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Kaneko T, Maeda M, Yokoyama H, Kai S, Obuchi K, Takase S, Horimoto T, Shimada R, Moriya T, Ohmae H, Amanai M, Okita Y, Takebayashi T. Therapeutic effect of adjuvant therapy added to constraint-induced movement therapy in patients with subacute to chronic stroke: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:4098-4112. [PMID: 37855247 DOI: 10.1080/09638288.2023.2269843] [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: 01/16/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE This review investigated the effectiveness of adjuvant therapy combined with constraint-induced movement therapy (CIMT) in improving the paretic upper limb functionality in adults with stroke sequelae during the subacute to chronic rehabilitation phase. MATERIALS AND METHODS In this systematic review and meta-analysis of randomized controlled trials (RCT), electronic databases, including PubMed, Web of Science, CINAHL, and MEDLINE, were searched. We included RCTs that investigated the outcomes of adjuvant therapy (i.e. other therapies) added to CIMT compared with CIMT alone. Key trial findings were qualitatively synthesized and analyzed. This meta-analysis examined variables, such as mean scores and standard deviations, using the following outcome measures: Fugl-Meyer Assessment (FMA) upper limb items, Action Research Arm Test (ARAT), Amount of Use (AOU) of Motor Activity Log (MAL), and Quality of Movement (QOM) of MAL. RESULTS Eighteen eligible RCTs were included in the analysis. Adding CIMT to adjunctive therapy significantly improved FMA compared with CIMT alone (mean difference [MD] 4.02, 95% confidence interval [CI] 2.60-5.44; I2 = 85%; 15 studies; 330 participants). Similarly, the ARAT and MAL-AOU scores improved significantly. CONCLUSIONS CIMT combined with several adjunctive therapies effectively improved upper limb function.
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Affiliation(s)
- Takao Kaneko
- Department of Rehabilitation, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Masanori Maeda
- Department of Occupational Therapy, JA Nagano Koseiren Kakeyu-Misayama Rehabilitation Center Kakeyu Hospital, Ueda, Japan
| | - Hiroki Yokoyama
- Department of Rehabilitation, Kansai Medical University Kuzuha Hospital, Hirakata, Japan
| | - Shinsuke Kai
- Department of Rehabilitation, Fukuoka Wajiro Hospital, Fukuoka, Japan
| | - Kohei Obuchi
- Department of Rehabilitation, Nagano Matsushiro General Hospital, Nagano, Japan
| | - Shun Takase
- Department of Rehabilitation, Kawasaki Kyodo Hospital, Kawasaki, Japan
| | - Takumi Horimoto
- Department of Rehabilitation, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Ryuichi Shimada
- Department of Occupational Therapy, Faculty of Health Sciences, Iryo Sosei University, Iwaki, Japan
| | - Takashi Moriya
- Department of Rehabilitation, Kosei Hospital, Medical Corporation Rokushinkai, Japan
| | - Hiroshi Ohmae
- Department of Rehabilitation, Tokushima University Hospital, Tokushima, Japan
| | - Masahiro Amanai
- Department of Rehabilitation, Kujira Hospital, Koto City, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness & Community Centre, Melbourne, Australia
| | - Takashi Takebayashi
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
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Annino G, Alashram AR, Alghwiri AA, Romagnoli C, Messina G, Tancredi V, Padua E, Mercuri NB. Effect of segmental muscle vibration on upper extremity functional ability poststroke: A randomized controlled trial. Medicine (Baltimore) 2019; 98:e14444. [PMID: 30762754 PMCID: PMC6408108 DOI: 10.1097/md.0000000000014444] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Upper extremity functional impairments are common consequences of stroke. Therefore, continuous investigation of effective interventions for upper extremity functions after stroke is a necessity. Segmental muscle vibration (SMV) is one of the interventions that incorporate sensory stimulation to improve motor cortical excitability. The aim of this study was to investigate the influence of 5-minute SMV application along with supervised physical therapy (SPT) on improving activities of daily living and motor recovery on the hemiparetic upper extremity in patients with stroke. METHODS A sample of 37 patients poststroke (29 males) was randomly allocated to either SPT control group (n = 18) or SPT and SMV (SPT-SMV) experimental group (n = 19). All patients received 3 sessions per week of SPT for 8 weeks. The SPT-SMV experimental group received SMV at the end of each SPT session. Outcome measures used were Barthel index (BI), modified Ashworth scale, manual muscle testing, and goniometry for range of motion (ROM) assessment. RESULTS Thirty-four patients completed the study. Patients in both groups improved significantly after treatment in BI, elbow ROM, and elbow muscles strength. However, muscle tone in elbow joint of the hemiplegic upper extremity improved significantly after SMV only in the experimental group (SPT-SMV). CONCLUSION The SPT intervention can improve functional outcomes of upper extremity in people after stroke. However, using SMV may have superior effect on improving muscle tone after stroke.
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Affiliation(s)
- Giuseppe Annino
- Department of Medicine Systems, University of Rome, “Tor Vergata”
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome
| | - Anas R. Alashram
- Faculty of Medicine and Surgery, University of Rome, “Tor Vergata,” Italy
| | - Alia A. Alghwiri
- Department of Physical Therapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | | | - Giuseppe Messina
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Virginia Tancredi
- Department of Medicine Systems, University of Rome, “Tor Vergata”
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome
| | | | - Nicola Biagio Mercuri
- Department of Medicine Systems, University of Rome, “Tor Vergata”
- Faculty of Medicine and Surgery, University of Rome, “Tor Vergata,” Italy
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The effect of task-oriented electromyography-triggered electrical stimulation of the paretic wrist extensors on upper limb motor function early after stroke: a pilot randomized controlled trial. Int J Rehabil Res 2018; 42:74-81. [PMID: 30540619 DOI: 10.1097/mrr.0000000000000333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The combined effect of task-oriented motor training and electromyography (EMG)-triggered electrical stimulation (ES) has been examined in chronic stroke, but there are no published reports in patients with early stroke. Therefore, the purpose of this study was to determine the short-term and long-term effects of task-oriented EMG-triggered ES on upper limb motor function in acute/subacute stroke. Twenty-seven patients with stroke within the first 3 months after stroke onset were randomly allocated to an experimental group and a control group. Twenty-three patients (12 patients in the experimental group and 11 patients in the control group) completed the study. The control group received a conventional physical therapy for 20 sessions, and the experimental group received task-oriented EMG-triggered ES therapy for the wrist/finger extensors in addition to conventional physical therapy for 5 sessions a week for 4 weeks. Primary outcome measures were the Action Research Arm Test, the Brunnstrom stages of the hand/upper extremity, and the motor Functional Independence Measure. All patients were evaluated before the treatment, after the treatment, and at 3 months. The parametric and nonparametric statistics at the 5% level of significance (α=0.05) was used for testing the differences between the two groups at each main end point. At the end of the treatment, the experimental group showed significantly greater improvements in Brunnstrom stages and ARAT grasp/grip/pinch scores, but not motor Functional Independence Measure scores, when compared with the control group. The differences between the 3-months and postintervention evaluations were not significant between the two groups suggesting retention of the postintervention gains. Our results indicate that task-oriented EMG-triggered ES training may result in improvements in the paretic upper limb function in patients with acute/subacute stroke that are superior to the conventional treatment.
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Lisiński P, Huber J, Samborski W, Witkowska A. Neurophysiological Assessment of the Electrostimulation Procedures Used in Stroke Patients during Rehabilitation. Int J Artif Organs 2018; 31:76-86. [DOI: 10.1177/039139880803100111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the effectiveness of the associated electrotherapeutical and kinesiotherapeutical treatment in patients after ischemic stroke (N=24), mainly by means of neurophysiological tests. All patients underwent the same 20 days of neurorehabilitation procedures. Particular attention was paid to three-stage modified electrotherapy procedures such as: oververtebral functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS) and the alternate neuromuscular functional electrical stimulation (NMFES) of antagonistic muscles of the wrist and the ankle (N=16). Electrotherapy was supplemented with kinesiotherapeutic (mainly PNF) procedures acting as an amplifier. Clinical assessment included muscle tension (Ashworth's scale), muscle force (Lovett's scale) and reflex scoring at wrist and ankle. However, the effectiveness of the procedures was measured by the assessment of results in complex and repetitive, bilaterally performed global electromyography (EMG) and electroneurography (ENG; M-wave studies). The statistical analysis obtained from results in clinical and neurophysiological examinations suggested that the dorsiflexion of wrist and ankle was improved in the majority of patients who took part in this study. EMG and ENG examinations showed that 20 days of therapy improved both activity in muscle motor units on the more paralyzed side (mainly within upper extremities) and to a lesser degree in the transmission of efferent impulses within motor fibers of nerves. The results obtained suggest that patients after ischemic strokes never show an isolated unilateral disability in motor functions. No definite similarities between the results of clinical and neurophysiological studies were found, which may suggest greater accuracy of the neurophysiological evaluation.
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Affiliation(s)
- P. Lisiński
- Clinic for Physiotherapy, Rheumatology and Rehabilitation, Wiktor Dega Clinical Orthopedic and Rehabilitation Hospital No 4, Karol Marcinkowski University of Medicine in Poznań - Poland
| | - J. Huber
- Department of Pathophysiology of Locomotor Organs, Wiktor Dega Clinical Orthopedic and Rehabilitation Hospital No 4, Karol Marcinkowski University of Medicine in Poznań - Poland
| | - W. Samborski
- Clinic for Physiotherapy, Rheumatology and Rehabilitation, Wiktor Dega Clinical Orthopedic and Rehabilitation Hospital No 4, Karol Marcinkowski University of Medicine in Poznań - Poland
| | - A. Witkowska
- Department of Pathophysiology of Locomotor Organs, Wiktor Dega Clinical Orthopedic and Rehabilitation Hospital No 4, Karol Marcinkowski University of Medicine in Poznań - Poland
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Abstract
This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke rehabilitation. Fundamental NMES principles and purposes in stroke rehabilitation are explained. NMES modalities used for upper and lower limb rehabilitation are described, and efficacy studies are summarized. The evidence for peripheral and central mechanisms of action is also summarized.
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Claflin ES, Krishnan C, Khot SP. Emerging treatments for motor rehabilitation after stroke. Neurohospitalist 2015; 5:77-88. [PMID: 25829989 DOI: 10.1177/1941874414561023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although numerous treatments are available to improve cerebral perfusion after acute stroke and prevent recurrent stroke, few rehabilitation treatments have been conclusively shown to improve neurologic recovery. The majority of stroke survivors with motor impairment do not recover to their functional baseline, and there remains a need for novel neurorehabilitation treatments to minimize long-term disability, maximize quality of life, and optimize psychosocial outcomes. In recent years, several novel therapies have emerged to restore motor function after stroke, and additional investigational treatments have also shown promise. Here, we familiarize the neurohospitalist with emerging treatments for poststroke motor rehabilitation. The rehabilitation treatments covered in this review will include selective serotonin reuptake inhibitor medications, constraint-induced movement therapy, noninvasive brain stimulation, mirror therapy, and motor imagery or mental practice.
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Affiliation(s)
- Edward S Claflin
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Sandeep P Khot
- Department of Neurology, University of Washington, Seattle, WA, USA
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Hughes AM, Burridge JH, Demain SH, Ellis-Hill C, Meagher C, Tedesco-Triccas L, Turk R, Swain I. Translation of evidence-based Assistive Technologies into stroke rehabilitation: users' perceptions of the barriers and opportunities. BMC Health Serv Res 2014; 14:124. [PMID: 24620739 PMCID: PMC4007558 DOI: 10.1186/1472-6963-14-124] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 02/23/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Assistive Technologies (ATs), defined as "electrical or mechanical devices designed to help people recover movement", demonstrate clinical benefits in upper limb stroke rehabilitation; however translation into clinical practice is poor. Uptake is dependent on a complex relationship between all stakeholders. Our aim was to understand patients', carers' (P&Cs) and healthcare professionals' (HCPs) experience and views of upper limb rehabilitation and ATs, to identify barriers and opportunities critical to the effective translation of ATs into clinical practice. This work was conducted in the UK, which has a state funded healthcare system, but the findings have relevance to all healthcare systems. METHODS Two structurally comparable questionnaires, one for P&Cs and one for HCPs, were designed, piloted and completed anonymously. Wide distribution of the questionnaires provided data from HCPs with experience of stroke rehabilitation and P&Cs who had experience of stroke. Questionnaires were designed based on themes identified from four focus groups held with HCPs and P&Cs and piloted with a sample of HCPs (N = 24) and P&Cs (N = 8). Eight of whom (four HCPs and four P&Cs) had been involved in the development. RESULTS 292 HCPs and 123 P&Cs questionnaires were analysed. 120 (41%) of HCP and 79 (64%) of P&C respondents had never used ATs. Most views were common to both groups, citing lack of information and access to ATs as the main reasons for not using them. Both HCPs (N = 53 [34%]) and P&C (N = 21 [47%]) cited Functional Electrical Stimulation (FES) as the most frequently used AT. Research evidence was rated by HCPs as the most important factor in the design of an ideal technology, yet ATs they used or prescribed were not supported by research evidence. P&Cs rated ease of set-up and comfort more highly. CONCLUSION Key barriers to translation of ATs into clinical practice are lack of knowledge, education, awareness and access. Perceptions about arm rehabilitation post-stroke are similar between HCPs and P&Cs. Based on our findings, improvements in AT design, pragmatic clinical evaluation, better knowledge and awareness and improvement in provision of services will contribute to better and cost-effective upper limb stroke rehabilitation.
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Affiliation(s)
- Ann-Marie Hughes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- Electronics and Computer Sciences, Faculty of Physical & Applied Sciences, University of Southampton, Southampton, UK
| | | | | | | | - Claire Meagher
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Ruth Turk
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Ian Swain
- School of Design, Engineering and Computing, Bournemouth University, Bournemouth, UK
- Clinical Science and Engineering, Salisbury NHS Foundation Trust, Salisbury, UK
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Kumar P, Kassam J, Denton C, Taylor E, Chatterley A. Risk factors for inferior shoulder subluxation in patients with stroke. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328810x12647087218596] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Pape KE. Developmental and maladaptive plasticity in neonatal SCI. Clin Neurol Neurosurg 2012; 114:475-82. [DOI: 10.1016/j.clineuro.2012.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
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Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, Billinger SA. Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient. Stroke 2010; 41:2402-48. [PMID: 20813995 DOI: 10.1161/str.0b013e3181e7512b] [Citation(s) in RCA: 484] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Trevisan CM, Trintinaglia V. Efeito das terapias associadas de imagem motora e de movimento induzido por restrição na hemiparesia crônica: estudo de caso. FISIOTERAPIA E PESQUISA 2010. [DOI: 10.1590/s1809-29502010000300014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo analisa os efeitos da associação das terapias de imagem motora e de movimento induzido por restrição na reeducação funcional do membro superior (MS) de um paciente com deficit sensorial e motor determinado por acidente vascular encefálico (AVE). A terapia de imagem motora (IM) consistiu em: 1o, estimulo visual do espelho, em 3 sessões semanais de 30 a 60 minutos por 4 semanas; e 2o, IM com prática mental, em 3 sessões semanais de 15 minutos por 3 semanas. Por último foi aplicada a terapia de indução ao movimento por restrição do membro superior não-afetado por 14 dias, em 10 dos quais foi feita atividade funcional do membro parético por 6 horas diárias. Além da avaliação clinica da sensibilidade e medida da força de preensão palmar, antes do tratamento e após cada modalidade de terapia foi medida a amplitude de movimentos de ombro, cotovelo e punho e aplicada a escala de avaliação motora (EAM). Os escores dos quatro momentos da coleta foram comparados estatisticamente. Após o tratamento os resultados mostraram diferença significativa (p<0,05) com aumento da amplitude de movimentos em todas as articulações do MS e na força de preensão palmar; redução no tempo de execução de tarefas da função de braço e mão na EAM; e recuperação clinica da sensibilidade, especialmente tátil e sensação de pressão. No paciente estudado a associação da IM e da terapia de movimento induzido por restrição foi eficaz na recuperação funcional do membro superior parético pós-AVE.
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Hayner K, Gibson G, Giles GM. Comparison of Constraint-Induced Movement Therapy and Bilateral Treatment of Equal Intensity in People With Chronic Upper-Extremity Dysfunction After Cerebrovascular Accident. Am J Occup Ther 2010; 64:528-39. [DOI: 10.5014/ajot.2010.08027] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. We compared the effectiveness of constraint-induced movement therapy (CIMT) with bilateral treatment of equal intensity for chronic upper-extremity (UE) dysfunction caused by cerebrovascular accident (CVA).
DESIGN. We conducted a 2-group, randomized intervention trial with stratification by severity of UE dysfunction. Twelve community-dwelling adults were provided with 6 hr of occupational therapy for 10 days plus additional home practice. Six participants wore a mitt on the unimpaired UE, and 6 participants were intrusively and repetitively cued to use both UEs. The Wolf Motor Function Test (WMFT) and the Canadian Occupational Performance Measure (COPM) were administered before and after treatment and at 6-mo follow-up.
RESULTS. Significant improvements were found in WMFT and COPM scores across time in both groups. No significant between-group differences were found on the WMFT.
CONCLUSION. High-intensity occupational therapy using a CIMT or a bilateral approach can improve UE function in people with chronic UE dysfunction after CVA. Treatment intensity rather than restraint may be the critical therapeutic factor.
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Affiliation(s)
- Kate Hayner
- Kate Hayner, EdD, OTR/L, is Associate Professor and Chairperson, Occupational Therapy Department, Samuel Merritt University, Oakland, CA
| | - Ginny Gibson
- Ginny Gibson, MS, OTR/L, CHT, is Assistant Professor, Samuel Merritt University, Oakland, CA, and Senior Occupational Therapist, Children’s Hospital and Research Center Oakland, Oakland, CA
| | - Gordon Muir Giles
- Gordon Muir Giles, PhD, OTR, FAOTA, is Professor, Department of Occupational Therapy, Samuel Merritt University, 450 30th Street, Oakland, CA 94609, and Director of Neurobehavioral Services, Idylwood Care Center, Sunnyvale, CA;
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Optimising long-term participation in physical activities after stroke: exploring new ways of working for physiotherapists. Physiotherapy 2009; 95:228-34. [PMID: 19635344 DOI: 10.1016/j.physio.2008.11.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Revised: 09/21/2008] [Accepted: 11/26/2008] [Indexed: 11/21/2022]
Abstract
There is now good empirical evidence of physical and functional benefits for individuals with stroke from long-term engagement in a range of physical activities. However, long-term participation of stroke survivors in physical activity after rehabilitation is low, and maximum benefits are not being achieved. This article reviews relevant literature and evidence, and suggests that physiotherapists are ideally placed to support patients in long-term participation in activity as they prepare patients for the end of physical rehabilitation. However, this requires the development, testing and application of stroke-specific evidence-based behavioural and motivational interventions that are feasible in clinical practice, take account of the role of carers, and seek to address the barriers to activity faced by stroke survivors at the end of rehabilitation. It also requires physiotherapists to take a leading role in developing appropriate policies and strategies with other exercise professionals and services to address the transition from rehabilitation to an active lifestyle following stroke.
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Woodbury ML, Velozo CA, Richards LG, Duncan PW, Studenski S, Lai SM. Longitudinal Stability of the Fugl-Meyer Assessment of the Upper Extremity. Arch Phys Med Rehabil 2008; 89:1563-9. [DOI: 10.1016/j.apmr.2007.12.041] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 12/04/2007] [Accepted: 12/06/2007] [Indexed: 11/16/2022]
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Abstract
Spontaneous behavioral recovery is usually limited after stroke, making stroke a leading source of disability. A number of therapies in development aim to improve patient outcomes not by acutely salvaging threatened tissue, but instead by promoting repair and restoration of function in the subacute or chronic phase after stroke. Examples include small molecules, growth factors, cell-based therapies, electromagnetic stimulation, device-based strategies, and task-oriented and repetitive training-based interventions. Stage of development across therapies varies widely, from preclinical to late-phase clinical trials. The optimal methods to prescribe such therapies require further studies, for example, to best identify appropriate patients or to guide features of dosing. Likely, anatomic, functional, and behavioral measures of brain state, as well as measures of injury, will each be useful in this regard. Considerations for clinical trials of restorative therapies are provided, emphasizing both similarities and points of divergence with acute stroke clinical trial design.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, University of California, Irvine, CA 92868-4280, USA.
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A four-week, task-specific neuroprosthesis program for a person with no active wrist or finger movement because of chronic stroke. Phys Ther 2008; 88:397-405. [PMID: 18187493 DOI: 10.2522/ptj.20070087] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE This case report describes a task-specific training protocol incorporating functional electrical stimulation for a person who had chronic stroke and who initially exhibited no active wrist or finger movement. CASE DESCRIPTION A 63-year-old man with hemiparesis caused by an ischemic stroke 7 years before the intervention described here received task-specific training incorporating an electrical stimulation neuroprosthesis 3 hours per day, 5 days per week, for 4 weeks. Testing was conducted before and after the intervention and again 6 weeks later with stroke-specific outcome measures. OUTCOMES Increases in function and quality of life were observed after the intervention. DISCUSSION An intervention incorporating task-specific training with functional electrical stimulation appears to have increased function and quality of life in a person with chronic stroke. This type of intervention might provide a pathway by which people with similar impairments would become eligible for more advanced treatment regimens, such as modified constraint-induced therapy.
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Modified constraint-induced therapy in chronic stroke: results of a single-blinded randomized controlled trial. Phys Ther 2008; 88:333-40. [PMID: 18174447 DOI: 10.2522/ptj.20060029] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE This single-blinded randomized controlled trial compared the efficacy of a reimbursable, outpatient, modified constraint-induced therapy (mCIT) protocol (half-hour therapy sessions occurring 3 days per week in which subjects used the more affected arm combined with less affected arm restriction 5 days per week for 5 hours; both of these regimens were administered during a 10-week period) with that of a time-matched exercise program for the more affected arm or a no-treatment control regimen. SUBJECTS Thirty-five subjects with chronic stroke participated in the study. METHODS The Action Research Arm Test (ARAT), Fugl-Meyer Assessment of Motor Recovery After Stroke (FM), and Motor Activity Log (MAL) were administered to the subjects. RESULTS After intervention, significant differences were observed on the ARAT and MAL Amount of Use and Quality of Movement scales, all in favor of the mCIT group. DISCUSSION AND CONCLUSION The data affirm previous findings suggesting that this reimbursable, outpatient protocol increases more affected arm use and function. Magnitude of changes was consistent with those reported in more intense protocols, such as constraint-induced therapy.
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Giuffrida JP, Lerner A, Steiner R, Daly J. Upper-Extremity Stroke Therapy Task Discrimination Using Motion Sensors and Electromyography. IEEE Trans Neural Syst Rehabil Eng 2008; 16:82-90. [DOI: 10.1109/tnsre.2007.914454] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Herrero Gallego P, Tricás Moreno JM, López OL, Caudevilla Polo S, Hidalgo García C, De Miguel EE. Indirect influence of specific Kaltenborn glide mobilizations of the carpal joint on a subject with neurological impairments. J Bodyw Mov Ther 2007. [DOI: 10.1016/j.jbmt.2006.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Page SJ, Levine P. Modified constraint-induced therapy in patients with chronic stroke exhibiting minimal movement ability in the affected arm. Phys Ther 2007; 87:872-8. [PMID: 17472950 DOI: 10.2522/ptj.20060202] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to determine the efficacy of a reimbursable, outpatient modified constraint-induced therapy (mCIT) protocol administered to subjects with chronic stroke who initially exhibited minimal movement ability in their affected wrists and fingers. SUBJECTS The subjects were 4 individuals who had experienced a stroke more than 1 year prior to study entry (mean age [+/-SD]=60.25+/-1.98 years, mean time since stroke=37.5+/-23.2 months). METHOD A multiple-baseline, preintervention-postintervention, single-blinded case series design was used. The intervention consisted of structured, 1/2-hour therapy sessions emphasizing affected arm use in valued activities, occurring 3 times per week for 10 weeks. Subjects' less affected arms also were restrained 5 days per week for 5 hours per day during the same 10-week period. The main outcome measures were the Action Research Arm Test (ARAT), the Motor Activity Log (MAL), and the Fugl-Meyer Assessment of Motor Recovery (FM). RESULTS The subjects exhibited improvements in use of the more affected arm (+1.9, +1.8, +1.7, and +2.3 for subjects 1 through 4, respectively) and in quality of movement (+1.5, +2.1, +1.63, and +1.9 for subjects 1 through 4, respectively), as measured by the MAL. They also exhibited reduced impairment, as measured by the FM (+5.0, +6.5, +5.5, and +5.0 for subjects 1 through 4, respectively), and increased fine motor skill movement, as measured by the ARAT (+7.5, +7.0, +7.0, and +5.5 for subjects 1 through 4, respectively). DISCUSSION AND CONCLUSION The findings demonstrated that mCIT participation was efficacious because it led to increased use of the affected arm and of function and to increased ability to perform valued activities. The subjects reported some new ability to perform some valued activities. These outcomes are significant because few therapies are believed to effectively increase use of the affected arm and function in this population.
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Affiliation(s)
- Stephen J Page
- Department of Rehabilitation Sciences, University of Cincinnati Academic Medical Center, Cincinnati, OH 45267-0530, USA.
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Woodbury ML, Velozo CA, Richards LG, Duncan PW, Studenski S, Lai SM. Dimensionality and Construct Validity of the Fugl-Meyer Assessment of the Upper Extremity. Arch Phys Med Rehabil 2007; 88:715-23. [PMID: 17532892 DOI: 10.1016/j.apmr.2007.02.036] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the dimensionality and construct validity of the Fugl-Meyer Assessment of the upper extremity by using Rasch analysis. DESIGN Secondary analysis of pooled data from 2 existing datasets: a randomized therapeutic exercise clinical trial and a cohort longitudinal study of stroke recovery. SETTING University research center. PARTICIPANTS A total of 512 subjects, ages 69.8+/-11.1 years, who were 0 to 145 days poststroke. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dimensionality was examined with principal components analysis and Rasch item-fit statistics. The Rasch-derived item hierarchy was examined for consistency with the expected course of poststroke upper-extremity recovery suggested by the reflex-hierarchical conceptual model underlying the assessment. RESULTS Factor loadings and item infit statistics suggested that the 3 reflex items were empirically disconnected from other assessment items. The reflex items were removed. The modified 30-item assessment showed a unidimensional structure. The Rasch-item-difficulty order was not consistent with the expected item order. CONCLUSIONS The items testing resting-state reflexes may threaten the assessment's dimensionality. With reflex items removed, the assessment is a unidimensional measure of volitional movement. The Rasch-generated item-difficulty order challenges the hierarchical structure implied by the instrument's underlying conceptual framework.
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Affiliation(s)
- Michelle L Woodbury
- Brain Rehabilitation Research Centers, Malcolm Randall VA Medical Center, Gainesville FL, USA.
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Abstract
Background and Purpose—
Understanding brain plasticity after stroke is important in developing rehabilitation strategies. Active movement therapies show considerable promise but depend on motor performance, excluding many otherwise eligible patients. Motor imagery is widely used in sport to improve performance, which raises the possibility of applying it both as a rehabilitation method and to access the motor network independently of recovery. Specifically, whether the primary motor cortex (M1), considered a prime target of poststroke rehabilitation, is involved in motor imagery is unresolved.
Summary of Review—
We review methodological considerations when applying motor imagery to healthy subjects and in patients with stroke, which may disrupt the motor imagery network. We then review firstly the motor imagery training literature focusing on upper-limb recovery, and secondly the functional imaging literature in healthy subjects and in patients with stroke.
Conclusions—
The review highlights the difficulty in addressing cognitive screening and compliance in motor imagery studies, particularly with regards to patients with stroke. Despite this, the literature suggests the encouraging effect of motor imagery training on motor recovery after stroke. Based on the available literature in healthy volunteers, robust activation of the nonprimary motor structures, but only weak and inconsistent activation of M1, occurs during motor imagery. In patients with stroke, the cortical activation patterns are essentially unexplored as is the underlying mechanism of motor imagery training. Provided appropriate methodology is implemented, motor imagery may provide a valuable tool to access the motor network and improve outcome after stroke.
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Affiliation(s)
- Nikhil Sharma
- Department of Clinical Neurosciences, University of Cambridge, England
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