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Sjattar EL, Megawati I, Irwan AM, Majid S. Development of Supportive-Educative Range of Motion Exercise for Post-stroke Patients: A Pilot Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223211035713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this pilot study was to assess of home care intervention on post-stroke related outcome of range of motion and muscle strength. Sample in 40 participants were divided into the intervention group and control group and included in this study according to the following criteria: post-stroke period of <12 months with hemiparesis, age of ≥18 years, and willingness to participate in the study. The intervention was carried out by nurses by providing education for 2 consecutive days and mentoring for 5 consecutive days, while the control group was given standard care and measured using a grip track, handheld dynamometer, and goniometer examination on June to September 2019. For the intervention group, paired t-test analysis confirmed a significant increase in the mean upper extremity muscle strength before (35.770 ± 46.063) and after (51.073 ± 50.866) the 7 day intervention ( p = .002), whereas the control group showed a value 36.570 ± 33.684 and then 31.400 ± 31.760 p = .256 and lower extremity strength before (3.627 ± 1.585) and after (4.365 ± 1.698) the 7-days intervention ( p = .000), whereas the control group showed a value 3.657 ± 1.671 and then 4.043 ± 1.849 p = .013. Almost all the items assessed from Range of Motion (ROM) in the upper and lower extremities showed a significant increase ( p < .05). Supportive-educative ROM exercise significantly contributed to an increase in the average muscle strength and ROM in post-stroke patients.
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Affiliation(s)
| | | | | | - Sintawati Majid
- Hasanuddin University, Makassar, Indonesia
- Nurse in Enterostomal Therapy Nurse (ETN) Centre Indonesia, Makassar, Indonesia
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Joo MC, Jung KM, Kim JH, Jung YJ, Chang WN, Shin HJ. Robot-Assisted Therapy Combined with Trunk Restraint in Acute Stroke Patients: A Randomized Controlled Study. J Stroke Cerebrovasc Dis 2022; 31:106330. [PMID: 35219973 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Reducing the compensatory mechanism by restraining unnecessary trunk movements may help enhance the effectiveness of robot-assisted therapy. OBJECTIVE This study aimed to investigate the effects of robot-assisted therapy in combination with trunk restraint on upper extremity function and on daily activities in patients with acute stroke (≤ 30days of onset). METHODS Thirty-six acute stroke patients were randomly assigned to an experimental (n=18) or control (n=18) group. The experimental group performed robot-assisted therapy combined with trunk restraint, while the control group performed only robot-assisted therapy. Both groups were treated for 30 min, 5 days a week, for a total of 3 weeks. The outcome measures included the Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, upper extremity muscle strength, and modified Barthel index. RESULTS After the intervention, both groups showed significant improvements in Fugl-Meyer assessment upper extremity, wolf motor function test, motor activity log, elbow extensor muscle strength, and modified Barthel index (p < 0.05). Post-intervention, the experimental group exhibited greater changes in the Fugl-Meyer assessment upper extremity, motor activity log, and elbow extensor muscle strength (p < 0.05). CONCLUSION Our study suggests that robot-assisted therapy in combination with trunk restraint is more effective for improving upper extremity function than only robot-assisted therapy in acute stroke patients.
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Affiliation(s)
- Min-Cheol Joo
- Department of Rehabilitation Medicine and Institute of Wonkwang Medical Science, Wonkwang University School of Medicine and Hospital, Iksan, South Korea
| | - Kyeoung-Man Jung
- Department of Physical Therapy, Wonkwang University Hospital, Iksan, South Korea.
| | - Ji-Hee Kim
- Department of Rehabilitation Medicine, Wonkwang University Medical School and Hospital, Iksan, South Korea
| | - Yu-Jin Jung
- Department of Occupational Therapy, Wonkwang University Hospital, Iksan, South Korea
| | - Woo-Nam Chang
- Department of Physical Therapy, College of Health & Welfare Science, Yong-In University, Gyeonggi, South Korea
| | - Hyeon-Jin Shin
- Department of Occupational Therapy, Wonkwang University Hospital, Iksan, South Korea
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Gomez-Cuaresma L, Lucena-Anton D, Gonzalez-Medina G, Martin-Vega FJ, Galan-Mercant A, Luque-Moreno C. Effectiveness of Stretching in Post-Stroke Spasticity and Range of Motion: Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11111074. [PMID: 34834426 PMCID: PMC8619362 DOI: 10.3390/jpm11111074] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/29/2023] Open
Abstract
Spasticity is one of the most frequent and disabling clinical manifestations of patients with stroke. In clinical practice, stretching is the most widely used physiotherapeutic intervention for this population. However, there is no solid evidence for its effectiveness. The aim of this study was to evaluate the effectiveness of different types of stretching in reducing post-stroke spasticity. Research was carried out until March 2021 in the following scientific databases: PubMed, CINAHL, Scopus, Cochrane Library, Web of Science, and PEDro. The PEDro scale and the Cochrane collaboration tool were used to assess the methodological quality and risk of bias of the studies. Eight articles were selected for qualitative analysis; six of them contributed information to the meta-analysis. No conclusive evidence was obtained on the effectiveness of stretching in terms of treating spasticity and range of motion in patients with stroke. Further research is necessary in order to determine the effectiveness of the use of stretching in this population, considering the different types of stretching (static and dynamic), the time of application, the measurement of the different components of spasticity, and the extrapolation of functional results.
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Affiliation(s)
- Laura Gomez-Cuaresma
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (L.G.-C.); (G.G.-M.); (F.J.M.-V.); (A.G.-M.); (C.L.-M.)
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (L.G.-C.); (G.G.-M.); (F.J.M.-V.); (A.G.-M.); (C.L.-M.)
- Intell-SOK (TIC-256) Research Group, Department of Informatics Engineering, University of Cádiz, 11519 Cádiz, Spain
- Correspondence: ; Tel.: +34-635695203
| | - Gloria Gonzalez-Medina
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (L.G.-C.); (G.G.-M.); (F.J.M.-V.); (A.G.-M.); (C.L.-M.)
- Investigation Group CTS-986, Physical Therapy and Health (FISA), University Institute of Research in Social Sustainable Development (INDESS), University of Cádiz, 11009 Cádiz, Spain
| | - Francisco Javier Martin-Vega
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (L.G.-C.); (G.G.-M.); (F.J.M.-V.); (A.G.-M.); (C.L.-M.)
| | - Alejandro Galan-Mercant
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (L.G.-C.); (G.G.-M.); (F.J.M.-V.); (A.G.-M.); (C.L.-M.)
- MOVE-IT Research Group, Department of Physical Education, Faculty of Education, Sciences University of Cádiz, 11002 Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital, University of Cádiz, 11002 Cádiz, Spain
| | - Carlos Luque-Moreno
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cádiz, Spain; (L.G.-C.); (G.G.-M.); (F.J.M.-V.); (A.G.-M.); (C.L.-M.)
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41009 Seville, Spain
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Effectiveness of a New 3D-Printed Dynamic Hand-Wrist Splint on Hand Motor Function and Spasticity in Chronic Stroke Patients. J Clin Med 2021; 10:jcm10194549. [PMID: 34640564 PMCID: PMC8509791 DOI: 10.3390/jcm10194549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022] Open
Abstract
Spasticity, a common stroke complication, can result in impairments and limitations in the performance of activities and participation. In this study, we investigated the effectiveness of a new dynamic splint on wrist and finger flexor muscle spasticity in chronic stroke survivors, using a randomized controlled trial. Thirty chronic stroke survivors were recruited and randomly allocated to either an experimental or control group; 25 completed the 6-week intervention program. The participants in the experimental group were asked to wear the dynamic splint at least 6 h/day at home, for the entire intervention. The participants in the control group did not wear any splint. All the participants were evaluated 1 week before, immediately, and after 3 and 6 weeks of splint use, with the modified Ashworth scale and the Fugl−Meyer assessment for upper extremity. User experience was evaluated by a self-reported questionnaire after the 6-week intervention. The timed within-group assessments showed a significant reduction in spasticity and improvements in functional movements in the experimental group. We found differences, in favor of the experimental group, between the groups after the intervention. The splint users indicated a very good satisfaction rating for muscle tone reduction, comfort, and ease of use. Therefore, this new splint can be used for at-home rehabilitation in chronic stroke patients with hemiparesis.
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Abstract
Pain is common but often underrecognized after stroke. Poststroke pain (PSP) hinders recovery, impairs quality of life, and is associated with the psychological state of patients with stroke. The most common subtypes of PSP include central PSP, complex regional pain syndrome, shoulder pain, spasticity-related pain, and headache. The pathophysiologies of these PSP subtypes are not yet clearly understood, and PSP is refractory to conventional treatment in many patients. However, recent studies have proposed potential pathophysiologies of PSP subtypes, which may help prioritize therapies that target specific mechanisms.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Woman's University Seoul Hospital, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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de-la-Torre R, Oña ED, Balaguer C, Jardón A. Robot-Aided Systems for Improving the Assessment of Upper Limb Spasticity: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5251. [PMID: 32937973 PMCID: PMC7570987 DOI: 10.3390/s20185251] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/02/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022]
Abstract
Spasticity is a motor disorder that causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Traditionally, the spasticity assessment is carried out by clinicians using standardized procedures for objective evaluation. However, these procedures are manually performed and, thereby, they could be influenced by the clinician's subjectivity or expertise. The automation of such traditional methods for spasticity evaluation is an interesting and emerging field in neurorehabilitation. One of the most promising approaches is the use of robot-aided systems. In this paper, a systematic review of systems focused on the assessment of upper limb (UL) spasticity using robotic technology is presented. A systematic search and review of related articles in the literature were conducted. The chosen works were analyzed according to the morphology of devices, the data acquisition systems, the outcome generation method, and the focus of intervention (assessment and/or training). Finally, a series of guidelines and challenges that must be considered when designing and implementing fully-automated robot-aided systems for the assessment of UL spasticity are summarized.
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Affiliation(s)
| | | | | | - Alberto Jardón
- Department of Systems Engineering and Automation, University Carlos III of Madrid, Avda. de la Universidad 30, 28911 Leganés, Spain; (R.d.-l.-T.); (E.D.O.); (C.B.)
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Kerr L, Jewell VD, Jensen L. Stretching and Splinting Interventions for Poststroke Spasticity, Hand Function, and Functional Tasks: A Systematic Review. Am J Occup Ther 2020; 74:7405205050p1-7405205050p15. [DOI: 10.5014/ajot.2020.029454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: Spasticity is one of the most common and disabling motor impairments after stroke.
Objective: To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity.
Data Sources: Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017.
Study Selection and Data Collection: Following PRISMA guidelines, we included articles describing Level I–III studies with participants who were adults with upper extremity spasticity and received a stretching intervention.
Findings: Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria.
Conclusion and Relevance: For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices.
What This Article Adds: This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks.
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Affiliation(s)
- Lindsey Kerr
- Lindsey Kerr, OTD, OTR/L, was Occupational Therapy Doctoral Student, Creighton University, Omaha, NE
| | - Vanessa D. Jewell
- Vanessa D. Jewell, PhD, OTR/L, is Assistant Professor and Vice Chair of Research and Assessment, Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE;
| | - Lou Jensen
- Lou Jensen, OTD, OTR/L, C/NDT, LSVT-BIG, is Associate Professor and Regis Pathway Coordinator, Department of Occupational Therapy, School of Pharmacy and Health Professions, Creighton University, Omaha, NE
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Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. Ann Phys Rehabil Med 2018; 62:274-282. [PMID: 30582986 DOI: 10.1016/j.rehab.2018.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To systematically review the effects of static stretching with positioning orthoses or simple positioning combined or not with other therapies on upper-limb spasticity and mobility in adults after stroke. METHODS This meta-analysis was conducted according to PRISMA guidelines and registered at PROSPERO. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, Scopus and PEDro databases were searched from inception to January 2018 for articles. Two independent researchers extracted data, assessed the methodological quality and rated the quality of evidence of studies. RESULTS Three studies (57 participants) were included in the spasticity meta-analysis and 7 (210 participants) in the mobility meta-analysis. Static stretching with positioning orthoses reduced wrist-flexor spasticity as compared with no therapy (mean difference [MD]=-1.89, 95% confidence interval [CI] -2.44 to -1.34; I2 79%, P<0.001). No data were available concerning the spasticity of other muscles. Static stretching with simple positioning, combined or not with other therapies, was not better than conventional physiotherapy in preventing loss of mobility of shoulder external rotation (MD=3.50, 95% CI -3.45 to 10.45; I2 54.7%, P=0.32), shoulder flexion (MD=-1.20, 95% CI -8.95 to 6.55; I2 0%, P=0.76) or wrist extension (MD=-0.32, 95% CI -6.98 to 5.75; I2 38.5%, P=0.92). No data were available concerning the mobility of other joints. CONCLUSION This meta-analysis revealed very low-quality evidence that static stretching with positioning orthoses reduces wrist flexion spasticity after stroke as compared with no therapy. Furthermore, we found low-quality evidence that static stretching by simple positioning is not better than conventional physiotherapy for preventing loss of mobility in the shoulder and wrist. Considering the limited number of studies devoted to this issue in post-stroke survivors, further randomized clinical trials are still needed. CLINICAL TRIAL REGISTRATION PROSPERO (CRD42017078784).
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Villafañe JH, Taveggia G, Galeri S, Bissolotti L, Mullè C, Imperio G, Valdes K, Borboni A, Negrini S. Efficacy of Short-Term Robot-Assisted Rehabilitation in Patients With Hand Paralysis After Stroke: A Randomized Clinical Trial. Hand (N Y) 2018; 13:95-102. [PMID: 28719996 PMCID: PMC5755871 DOI: 10.1177/1558944717692096] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the effectiveness of robot-assisted motion and activity in additional to physiotherapy (PT) and occupational therapy (OT) on stroke patients with hand paralysis. METHODS A randomized controlled trial was conducted. Thirty-two patients, 34.4% female (mean ± SD age: 68.9 ± 11.6 years), with hand paralysis after stroke participated. The experimental group received 30 minutes of passive mobilization of the hand through the robotic device Gloreha (Brescia, Italy), and the control group received an additional 30 minutes of PT and OT for 3 consecutive weeks (3 d/wk) in addition to traditional rehabilitation. Outcomes included the National Institutes of Health Stroke Scale (NIHSS), Modified Ashworth Scale, Barthel Index (BI), Motricity Index (MI), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the visual analog scale (VAS) measurements. All measures were collected at baseline and end of the intervention (3 weeks). RESULTS A significant effect of time interaction existed for NIHSS, BI, MI, and QuickDASH, after stroke immediately after the interventions (all, P < .001). The experimental group had a greater reduction in pain compared with the control group at the end of the intervention, a reduction of 11.3 mm compared with 3.7 mm, using the 100-mm VAS scale. CONCLUSIONS In the treatment of pain and spasticity in hand paralysis after stroke, robot-assisted mobilization performed in conjunction with traditional PT and OT is as effective as traditional rehabilitation.
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Affiliation(s)
- Jorge H. Villafañe
- IRCCS Don Gnocchi Foundation, Milan, Italy,Jorge H. Villafañe, IRCCS Don Gnocchi Foundation, Regione Generala 11/16, Piossasco 10045, Italy.
| | | | | | - Luciano Bissolotti
- Fondazione Teresa Camplani-Casa di Cura Domus Salutis, Brescia, Italy,LARIN: Neuromuscular and Adapted Physical Activity Laboratory, Brescia, Italy
| | - Chiara Mullè
- Habilita, Istituto Clinico Ospedale di Sarnico, Italy
| | | | | | | | - Stefano Negrini
- IRCCS Don Gnocchi Foundation, Milan, Italy,University of Brescia, Italy
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Gras M, Leclercq C. Spasticity and hyperselective neurectomy in the upper limb. HAND SURGERY & REHABILITATION 2017; 36:391-401. [DOI: 10.1016/j.hansur.2017.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/15/2017] [Accepted: 06/13/2017] [Indexed: 10/18/2022]
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Harvey LA, Katalinic OM, Herbert RD, Moseley AM, Lannin NA, Schurr K. Stretch for the treatment and prevention of contractures. Cochrane Database Syst Rev 2017; 1:CD007455. [PMID: 28146605 PMCID: PMC6464268 DOI: 10.1002/14651858.cd007455.pub3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Contractures are a common complication of neurological and non-neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review. OBJECTIVES The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events. SEARCH METHODS In November 2015 we searched CENTRAL, DARE, HTA; MEDLINE; Embase; CINAHL; SCI-EXPANDED; PEDro and trials registries. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials of stretch applied for the purpose of treating or preventing contractures. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, and assessed risk of bias. The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions and adverse events. We evaluated outcomes in the short term (up to one week after the last stretch) and in the long term (more than one week). We expressed effects as mean differences (MD) or standardised mean differences (SMD) with 95% confidence intervals (CI). We conducted meta-analyses with a random-effects model. We assessed the quality of the body of evidence for the main outcomes using GRADE. MAIN RESULTS Forty-nine studies with 2135 participants met the inclusion criteria. No study performed stretch for more than seven months. Just over half the studies (51%) were at low risk of selection bias; all studies were at risk of detection bias for self reported outcomes such as pain and at risk of performance bias due to difficulty of blinding the intervention. However, most studies were at low risk of detection bias for objective outcomes including range of motion, and the majority of studies were free from attrition and selective reporting biases. The effect of these biases were unlikely to be important, given that there was little benefit with treatment. There was high-quality evidence that stretch did not have clinically important short-term effects on joint mobility in people with neurological conditions (MD 2°; 95% CI 0° to 3°; 26 studies with 699 participants) or non-neurological conditions (SMD 0.2, 95% CI 0 to 0.3, 19 studies with 925 participants).In people with neurological conditions, it was uncertain whether stretch had clinically important short-term effects on pain (SMD 0.2; 95% CI -0.1 to 0.5; 5 studies with 174 participants) or activity limitations (SMD 0.2; 95% CI -0.1 to 0.5; 8 studies with 247 participants). No trials examined the short-term effects of stretch on quality of life or participation restrictions in people with neurological conditions. Five studies involving 145 participants reported eight adverse events including skin breakdown, bruising, blisters and pain but it was not possible to statistically analyse these data.In people with non-neurological conditions, there was high-quality evidence that stretch did not have clinically important short-term effects on pain (SMD -0.2, 95% CI -0.4 to 0.1; 7 studies with 422 participants) and moderate-quality evidence that stretch did not have clinically important short-term effects on quality of life (SMD 0.3, 95% CI -0.1 to 0.7; 2 studies with 97 participants). The short-term effect of stretch on activity limitations (SMD 0.1; 95% CI -0.2 to 0.3; 5 studies with 356 participants) and participation restrictions were uncertain (SMD -0.2; 95% CI -0.6 to 0.1; 2 studies with 192 participants). Nine studies involving 635 participants reported 41 adverse events including numbness, pain, Raynauds' phenomenon, venous thrombosis, need for manipulation under anaesthesia, wound infections, haematoma, flexion deficits and swelling but it was not possible to statistically analyse these data. AUTHORS' CONCLUSIONS There was high-quality evidence that stretch did not have clinically important effects on joint mobility in people with or without neurological conditions if performed for less than seven months. Sensitivity analyses indicate results were robust in studies at risk of selection and detection biases in comparison to studies at low risk of bias. Sub-group analyses also suggest the effect of stretch is consistent in people with different types of neurological or non-neurological conditions. The effects of stretch performed for periods longer than seven months have not been investigated. There was moderate- and high-quality evidence that stretch did not have clinically important short-term effects on quality of life or pain in people with non-neurological conditions, respectively. The short-term effects of stretch on quality of life and pain in people with neurological conditions, and the short-term effects of stretch on activity limitations and participation restrictions for people with and without neurological conditions are uncertain.
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Affiliation(s)
- Lisa A Harvey
- Kolling Institute, Northern Sydney Local Health DistrictJohn Walsh Centre for Rehabilitation ResearchRoyal North Shore HospitalSt LeonardsNSWAustralia2065
| | - Owen M Katalinic
- Telstra HealthEmerging Systems18/9 Hoyle AvenueCastle HillNSWAustralia2154
| | - Robert D Herbert
- Neuroscience Research AustraliaBarker StreetRandwickSydneyAustralia2031
| | - Anne M Moseley
- The George Institute for Global Health, Sydney Medical School, The University of SydneyPO Box M201Missenden RdSydneyNSWAustralia2050
| | - Natasha A Lannin
- La Trobe UniversityOccupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, College of Science, Health and EngineeringMelbourneVictoriaAustralia
| | - Karl Schurr
- Bankstown HospitalPhysiotherapy DepartmentLocked Bag 1600BankstownNSWAustralia2200
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Robot-Assisted Rehabilitation of Hand Paralysis After Stroke Reduces Wrist Edema and Pain: A Prospective Clinical Trial. J Manipulative Physiol Ther 2017; 40:21-30. [DOI: 10.1016/j.jmpt.2016.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 12/12/2022]
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Lee KW, Kim SB, Lee JH, Lee SJ, Yoo SW. Effect of Upper Extremity Robot-Assisted Exercise on Spasticity in Stroke Patients. Ann Rehabil Med 2016; 40:961-971. [PMID: 28119825 PMCID: PMC5256323 DOI: 10.5535/arm.2016.40.6.961] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/01/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the efficacy of a stretching and strengthening exercise program using an upper extremity robot, as compared with a conventional occupational therapy program for upper extremity spasticity in stroke patients. METHODS Subjects were randomly divided into a robot-assisted therapy (RT) group and a conventional rehabilitation therapy (CT) group. RT group patients received RT and CT once daily for 30 minutes each, 5 days a week, for 2 weeks. RT was performed using an upper-extremity robot (Neuro-X; Apsun Inc., Seoul, Korea), and CT was administered by occupational therapists. CT group patients received CT alone twice daily for 30 minutes, 5 days a week, for 2 weeks. Modified Ashworth Scale (MAS) was used to measure the spasticity of upper extremity. Manual muscle tests (MMT), Manual Function Tests (MFT), Brunnstrom stage, and the Korean version of Modified Barthel Index (K-MBI) were used to measure the strength and function of upper extremity. All measurements were obtained before and after 2-week treatment. RESULTS The RT and CT groups included 22 subjects each. After treatment, both groups showed significantly lower MAS scores and significant improvement in the MMT, MFT, Brunnstrom stage, and K-MBI scores. Treatment effects showed no significant differences between the two groups. CONCLUSION RT showed similar treatment benefits on spasticity, as compared to CT. The study results suggested that RT could be a useful method for continuous, repeatable, and relatively accurate range of motion exercise in stroke patients with spasticity.
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Affiliation(s)
- Kyeong Woo Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Sang Beom Kim
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Jong Hwa Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Sook Joung Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
| | - Seung Wan Yoo
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine & Busan-Ulsan Regional Cardiocerebrovascular Center, Busan, Korea
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Gupta M, Lal Rajak B, Bhatia D, Mukherjee A. Effect of r-TMS over standard therapy in decreasing muscle tone of spastic cerebral palsy patients. J Med Eng Technol 2016; 40:210-6. [DOI: 10.3109/03091902.2016.1161854] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Meena Gupta
- Biomedical Engineering, North Eastern Hill University, Shillong, India
| | - Bablu Lal Rajak
- Biomedical Engineering, North Eastern Hill University, Shillong, India
| | - Dinesh Bhatia
- Biomedical Engineering, North Eastern Hill University, Shillong, India
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Wei YX, Zhao X, Zhang BC. Synergistic effect of moxibustion and rehabilitation training in functional recovery of post-stroke spastic hemiplegia. Complement Ther Med 2016; 26:55-60. [PMID: 27261982 DOI: 10.1016/j.ctim.2016.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 01/26/2016] [Accepted: 02/17/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the therapeutic benefit of combining moxibustion and rehabilitation training for functional recovery in post-stroke spastic hemiplegic patients. METHODS We randomly divided 84 cases subjecting to inclusion criteria into moxibustion plus rehabilitation training group (MRT group, n=44) and rehabilitation training group (RT group, n=40). Evaluation of therapeutic effect was observed before treatment, 2 weeks during treatment and 6 months after treatment. Spasticity was evaluated using modified Ashworth scale (MAS) and Clinical Spasticity Index (CSI), recovery of motor function was assessed by Brunnstrom recovery stages and Simplified Fugl-Meyer Motor Scale, and performance of activities of daily living (ADL) was measured, and the quality of life was assessed by Patient Reported Outcomes (PRO). RESULTS Evaluation of upper limbs, hands and lower limbs based on CSI and MAS revealed significant improvements in patients treated with MRT, compared to RT alone, both during and after therapy. CSI and MAS also showed significant improvement in patients at each time point in the MRT group, compared to RT group. Marked improvement in Fugl-Meyer Motor Scale was also observed in MRT group at each time point. Based on Brunnstrom grades of upper limbs, hands and lower limbs, significant differences between the two groups were recorded at all time points during and after therapy. Barthel index (BI) and PRO also confirmed the dramatic differences between the two therapy groups. CONCLUSIONS Our results demonstrate that combination therapy with moxibustion and rehabilitation training offers greater clinical benefits in relieving spasticity, promoting function recovery of motion, improving the performance of ADL, and increasing quality of life in post-stroke spastic hemiplegic patients, compared to RT alone.
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Affiliation(s)
- Yan-Xia Wei
- Department of Rehabilitation, the Affiliated Hospital of Zhengzhou University, Nanyang 473009, China
| | - Xia Zhao
- Department of ENT, the Affiliated Hospital of Zhengzhou University, Nanyang 473009, China
| | - Bao-Chao Zhang
- Department of Neurology, the Affiliated Hospital of Zhengzhou University, Nanyang 473009, China.
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Triandafilou KM, Kamper DG. Carryover effects of cyclical stretching of the digits on hand function in stroke survivors. Arch Phys Med Rehabil 2014; 95:1571-6. [PMID: 24794423 DOI: 10.1016/j.apmr.2014.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/10/2014] [Accepted: 04/19/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the longevity and cumulative impact of multiple sessions of passive, cyclical stretching of the digits on hand function in subacute stroke survivors. DESIGN Before-after trial with intervention repeated on 3 consecutive days. SETTING Research laboratory. PARTICIPANTS Individuals (N=27) with moderate to severe hand impairment, 2 to 6 months (subacute, n=12) and >7 months (chronic, n=15) poststroke. INTERVENTIONS Subjects wore an actuated glove orthosis that cyclically moved their fingers and thumb from a relaxed/flexed posture into neutral extension for 30 minutes on 3 consecutive days. MAIN OUTCOME MEASURES Three hand-specific tasks from the Graded Wolf Motor Function Test, Box and Block Test (BBT), grip strength, and lateral pinch strength. Recordings were taken before stretching and at 3 time points, each separated by 30 minutes after completion of stretching on each day. RESULTS Significant improvement was observed immediately after the stretching for both groups. Improvements in the subacute group were largely maintained up to 1 hour poststretching, with significant carryover from day to day for some outcomes measures such as the BBT (P=.006) and grip strength (P=.012). In contrast, improvements after stretching for the chronic group were transient, with the changes largely dissipating over time and no significant cumulative effect across days. CONCLUSIONS Cyclical stretching of the digits had a lasting and reinforcing effect on improving hand motor control for subacute stroke survivors. Incorporation of cyclical stretching before active hand therapy may prove to be a beneficial treatment for stroke survivors, especially during the subacute phase of recovery.
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Affiliation(s)
| | - Derek G Kamper
- Sensory Motor Performance Program, Rehabilitation Institute of Chicago, Chicago, IL; Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, IL
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