Occupational therapy assessment and treatment approach in patients with subacute and chronic stroke: A single-blind, prospective, randomized clinical trial

[Occupational Therapy intervention after a cerebrovascular accident: case report.]

The sequelae produced by a cerebrovascular accident (CVA) have an impact on occupational performance and restrict the person's participation in their occupational roles. C. is a 31-year-old young adult who, after having suffered an ischemic stroke, enters an inpatient rehabilitation center for patients with neurological injury and receives occupational therapy treatment. From this area, an approach is made based on the planning and implementation of person-centered interventions, establishing short and medium-term objectives in a collaborative manner. The effectiveness of these interventions were measured using specific evaluation tools to document the changes produced between hospital admission and discharge. This case report exposes the implementation of these approaches in C.'s rehabilitation process, in which she managed to improve her occupational performance and increase her participation in significant occupations.

Screening and validation of the iris manifestation among patients with hemiplegia - an observational study

OBJECTIVES

Understanding and validating the science behind traditional diagnostic methods is a niche area to be explored. Iris diagnosis is one such valuable diagnostic tool used in Naturopathy. In the current study, we have assessed and documented the iris changes observed among patients with hemiplegia with respect to the iridology chart.

METHODS

We recruited 35 patients with hemiplegia which includes both genders. Iris image was captured by Angel Kiss New 5.0MP Iridology Camera with Pro Iris Analysis Software. Lesion characters, such as open lesion, closed lesion, spot, furrow, radii solaris, intestinal crypts etc., in the iris were noted along with its various characteristics in an excel sheet in numerical order for analysis.

RESULTS

Majority of the included patients were male (n=30) and the mean age of the patients was 46 years. The most common iris lesions noted were radii solaris and intestinal crypt in the cerebrum and cerebellum regions. Other notable lesions include open lesion, closed lesion, brown spot, hole and nerve ring. ROC analysis for selected iris lesions showed that intestinal crypt (AUC=0.82, p=0.01) and radii solaris (AUC=0.62, p=0.04) to be potential markers for hemiplegia.

CONCLUSIONS

Two common lesions observed in patients with hemiplegia are radii solaris and intestinal crypt, corresponding to the cerebrum and cerebellum regions of the iris. Future studies with larger sample size would help warrant our current findings, and also the possible application of iris diagnosis as an early diagnostic marker for hemiplegia.

Botulinum Toxin and Dynamic Splint Restore Grasping Function after Stroke: A Case Report

Evidence on the effectiveness of upper extremity rehabilitation post-stroke is inconclusive. We evaluated a tailored therapeutic program with dynamic splint and botulinum toxin injections for the treatment of upper extremity muscle spasticity. A case of a 43-year-old woman with chronic spastic hemiparesis after ischemic stroke with significant mobility impairment in the left upper extremity was described. A 16-week program consisted of three 50-min sessions daily and focused on grasping and releasing with and without the splint. The patient was evaluated before botulinum toxin injection and after 6, 12 and 16 weeks according to the International Classification of Functioning, Disability and Health, and included the following scales: Fugl-Meyer Upper Extremity Assessment (FMA-UE), Modified Ashworth Scale, Numerical Rating Scale (NRS), MyotonPro, Stroke Impact Scale, Box and Blocks. Photographic documentation made before and after the experiment was compared. Motor functions improved by 19.7% on FMA-UE, spasticity was reduced by one degree and pain at rest and during activity decreased by one score on NRS. A reduction in the oscillation frequency of the relaxed muscle and the stiffness of the examined muscles was observed. The patient regained grasping function. Health-related quality of life was systematically improving with a 35% increase at week 16 compared to the baseline. The combination treatment for spasticity based on botulinum toxin and SaeboFlex^® dynamic splint in a patient with chronic spastic hemiparesis reduces disability and improves quality of life. However, further research is needed to investigate the treatment results.

Occupational class differences in outcomes after ischemic stroke: a prospective observational study

BACKGROUND

Occupational class is an integral part of socioeconomic status. The studies focused on the occupational difference in ischemic stroke outcome in a Chinese population are limited. We aimed to investigate the associations between occupational class and the prognosis of patients with ischemic stroke in China.

METHODS

We included 1484 ischemic stroke participants (mean age: 63.42 ± 11.26 years) from the prospective cohort study: Infectious Factors, Inflammatory Markers and Prognosis of Acute Ischemic Stroke (IIPAIS). Occupational class was categorized into white-collar workers, blue-collar workers and farmers in our study. Study outcomes were cardiovascular events and all-cause mortality within 12 months after ischemic stroke onset. We applied Cox proportional hazard model to evaluate the associations between the occupational class and study outcomes after ischemic stroke.

RESULTS

Within 12 months after ischemic stroke, there were 106 (7.5%) cardiovascular events and 69 (4.9%) all-cause deaths. The Kaplan-Meier plots showed that white-collar workers had highest risk of cardiovascular events after 12-month follow-up (Log-rank P = 0.02). Multivariate adjusted hazard ratio and 95% confidence intervals (CIs) of farmers versus white-collar workers was 0.43(0.20-0.91) for cardiovascular events. No significant difference showed in blue-collar workers versus white-collar workers, with fully adjusted hazard ratio 0.62(95% CIs, 0.23-1.67).

CONCLUSIONS

Compared with white-collar workers, farmers are associated with less risk of cardiovascular events at 12 months after ischemic stroke, while there are no significant differences in blue-collar workers.

Effects of different rehabilitation provision systems on functional recovery in patients with subacute stroke

INTRODUCTION

The extent of rehabilitation is a key element in promoting functional recovery in patients with stroke. However, the type of rehabilitation therapy that should be provided to improve functional outcomes remains unclear.

OBJECTIVE

This study aimed to compare the effects of three different rehabilitation provision systems, namely conventional rehabilitation therapy, conventional rehabilitation therapy plus physical therapy (PT) on weekends, and conventional rehabilitation therapy plus PT and occupational therapy (OT) on weekends, on functional recovery in patients with subacute stroke.

DESIGN

Retrospective observational cohort study.

SETTING

Convalescence Rehabilitation Hospital.

PATIENTS

Three hundred and one patients with subacute stroke (mean age, 69.7 ± 12.8 years).

INTERVENTIONS

Patients were classified into three groups according to rehabilitation therapy they received: a conventional group (only weekdays PT and OT; n = 70), an additional PT group (additional PT on weekends; n = 119), and an additional PT + OT group (additional PT and OT on weekends; n = 112).

MAIN OUTCOME MEASURE

Functional Independence Measure (FIM) effectiveness was calculated as (discharge FIM - admission FIM/maximum FIM - admission FIM) × 100. A multivariate general linear model was used to assess the difference in FIM effectiveness among the groups.

RESULTS

The mean FIM effectiveness in the conventional, additional PT, and additional PT + OT groups were 39.3 ± 30.1, 43.4 ± 33.2, and 54.3 ± 29.1, respectively. The multivariate analysis revealed a significant difference in FIM effectiveness among the three groups (P = 0.036), and the η_p ² was 0.02, indicating a small effect. The additional PT + OT group showed significantly greater improvements in FIM effectiveness than the conventional group (mean difference = 8.78, SE = 3.58, 95% confidence interval: 0.17-17.39).

CONCLUSIONS

This study showed that the additional PT + OT group had better functional recovery than did the conventional group. This indicates that increasing the amount of both PT and OT can promote post-stroke functional recovery. This article is protected by copyright. All rights reserved.

Quantification of the Therapist's Gentle Pull for Pinch Strength Testing Based on FMA and MMT: An Experimental Study with Healthy Subjects

Static pinch strength against a therapist’s gentle pull is evaluated using the pincer grasp component of the Fugl Meyer Assessment (FMA) to assess pinch impairment after stroke. In the pincer grasp component, therapists applied a gentle pull to distinguish between a score of 1 (moderate pinch impairment) and a score of 2 (no pinch impairment). The gentle pull is described as a resistance equivalent to a manual muscle test (MMT) score 4/5. The accepted use of “gentle” as a qualitative description for the pull results is a non-standardized subjective interpretation. The goal of this paper was to determine the quantitative value of the gentle pull applied by the therapists as in their clinical practice using a pinch–pull gripping system. The FMA protocol was used to standardize the body and fingers positions of three occupational therapists who were then instructed to apply a gentle pull of 4/5 MMT using their thumb and index fingers (in a tip-to-tip pinch). The results show that the therapists exerted a mean gentle pull (4/5 MMT score) of 6.34 ± 0.98 N with high reliability and acceptable repeatability. In investigating the ability of healthy subjects to resist the gentle pull, 50 adult male volunteers were instructed to pinch the pincer object and resist a dynamic loading exerted by the pinch–pull gripping system as much as possible to the moment the pincer object slips away. The results show that all subjects were able to exert a pulling force higher than the quantitative value of the gentle pull.