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Wang Z, Zhang T, Fan J, Gu F, Yu Q, Wang H, Yang J, Zhu Q. Clinical validation of automated depth camera-based measurement of the Fugl-Meyer assessment for upper extremity. Clin Rehabil 2024:2692155241251434. [PMID: 38693881 DOI: 10.1177/02692155241251434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Depth camera-based measurement has demonstrated efficacy in automated assessment of upper limb Fugl-Meyer Assessment for paralysis rehabilitation. However, there is a lack of adequately sized studies to provide clinical support. Thus, we developed an automated system utilizing depth camera and machine learning, and assessed its feasibility and validity in a clinical setting. DESIGN Validation and feasibility study of a measurement instrument based on single cross-sectional data. SETTING Rehabilitation unit in a general hospital. PARTICIPANTS Ninety-five patients with hemiparesis admitted for inpatient rehabilitation unit (2021-2023). MAIN MEASURES Scores for each item, excluding those related to reflexes, were computed utilizing machine learning models trained on participant videos and readouts from force test devices, while the remaining reflex scores were derived through regression algorithms. Concurrent criterion validity was evaluated using sensitivity, specificity, percent agreement and Cohen's Kappa coefficient for ordinal scores of individual items, as well as correlations and intraclass correlation coefficients for total scores. Video-based manual assessment was also conducted and compared to the automated tools. RESULT The majority of patients completed the assessment without therapist intervention. The automated scoring models demonstrated superior validity compared to video-based manual assessment across most items. The total scores derived from the automated assessment exhibited a high coefficient of 0.960. However, the validity of force test items utilizing force sensing resistors was relatively low. CONCLUSION The integration of depth camera technology and machine learning models for automated Fugl-Meyer Assessment demonstrated acceptable validity and feasibility, suggesting its potential as a valuable tool in rehabilitation assessment.
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Affiliation(s)
- Zhaoyang Wang
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyuan Fan
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fanbin Gu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Honggang Wang
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory for Orthopedics and Traumatology, Guangzhou, China
| | - Jiantao Yang
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory for Orthopedics and Traumatology, Guangzhou, China
| | - Qingtang Zhu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory for Orthopedics and Traumatology, Guangzhou, China
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Wiesner K, Schwarz A, Meya L, Kaufmann JE, Traenka C, Luft AR, Held JPO, Engelter S. Interrater reliability of the Fugl-Meyer Motor assessment in stroke patients: a quality management project within the ESTREL study. Front Neurol 2024; 15:1335375. [PMID: 38651097 PMCID: PMC11034517 DOI: 10.3389/fneur.2024.1335375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction The Fugl-Meyer Motor Assessment (FMMA) is recommended for evaluating stroke motor recovery in clinical practice and research. However, its widespread use requires refined reliability data, particularly across different health professions. We therefore investigated the interrater reliability of the FMMA scored by a physical therapist and a physician using video recordings of stroke patients. Methods The FMMA videos of 50 individuals 3 months post stroke (28 females, mean age 71.64 years, median National Institutes of Health Stroke Scale score 3.00) participating in the ESTREL trial (Enhancement of Stroke Rehabilitation with Levodopa: a randomized placebo-controlled trial) were independently scored by two experienced assessors (i.e., a physical therapist and a physician) with specific training to ensure consistency. As primary endpoint, the interrater reliability was calculated for the total scores of the entire FMMA and the total scores of the FMMA for the upper and lower extremities using intraclass correlation coefficients (ICC). In addition, Spearman's rank order correlation coefficients (Spearman's rho) were calculated for the total score and subscale levels. Secondary endpoints included the FMMA item scores using percentage agreement, weighted Cohen's kappa coefficients, and Gwet's AC1/AC2 coefficients. Results ICCs were 0.98 (95% confidence intervals (CI) 0.96-0.99) for the total scores of the entire FMMA, 0.98 (95% CI 0.96-0.99) for the total scores of the FMMA for the upper extremity, and 0.85 (95% CI 0.70-0.92) for the total scores of the FMMA for the lower extremity. Spearman's rho ranged from 0.61 to 0.94 for total and subscale scores. The interrater reliability at the item level of the FMMA showed (i) percentage agreement values with a median of 77% (range 44-100%), (ii) weighted Cohen's kappa coefficients with a median of 0.69 (range 0.00-0.98) and (iii) Gwet's AC1/AC2 coefficients with a median of 0.84 (range 0.42-0.98). Discussion and conclusion The FMMA appears to be a highly reliable measuring instrument at the overall score level for assessors from different health professions. The FMMA total scores seem to be suitable for the quantitative measurement of stroke recovery in both clinical practice and research, although there is potential for improvement at the item level.
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Affiliation(s)
- Karin Wiesner
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Louisa Meya
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Josefin Emelie Kaufmann
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Christopher Traenka
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Andreas Rüdiger Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo Center of Neurology and Rehabilitation, Zurich, Switzerland
| | - Jeremia Philipp Oskar Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Valens Clinics, Reha Center Triemli, Vitznau, Switzerland
| | - Stefan Engelter
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Arya KN, Pandian S, Bhatnagar N, Sharma A. Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects: A Case Series. Neurol India 2021; 69:1309-1317. [PMID: 34747804 DOI: 10.4103/0028-3886.329613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. Objectives To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. Materials and Methods Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. Results Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. Conclusion The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.
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Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Nidhi Bhatnagar
- Department of Radiodiagnosis, Mata Chanan Devi Hospital, New Delhi, India
| | - Abhishek Sharma
- Pandit Deendayal Upadhyaya National Institute for Persons with Physical Disabilities, New Delhi, India
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Kotaro N, Nakano H, Iki S, Ishigaki T, Kawaguchi T. Effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients: A pilot study. Physiother Theory Pract 2020; 38:1366-1372. [PMID: 33320740 DOI: 10.1080/09593985.2020.1861669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Although it has been reported that neurocognitive rehabilitation is effective for improving upper limb function in acute and subacute stroke patients, its effectiveness has not been clarified in community-dwelling chronic stroke patients.Objective: To examine the effect of neurocognitive rehabilitation on upper limb function in community-dwelling chronic stroke patients.Methods: Eight community-dwelling chronic stroke patients participated in the study. The mean period from the stroke onset to the start of the intervention was 425.3 days (approximately 14 months post-stroke). All patients received neurocognitive rehabilitation for 60 min, twice per week, for 3 months. Fugl-Meyer Assessments (FMA) were performed, and the amount of use (AOU) and quality of movement (QOM) of the Motor Activity Log (MAL) were measured before and after the intervention. We used the Wilcoxon signed-rank test to analyze the data.Results: The total, shoulder/elbow/forearm, and wrist scores of the FMA, MAL-AOU, and MAL-QOM significantly improved after the intervention compared to those before the intervention. However, significant improvement was not observed in the hand score of the FMA.Conclusion:Neurocognitive rehabilitation could be effective for improving upper limb function in community-dwelling chronic stroke patients.
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Affiliation(s)
- Nakagawa Kotaro
- Nagoya Gakuin University, Kawaguchi Neurosurgery Rehabilitation Clinic, Osaka, Japan
| | - Hideki Nakano
- Neurorehabilitation Laboratory, Graduate School of Health Sciences, Kyoto Tachibana University, Kyoto, Japan
| | - Shinya Iki
- Nagoya Gakuin University, Kawaguchi Neurosurgery Rehabilitation Clinic, Osaka, Japan
| | | | - Takuya Kawaguchi
- Nagoya Gakuin University, Kawaguchi Neurosurgery Rehabilitation Clinic, Osaka, Japan
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Sebastián-Romagosa M, Cho W, Ortner R, Murovec N, Von Oertzen T, Kamada K, Allison BZ, Guger C. Brain Computer Interface Treatment for Motor Rehabilitation of Upper Extremity of Stroke Patients-A Feasibility Study. Front Neurosci 2020; 14:591435. [PMID: 33192277 PMCID: PMC7640937 DOI: 10.3389/fnins.2020.591435] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/10/2020] [Indexed: 12/21/2022] Open
Abstract
Introduction Numerous recent publications have explored Brain Computer Interfaces (BCI) systems as rehabilitation tools to help subacute and chronic stroke patients recover upper extremity movement. Recent work has shown that BCI therapy can lead to better outcomes than conventional therapy. BCI combined with other techniques such as Functional Electrical Stimulation (FES) and Virtual Reality (VR) allows to the user restore the neurological function by inducing the neural plasticity through improved real-time detection of motor imagery (MI) as patients perform therapy tasks. Methods Fifty-one stroke patients with upper extremity hemiparesis were recruited for this study. All participants performed 25 sessions with the MI BCI and assessment visits to track the functional changes before and after the therapy. Results The results of this study demonstrated a significant increase in the motor function of the paretic arm assessed by Fugl-Meyer Assessment (FMA-UE), ΔFMA-UE = 4.68 points, P < 0.001, reduction of the spasticity in the wrist and fingers assessed by Modified Ashworth Scale (MAS), ΔMAS-wrist = -0.72 points (SD = 0.83), P < 0.001, ΔMAS-fingers = -0.63 points (SD = 0.82), P < 0.001. Other significant improvements in the grasp ability were detected in the healthy hand. All these functional improvements achieved during the BCI therapy persisted 6 months after the therapy ended. Results also showed that patients with Motor Imagery accuracy (MI) above 80% increase 3.16 points more in the FMA than patients below this threshold (95% CI; [1.47–6.62], P = 0.003). The functional improvement was not related with the stroke severity or with the stroke stage. Conclusion The BCI treatment used here was effective in promoting long lasting functional improvements in the upper extremity in stroke survivors with severe, moderate and mild impairment. This functional improvement can be explained by improved neuroplasticity in the central nervous system.
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Affiliation(s)
| | - Woosang Cho
- g.tec Medical Engineering GmbH, Schiedlberg, Austria.,Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany.,International Max Planck Research School for Neural & Behavioral Sciences, Tübingen, Germany
| | - Rupert Ortner
- g.tec Medical Engineering Spain SL, Barcelona, Spain
| | - Nensi Murovec
- g.tec Medical Engineering GmbH, Schiedlberg, Austria
| | - Tim Von Oertzen
- Department of Neurology 1, Kepler Universitätsklinik, Linz, Austria
| | | | - Brendan Z Allison
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, United States
| | - Christoph Guger
- g.tec Medical Engineering Spain SL, Barcelona, Spain.,g.tec Medical Engineering GmbH, Schiedlberg, Austria
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Germanotta M, Cruciani A, Galli C, Cattaneo D, Spedicato A, Aprile I. Time course of the upper limb motor recovery in subacute stroke patients undergoing conventional or robotic rehabilitation. A preliminary report. J BIOL REG HOMEOS AG 2020; 34:201-208. Technology in Medicine. [PMID: 33386050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Upper limb recovery is a complex process and a strong challenge in the rehabilitation of patients after stroke. Several studies have been conducted to compare the efficacy of conventional and robotic rehabilitation to restore the upper limb motor impairment following a stroke. However, the evolution of the upper limb motor ability during an intervention, as well as the time point when the patient stops improving (the so call plateau), are rarely measured, and never compared between the two approaches. These latter aspects are very important considering the need for an optimization of the economic resources. In this study, the time course of the upper limb motor recovery of 24 subacute stroke patients undergoing a 30-session robotic or conventional treatment was analyzed through the upper extremity portion of the Fugl-Meyer Assessment scale (FMA-UE). The FMA-UE was administered before the treatment, and after 10, 20, and 30 rehabilitation sessions. Statistical analysis showed that, according to the FMA-UE, the time course in the two groups was similar: patients did not change between the baseline and the 10-session assessment, while they improved between 10 and 20 sessions, and between 20 and 30 sessions, with most of the gain observed between 10 and 20 sessions. This result suggests that 30-session robotic or conventional rehabilitation programs induce a similar curve trend in the upper limb motor recovery of patients with subacute stroke, with an important increase in the middle of the program and without reaching a clear plateau in the analyzed time interval.
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Affiliation(s)
- M Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Florence, Italy
| | - A Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Florence, Italy
| | - C Galli
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Florence, Italy
| | - D Cattaneo
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Milan, Italy
| | - A Spedicato
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Milan, Italy
| | - I Aprile
- IRCCS Fondazione Don Carlo Gnocchi, ONLUS, Florence, Italy
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Saita K, Morishita T, Hyakutake K, Ogata T, Fukuda H, Kamada S, Inoue T. Feasibility of Robot-assisted Rehabilitation in Poststroke Recovery of Upper Limb Function Depending on the Severity. Neurol Med Chir (Tokyo) 2020; 60:217-222. [PMID: 32173715 PMCID: PMC7174245 DOI: 10.2176/nmc.oa.2019-0268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The single-joint Hybrid Assistive Limb (HAL-SJ) robot is an exoskeleton-type suit developed for the neurorehabilitation of upper limb function. Several studies have addressed the usefulness of the robot; however, the appropriate patient selection remains unclear. In this study, we evaluated the effectiveness of the HAL-SJ exoskeleton in improving upper limb function in the subacute phase after a stroke, as a function of the severity of arm paralysis. Our analysis was based on a retrospective review of 35 patients, treated using the HAL-SJ exoskeleton in the subacute phase after their stroke, between October 2014 and December 2018. The severity of upper limb impairment was quantified using the Brunnstrom recovery stage (BRS) as follows: severe, BRS score 1–2, n = 10; moderate, BRS 3–4, n = 12; and mild, BRS 5–6, n = 13. The primary endpoint was the improvement in upper limb function, from baseline to post-intervention, measured using the Fugl-Meyer assessment upper limb motor score (ΔFMA-UE; range 0–66). The ΔFMA-UE score was significant for all three severity groups (P <0.05). The magnitude of improvement was greater in the moderate group than in the mild group (P <0.05). The greatest improvement was attained for patients with a moderate level of upper limb impairment at baseline. Our findings support the feasibility of the HAL-SJ to improve upper limb function in the subacute phase after a stroke with appropriate patient selection. This study is the first report showing the effect of robot-assisted rehabilitation using the HAL-SJ, according to the severity of paralysis in acute stroke patients with upper extremity motor deficits.
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Affiliation(s)
- Kazuya Saita
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | | | - Koichi Hyakutake
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | | | - Hiroyuki Fukuda
- Department of Neurosurgery, Fukuoka University Hospital.,Department of Rehabilitation, Fukuoka University Hospital
| | - Satoshi Kamada
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University Hospital
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Wei YH, Du DC, Jiang K. Therapeutic efficacy of acupuncture combined with neuromuscular joint facilitation in treatment of hemiplegic shoulder pain. World J Clin Cases 2019; 7:3964-3970. [PMID: 31832398 PMCID: PMC6906577 DOI: 10.12998/wjcc.v7.i23.3964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 11/19/2019] [Accepted: 11/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stroke is a type of cerebrovascular disease with high prevalence, mortality, and onset of disability. As a neurodevelopmental therapy, neuromuscular joint facilitation (NJF) is widely used in the treatment of orthopedic and neurological disorders in the clinical practice. It is mainly used for central nervous system diseases or orthopedic diseases, movement disorders, and pain rehabilitation. According to related studies, NJF can also be used as a rehabilitation treatment in patients with hemiplegic shoulder pain (HSP).
AIM To investigate the clinical efficacy of acupuncture combined with NJF in patients with HSP.
METHODS Forty patients with HSP were randomly divided into a treatment group and a control group. The treatment group was treated with acupuncture combined with NJF and the control group was treated with acupuncture alone. All patients were assessed by using the visual analogue scale (VAS), Fugl-Meyer assessment (FMA), Barthel index (BI), and passive range of motion (PROM) before and after the training. All the clinical data were analyzed using SPSS 20.0 statistical software.
RESULTS There was no statistical difference in the general characteristics between the two groups. In the terms of duration of treatment, age, and pre-treatment indicators, the two groups were comparable (P > 0.05). After the treatment, VAS, PROM, BI, and FMA scores were significantly improved in the two groups of patients (P < 0.05). The VAS, PROM and FMA scores were significantly higher in the treatment group than in the control group (P < 0.05). However, there was no significant difference in BI scores between the two groups (P > 0.05).
CONCLUSION Both acupuncture alone and acupuncture combined with NJF in the treatment of HSP are effective, and can improve the clinical symptoms of patients. Acupuncture combined with NJF can improve the upper limb motor function, relieve pain, and increase joint mobility in patients with HSP. The combination therapy is better than acupuncture alone. However, there is no significant difference in improving the score of patients’ self-care ability.
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Affiliation(s)
- Yan-Hui Wei
- Department of Rehabilitation, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, China
| | - De-Chao Du
- Department of Rehabilitation, Nanjing Red Cross Hospital, Nanjing 210028, Jiangsu Province, China
| | - Ke Jiang
- Department of Rehabilitation Physiotherapy, Jiangsu Provincial Hospital of Integration of Chinese and Western Medicine, Nanjing 210028, Jiangsu Province, China
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Hiragami S, Inoue Y, Harada K. Minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis. J Phys Ther Sci 2019; 31:917-921. [PMID: 31871377 PMCID: PMC6879402 DOI: 10.1589/jpts.31.917] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To estimate the minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity by using anchor-based methods in stroke patients with moderate to severe hemiparesis. [Participants and Methods] Fourteen patients who were hospitalized in a convalescent phase rehabilitation ward were included in this study. Fugl-Meyer assessment of the upper extremity was used to assess the impairment prior to intervention and at follow-up (six weeks later). Participants were asked to evaluate the degree of improvement of paresis of the upper extremity using the global rating of change scale at follow-up. The mean change in Fugl-Meyer assessment scores in the group of patients who answered "a little better, meaningful in daily life" in the global rating of change scale was considered as the minimal clinically important difference. [Results] The mean post-onset period of participants for analysis was 49.4 days. The minimal clinically important difference of the Fugl-Meyer assessment scores were 12.4 (upper extremity), 5.6 (upper arm), and 4.9 (wrist/hand). [Conclusion] A score of 12.4 in the Fugl-Meyer assessment of the upper extremity is likely to be perceived as meaningful in stroke patients with moderate to severe hemiparesis.
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Affiliation(s)
- Shogo Hiragami
- Faculty of Rehabilitation, Hyogo University of Health Sciences: 1-3-6 Minatojima, Chuo-ku, Kobe-shi, Hyogo 650-8530, Japan
| | - Yu Inoue
- Department of Rehabilitation, Kurashiki Heisei Hospital, Japan
| | - Kazuhiro Harada
- Department of Physical Therapy, School of Health Sciences and Social Welfare, Kibi International University, Japan
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Lee MJ, Lee JH, Lee SM. Effects of robot-assisted therapy on upper extremity function and activities of daily living in hemiplegic patients: A single-blinded, randomized, controlled trial. Technol Health Care 2019; 26:659-666. [PMID: 30124459 DOI: 10.3233/thc-181336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many robots can induce passive movements and passive resistance movements to facilitate recovery of upper-extremity function, but it is rare to find robots that can also enable active resistance movements. OBJECTIVE The purpose of this study was to investigate the effects of robot-assisted therapy on upper-extremity function and the ability to perform activities of daily living (ADL) in patients with stroke-induced hemiplegia. METHODS Thirty patients with stroke-induced hemiplegia were randomly assigned to the experimental and control groups, with 15 patients in each group. All subjects underwent general occupational therapy consisting of five 30-min sessions per week for 8 weeks, in addition to 30 min of robot-assisted therapy for the experimental group and 30 additional min of general occupational therapy for the control group for each session. RESULTS Both the experimental and control groups showed a statistically significant increase in post-treatment Fugl-Meyer assessment and modified Barthel index scores compared to the pre-treatment scores. Intergroup comparisons revealed that the experimental group showed a statistically significant greater increase in scores for all assessments than the control group did (p< 0.05). CONCLUSION The findings from this study showed that combining robot-assisted therapy with general occupational therapy may enhance upper-extremity function and the ability to perform ADL in patients with stroke-induced hemiplegia compared to those obtained with general occupational therapy alone.
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Affiliation(s)
- Min-Jae Lee
- Department of Occupational Therapy, Graduate School of Rehabilitation Science, Daegu University, Gyeongsan-si, Korea
| | - Jung-Hoon Lee
- Department of Physical Therapy, College of Nursing, Healthcare Sciences and Human Ecology, Dong-Eui University, Busan, Korea
| | - Sun-Min Lee
- Department of Occupational Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan-si, Korea
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11
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Scano A, Chiavenna A, Malosio M, Molinari Tosatti L, Molteni F. Muscle Synergies-Based Characterization and Clustering of Poststroke Patients in Reaching Movements. Front Bioeng Biotechnol 2017; 5:62. [PMID: 29082227 PMCID: PMC5645509 DOI: 10.3389/fbioe.2017.00062] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/26/2017] [Indexed: 11/13/2022] Open
Abstract
Background A deep characterization of neurological patients is a crucial step for a detailed knowledge of the pathology and maximal exploitation and customization of the rehabilitation therapy. The muscle synergies analysis was designed to investigate how muscles coactivate and how their eliciting commands change in time during movement production. Few studies investigated the value of muscle synergies for the characterization of neurological patients before rehabilitation therapies. In this article, the synergy analysis was used to characterize a group of chronic poststroke hemiplegic patients. Methods Twenty-two poststroke patients performed a session composed of a sequence of 3D reaching movements. They were assessed through an instrumental assessment, by recording kinematics and electromyography to extract muscle synergies and their activation commands. Patients’ motor synergies were grouped by the means of cluster analysis. Consistency and characterization of each cluster was assessed and clinically profiled by comparison with standard motor assessments. Results Motor synergies were successfully extracted on all 22 patients. Five basic clusters were identified as a trade-off between clustering precision and synthesis power, representing: healthy-like activations, two shoulder compensatory strategies, two elbow predominance patterns. Each cluster was provided with a deep characterization and correlation with clinical scales, range of motion, and smoothness. Conclusion The clustering of muscle synergies enabled a pretherapy characterization of patients. Such technique may affect several aspects of the therapy: prediction of outcomes, evaluation of the treatments, customization of doses, and therapies.
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Affiliation(s)
- Alessandro Scano
- Institute of Industrial Technologies and Automation (ITIA), Italian National Research Council (CNR), Milan, Italy
| | - Andrea Chiavenna
- Institute of Industrial Technologies and Automation (ITIA), Italian National Research Council (CNR), Milan, Italy
| | - Matteo Malosio
- Institute of Industrial Technologies and Automation (ITIA), Italian National Research Council (CNR), Milan, Italy
| | - Lorenzo Molinari Tosatti
- Institute of Industrial Technologies and Automation (ITIA), Italian National Research Council (CNR), Milan, Italy
| | - Franco Molteni
- Rehabilitation Presidium of Valduce Ospedale Villa Beretta, Lecco, Italy
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Pavlova EL, Lindberg P, Khan A, Ruschkowski S, Nitsche MA, Borg J. Transcranial direct current stimulation combined with visuo-motor training as treatment for chronic stroke patients. Restor Neurol Neurosci 2017; 35:307-317. [PMID: 28506002 DOI: 10.3233/rnn-160706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recent studies exploring the combined effect of motor learning and transcranial direct current stimulation (tDCS) for stroke rehabilitation have shown partially conflicting results. OBJECTIVE To test the efficacy of an optimized hand training approach combined with tDCS in stroke patients. METHODS In the present pilot study we investigated motor effects of four-week training with a visuomotor grip force tracking task combined with tDCS in 11 chronic stroke patients. Anodal (0.5 mA) or sham tDCS was applied over the primary motor cortex of the lesioned side for 20 minutes, twice a day, during training. RESULTS No difference between the Active and Sham groups in the total upper extremity (UE) Fugl-Meyer Assessment (FMA) score was found. The most prominent recovery occurred in the shoulder-elbow FMA sub-score; in this segment a significantly greater improvement in the Active compared to the Sham group was observed up to two months after the intervention. Mean hold force during the first treatment session predicted the change in the total UE FMA score after treatment. CONCLUSION Four-week visuo-motor training combined with tDCS showed no difference between the Active and Sham groups in the total UE FMA score, which may be explained by heterogeneity of the degree of recovery in the Active group. However, the shoulder-elbow FMA sub-score improved significantly more in the Active compared to the Sham group, which deserves further study.
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Affiliation(s)
- Elena L Pavlova
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Påvel Lindberg
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden.,Centre de Psychiatrie et Neurosciences, INSERM U894, Paris, France.,FR3636 Neurosciences, CNRS, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Amirah Khan
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
| | - Sigurd Ruschkowski
- Stockholm County Council Innovation, Danderyd University Hospital, Stockholm, Sweden
| | - Michael A Nitsche
- Leibniz Research Centre for Working Environment and Human Factors, Technical University of Dortmund, Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Jörgen Borg
- Department of Clinical Sciences Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden
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Choi JT, Vining EPG, Mori S, Bastian AJ. Sensorimotor function and sensorimotor tracts after hemispherectomy. Neuropsychologia 2009; 48:1192-9. [PMID: 20018199 DOI: 10.1016/j.neuropsychologia.2009.12.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 08/17/2009] [Accepted: 12/10/2009] [Indexed: 12/01/2022]
Abstract
Hemispherectomy is currently the only effective treatment for relieving constant seizures in children with severe or progressive unilateral cortical disease. Although early hemispherectomy has been advocated to avoid general dysfunction due to continued seizures, it remains unclear whether age at surgery affects specific sensorimotor functions. Little is know about the anatomical status of sensorimotor pathways after hemispherectomy and how it might relate to sensorimotor function. Here we measured motor function and sensory thresholds of the upper and lower limbs in 12 hemispherectomized patients. Diffusion tensor imaging (DTI) was used to determine status of brainstem corticospinal tracts and medial lemniscus. Hemispherectomy subjects showed remarkable recovery in both sensory and motor function. Many patients showed normal sensory vibration thresholds. Within the smaller Rasmussen's subgroup, we saw a relationship between age at surgery and sensorimotor function recovery (i.e. earlier was better). Anatomically, we found marked asymmetry in brainstem corticospinal tracts but preserved symmetry in the medial lemniscus, which may relate to robust sensory recovery. Age at surgery predicted anatomical status of brainstem sensorimotor tracts. In sum, we found that age at surgery influences anatomical changes in brainstem motor pathways, and may also relate to sensorimotor recovery patterns.
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Affiliation(s)
- Julia T Choi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.
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