Effects of Upper Limb Control on the Less-Affected Side on Upper Limb Function, Respiration, Balance, and Activities of Daily Living in Stroke

Background and Objectives: This study aimed to investigate the effects of upper limb control exercises on upper limb function, respiration, balance, and activities of daily living in patients with stroke. Materials and Methods: The 28 patients who met the selection criteria were randomly assigned to two groups of 14 patients each. Subsequently, upper limb control exercises using real-time feedback were applied. The same interventional exercise was applied to both the less-affected and affected limbs of the study participants, who were classified into a less-affected side upper limb control group and an affected side upper limb control exercise group. Interventional exercises, 30 min each, were performed five times weekly for 4 weeks, and follow-up examinations were performed 2 weeks after the end of exercise. Electronic muscle strength measurements and an electronic goniometer were used to evaluate upper limb function. A spirometer was used to measure respiration. Balance ability was evaluated using a force plate pressure distribution measuring system with a sensor that detects the movement of the body center on the ground. Daily life movements were evaluated using the Korean version of the modified Barthel index. Results: When examining the results, the upper limb function on the paralyzed side showed an increase in the electromyographic strength of shoulder joint depression and flexion angle. Improvements were also observed in respiration (forced vital capacity [L] and forced expiratory volume in 1 s [L]), balance (95% confidence ellipse area [mm2] and center of pressure displacement [mm]), and daily life activities, all of which showed statistically significant differences in the time × group interaction effect (p < 0.05). Conclusions: Thus, it was found that the upper limb control exercise on the less-affected side had a significant effect when the exercise was performed together with treatment on the affected side in patients with stroke. It is anticipated that this study will provide basic data for evaluating both the trunk and upper limbs of the less-affected and affected sides.

Interactive Videogame Improved Rehabilitation Motivation and Walking Speed in Chronic Stroke Patients: A Dual-Center Controlled Trial

Objective: This study aimed to evaluate the effectiveness of interactive video games (IVGs) in rehabilitation motivation and walking and balance abilities in chronic stroke patients. Materials and Methods: In this dual-center controlled trial, 24 chronic stroke patients from rehabilitation centers A and B were randomly assigned to an experimental (IVGs + traditional neurodevelopment treatment [TNT], n = 12) or a control group (walking training + TNT, n = 12). The patients in both the groups underwent TNT for 4 weeks (5 days/week) before undergoing either IVGs or walking training (4 weeks, 3 days/week) depending on the group. The primary and secondary outcomes were rehabilitation motivation and the Berg Balance Scale (BBS) score, Functional Reach Test (FRT) performance, and walking speed (WS), respectively. Results: The patients in both the groups showed significant increase in the BBS score, FRT performance, and WS; however, the experimental group showed more significant improvements in rehabilitation motivation (P = 0.02, η² = 0.415) and WS (P = 0.05, η² = 0.333) than the patients in the control group. Conclusion: This study suggests that the IVGs in combination with TNT provide effective rehabilitation motivation in chronic stroke patients. Clinical Trial Registration number: KCT0003408.

Effect of virtual reality on motor coordination in children with cerebral palsy: a systematic review and meta-analysis of randomized controlled trials

Background

Improving motor coordination is an important prerequisite for the functional development of children with cerebral palsy (CP). Virtual reality (VR) may be efficient, interactive, adjustable and motivating physiotherapy choice for children with deficient coordination. This review aimed to identify, evaluate and formulate all the evidence concerning the efficacy of VR on motor coordination in children with CP and to compare the Physiotherapy Evidence Database (PEDro) with Cochrane Risk of Bias (RoB).

Main text

Five databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Science Direct and google scholar) were systemically searched from inception up to 1st January 2019. Studies included VR intervention for children with cerebral palsy with motor incoordination. Studies methodological quality was assessed by Cochrane RoB and PEDro scale. Nineteen studies met the prespecified eligibility criteria. There was a large effect size (SMD 0.75) on fine motor coordination. However, there was a non-significant, small beneficial effect (SMD 0.15) on gross motor coordination. The association between the overall Cochrane RoB and PEDro scores was fair (r = 0.28, P value 0.248). There was a slight agreement between overall and moderate categories PEDro scores and Cochrane RoB (κ = 0.02) and κ = 0.10), respectively. However, high and low categories were moderately agreed with Cochrane RoB (κ = 0.43) and (κ = 0.46).

Conclusion

VR seems to be effective for improving fine motor coordination with questionable effect on gross motor coordination. PEDro scale is fairly correlated with Cochrane RoB, so development and validation of a more compatible quality assessment tools specific to physiotherapy trials are needed.