations for 9HPT nor in MAS. Conclusion Although the results found in this research are preliminary, they are indicative that the VR can contribute for the recovery of the upper limb in hemiparetic Stroke patients.

Força de preensão e destreza manual na criança com Síndrome de Down

Crianças com Síndrome de Down (SD) apresentam atraso na aquisição das habilidades motoras em relação às crianças com desenvolvimento normal, podendo interferir em atividades como a força de preensão e a destreza manual. A avaliação destas atividades pode fornecer indicadores de desempenho nas atividades diárias. O objetivo deste estudo foi analisar a correlação entre força de preensão e destreza manual em crianças com SD e crianças saudáveis com idade entre 7 e 9 anos. Participaram 26 crianças com SD, de ambos os sexos, que constituíram o Grupo SD, e 30 crianças saudáveis, compondo o Grupo Controle (GC). A avaliação da força de preensão foi realizada com o dinamômetro Jamar, e a da destreza manual pelo Teste Caixa e Blocos. O Grupo SD apresentou desempenho inferior tanto na força de preensão quanto na destreza manual, quando comparado ao GC; não houve correlação significativa entre a força de preensão e a destreza manual no Grupo SD; no GC esta correlação existiu; não houve diferença de desempenho entre os sexos para os itens avaliados; o desempenho nos testes de força de preensão e destreza manual no GC mostrou uma evolução com o decorrer da idade; no Grupo SD esta evolução não ocorreu. Conclui-se que foram encontradas diferenças no desempenho dos dois grupos, indicando características peculiares para a SD. Estes dados merecem maior investigação, uma vez que podem contribuir para a identificação de objetivos a serem considerados nos programas de estimulação.

Dinamometria de preensão manual como parâmetro de avaliação funcional do membro superior de pacientes hemiparéticos por acidente vascular cerebral

A força muscular é a valência física mais importante. É provável que exista correlação entre a força de preensão manual e outros testes para o membro superior afetado por um acidente vascular cerebral (AVC). O propósito deste estudo é analisar o valor preditivo da dinamometria de preensão manual (DPM) para recuperação do membro superior parético por AVC. Foram avaliados 43 pacientes hemiparéticos pós-AVC (60,7 anos±12,1). Vários testes (Escala de movimento da mão (EMM), Estesiometria, Teste de caixa e blocos, 9 buracos e pinos, Escala de Ashworth modificada e Índice de Barthel) foram relacionados com a DPM. Os resultados apontaram que a DPM apresenta boa correlação com EMM e, contrariamente, os testes de destreza manual, a sensibilidade e o índice de independência funcional não apresentaram valores significativos. A DPM é um teste rápido, fácil e acessível, e pode fazer parte dos protocolos de avaliação funcional do membro superior de pacientes hemiparéticos por AVC.

Evaluation of performance and personal satisfaction of the patient with spastic hand after using a volar dorsal orthosis

The performance and the satisfaction of the patient were quantitatively compared with the use of the volar dorsal orthosis in order to position the spastic hand. Thirty patients wearing the orthosis for eight hours daily were evaluated by the Canadian Occupational Performance Measure and the box and blocks test, for a three-month period. Five activities were selected (among daily life activities, productive activities, and leisure activities) by the patients, which were impaired by spasticity. There was an improvement related to performance after use of orthosis, with an average of 1.4 + or - 0.5 to 6.3 + or - 0.8 (p<0.01). Patient satisfaction average after wearing the orthosis was of 1.7 + or - 0.4 to 6.3 + or - 0.6 (p<0.01). In this casuistic, the use of orthosis for wrist and finger spasticity has shown an improvement in the functional performance and patient satisfaction.

Padronização da Multiple Sclerosis Functional Composite Measure (MSFC) na população brasileira

A Multiple Sclerosis Functional Composite Measure (MSFC) é escala para avaliação dos pacientes portadores de esclerose múltipla, desenvolvida pela National Multiple Sclerosis Society dos EUA em 1994, que envolve uma composição de três testes - 9-Hole Peg Test, Timed 25-Foot Walk e PASAT - abrangendo de maneira multidimensional as principais funções neurológicas comprometidas nestes pacientes. A MSFC foi aplicada em 91 indivíduos sadios com o objetivo de padronizá-la na população brasileira para posterior uso nos diversos centros de tratamento e pesquisa no Brasil.