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Bayazeed A, Almalki G, Alnuaim A, Klem M, Sethi A. Factors Influencing Real-World Use of the More-Affected Upper Limb After Stroke: A Scoping Review. Am J Occup Ther 2024; 78:7802180250. [PMID: 38634670 DOI: 10.5014/ajot.2024.050512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
IMPORTANCE Current interventions are limited in improving use of the more-affected upper limb in real-world daily occupations and functional independence poststroke. A comprehensive understanding of the factors influencing real-world upper limb use is required to develop interventions to improve functional independence poststroke. OBJECTIVE To systematically review the factors that influence real-world use of the more-affected upper limb poststroke. DATA SOURCES We searched MEDLINE, Embase, PsycINFO, and the Physiotherapy Evidence Database for English-language articles from 2012 to 2023. STUDY SELECTION AND DATA COLLECTION Of 774 studies, we included 33 studies that had participants at least age 18 yr who exhibited upper limb impairments poststroke, objectively measured real-world upper limb use using a movement sensor, and measured factors affecting upper limb use. Two reviewers independently screened the abstracts. FINDINGS The results were categorized by International Classification of Functioning, Disability and Health domains. Prominent factors were upper limb impairment; motor ability; functional independence; task type; hand dominance; stroke-related factors, including time since stroke; and perception of use of the more-affected upper limb. CONCLUSIONS AND RELEVANCE Existing interventions primarily focus on upper limb impairments and motor ability. Our findings suggest that interventions should also incorporate other factors: task type (unilateral vs. bilateral), hand dominance, self-efficacy, and perception of more-affected limb use as active ingredients in improving real-world use of the more-affected upper limb poststroke. We also provide recommendations to use behavioral activation theory in designing an occupation-focused intervention to augment self-efficacy and confidence in use of the more-affected upper limb in daily occupations. Plain-Language Summary: In order to develop interventions to improve functional independence poststroke, occupational therapy practitioners must have a comprehensive understanding of the factors that influence real-world more-affected upper limb use. The study findings provide a set of distinct factors that practitioners can target separately or in combination to improve real-world use of the more-affected upper limb poststroke.
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Affiliation(s)
- Anadil Bayazeed
- Anadil Bayazeed, MSOT, is PhD Candidate, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, and Teaching Assistant, Occupational Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia;
| | - Ghaleb Almalki
- Ghaleb Almalki, MSOT, is PhD Candidate, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, and Teaching Assistant, Occupational Therapy Department, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Amjad Alnuaim
- Amjad Alnuaim, MSc, is Teaching Assistant, Department of Occupational Therapy, King Saud University, Riyadh, Saudi Arabia. At the time of the study, Alnuaim was Master's Student, Occupational Therapy Department, University of Pittsburgh, Pittsburgh, PA
| | - Mary Klem
- Mary Klem, PhD, MLIS, is Assistant Director for Advanced Information Support, Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA
| | - Amit Sethi
- Amit Sethi, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA
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Fujimoto K, Ueno M, Etoh S, Shimodozono M. Combined repetitive facilitative exercise under continuous neuromuscular electrical stimulation and task-oriented training for hemiplegic upper extremity during convalescent phase after stroke: before-and-after feasibility trial. Front Neurol 2024; 15:1356732. [PMID: 38456153 PMCID: PMC10919145 DOI: 10.3389/fneur.2024.1356732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Whereas repetitive facilitative exercise (RFE) affects primarily recovery of motor impairment after stroke, task-oriented training (TOT) focuses on facilitating daily use of the affected upper extremity. However, feasibility of combined RFE and TOT has not been reported. We originated "task-oriented RFE," as a new combination therapy for patients with hemiplegic upper extremity after subacute stroke, to examine its feasibility in convalescent rehabilitation wards. Methods This is a before-and-after pilot study. Eight patients with hemiplegic upper extremity after subacute stroke received the task-oriented RFE program for 6 weeks at 80 min per day (20-60 min of TOT applied after 60-20 min of RFE under continuous neuromuscular electrical stimulation) in a convalescent rehabilitation ward. In the current program, we introduced the Aid for Decision-making in Occupation Choice (ADOC) iPad application as a goal-setting method for determining tasks. Feasibility was assessed with adherence to the protocol, adverse events in response to the intervention, and preliminary efficacy. Motor functions, amount of use and quality of movement in the hemiparetic upper extremity, and satisfaction of the patients were evaluated with Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the motor activity log (MAL) for the amount of use (AOU) and quality of movement (QOM) of the paralyzed hand, and ADOC. Results All participants accomplished the program, which was implemented as originally planned; neither nonattendance nor an adverse event occurred during the study. Favorable outcomes were obtained with all measures; mean changes in FMA, ARAT in the dominant hand, MAL-AOU, and MAL-QOM were greater than minimal clinically important differences. Mean changes in ADOC were greater than the minimal detectable change. Discussion The task-oriented RFE program was safe, well-tolerated, beneficial, and feasible within 80 min a day of occupational therapy, which means also within the procedural constraints of the Japanese health insurance system during the convalescent phase. Future studies are warranted to examine whether combined RFE and TOT enhances the efficacies of each program alone.
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Affiliation(s)
- Koya Fujimoto
- Department of Rehabilitation, Kirishima Sugiyasu Hospital, Kirishima, Kagoshima, Japan
| | - Makoto Ueno
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Seiji Etoh
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Megumi Shimodozono
- Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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da Silva Matuti G, Firmo Dos Santos J, da Silva ML, Menezes de Oliveira E, Lunardi AC, Biney F, Uswatte G, Taub E, Regina Alouche S. Grade-4/5 motor activity log-Brazil for post-stroke individuals with a severely impaired upper limb: a validity, reliability and measurement error study. Disabil Rehabil 2024:1-9. [PMID: 38265026 DOI: 10.1080/09638288.2024.2305298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE This study examined the clinimetrics of the Brazilian-Portuguese translation of the Grade-4/5 Motor Activity Log (MAL 4/5), which assesses everyday use of the more affected upper-limb (UL) in stroke survivors with moderate/severe or severe motor impairment. MATERIALS AND METHODS The translated MAL 4/5 was administered to 47 stroke survivors with moderate/severe or severe UL motor impairment. Accelerometers were worn on participants' wrists for five days on average prior to the first assessment. Test-retest and inter-rater reliabilities were assessed using the intraclass correlation coefficient (ICC), internal consistency using Cronbach's α, and construct validity was tested with correlations with the accelerometry. The measurement error (SEM) and the minimal detectable change (MDC) were calculated. RESULTS MAL4/5-Brazil's test-retest reliability (AOU: ICC = 0.84; QOU: ICC = 0.90), inter-rater reliability (AOU: ICC = 0.83; QOU: ICC = 0.91), internal consistency (Cronbach's α = 0.91 and 0.95 for AOU and QOU scales, respectively), the SEM and MDC were 0.3 and 0.8 points for the AOU subscale and 0.2 and 0.5 points for the QOU subscale, respectively. The construct validity (AOU scale: r = 0.67; QOU scale: r = 0.76) was high. CONCLUSION Grade-4/5 Motor Activity Log-Brazil is a reliable and valid instrument for assessing the more-affected UL use of stroke patients with moderate/severe or severe UL motor impairments.
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Affiliation(s)
| | | | - Maria Liliane da Silva
- Physiotherapy Department of Associação de Assistência à Criança Deficiente, São Paulo, Brazil
| | | | - Adriana Cláudia Lunardi
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Fedora Biney
- Department of Physical Medicine and Rehabilitation, University of AL at Birmingham, Birmingham, AL, USA
| | - Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sandra Regina Alouche
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
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Subramaniam S, Wang E, Bhatt T. A survey to assess perspectives of people with chronic stroke about customized safety harnesses for dance-based exergaming in home settings. PM R 2023; 15:1249-1257. [PMID: 36459574 DOI: 10.1002/pmrj.12929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Early dance-based exergaming (DBExG) trials in people with chronic stroke (PwCS) have shown promising results, but there remains a lack of knowledge if PwCS are interested in receiving such training in their homes and the applicability of a fall-protection safety harness in the home environment. OBJECTIVE To survey people with chronic stroke to understand the perspectives and preferences of various customized safety harnesses for home-based harness assisted dance-based exergaming rehabilitation. METHODS Participants were included in this survey study if they had a stroke, lived in the community, and understood English. Participants completed a study-specific safety harness survey via mail, in-person, or online. Descriptive statistics were used to characterize the sample and survey responses. RESULTS One hundred two survey responses were returned. The majority of participants voted for a door mountable harness (51%), side-release style buckle (58%), and preferred to receive a manual to explain how to use the harness (51%). Seventy-eight percent of the participants required permission to install or use a harness system in their homes. More than half of the participants preferred exhibiting independence by strapping the harness themselves (68%), along with choosing to live independently (the ability to live in one's own home and community safely, independently, comfortably, and able also perform their activities of daily living, regardless of physical ability level) (89%). CONCLUSIONS PwCS opted to use ShA-DBExG in their homes. The current survey serves as a guideline to develop, customize, and prescribe home-based ShA-DBExG rehabilitation.
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Affiliation(s)
- Savitha Subramaniam
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Edward Wang
- Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
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Srinivasan S, Amonkar N, Kumavor P, Morgan K, Bubela D. Outcomes Associated with a Single Joystick-Operated Ride-on-Toy Navigation Training Incorporated into a Constraint-Induced Movement Therapy Program: A Pilot Feasibility Study. Behav Sci (Basel) 2023; 13:bs13050413. [PMID: 37232651 DOI: 10.3390/bs13050413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Our research aims to evaluate the utility of joystick-operated ride-on-toys (ROTs) as therapeutic adjuncts to improve upper extremity (UE) function in children with hemiplegic cerebral palsy (HCP). This study assessed changes in affected UE use and function following a three-week ROT navigation training incorporated into an existing constraint-induced movement therapy (CIMT) camp in 11 children (3-14 years old) with HCP. We report changes in scores on the standardized Shriners Hospital Upper Extremity Evaluation (SHUEE) from pretest-to-posttest and changes from early-to-late sessions in percent time spent by the affected arm in: (a) "moderate-to-vigorous activity", "light activity" and "no activity" bouts based on accelerometer data and (b) "independent", "assisted", and "no activity" bouts based on video data. We also explored relationships between standardized measures and training-specific measures of affected UE activity. We found small-to-medium improvements in the SHUEE scores. Between 90 and 100% of children also showed medium-to-large improvements in affected UE activity from early-to-late sessions using accelerometers and small improvements via video-based assessments. Exploratory analyses suggested trends for relationships between pretest-posttest and training-specific objective and subjective measures of arm use and function. Our pilot data suggest that single joystick-operated ROTs may serve as motivating, child-friendly tools that can augment conventional therapies such as CIMT to boost treatment dosing, promote affected UE movement practice during real-world navigation tasks, and ultimately improve functional outcomes in children with HCP.
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Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06268, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Nidhi Amonkar
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06268, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA
| | - Deborah Bubela
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06268, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
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Anmoto N, Takebayashi T, Okita Y, Ishigaki M, Hibino S, Hanada K. Effectiveness of combining robotic therapy and modified constraint-induced movement therapy for moderate to severe upper limb paresis after stroke in subacute phase: Case–control study by propensity score analysis. Br J Occup Ther 2022. [DOI: 10.1177/03080226221121745] [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
Introduction: Robotic assisted therapy and modified constraint-induced movement therapy are used evidence-based approach in stroke rehabilitation. However, there is no study showing a combination of robotic assisted therapy and modified constraint-induced movement therapy (combined therapy) in the subacute phase. This study investigated the effectiveness of combined therapy in stroke patients with moderate to severe upper limb paresis compared with conventional occupational therapy at subacute setting. Methods: This research used a case–control study. The intervention group ( n = 15) consisting of patients with moderate to severe upper limb paresis (Brunnstrom recovery stage upper extremity III or IV and above hand III) 4–8 weeks since stroke onset received a combined therapy for 3 weeks (total intervention time: 1440 minutes). The control group ( n = 15) extracted by propensity score matching received a conventional occupational therapy for 4 weeks (total intervention time: 1680–2240 minutes). The primary outcome was the Fugl-Meyer assessment upper limb score change before and after the intervention. Results: The intervention group exhibited significantly greater improvement on Fugl-Meyer assessment upper lim change ( p = 0.005). Conclusion: In the subacute phase, the combined therapy of robotic assisted therapy and modified constraint-induced movement therapy helped improve upper limb motor function more effectively and efficiently than conventional occupational therapy.
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Affiliation(s)
- Naoya Anmoto
- Department of Occupational Therapy, Nagoya City Rehabilitation Centre, Nagoya, Japan
| | - Takashi Takebayashi
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, College of Health and Human Sciences, Osaka Prefecture University, Habikino, Japan
| | - Yuho Okita
- Soaring Health Sports, Wellness and Community Centre, Melbourne, Australia
| | - Masakazu Ishigaki
- Department of Lifestyle Support, Home Comprehensive Care Centre Motoasakusa, Medical Corporation Kiseikai, Motoasakusa, Japan
| | - Shin Hibino
- Department of Planning and Research, Nagoya City Rehabilitation Centre, Nagoya, Japan
| | - Keisuke Hanada
- Department of Occupational Therapy, School of Comprehensive Rehabilitation, College of Health and Human Sciences, Osaka Prefecture University, Habikino, Japan
- Department of Rehabilitation, Kinshukai Hanwa Memorial Hospital, Osaka, Japan
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Yurkewich A, Ortega S, Sanchez J, Wang RH, Burdet E. Integrating hand exoskeletons into goal-oriented clinic and home stroke and spinal cord injury rehabilitation. J Rehabil Assist Technol Eng 2022; 9:20556683221130970. [PMID: 36212185 PMCID: PMC9535266 DOI: 10.1177/20556683221130970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Robotic exoskeletons are emerging as rehabilitation and assistive
technologies that simultaneously restore function and enable independence
for people with disabilities. Aim We investigated the feasibility and orthotic and restorative effects of an
exoskeleton-supported goal-directed rehabilitation program for people with
hand impairments after stroke or Spinal Cord Injury (SCI). Method A single-arm case-series feasibility study was conducted using a wearable
untethered hand exoskeleton during goal-directed therapy programs with
in-clinic and at-home components. Therapists trained stroke and SCI patients
to use a hand exoskeleton during rehabilitation exercises, activities of
daily living and patient-selected goals. Each patient received a 1-hour
in-clinic training session on five consecutive days, then took the
exoskeleton home for two consecutive days to perform therapist-recommended
tasks. Goal Attainment Scaling (GAS) and the Box and Block Test (BBT) were
administered at baseline, after in-clinic
therapy and after home use, with and again without wearing
the exoskeleton. The System Usability Scale (SUS), Motor Activity Log, and
Fugl-Meyer Assessment were also administered to assess the intervention’s
acceptability, adherence, usability and effectiveness. Results Four stroke patients (Chedoke McMaster Stage of Hand 2–4) and one SCI patient
(ASIA C8 Motor Stage 1) 23 ± 19 months post-injury wore the hand exoskeleton
to perform 280 ± 23 exercise repetitions in the clinic and additional
goal-oriented tasks at home. The patients performed their own goals and the
dexterity task with higher performance following the 7-days therapy program
in comparison to baseline for both exoskeleton-assisted (ΔGAS: 18 ± 10,
ΔBBT: 1 ± 5) and unassisted (ΔGAS: 14 ± 14, ΔBBT: 3 ± 4) assessments.
Therapists and patients provided ‘good’ SUS ratings of 78 ± 6 and no harmful
events were reported. Conclusions The exoskeleton-supported stroke and SCI therapy program with in-clinic and
at-home training components was feasible.
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Affiliation(s)
- Aaron Yurkewich
- Bioengineering Department, Imperial College of Science
Technology and Medicine, London UK,Aaron Yurkewich, MESc, Institute of
Biomaterials and Biomedical Engineering, University of Toronto, Room 407,
Rosebrugh Bldg, 164 College St, Toronto, ON M5S 3G9, Canada.
| | - Sara Ortega
- Occupational Therapy, Centro Europeo de
Neurociencias, Madrid, Spain
| | - José Sanchez
- Occupational Therapy, Centro Europeo de
Neurociencias, Madrid, Spain
| | - Rosalie H Wang
- Occupational Science and
Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Etienne Burdet
- Bioengineering Department, Imperial College of Science
Technology and Medicine, London UK
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Effectiveness of Repetitive Facilitative Exercise Combined with Electrical Stimulation Therapy to Improve Very Severe Paretic Upper Limbs in with Stroke Patients: A Randomized Controlled Trial. Occup Ther Int 2022; 2022:4847363. [PMID: 35572164 PMCID: PMC9068343 DOI: 10.1155/2022/4847363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background The difference in the effects of combined therapy with repetitive facilitative exercise (RFE) and neuromuscular electrical stimulation (NMES) on stroke upper limb paralysis was only reported by a pilot study; it has not been investigated in many patients. Objective We investigated the effect of combined therapy with RFE and NMES on stroke patients with severe upper paresis. Methods This study included 99 of the very severe paresis stroke patients with scores of zero or 1a in the Finger-Function test of the Stroke Impairment Assessment Set (SIAS). We randomly divided the patients into four groups, namely, NMES, RFE, RFE under NMES, and conventional training (CT) groups. A total of 20 min of group-specific training in addition to 40 min of conventional exercise per day, seven times a week for 4 weeks after admission, was performed. The upper extremity items of the Fugl-Meyer Assessment (FMA) were evaluated before and after the training period. Results The total score gains of the FMA, FMA wrist item, and FMA finger item were significantly larger in the RFE under NMES group than those in the CT group (p < 0.05). Conclusion The combination of voluntary movement and electrical stimulation may promote the activation of paralyzed muscles and improve distal function for very severe paralyzed upper limbs.
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Otaki R, Oouchida Y, Aizu N, Sudo T, Sasahara H, Saito Y, Takemura S, Izumi SI. Relationship Between Body-Specific Attention to a Paretic Limb and Real-World Arm Use in Stroke Patients: A Longitudinal Study. Front Syst Neurosci 2022; 15:806257. [PMID: 35273480 PMCID: PMC8902799 DOI: 10.3389/fnsys.2021.806257] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Learned nonuse is a major problem in upper limb (UL) rehabilitation after stroke. Among the various factors that contribute to learned nonuse, recent studies have focused on body representation of the paretic limb in the brain. We previously developed a method to measure body-specific attention, as a marker of body representation of the paretic limb and revealed a decline in body-specific attention to the paretic limb in chronic stroke patients by a cross-sectional study. However, longitudinal changes in body-specific attention and paretic arm use in daily life (real-world arm use) from the onset to the chronic phase, and their relationship, remain unknown. Here, in a longitudinal, prospective, observational study, we sought to elucidate the longitudinal changes in body-specific attention to the paretic limb and real-world arm use, and their relationship, by using accelerometers and psychophysical methods, respectively, in 25 patients with subacute stroke. Measurements were taken at baseline (TBL), 2 weeks (T2w), 1 month (T1M), 2 months (T2M), and 6 months (T6M) after enrollment. UL function was measured using the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). Real-world arm use was measured using accelerometers on both wrists. Body-specific attention was measured using a visual detection task. The UL function and real-world arm use improved up to T6M. Longitudinal changes in body-specific attention were most remarkable at T1M. Changes in body-specific attention up to T1M correlated positively with changes in real-world arm use up to T6M, and from T1M to T6M, and the latter more strongly correlated with changes in real-world arm use. Changes in real-world arm use up to T2M correlated positively with changes in FMA up to T2M and T6M. No correlation was found between body-specific attention and FMA scores. Thus, these results suggest that improved body-specific attention to the paretic limb during the early phase contributes to increasing long-term real-world arm use and that increased real-world use is associated with the recovery of UL function. Our results may contribute to the development of rehabilitation strategies to enhance adaptive changes in body representation in the brain and increase real-world arm use after stroke.
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Affiliation(s)
- Ryoji Otaki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan
| | - Yutaka Oouchida
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Education, Osaka Kyoiku University, Osaka, Japan
| | - Naoki Aizu
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Tamami Sudo
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Computer and Information Sciences, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Hiroshi Sasahara
- Department of Rehabilitation, Yamagata Saisei Hospital, Yamagata, Japan
| | - Yuki Saito
- Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan
| | - Sunao Takemura
- Department of Neurosurgery, Yamagata Saisei Hospital, Yamagata, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan
- *Correspondence: Shin-Ichi Izumi
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Kuroda MM, Iwasaki N, Yoshikawa K, Takeuchi R, Mataki Y, Nakayama T, Nakayama J, Ohguro H, Tokeji K, Mutsuzaki H. Voluntary-assisted Upper Limb Training for Severe Cerebral Palsy Using Robotics Devices and Neuromuscular Electrical Stimulation: Three Case Reports. Prog Rehabil Med 2022; 7:20220050. [PMID: 36188138 PMCID: PMC9475054 DOI: 10.2490/prm.20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 08/23/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Constraint-induced movement therapy (CIMT) improves the motor function of paralyzed
upper limbs of adults after stroke. However, in patients with severe spastic cerebral
palsy (CP), the use of CIMT is not warranted. Our aim was to investigate the feasibility
and effectiveness of repetitive voluntary-assisted upper limb training (VAUT) for three
patients with severe CP using a combination of robotics [Hybrid Assistive Limb (HAL)]
and functional electrical stimulation [Integrated Volitional Control Electrical
Stimulation (IVES)]. Case: Three patients with CP were enrolled. Patients 1, 2, and 3 were 8-, 19-, and
18-year-old males, respectively. Patient 1 had spastic hemiplegia, while patients 2 and
3 had spastic quadriplegia. VAUT using single-joint HAL was performed for 1 or 2
sessions/month for 50 min/session over an 8-month period for 9–13 sessions in total. One
patient’s voluntary hand movement was insufficient, affecting his upper limb exercise
performance; therefore, IVES was required in addition to HAL. Outcome measures included
motor function of the upper limbs and use of paralyzed hands, which were measured before
and after intervention. No adverse events were observed during VAUT. After intervention,
the Action Research Arm Test scores showed improvements in all three patients. The
Children’s Hand-use Experience Questionnaire showed improvements in two patients. Discussion: The use of VAUT, together with new systems such as HAL and IVES, for severe CP is safe
and may be effective. Our study suggested that upper limb function can be improved for
patients with severe CP.
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Affiliation(s)
- Mayumi Matsuda Kuroda
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
| | - Nobuaki Iwasaki
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kenichi Yoshikawa
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Ryoko Takeuchi
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Yuki Mataki
- Department of Orthopedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Tomohiro Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Junko Nakayama
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Haruka Ohguro
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Kayo Tokeji
- Department of Pediatrics, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, Ibaraki, Japan
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11
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Park SH, Hsu CJ, Dee W, Roth EJ, Rymer WZ, Wu M. Enhanced error facilitates motor learning in weight shift and increases use of the paretic leg during walking at chronic stage after stroke. Exp Brain Res 2021; 239:3327-3341. [PMID: 34477919 DOI: 10.1007/s00221-021-06202-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/18/2021] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to determine whether the application of lateral pelvis pulling force toward the non-paretic side during the stance phase of the paretic leg would enhance forced use of the paretic leg and increase weight shift toward the paretic side in stroke survivors. Eleven chronic stroke survivors participated in two experimental sessions, which consisted of (1) treadmill walking with the application of "pelvis resistance" or "pelvis assistance" and (2) overground walking. During the treadmill walking, the laterally pulling force was applied during the stance phase of the paretic leg toward the non-paretic side for the "pelvis resistance" condition or toward the paretic side for the "pelvis assistance" condition during the stance phase of the paretic leg. After force release, the "pelvis resistance" condition exhibited greater enhancement in muscle activation of hip ABD, ADD, and SOL and greater improvement in lateral weight shift toward the paretic side, compared with the effect of the "pelvis assistance" condition (P < 0.03). This improved lateral weight shift was associated with the enhanced muscle activation of hip ABD and ADD (R2 = 0.67, P = 0.01). The pelvis resistance condition also improved overground walking speed and stance phase symmetry when measured 10 min after the treadmill walking (P = 0.004). In conclusion, applying pelvis resistance forces to increase error signals may facilitate motor learning of weight shift toward the paretic side and enhance use of the paretic leg in chronic stroke survivors. Results from this study may be utilized to develop an intervention approach to improve walking in stroke survivors.
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Affiliation(s)
- Seoung Hoon Park
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Chao-Jung Hsu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Weena Dee
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
| | - Elliot J Roth
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - William Z Rymer
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Ming Wu
- Legs and Walking Lab, Shirley Ryan AbilityLab, 355 E. Erie Street, 23rd floor, Chicago, IL, 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL, USA.
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12
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Yurkewich A, Kozak IJ, Ivanovic A, Rossos D, Wang RH, Hebert D, Mihailidis A. Myoelectric untethered robotic glove enhances hand function and performance on daily living tasks after stroke. J Rehabil Assist Technol Eng 2020; 7:2055668320964050. [PMID: 33403121 PMCID: PMC7745545 DOI: 10.1177/2055668320964050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Wearable robots controlled using electromyography could motivate greater use of the affected upper extremity after stroke and enable bimanual activities of daily living to be completed independently. Methods We have developed a myoelectric untethered robotic glove (My-HERO) that provides five-finger extension and grip assistance. Results The myoelectric controller detected the grip and release intents of the 9 participants after stroke with 84.7% accuracy. While using My-HERO, all 9 participants performed better on the Fugl-Meyer Assessment-Hand (8.4 point increase, scale out of 14, p < 0.01) and the Chedoke Arm and Hand Activity Inventory (8.2 point increase, scale out of 91, p < 0.01). Established criteria for clinically meaningful important differences were surpassed for both the hand function and daily living task assessments. The majority of participants provided satisfaction and usability questionnaire scores above 70%. Seven participants desired to use My-HERO in the clinic and at home during their therapy and daily routines. Conclusions People with hand impairment after stroke value that myoelectric untethered robotic gloves enhance their motion and bimanual task performance and motivate them to use their muscles during engaging activities of daily living. They desire to use these gloves daily to enable greater independence and investigate the effects on neuromuscular recovery.
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Affiliation(s)
- Aaron Yurkewich
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Bioengineering, Imperial College London, London, UK
| | - Illya J Kozak
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada
| | - Andrei Ivanovic
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada
| | - Daniel Rossos
- Faculty of Applied Science and Engineering, University of Toronto, Toronto, Canada
| | - Rosalie H Wang
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Debbie Hebert
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Alex Mihailidis
- Toronto Rehabilitation Institute-KITE, University Health Network, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
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13
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Effect of Task-Specific Training on Trunk Control and Balance in Patients with Subacute Stroke. Neurol Res Int 2020; 2020:5090193. [PMID: 33294224 PMCID: PMC7688364 DOI: 10.1155/2020/5090193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Impairment of static and dynamic posture control is common after stroke. It is found to be a predictor and an essential component for balance, walking ability, and activities of daily living (ADL) outcomes. Studies investigating effect of physical therapy techniques with an aim to improve trunk function after stroke are limited. This study aimed at studying the effect of task-specific training on trunk control and balance in patients with subacute stroke. Methods In this randomized controlled trail, thirty-four patients were alienated into two equal groups. The study group (n = 17) received task-specific training, and the control group (n = 17) received conventional physical therapy based on the neurodevelopmental technique. Task-specific training was applied through two phases with criteria of progression based on Chedoke-McMaster Stroke Assessment postural control stages. The interventions were applied in a dosage of 60 min per session, three times a week for ten weeks. Static and dynamic balance were measured by the trunk impairment scale (TIS), postural assessment scale (PAS), and functional reach test (FRT). Laser-guided digital goniometer was used to measure the trunk ranges of motions (ROM) as a secondary outcome. Results Significant differences between the baseline and the follow-up measures including TIS, PAS, FRT, and trunk (ROM) were found in both groups (P ≤ 0.05). In-between group comparison also showed significant differences between the results of both groups indicating more improvements among patients representing the study group. Conclusion Task-specific training may be effective in improving the static and dynamic postural control and trunk ranges of motion among subacute stroke patients.
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14
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Lum PS, Shu L, Bochniewicz EM, Tran T, Chang LC, Barth J, Dromerick AW. Improving Accelerometry-Based Measurement of Functional Use of the Upper Extremity After Stroke: Machine Learning Versus Counts Threshold Method. Neurorehabil Neural Repair 2020; 34:1078-1087. [PMID: 33150830 PMCID: PMC7704838 DOI: 10.1177/1545968320962483] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Wrist-worn accelerometry provides objective monitoring of upper-extremity functional use, such as reaching tasks, but also detects nonfunctional movements, leading to ambiguity in monitoring results. OBJECTIVE Compare machine learning algorithms with standard methods (counts ratio) to improve accuracy in detecting functional activity. METHODS Healthy controls and individuals with stroke performed unstructured tasks in a simulated community environment (Test duration = 26 ± 8 minutes) while accelerometry and video were synchronously recorded. Human annotators scored each frame of the video as being functional or nonfunctional activity, providing ground truth. Several machine learning algorithms were developed to separate functional from nonfunctional activity in the accelerometer data. We also calculated the counts ratio, which uses a thresholding scheme to calculate the duration of activity in the paretic limb normalized by the less-affected limb. RESULTS The counts ratio was not significantly correlated with ground truth and had large errors (r = 0.48; P = .16; average error = 52.7%) because of high levels of nonfunctional movement in the paretic limb. Counts did not increase with increased functional movement. The best-performing intrasubject machine learning algorithm had an accuracy of 92.6% in the paretic limb of stroke patients, and the correlation with ground truth was r = 0.99 (P < .001; average error = 3.9%). The best intersubject model had an accuracy of 74.2% and a correlation of r =0.81 (P = .005; average error = 5.2%) with ground truth. CONCLUSIONS In our sample, the counts ratio did not accurately reflect functional activity. Machine learning algorithms were more accurate, and future work should focus on the development of a clinical tool.
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Affiliation(s)
- Peter S Lum
- The Catholic University of America, Washington, DC, USA.,MedStar National Rehabilitation Network, Washington, DC, USA
| | - Liqi Shu
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Tan Tran
- The Catholic University of America, Washington, DC, USA
| | | | - Jessica Barth
- MedStar National Rehabilitation Network, Washington, DC, USA
| | - Alexander W Dromerick
- MedStar National Rehabilitation Network, Washington, DC, USA.,Georgetown University School of Medicine, Washington, DC, USA
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15
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Bani-Ahmed AA. Post-stroke motor recovery and cortical organization following Constraint-Induced Movement Therapies: a literature review. J Phys Ther Sci 2019; 31:950-959. [PMID: 31871384 PMCID: PMC6879401 DOI: 10.1589/jpts.31.950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This review synthesizes findings from studies on two forms of Constraint-Induced Movement Therapies: the original Constraint-Induced Movement Therapy and the modified Constraint-Induced Movement Therapy, in adult stroke patients including the evidence, current limitations and future directions. [Methods] We critically reviewed studies evaluating the effectiveness of Constraint-Induced Movement Therapies in chronic stoke focusing on the functional (i.e. motor recovery) and the neural (i.e. cortical organization) levels. [Results] Constraint-Induced Movement Therapies seemed to improve the upper limb functional usage in chronic stoke with no reliable neurophysiological underlying mechanisms. The Motor Activity Log was the common outcome measuring motor recovery. The work that has been done on modified Constraint-Induced Movement Therapy was far less than the work done on the original Constraint-Induced Movement Therapy. [Conclusion] Evident lack of understanding of the association between changes in motor recovery and the underlying neural mechanisms in-terms of measures of assessing and defining functional recovery (i.e Motor Activity Log) that lacks sufficient sensitivity to characterize changes in movement strategies and thereby lack of distinction between recovery and behavioral compensation. Future studies should employ using kinematic metrics to quantify and explain the training-related changes in behavior following Constraint-Induced Movement Therapies in chronic stroke.
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Affiliation(s)
- Ali Ahmed Bani-Ahmed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk: 71491 Tabuk, KSA
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16
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Kim Y, Jung HT, Park J, Kim Y, Ramasarma N, Bonato P, Choe EK, Lee SI. Towards the Design of a Ring Sensor-based mHealth System to Achieve Optimal Motor Function in Stroke Survivors. ACTA ACUST UNITED AC 2019. [DOI: 10.1145/3369817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Maximizing the motor practice in stroke survivors' living environments may significantly improve the functional recovery of their stroke-affected upper-limb. A wearable system that can continuously monitor upper-limb performance has been considered as an effective clinical solution for its potential to provide patient-centered, data-driven feedback to improve the motor dosage. Towards that end, we investigate a system leveraging a pair of finger-worn, ring-type accelerometers capable of monitoring both gross-arm and fine-hand movements that are clinically relevant to the performance of daily activities. In this work, we conduct a mixed-methods study to (1) quantitatively evaluate the efficacy of finger-worn accelerometers in measuring clinically relevant information regarding stroke survivors' upper-limb performance, and (2) qualitatively investigate design requirements for the self-monitoring system, based on data collected from 25 stroke survivors and seven occupational therapists. Our quantitative findings demonstrate strong face and convergent validity of the finger-worn accelerometers, and its responsiveness to changes in motor behavior. Our qualitative findings provide a detailed account of the current rehabilitation process while highlighting several challenges that therapists and stroke survivors face. This study offers promising directions for the design of a self-monitoring system that can encourage the affected limb use during stroke survivors' daily living.
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Affiliation(s)
- Yoojung Kim
- Seoul National University, Seoul, Republic of Korea
| | - Hee-Tae Jung
- University of Massachusetts Amherst, Amherst, Massachusetts, United States
| | - Joonwoo Park
- Smilegreen Child Development Center, Daegu, Republic of Korea
| | - Yangsoo Kim
- Heeyeon Rehabilitation Hospital, Changwon, Republic of Korea
| | | | - Paolo Bonato
- Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States
| | - Eun Kyoung Choe
- University of Maryland, College Park, College Park, Maryland, United States
| | - Sunghoon Ivan Lee
- University of Massachusetts Amherst, Amherst, Massachusetts, United States
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17
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Lee SI, Liu X, Rajan S, Ramasarma N, Choe EK, Bonato P. A novel upper-limb function measure derived from finger-worn sensor data collected in a free-living setting. PLoS One 2019; 14:e0212484. [PMID: 30893308 PMCID: PMC6426183 DOI: 10.1371/journal.pone.0212484] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/03/2019] [Indexed: 12/30/2022] Open
Abstract
The use of wrist-worn accelerometers has recently gained tremendous interest among researchers and clinicians as an objective tool to quantify real-world use of the upper limbs during the performance of activities of daily living (ADLs). However, wrist-worn accelerometers have shown a number of limitations that hinder their adoption in the clinic. Among others, the inability of wrist-worn accelerometers to capture hand and finger movements is particularly relevant to monitoring the performance of ADLs. This study investigates the use of finger-worn accelerometers to capture both gross arm and fine hand movements for the assessment of real-world upper-limb use. A system of finger-worn accelerometers was utilized to monitor eighteen neurologically intact young adults while performing nine motor tasks in a laboratory setting. The system was also used to monitor eighteen subjects during the day time of a day in a free-living setting. A novel measure of real-world upper-limb function—comparing the duration of activities of the two limbs—was derived to identify which upper limb subjects predominantly used to perform ADLs. Two validated handedness self-reports, namely the Waterloo Handedness Questionnaire and the Fazio Laterality Inventory, were collected to assess convergent validity. The analysis of the data recorded in the laboratory showed that the proposed measure of upper-limb function is suitable to accurately detect unilateral vs. bilateral use of the upper limbs, including both gross arm movements and fine hand movements. When applied to recordings collected in a free-living setting, the proposed measure showed high correlation with self-reported handedness indices (i.e., ρ = 0.78 with the Waterloo Handedness Questionnaire scores and ρ = 0.77 with the Fazio Laterality Inventory scores). The results herein presented establish face and convergent validity of the proposed measure of real-world upper-limb function derived using data collected by means of finger-worn accelerometers.
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Affiliation(s)
- Sunghoon Ivan Lee
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
- * E-mail:
| | - Xin Liu
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
| | - Smita Rajan
- College of Information and Computer Sciences, University of Massachusetts, Amherst, MA, United States of America
| | | | - Eun Kyoung Choe
- College of Information Studies, University of Maryland, College Park, MD, United States of America
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, United States of America
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18
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Lu K, Xu G, Li W, Huo C, Liu Q, Lv Z, Wang Y, Li Z, Fan Y. Frequency-specific functional connectivity related to the rehabilitation task of stroke patients. Med Phys 2019; 46:1545-1560. [PMID: 30675729 DOI: 10.1002/mp.13398] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/21/2018] [Accepted: 01/17/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSES Stroke survivors suffering from deficits in motor control typically show persistent motor symptoms and limited functional abilities, which affect their functional independence in daily life. Active rehabilitation training is commonly applied for stroke patients to recover from motor dysfunction. The global connectivity reflects the synchronization of cardiac and respiratory activities in the cerebral regions. However, the understanding of the patterns of frequency-specific global connectivity (GC) and functional connectivity (FC) when performing active rehabilitation training is still far from comprehensive. This study was conducted to investigate the brain network patterns of stroke patients while performing a four-limb linkage rehabilitation training using the functional near-infrared spectroscopy (fNIRS) method. METHODS Two groups of stroke patients (LH, left hemiplegia; RH, right hemiplegia) and one healthy group were recruited to participate in this study. The wavelet phase coherence (WPCO) method was used to calculate the frequency-specific GC and FC of the brain network in four frequency bands: I, 0.6-2 Hz; II, 0.145-0.6 Hz; III, 0.052-0.145 Hz; and IV, 0.021-0.052 Hz. RESULTS Results showed that the healthy group exhibited lower WPCO in the four frequency bands during the task state than during the resting state (P < 0.05). Interestingly, the stroke groups showed increased WPCO in the frequency band II during the task state than during the resting state (P < 0.05). Moreover, significantly lower WPCO values in the frequency bands III (P < 0.05) were found during task state in the RH and LH groups compared with the healthy group. The RH group showed increased WPCO values in the frequency band II during the task state compared with the healthy group (P < 0.05). In addition, the RH group showed increased WPCO in the frequency bands I (P < 0.05) and II (P < 0.05) than the LH group. Notably, the rehabilitation task did not induce significant changes in stroke groups in the frequency band IV, which implied the neurogenic activity. CONCLUSIONS The reductions in FC suggested that the brain impairments caused a disturbed neurovascular coupling regulation in stroke patients. Results in frequency band IV suggested that the limb movement rehabilitation task intrinsically may not produce remarkable effect on the neurogenic activity of stroke patients. Significant differences in WPCO between the LH and RH groups suggested that the rehabilitation task should be specifically designed for individual rehabilitation. The frequency-specific FC methods based on WPCO would provide a potential approach to quantitatively assess the effect of rehabilitation tasks.
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Affiliation(s)
- Kuan Lu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Gongcheng Xu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Wenhao Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Congcong Huo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, Beijing, 100176, China
| | - Qianying Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China
| | - Zeping Lv
- Rehabilitation Hospital, National Research Center for Rehabilitation Technical Aids, Beijing, 100176, China
| | - Yonghui Wang
- Qilu Hospital, ShanDong University, Jinan, 250061, China
| | - Zengyong Li
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, Beijing, 100176, China.,Key Laboratory of Rehabilitation Aids Technology and System of the Ministry of Civil Affairs, Beijing, 100176, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 100086, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, National Research Center for Rehabilitation Technical Aids Beijing, Beijing, 100176, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
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19
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Mark VW, Taub E, Uswatte G, Morris DM, Cutter GR, Adams TL, Bowman MH, McKay S. Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 1: Effects on Real-World Function. Neurorehabil Neural Repair 2019; 32:223-232. [PMID: 29668399 DOI: 10.1177/1545968318761050] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Constraint-Induced Movement therapy (CIMT) has controlled evidence of efficacy for improving real-world paretic limb use in non-progressive physically disabling disorders (stroke, cerebral palsy). OBJECTIVE This study sought to determine whether this therapy can produce comparable results with a progressive disorder such as multiple sclerosis (MS). We conducted a preliminary phase II randomized controlled trial of CIMT versus a program of complementary and alternative medicine (CAM) treatments for persons with MS, to evaluate their effect on real-world disability. METHODS Twenty adults with hemiparetic MS underwent 35 hours of either CIMT or CAM over 10 consecutive weekdays. The primary clinical outcome was change from pretreatment on the Motor Activity Log (MAL). RESULTS The CIMT group improved more on the MAL (2.7 points, 95% confidence interval 2.2-3.2) than did the CAM group (0.5 points, 95% confidence interval -0.1 to 1.1; P < .001). These results did not change at 1-year follow-up, indicating long-term retention of functional benefit for CIMT. The treatments were well tolerated and without adverse events. CONCLUSION These results suggest that CIMT can increase real-world use of the more-affected arm in patients with MS for at least 1 year. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01081275.
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Affiliation(s)
- Victor W Mark
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Edward Taub
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - David M Morris
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary R Cutter
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Terrie L Adams
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mary H Bowman
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Staci McKay
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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20
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Levy T, Laver K, Killington M, Lannin N, Crotty M. A systematic review of measures of adherence to physical exercise recommendations in people with stroke. Clin Rehabil 2018; 33:535-545. [PMID: 30458647 PMCID: PMC6416703 DOI: 10.1177/0269215518811903] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE: To review methods for measuring adherence to exercise or physical activity practice recommendations in the stroke population and evaluate measurement properties of identified tools. DATA SOURCES: Two systematic searches were conducted in eight databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library of Systematic Reviews, Sports Discus, PEDro, PubMed and EMBASE). Phase 1 was conducted to identify measures. Phase 2 was conducted to identify studies investigating properties of these measures. REVIEW METHODS: Phase 1 articles were selected if they were published in English, included participants with stroke, quantified adherence to exercise or physical activity recommendations, were patient or clinician reported, were defined and reproducible measures and included patients >18 years old. In phase 2, articles were included if they explored psychometric properties of the identified tools. Included articles were screened based on title/abstract and full-text review by two independent reviewers. RESULTS: In phase 1, seven methods of adherence measurement were identified, including logbooks ( n = 16), diaries ( n = 18), 'record of practice' ( n = 3), journals ( n = 1), surveys ( n = 2) and questionnaires ( n = 4). One measurement tool was identified, the Physical Activity Scale for Individuals with Physical Disabilities ( n = 4). In phase 2, no eligible studies were identified. CONCLUSION: There is not a consistent measure of adherence that is currently utilized. Diaries and logbooks are the most frequently utilized tools.
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Affiliation(s)
- Tamina Levy
- 1 Flinders University, Adelaide, SA, Australia
| | - Kate Laver
- 1 Flinders University, Adelaide, SA, Australia
| | | | - Natasha Lannin
- 2 School of Allied Health, La Trobe University, Melbourne, VIC, Australia.,3 Alfred Health, Melbourne, VIC, Australia
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21
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Effects of modified constraint-induced movement therapy in the recovery of upper extremity function affected by a stroke: a single-blind randomized parallel trial-comparing group versus individual intervention. Int J Rehabil Res 2018; 41:35-40. [PMID: 28957983 DOI: 10.1097/mrr.0000000000000257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An extensive corpus of literature supports the positive impact of constraint-induced movement therapy (CIMT) on neuroplasticity and the recovery of function. However, its clinical applicability is limited by the time of intervention and individual modality. We propose to assess the efficacy of modified CIMT protocols through a group therapy intervention. To determine the effectiveness of a group therapy, compared with individual modified CIMT, in increasing the use and functionality of movement of a paretic upper limb. The study was a single-blind, randomized parallel trial. Thirty-six patients who had had a stroke more than 6 months previously were divided randomly into two intervention groups. The independent variable was the implementation of group or individual modalities for 3 h for 10 consecutive days and the dependent variables were evaluated by the Motor Activity Log and Action Research Arm Test, at baseline (preintervention evaluation), end (postintervention evaluation), and 6 months after intervention (follow-up). By controlling the preintervention evaluations, analyses of covariance indicated that both dependent variables presented significant differences in favor of the group therapy at both the postintervention evaluation and the follow-up evaluations. Both types of intervention generated increases in the function and use of the upper extremity, with these increases being higher in the group therapy. The effects of the group therapy modality were maintained 6 months after the intervention ended.
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22
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Hirakawa Y, Takeda K, Tanabe S, Koyama S, Motoya I, Sakurai H, Kanada Y, Kawamura N, Kawamura M, Nagata J, Kanno T. Effect of intensive motor training with repetitive transcranial magnetic stimulation on upper limb motor function in chronic post-stroke patients with severe upper limb motor impairment. Top Stroke Rehabil 2018; 25:321-325. [PMID: 29718776 DOI: 10.1080/10749357.2018.1466971] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background Intensive motor training with low-frequency repetitive transcranial magnetic stimulation (rTMS) has efficacy as a therapeutic method for motor dysfunction of the affected upper limb in patients with mild to moderate stroke. However, it is not clear whether this combination therapy has the same effect in chronic post-stroke patients with severe upper limb motor impairment. Objectives The aim of this study was to test the treatment effects of intensive motor training with low-frequency rTMS in chronic post-stroke patients with severe upper limb motor impairment. Methods A convenience sample of 26 chronic post-stroke patients with severe upper limb motor impairment participated in this study with the non-randomized, non-controlled clinical trial. All subjects were hospitalized to receive intensive motor training with low-frequency rTMS. During 2 weeks in which Sundays were excluded, a total of 24 sessions (2 sessions per day) of the intervention were conducted. The Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT) were used to assess motor impairment and function of the affected upper limb, respectively, before and after intervention. Paired t-test was used to analyze the effects of the intervention. Results The FMA total score and WMFT log performance time significantly improved from before to after intervention (FMA: 12.6-18.0; WMFT: 3.6-3.3, p < 0.001). Conclusions The present results suggest that intensive motor training with low-frequency rTMS could improve motor impairment in chronic post-stroke patients with severe upper limb motor impairment and contribute to the expansion of the application range of this combination therapy.
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Affiliation(s)
- Yuichi Hirakawa
- a Department of Rehabilitation , Kawamura Hospital , Gifu , Japan
| | - Kazuya Takeda
- a Department of Rehabilitation , Kawamura Hospital , Gifu , Japan.,c Graduate School of Health Science , Kio University , Kitakatsuragigun , Japan
| | - Shigeo Tanabe
- b Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | - Soichiro Koyama
- b Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | - Ikuo Motoya
- a Department of Rehabilitation , Kawamura Hospital , Gifu , Japan
| | - Hiroaki Sakurai
- b Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | - Yoshikiyo Kanada
- b Faculty of Rehabilitation, School of Health Sciences , Fujita Health University , Toyoake , Japan
| | | | - Mami Kawamura
- d Department of Neurology , Kawamura Hospital , Gifu , Japan
| | - Junji Nagata
- e Department of Neurosurgical , Kawamura Hospital , Gifu , Japan
| | - Tetsuo Kanno
- e Department of Neurosurgical , Kawamura Hospital , Gifu , Japan
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23
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Uswatte G, Taub E, Bowman MH, Delgado A, Bryson C, Morris DM, Mckay S, Barman J, Mark VW. Rehabilitation of stroke patients with plegic hands: Randomized controlled trial of expanded Constraint-Induced Movement therapy. Restor Neurol Neurosci 2018. [PMID: 29526860 DOI: 10.3233/rnn-170792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the efficacy of an expanded form of Constraint-Induced Movement Therapy (eCIMT) that renders CIMT, originally designed for treating mild-to-moderate upper-extremity hemiparesis, suitable for treating severe hemiparesis. METHODS Twenty-one adults ≥1 year after stroke with severe upper-extremity hemiparesis (with little or no capacity to make movements with the more-affected hand) were randomly assigned to eCIMT (n = 10), a placebo-control procedure (n = 4), or usual care (n = 7). The participants who received usual care were crossed over to eCIMT four months after enrollment. The CIMT protocol was altered to include fitting of orthotics and adaptive equipment, selected neurodevelopmental techniques, and electromyography-triggered functional electrical stimulation. Treatment was given for 15 consecutive weekdays with 6 hours of therapy scheduled daily for the immediate eCIMT group and 3.5 hours daily for the cross-over eCIMT group. RESULTS At post-treatment, the immediate eCIMT group showed significant gains relative to the combination of the control groups on the Grade-4/5 Motor Activity Log (MAL; mean = 1.5 points, P < 0.001, f = 4.2) and a convergent measure, the Canadian Occupational Performance Measure (COPM; mean = 2.3, P = 0.014, f = 1.1; f values ≥0.4 are considered large, on the COPM changes ≥2 are considered clinically meaningful). At 1-year follow-up, the MAL gains in the immediate eCIMT group were only 13% less than at post-treatment. The short and long-term outcomes of the crossover eCIMT group were similar to those of the immediate eCIMT group. CONCLUSIONS This small, randomized controlled trial (RCT) suggests that eCIMT produces a large, meaningful, and persistent improvement in everyday use of the more-affected arm in adults with severe upper-extremity hemiparesis long after stroke. These promising findings warrant confirmation by a large RCT.
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Affiliation(s)
- Gitendra Uswatte
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Physical Therapy, UAB, Birmingham, AL, USA
| | - Edward Taub
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Mary H Bowman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Adriana Delgado
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Camille Bryson
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - David M Morris
- Department of Physical Therapy, UAB, Birmingham, AL, USA
| | - Staci Mckay
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Joydip Barman
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Victor W Mark
- Department of Psychology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.,Department of Physical Medicine and Rehabilitation, UAB, Birmingham, AL, USA.,Department of Neurology, UAB, Birmingham, AL, USA
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24
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Bondoc S, Booth J, Budde G, Caruso K, DeSousa M, Earl B, Hammerton K, Humphreys J. Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity. Am J Occup Ther 2018; 72:7202205080p1-7202205080p8. [PMID: 29426386 DOI: 10.5014/ajot.2018.025064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE This study investigates the effect of mirror therapy and task-oriented training on the paretic upper extremity function and occupational performance of people with stroke. METHOD This study used a repeated-measures, case-series design in which 4 participants completed a 4-wk intervention consisting of mirror therapy and task-specific training. The intervention was conducted 2×/wk in the clinic and 4×/wk at home. RESULTS All participants displayed clinically meaningful improvements in self-identified goals at the end of the intervention and at follow-up. Three participants showed clinically meaningful changes in motor function. Although only 1 participant improved in his reported amount of use, all participants showed clinically meaningful improvements in perceived movement quality at varying points of assessment. CONCLUSION Mirror therapy, when used as priming for task-oriented training, can produce clinical improvements in upper extremity function and occupational performance in people with hemiparesis.
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Affiliation(s)
- Salvador Bondoc
- Salvador Bondoc, OTD, OTR/L, FAOTA, is Professor and Chair of Occupational Therapy, School of Health Sciences, Quinnipiac University, Hamden, CT;
| | - Julie Booth
- Julie Booth, DPT, PCS, is Clinical Associate Professor of Physical Therapy, School of Health Sciences, Quinnipiac University, Hamden, CT
| | - Grace Budde
- Grace Budde, MOT, OTR/L, is Occupational Therapist, Professional Hand Therapy, Merrick, NY
| | - Katelyn Caruso
- Katelyn Caruso, MOT, OTR/L, is Occupational Therapist, Excel Orthopaedic Specialists, Woburn, MA
| | - Michelle DeSousa
- Michelle DeSousa, DPT, is Physical Therapist, Lawrence + Memorial Hospital, New London, CT
| | - Brittany Earl
- Brittany Earl, MOT, OTR/L, is Occupational Therapist, CareOne at Wall, Wall Township, NJ
| | - Kaitlynn Hammerton
- Kaitlynn Hammerton, DPT, is Physical Therapist, Burke Rehabilitation Hospital, White Plains, NY
| | - Jill Humphreys
- Jill Humphreys, DPT, is Physical Therapist, The Center at Lowry, Denver, CO
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25
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Womble B, Taub E, Hickson B, Purvis J, Mark V, Yarar-Fisher C, McLain A, Uswatte G. Upper extremity motor training of a subject with initially motor complete chronic high tetraplegia using constraint-induced biofeedback therapy. Spinal Cord Ser Cases 2018; 3:17093. [PMID: 29423298 DOI: 10.1038/s41394-017-0007-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction The purpose of this case study was to determine if a subject with chronic high tetraplegia (C3 AIS A) could learn to use an initially paralyzed upper extremity on the basis of training procedures alone. Case presentation Initially, an AIS examination revealed no purposive movement below the neck other than minimal shoulder movement. Training was carried out weekly over 39 months. Training began based on electromyographic biofeedback; the electrical activity of a muscle (biceps or triceps) was displayed visually on a computer monitor and the subject was encouraged to progressively increase the magnitude of the response in small increments on a trial-by-trial basis (i.e., shaping). When small, overt movements began to appear; these were, in turn, shaped so that their excursion progressively increased. Training then progressed to enable lifting the arm with the aid of the counterweight of a Swedish Help Arm. Mean movement excursions in the best session were: internal rotation 52.5 cm; external rotation 26.9 cm; shoulder extension 22.1 cm; shoulder flexion 15.2 cm; pronation/supination 120°; extension of index finger (D2) 2.5 cm. Movements were initially saltatory, becoming smoother over time. With the Swedish Help Arm, the subject was able to lift her hand an average of 24.3 cm in the best session with 0.7 kg counterweight acting at the wrist (1.9 J of work). Discussion Results suggest in preliminary fashion the effectiveness of this approach for improving upper extremity function after motor complete high tetraplegia. Thus, future studies are warranted. Possible mechanisms are discussed.
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Affiliation(s)
- Brent Womble
- 1Department of Psychology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Edward Taub
- 1Department of Psychology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Brennan Hickson
- 1Department of Psychology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Joshua Purvis
- 1Department of Psychology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Victor Mark
- 1Department of Psychology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA.,2Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA.,3Department of Neurology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Ceren Yarar-Fisher
- 2Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Amie McLain
- 2Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
| | - Gitendra Uswatte
- 1Department of Psychology, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA.,2Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA.,4Department of Physical Therapy, University of Alabama at Birmingham, CPM 110 1713 6th Ave S, Birmingham, AL 35284 USA
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26
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Hsieh YW, Lin KC, Wu CY, Shih TY, Li MW, Chen CL. Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: a cluster controlled trial. Sci Rep 2018; 8:2091. [PMID: 29391492 PMCID: PMC5794971 DOI: 10.1038/s41598-018-20330-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022] Open
Abstract
This study examined the treatment efficacy of proximal-emphasized robotic rehabilitation by using the InMotion ARM (P-IMT) versus distal-emphasized robotic rehabilitation by using the InMotion WRIST (D-IMT) in patients with stroke. A total of 40 patients with stroke completed the study. They received P-IMT, D-IMT, or control treatment (CT) for 20 training sessions. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scale. Secondary outcomes were the Motor Activity Log (MAL) and wrist-worn accelerometers. The differences on the distal FMA, total MRC, distal MRC, and MAL quality of movement scores among the 3 groups were statistically significant (P = 0.02 to 0.05). Post hoc comparisons revealed that the D-IMT group significantly improved more than the P-IMT group on the total MRC and distal MRC. Furthermore, the distal FMA and distal MRC improved more in the D-IMT group than in the CT group. Our findings suggest that distal upper-limb robotic rehabilitation using the InMotion WRIST system had superior effects on distal muscle strength. Further research based on a larger sample is needed to confirm long-term treatment effects of proximal versus distal upper-limb robotic rehabilitation.
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Affiliation(s)
- Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan. .,Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.
| | - Tsai-Yu Shih
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Li
- Department of Physical Medicine and Rehabilitation, Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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27
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Li YY, Zhang B, Yu KW, Li C, Xie HY, Bao WQ, Kong YY, Jiao FY, Guan YH, Bai YL. Effects of constraint-induced movement therapy on brain glucose metabolism in a rat model of cerebral ischemia: a micro PET/CT study. Int J Neurosci 2018; 128:736-745. [PMID: 29251083 DOI: 10.1080/00207454.2017.1418343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ying-Ying Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Bei Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ke-Wei Yu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ce Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong-Yu Xie
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei-Qi Bao
- Center, Department of Nuclear Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan-Yan Kong
- Center, Department of Nuclear Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fang-Yang Jiao
- Center, Department of Nuclear Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yi-Hui Guan
- Center, Department of Nuclear Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
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28
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Chuang IC, Lin KC, Wu CY, Hsieh YW, Liu CT, Chen CL. Using Rasch Analysis to Validate the Motor Activity Log and the Lower Functioning Motor Activity Log in Patients With Stroke. Phys Ther 2017; 97:1030-1040. [PMID: 29029552 DOI: 10.1093/ptj/pzx071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/29/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Motor Activity Log (MAL) and Lower-Functioning MAL (LF-MAL) are used to assess the amount of use of the more impaired arm and the quality of movement during activities in real-life situations for patients with stroke. OBJECTIVE This study used Rasch analysis to examine the psychometric properties of the MAL and LF-MAL in patients with stroke. DESIGN This is a methodological study. METHODS The MAL and LF-MAL include 2 scales: the amount of use (AOU) and the quality of movement (QOM). Rasch analysis was used to examine the unidimensionality, item difficulty hierarchy, targeting, reliability, and differential item functioning (DIF) of the MAL and LF-MAL. RESULTS A total of 403 patients with mild or moderate stroke completed the MAL, and 134 patients with moderate/severe stroke finished the LF-MAL. Evidence of disordered thresholds and poor model fit were found both in the MAL and LF-MAL. After the rating categories were collapsed and misfit items were deleted, all items of the revised MAL and LF-MAL exhibited ordering and constituted unidimensional constructs. The person-item map showed that these assessments were difficult for our participants. The person reliability coefficients of these assessments ranged from .79 to .87. No items in the revised MAL and LF-MAL exhibited bias related to patients' characteristics. LIMITATIONS One limitation is the recruited patients, who have relatively high-functioning ability in the LF-MAL. CONCLUSIONS The revised MAL and LF-MAL are unidimensional scales and have good reliability. The categories function well, and responses to all items in these assessments are not biased by patients' characteristics. However, the revised MAL and LF-MAL both showed floor effect. Further study might add easy items for assessing the performance of activity in real-life situations for patients with stroke.
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Affiliation(s)
- I-Ching Chuang
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Guang University
| | - Keh-Chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Guang University.,Healthy Aging Research Center of Chang Gung University, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, 259 Wen-hwa 1st Road, Taoyuan, Taiwan
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Guang University.,Healthy Aging Research Center of Chang Gung University, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, 259 Wen-hwa 1st Road, Taoyuan, Taiwan
| | - Chien-Ting Liu
- Department of Physical Medicine and Rehabilitation, Taipei Tzuchi Hospital, Buddhist Tzuchi Medical Foundation, New Taipei City, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital.,Graduate Institute of Early Intervention, College of Medicine, Chang Gung University
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29
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[Brain plasticity and early rehabilitative care for children after neonatal arterial cerebral infarction]. Arch Pediatr 2017; 24:9S61-9S68. [PMID: 28867040 DOI: 10.1016/s0929-693x(17)30333-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Currently, in the literature of the evidence based medicine, little data are available to confirm the benefit and the specific procedures of an early intervention for a neonatal arterial ischemic stroke. However, data about the effect of an early physical rehabilitation program on the cerebral plasticity, and preliminary results of clinical studies in children with cerebral palsy strongly suggest the benefit of an early rehabilitation with a multidisciplinary approach. The type of the rehabilitation and its frequency must be determined because a wide variability in the practices exists. A comprehensive care, of the children and his family is necessary to limit the orthopaedics but also the social consequences of a neonatal stroke.
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30
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Gauthier LV, Kane C, Borstad A, Strahl N, Uswatte G, Taub E, Morris D, Hall A, Arakelian M, Mark V. Video Game Rehabilitation for Outpatient Stroke (VIGoROUS): protocol for a multi-center comparative effectiveness trial of in-home gamified constraint-induced movement therapy for rehabilitation of chronic upper extremity hemiparesis. BMC Neurol 2017; 17:109. [PMID: 28595611 PMCID: PMC5465449 DOI: 10.1186/s12883-017-0888-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/26/2017] [Indexed: 11/15/2022] Open
Abstract
Background Constraint-Induced Movement therapy (CI therapy) is shown to reduce disability, increase use of the more affected arm/hand, and promote brain plasticity for individuals with upper extremity hemiparesis post-stroke. Randomized controlled trials consistently demonstrate that CI therapy is superior to other rehabilitation paradigms, yet it is available to only a small minority of the estimated 1.2 million chronic stroke survivors with upper extremity disability. The current study aims to establish the comparative effectiveness of a novel, patient-centered approach to rehabilitation utilizing newly developed, inexpensive, and commercially available gaming technology to disseminate CI therapy to underserved individuals. Video game delivery of CI therapy will be compared against traditional clinic-based CI therapy and standard upper extremity rehabilitation. Additionally, individual factors that differentially influence response to one treatment versus another will be examined. Methods This protocol outlines a multi-site, randomized controlled trial with parallel group design. Two hundred twenty four adults with chronic hemiparesis post-stroke will be recruited at four sites. Participants are randomized to one of four study groups: (1) traditional clinic-based CI therapy, (2) therapist-as-consultant video game CI therapy, (3) therapist-as-consultant video game CI therapy with additional therapist contact via telerehabilitation/video consultation, and (4) standard upper extremity rehabilitation. After 6-month follow-up, individuals assigned to the standard upper extremity rehabilitation condition crossover to stand-alone video game CI therapy preceded by a therapist consultation. All interventions are delivered over a period of three weeks. Primary outcome measures include motor improvement as measured by the Wolf Motor Function Test (WMFT), quality of arm use for daily activities as measured by Motor Activity Log (MAL), and quality of life as measured by the Quality of Life in Neurological Disorders (NeuroQOL). Discussion This multi-site RCT is designed to determine comparative effectiveness of in-home technology-based delivery of CI therapy versus standard upper extremity rehabilitation and in-clinic CI therapy. The study design also enables evaluation of the effect of therapist contact time on treatment outcomes within a therapist-as-consultant model of gaming and technology-based rehabilitation. Trial registration Clinicaltrials.gov, NCT02631850.
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Affiliation(s)
- Lynne V Gauthier
- The Ohio State University, Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, 480 Medical Center Drive, Columbus, OH, 43210, USA.
| | - Chelsea Kane
- The Ohio State University, Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, 480 Medical Center Drive, Columbus, OH, 43210, USA
| | - Alexandra Borstad
- Department of Physical Therapy, College of St. Scholastica, 1200 Kenwood Ave, Duluth, MN, 55811, USA
| | - Nancy Strahl
- Providence Medford Medical Center, 1111 Crater Lake Ave, Medford, Oregon, 97504, USA
| | - Gitendra Uswatte
- Department of Psychology; UAB Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA
| | - Edward Taub
- Department of Psychology; UAB Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA
| | - David Morris
- Department of Physical Therapy; UAB Department of Physical Therapy, University of Alabama at Birmingham, 1720 2nd Avenue South, School of Health Professions Building 360X, Birmingham, AL, 35294-1212, USA
| | - Alli Hall
- The Ohio State University, Department of Physical Medicine and Rehabilitation, Division of Rehabilitation Psychology, 480 Medical Center Drive, Columbus, OH, 43210, USA
| | - Melissa Arakelian
- Providence Medford Medical Center, 1111 Crater Lake Ave, Medford, Oregon, 97504, USA
| | - Victor Mark
- Department of Psychology; UAB Department of Psychology, University of Alabama at Birmingham, Campbell Hall 415, 1530 3rd Avenue South, Birmingham, AL, 35294-1170, USA.,Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294-7330, USA.,Department of Neurology, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL, 35294, USA
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31
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Chen HL, Lin KC, Hsieh YW, Wu CY, Liing RJ, Chen CL. A study of predictive validity, responsiveness, and minimal clinically important difference of arm accelerometer in real-world activity of patients with chronic stroke. Clin Rehabil 2017; 32:75-83. [DOI: 10.1177/0269215517712042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hao-ling Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Rong-jiuan Liing
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-ling Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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32
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Doussoulin A, Arancibia M, Saiz J, Silva A, Luengo M, Salazar A. Recovering functional independence after a stroke through Modified Constraint-Induced Therapy. NeuroRehabilitation 2017; 40:243-249. [DOI: 10.3233/nre-161409] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Doussoulin
- Department of Pediatrics and Child Surgery, Universidad de La Frontera, Temuco, Chile
| | - M. Arancibia
- Department of Pediatrics and Child Surgery, Universidad de La Frontera, Temuco, Chile
| | - J. Saiz
- Department of Psychology, Universidad de La Frontera, Temuco, Chile
| | - A. Silva
- Graduate Program of Health Sciences, Federal University of Porto Alegre, Brazil
| | - M. Luengo
- Domiciliary Hospitalization Program, Hospital Villarrica, Chile
| | - A.P. Salazar
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
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Narai E, Hagino H, Komatsu T, Togo F. Accelerometer-Based Monitoring of Upper Limb Movement in Older Adults With Acute and Subacute Stroke. J Geriatr Phys Ther 2016; 39:171-7. [DOI: 10.1519/jpt.0000000000000067] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Miltner WHR. Plasticity and Reorganization in the Rehabilitation of Stroke. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1027/2151-2604/a000243] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract. This paper outlines some actual developments in the behavioral treatment and rehabilitation of stroke and other brain injuries in post-acute and chronic conditions of brain lesion. It points to a number of processes that demonstrate the enormous plasticity and reorganization capacity of the human brain following brain lesion. It also highlights a series of behavioral and neuroscientific studies that indicate that successful behavioral rehabilitation is paralleled by plastic changes of brain structures and by cortical reorganization and that the amount of such plastic changes is obviously significantly determining the overall outcome of rehabilitation.
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Affiliation(s)
- Wolfgang H. R. Miltner
- Department of Biological and Clinical Psychology, Friedrich Schiller University, Jena, Germany
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Hsieh YW, Liing RJ, Lin KC, Wu CY, Liou TH, Lin JC, Hung JW. Sequencing bilateral robot-assisted arm therapy and constraint-induced therapy improves reach to press and trunk kinematics in patients with stroke. J Neuroeng Rehabil 2016; 13:31. [PMID: 27000446 PMCID: PMC4802889 DOI: 10.1186/s12984-016-0138-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/11/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The combination of robot-assisted therapy (RT) and a modified form of constraint-induced therapy (mCIT) shows promise for improving motor function of patients with stroke. However, whether the changes of motor control strategies are concomitant with the improvements in motor function after combination of RT and mCIT (RT + mCIT) is unclear. This study investigated the effects of the sequential combination of RT + mCIT compared with RT alone on the strategies of motor control measured by kinematic analysis and on motor function and daily performance measured by clinical scales. METHODS The study enrolled 34 patients with chronic stroke. The data were derived from part of a single-blinded randomized controlled trial. Participants in the RT + mCIT and RT groups received 20 therapy sessions (90 to 105 min/day, 5 days for 4 weeks). Patients in the RT + mCIT group received 10 RT sessions for first 2 weeks and 10 mCIT sessions for the next 2 weeks. The Bi-Manu-Track was used in RT sessions to provide bilateral practice of wrist and forearm movements. The primary outcome was kinematic variables in a task of reaching to press a desk bell. Secondary outcomes included scores on the Wolf Motor Function Test, Functional Independence Measure, and Nottingham Extended Activities of Daily Living. All outcome measures were administered before and after intervention. RESULTS RT + mCIT and RT demonstrated different benefits on motor control strategies. RT + mCIT uniquely improved motor control strategies by reducing shoulder abduction, increasing elbow extension, and decreasing trunk compensatory movement during the reaching task. Motor function and quality of the affected limb was improved, and patients achieved greater independence in instrumental activities of daily living. Force generation at movement initiation was improved in the patients who received RT. CONCLUSION A combination of RT and mCIT could be an effective approach to improve stroke rehabilitation outcomes, achieving better motor control strategies, motor function, and functional independence of instrumental activities of daily living. TRIAL REGISTRATION ClinicalTrials.gov. NCT01727648.
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Affiliation(s)
- Yu-wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan
| | - Rong-jiuan Liing
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Keh-chung Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-yi Wu
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, and Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Rd, Taoyuan, Taiwan.
| | - Tsan-hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jui-chi Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jen-wen Hung
- Department of Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
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Zhang B, He Q, Li YY, Li C, Bai YL, Hu YS, Zhang F. Constraint-induced movement therapy promotes motor function recovery and downregulates phosphorylated extracellular regulated protein kinase expression in ischemic brain tissue of rats. Neural Regen Res 2016; 10:2004-10. [PMID: 26889190 PMCID: PMC4730826 DOI: 10.4103/1673-5374.172319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Motor function impairment is a common outcome of stroke. Constraint-induced movement therapy (CIMT) involving intensive use of the impaired limb while restraining the unaffected limb is widely used to overcome the effects of 'learned non-use' and improve limb function after stroke. However, the underlying mechanism of CIMT remains unclear. In the present study, rats were randomly divided into a middle cerebral artery occlusion (model) group, a CIMT + model (CIMT) group, or a sham group. Restriction of the affected limb by plaster cast was performed in the CIMT and sham groups. Compared with the model group, CIMT significantly improved the forelimb functional performance in rats. By western blot assay, the expression of phosphorylated extracellular regulated protein kinase in the bilateral cortex and hippocampi of cerebral ischemic rats in the CIMT group was significantly lower than that in the model group, and was similar to sham group levels. These data suggest that functional recovery after CIMT may be related to decreased expression of phosphorylated extracellular regulated protein kinase in the bilateral cortex and hippocampi.
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Affiliation(s)
- Bei Zhang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang He
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ying-Ying Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ce Li
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu-Long Bai
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yong-Shan Hu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Feng Zhang
- Department of Rehabilitation, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
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Tarovskaya AM, Prokopenko SV, Ondar VS. [Evaluation of a method based on the principle of CI therapy in the correction of walking function in patients with post-stroke hemiparesis syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:41-44. [PMID: 28300802 DOI: 10.17116/jnevro201611612241-44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To develop a new, effective, affordable method of neurorehabilitation for the correction of walking functions based on the principle of CI (constraint-induced movement therapy) therapy in patients with the syndrome of hemiparesis of post-stroke origin. MATERIAL AND METHODS The study included 100 patients with moderate to marked syndrome of central hemiparesis in the recovery period of stroke. Patients were randomized into two groups. In the main group, the walk recovery was carried out using CI-therapy in complex with traditional methods of neurorehabilitation and in the comparison group, walk correction was performed by generally accepted methods of kinesiotherapy and physical therapy. Both groups were comparable by stage of stroke, the severity of paresis, age. RESULTS AND CONCLUSION The risk of fall significantly decreased in both groups of patients. The length and paretic step time significantly decreased in the main group. The effectiveness of the restoration of the function of walking was higher in the main group that allows us to recommend the method of correction of the walk based on the principle of CI therapy in the complex neurorehabilitation.
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Affiliation(s)
- A M Tarovskaya
- Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S V Prokopenko
- Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - V S Ondar
- Voyno-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Validity of body-worn sensor acceleration metrics to index upper extremity function in hemiparetic stroke. J Neurol Phys Ther 2015; 39:111-8. [PMID: 25742378 DOI: 10.1097/npt.0000000000000085] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Accelerometers have been used to capture real-world use of the paretic upper extremity in people with stroke. It may be possible to characterize different aspects of the recorded acceleration to gain insight about movement capabilities during task-specific behavior. These measures may be of value for guiding rehabilitation. We undertook a study to identify the acceleration characteristics that have a stable association with upper extremity function and sensitivity to within-participant fluctuations in function over multiple sessions of task-specific training. METHODS Twenty-seven adults 6 months or more poststroke with upper extremity paresis participated. Signals from wrist-worn accelerometers were sampled at 30 Hz during 7 sessions of task-specific training. Paretic upper extremity function was evaluated with the Action Research Arm Test. We used Spearman correlations to examine within-session associations between acceleration metrics and Action Research Arm Test performance. A mixed model was used to determine which metrics were sensitive to within-participant fluctuations in upper extremity function across the 7 training sessions. RESULTS Upper extremity function correlated with bilateral acceleration variability and use ratio during 5 and 6 sessions, respectively. Time accelerating between 76% and 100% of peak acceleration correlated with function in 6 sessions. Variability of the paretic upper extremity acceleration and the ratio of acceleration variability between upper extremities were associated with function during all 7 sessions. Variability in both the acceleration of the paretic upper extremity, and acceleration of the paretic and nonparetic extremities combined were sensitive to within-participant fluctuations in function across training sessions. DISCUSSION AND CONCLUSIONS Multiple features of the acceleration profile track with upper extremity function within and across sessions of task-specific training. It may be possible to monitor these features with accelerometers to index upper extremity function outside of clinical settings.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A91).
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Lee DG, Lee DY. Effects of adjustment of transcranial direct current stimulation on motor function of the upper extremity in stroke patients. J Phys Ther Sci 2015; 27:3511-3. [PMID: 26696727 PMCID: PMC4681934 DOI: 10.1589/jpts.27.3511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/19/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of transcranial direct
current stimulation (tDCS) applied to the cerebral cortex motor area on the upper
extremity functions of hemiplegic patients. [Subjects and Methods] Twenty four Patients
with hemiplegia resulting from a stroke were divided into two groups: a tDCS group that
received tDCS and physical therapy and a control group that received only physical
therapy. A functional evaluation of the two groups was performed, and an
electrophysiological evaluation was conducted before and after the experiment. Statistical
analyses were performed to verify differences before and after the experiment. All
statistical significance levels were set at 0.05. [Results] The results showed that
functional evaluation scores for the elbow joint and hand increased after the treatment in
both the experimental group and the control group, and the increases were statistically
significantly different. [Conclusion] tDCS was effective in improving the upper extremity
motor function of stroke patients. Additional research is warranted on the usefulness of
tDCS in the rehabilitation of stroke patients in the clinical field.
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Affiliation(s)
- Dong-Geol Lee
- Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Republic of Korea
| | - Dong-Yeop Lee
- Department of Physical Therapy, Sunmoon University, Republic of Korea
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Exploring the Role of Accelerometers in the Measurement of Real World Upper-Limb Use After Stroke. BRAIN IMPAIR 2015. [DOI: 10.1017/brimp.2015.21] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ultimate goal of upper-limb rehabilitation after stroke is to promote real-world use, that is, use of the paretic upper-limb in everyday activities outside the clinic or laboratory. Although real-world use can be collected through self-report questionnaires, an objective indicator is preferred. Accelerometers are a promising tool. The current paper aims to explore the feasibility of accelerometers to measure upper-limb use after stroke and discuss the translation of this measurement tool into clinical practice. Accelerometers are non-invasive, wearable sensors that measure movement in arbitrary units called activity counts. Research to date indicates that activity counts are a reliable and valid index of upper-limb use. While most accelerometers are unable to distinguish between the type and quality of movements performed, recent advancements have used accelerometry data to produce clinically meaningful information for clinicians, patients, family and care givers. Despite this, widespread uptake in research and clinical environments remains limited. If uptake was enhanced, we could build a deeper understanding of how people with stroke use their arm in real-world environments. In order to facilitate greater uptake, however, there is a need for greater consistency in protocol development, accelerometer application and data interpretation.
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Proximal Fugl-Meyer Assessment Scores Predict Clinically Important Upper Limb Improvement After 3 Stroke Rehabilitative Interventions. Arch Phys Med Rehabil 2015; 96:2137-44. [PMID: 26260019 DOI: 10.1016/j.apmr.2015.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/27/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To identify the baseline motor characteristics of the patients who responded to 3 prominent intervention programs. DESIGN Observational cohort study. SETTING Outpatient rehabilitation clinics. PARTICIPANTS Individuals with chronic stroke (N=174). INTERVENTIONS Participants received 30 hours of constraint-induced movement therapy (CIMT), robot-assisted therapy, or mirror therapy (MT). MAIN OUTCOME MEASURES The primary outcome measure was the change score of the Upper Extremity Fugl-Meyer Assessment (UE-FMA). The potential predicting variables were baseline proximal, distal, and total UE-FMA and Action Research Arm Test scores. We combined polynomial regression analyses and the minimal clinically important difference to stratify the patients as responders and nonresponders for each intervention approach. RESULTS Baseline proximal UE-FMA scores significantly predicted clinically important improvement on the primary outcome measure after all 3 interventions. Participants with baseline proximal UE-FMA scores of approximately <30 benefited significantly from CIMT and robot-assisted therapy, whereas participants with scores between 21 and 35 demonstrated significant improvement after MT. Baseline distal and total UE-FMA and Action Research Arm Test scores could also predict upper limb improvement after CIMT and MT, but not after robot-assisted therapy. CONCLUSIONS This study could inform clinicians about the selection of suitable rehabilitation approaches to help patients achieve clinically meaningful improvement in upper extremity function.
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Urbin MA, Waddell KJ, Lang CE. Acceleration metrics are responsive to change in upper extremity function of stroke survivors. Arch Phys Med Rehabil 2014; 96:854-61. [PMID: 25497517 DOI: 10.1016/j.apmr.2014.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 11/14/2014] [Accepted: 11/23/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To (1) determine whether acceleration metrics derived from monitoring outside of treatment are responsive to change in upper extremity (UE) function; and secondarily to (2) compare metric values during task-specific training and while in the free-living environment, and (3) establish metric associations with an in-clinic measure of movement capabilities. DESIGN Before-after observational study. SETTING Inpatient hospital (primary purpose); outpatient hospital (secondary purpose). PARTICIPANTS Individuals (n=8) with UE hemiparesis <30 days poststroke (primary purpose); individuals (n=27) with UE hemiparesis ≥6 months poststroke (secondary purpose). INTERVENTION The inpatient sample was evaluated for UE movement capabilities and monitored with wrist-worn accelerometers for 22 hours outside of treatment before and after multiple sessions of task-specific training. The outpatient sample was evaluated for UE movement capabilities and monitored during a single session of task-specific training and the subsequent 22 hours outside clinical settings. MAIN OUTCOME MEASURES Action Research Arm Test (ARAT) and acceleration metrics quantified from accelerometer recordings. RESULTS Five metrics improved in the inpatient sample, along with UE function as measured on the ARAT: use ratio, magnitude ratio, variation ratio, median paretic UE acceleration magnitude, and paretic UE acceleration variability. Metric values were greater during task-specific training than in the free-living environment, and each metric was strongly associated with ARAT score. CONCLUSIONS Multiple metrics that characterize different aspects of UE movement are responsive to change in function. Metric values are different during training than in the free-living environment, providing further evidence that what the paretic UE does in the clinic may not generalize to what it does in everyday life.
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Affiliation(s)
- M A Urbin
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO.
| | - Kimberly J Waddell
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO; Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO; Department of Neurology, Washington University School of Medicine, St. Louis, MO
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Direct and crossed effects of somatosensory stimulation on neuronal excitability and motor performance in humans. Neurosci Biobehav Rev 2014; 47:22-35. [DOI: 10.1016/j.neubiorev.2014.07.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/07/2014] [Accepted: 07/14/2014] [Indexed: 12/11/2022]
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Noorkõiv M, Rodgers H, Price CI. Accelerometer measurement of upper extremity movement after stroke: a systematic review of clinical studies. J Neuroeng Rehabil 2014; 11:144. [PMID: 25297823 PMCID: PMC4197318 DOI: 10.1186/1743-0003-11-144] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022] Open
Abstract
The aim of this review was to identify and summarise publications, which have reported clinical applications of upper limb accelerometry for stroke within free-living environments and make recommendations for future studies. Data was searched from MEDLINE, Scopus, IEEExplore and Compendex databases. The final search was 31st October 2013. Any study was included which reported clinical assessments in parallel with accelerometry in a free-living hospital or home setting. Study quality is reflected by participant numbers, methodological approach, technical details of the equipment used, blinding of clinical measures, whether safety and compliance data was collected. First author screened articles for inclusion and inclusion of full text articles and data extraction was confirmed by the third author. Out of 1375 initial abstracts, 8 articles were included. All participants were stroke patients. Accelerometers were worn for either 24 hours or 3 days. Data were collected as summed acceleration counts over a specified time or as the duration of active/inactive periods. Activity in both arms was reported by all studies and the ratio of impaired to unimpaired arm activity was calculated in six studies. The correlation between clinical assessments and accelerometry was tested in five studies and significant correlations were found. The efficacy of a rehabilitation intervention was assessed using accelerometry by three studies: in two studies both accelerometry and clinical test scores detected a post-treatment difference but in one study accelerometry data did not change despite clinical test scores showing motor and functional improvements. Further research is needed to understand the additional value of accelerometry as a measure of upper limb use and function in a clinical context. A simple and easily interpretable accelerometry approach is required.
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Affiliation(s)
- Marika Noorkõiv
- Stroke Research Group, Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
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Taub E, Mark VW, Uswatte G. Implications of CI therapy for visual deficit training. Front Integr Neurosci 2014; 8:78. [PMID: 25346665 PMCID: PMC4191165 DOI: 10.3389/fnint.2014.00078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/17/2014] [Indexed: 11/29/2022] Open
Abstract
We address here the question of whether the techniques of Constraint Induced (CI) therapy, a family of treatments that has been employed in the rehabilitation of movement and language after brain damage might apply to the rehabilitation of such visual deficits as unilateral spatial neglect and visual field deficits. CI therapy has been used successfully for the upper and lower extremities after chronic stroke, cerebral palsy (CP), multiple sclerosis (MS), other central nervous system (CNS) degenerative conditions, resection of motor areas of the brain, focal hand dystonia, and aphasia. Treatments making use of similar methods have proven efficacious for amblyopia. The CI therapy approach consists of four major components: intensive training, training by shaping, a "transfer package" to facilitate the transfer of gains from the treatment setting to everyday activities, and strong discouragement of compensatory strategies. CI therapy is said to be effective because it overcomes learned nonuse, a learned inhibition of movement that follows injury to the CNS. In addition, CI therapy produces substantial increases in the gray matter of motor areas on both sides of the brain. We propose here that these mechanisms are examples of more general processes: learned nonuse being considered parallel to sensory nonuse following damage to sensory areas of the brain, with both having in common diminished neural connections (DNCs) in the nervous system as an underlying mechanism. CI therapy would achieve its therapeutic effect by strengthening the DNCs. Use-dependent cortical reorganization is considered to be an example of the more general neuroplastic mechanism of brain structure repurposing. If the mechanisms involved in these broader categories are involved in each of the deficits being considered, then it may be the principles underlying efficacious treatment in each case may be similar. The lessons learned during CI therapy research might then prove useful for the treatment of visual deficits.
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Affiliation(s)
- Edward Taub
- University of Alabama at BirminghamBirmingham, AL, USA
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Taub E, Uswatte G, Mark VW. The functional significance of cortical reorganization and the parallel development of CI therapy. Front Hum Neurosci 2014; 8:396. [PMID: 25018720 PMCID: PMC4072972 DOI: 10.3389/fnhum.2014.00396] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 05/17/2014] [Indexed: 12/22/2022] Open
Abstract
For the nineteenth and the better part of the twentieth centuries two correlative beliefs were strongly held by almost all neuroscientists and practitioners in the field of neurorehabilitation. The first was that after maturity the adult CNS was hardwired and fixed, and second that in the chronic phase after CNS injury no substantial recovery of function could take place no matter what intervention was employed. However, in the last part of the twentieth century evidence began to accumulate that neither belief was correct. First, in the 1960s and 1970s, in research with primates given a surgical abolition of somatic sensation from a single forelimb, which rendered the extremity useless, it was found that behavioral techniques could convert the limb into an extremity that could be used extensively. Beginning in the late 1980s, the techniques employed with deafferented monkeys were translated into a rehabilitation treatment, termed Constraint Induced Movement therapy or CI therapy, for substantially improving the motor deficit in humans of the upper and lower extremities in the chronic phase after stroke. CI therapy has been applied successfully to other types of damage to the CNS such as traumatic brain injury, cerebral palsy, multiple sclerosis, and spinal cord injury, and it has also been used to improve function in focal hand dystonia and for aphasia after stroke. As this work was proceeding, it was being shown during the 1980s and 1990s that sustained modulation of afferent input could alter the structure of the CNS and that this topographic reorganization could have relevance to the function of the individual. The alteration in these once fundamental beliefs has given rise to important recent developments in neuroscience and neurorehabilitation and holds promise for further increasing our understanding of CNS function and extending the boundaries of what is possible in neurorehabilitation.
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Affiliation(s)
- Edward Taub
- Department of Psychology, University of Alabama at BirminghamBirmingham, AL, USA
| | - Gitendra Uswatte
- Departments of Psychology and Physical Therapy, University of Alabama at BirminghamBirmingham, AL, USA
| | - Victor W. Mark
- Departments of Physical Medicine and Rehabilitation, Neurology, and Psychology, University of Alabama at BirminghamBirmingham, AL, USA
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Takebayashi T, Amano S, Hanada K, Umeji A, Takahashi K, Koyama T, Domen K. Therapeutic synergism in the treatment of post-stroke arm paresis utilizing botulinum toxin, robotic therapy, and constraint-induced movement therapy. PM R 2014; 6:1054-8. [PMID: 24880058 DOI: 10.1016/j.pmrj.2014.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/20/2014] [Accepted: 04/15/2014] [Indexed: 11/18/2022]
Abstract
Botulinum toxin type A (BtxA) injection, constraint-induced movement therapy (CIMT), and robotic therapy (RT) each represent promising approaches to enhance arm motor recovery after stroke. To provide more effective treatment for a 50-year-old man with severe left spastic hemiparesis, we attempted to facilitate CIMT with adaptive approaches to extend the wrist and fingers using RT for 10 consecutive weeks after BtxA injection. This combined treatment resulted in substantial improvements in arm function and the amount of arm use in activities of daily living, and may be effective for stroke patients with severe arm paresis. However, we were unable to sufficiently prove the efficacy of combined treatment based only on a single case. To fully elucidate the efficacy of the combined approach for patients with severe hemiparesis after stroke, future studies of a larger number of patients are needed.
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Affiliation(s)
- Takashi Takebayashi
- Department of Rehabilitation, The Hospital of Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan∗.
| | - Satoru Amano
- Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(†)
| | - Keisuke Hanada
- Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(‡)
| | - Atsushi Umeji
- Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(§)
| | - Kayoko Takahashi
- Department of Allied Health Science, Kitasato University, Sagamihara, Kanagawa, Japan(‖)
| | - Tetsuo Koyama
- Department of Rehabilitation Medicine, Nishinomiya Kyoritsu Neurosurgical Hospital, Nishinomiya, Hyogo, Japan(¶)
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan(#)
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Hsieh YW, Lin KC, Horng YS, Wu CY, Wu TC, Ku FL. Sequential combination of robot-assisted therapy and constraint-induced therapy in stroke rehabilitation: a randomized controlled trial. J Neurol 2014; 261:1037-45. [PMID: 24748465 DOI: 10.1007/s00415-014-7345-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/26/2014] [Accepted: 04/05/2014] [Indexed: 12/27/2022]
Abstract
Robot-assisted therapy (RT) and constraint-induced therapy (CIT) both show great promise to improve stroke rehabilitation outcomes. Although the respective treatment efficacy of RT and CIT has been validated, the additive effects of RT combined with CIT remain unknown. This study investigated the treatment effects of RT in sequential combination with a distributed form of CIT (RT + dCIT) compared with RT and conventional rehabilitation (CR). Forty-eight patients with stroke were enrolled and randomized to receive one of the three interventions for 4 weeks. Primary outcomes assessed the changes of motor impairment and motor function on the Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test (WMFT). Secondary outcomes, including the Motor Activity Log (MAL) and accelerometers, examined functional performance during daily activities. The three treatment groups improved significantly on most primary and secondary outcomes over time. The combined RT + dCIT group exhibited significantly greater improvement on the FMA and functional ability subscale of the WMFT than the RT and CR groups. The improvements on the MAL and accelerometers were not significantly different among the three groups. RT in sequential combination with CIT led to additive effects on participants' motor ability and functional ability to perform motor tasks after stroke, which support that combined therapy can be an effective means to intensify outcomes. Further research investigating the potential long-term effects of combination therapy, especially on real-life performance, would be valuable.
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Affiliation(s)
- Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wen-hwa 1st Road, Taoyuan, Taiwan
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Network of Movement and Proximity Sensors for Monitoring Upper-Extremity Motor Activity After Stroke: Proof of Principle. Arch Phys Med Rehabil 2014; 95:499-505. [DOI: 10.1016/j.apmr.2013.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/14/2013] [Accepted: 09/16/2013] [Indexed: 11/24/2022]
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Pooyania S, Semenko B. Botulinum toxin type-A (BoNTA) and dynamic wrist-hand orthoses versus orthoses alone for the treatment of spastic-paretic upper extremity in chronic stroke patients. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojtr.2014.21003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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