Feasibility and efficacy of an early sensory-motor rehabilitation program on hand function in patients with stroke: a pilot, single-subject experimental design

OBJECTIVE

Hand and upper limb functional impairments following stroke lead to limitations in performing activities of daily living. We aimed to investigate feasibility and efficacy of an early sensory-motor rehabilitation program on hand and upper limb function in patients with acute stroke.

DESIGN

A pilot, single-subject experimental, A-B-A study.

SETTING

Stroke unit of an educational hospital and an outpatient occupational therapy clinic.

PARTICIPANTS

A convenience sample including five people with acute stroke.

PROCEDURES

Participants received 3 h of an intensive hand and upper limb sensory and motor rehabilitation program, 5 days per week for 3 months (15-min mental imagery, 15-min action observation, 30-min mirror therapy, 1.5-h constraint-induced movement therapy, and 30-min bilateral arm training). Activities were chosen based on the task-oriented occupational therapy approach.

OUTCOME MEASURES

An assessor blinded to intervention program measured sensory and motor functions using action research arm test, box and block test, Semmes-Weinstein monofilaments, and upper extremity section of Fugl-Meyer assessment.

RESULTS

Assessment data points in intervention and follow-up phases compared to baseline were in higher levels, sloped upwardly, and increased significantly for all participants in all outcome measures.

CONCLUSIONS

The present pilot study showed that a package of nowadays evidence-based rehabilitation methods including mental imagery, action observation, mirror therapy, modified constraint-induced movement therapy, bilateral arm training, and task-oriented occupational therapy approach is able to improve sensory and motor functions of the hand and upper limb in patients with acute stroke.

Discriminative factors for post-stroke depression

BACKGROUND

Depression is the most common mood disorder following stroke. It can negatively affects different domains of patient's life. The present study aimed to explore demographic and clinical predictors of post stroke depression and determine discriminative cognitive, motor, and functional factors in stroke patients with and without depression.

METHODS

In a cross sectional study, 100 patients with stroke were investigated. Measurements consisted of Beck Depression Inventory-II, Trail Making Test A & B, Digit Span Subtest of Wechsler Memory Scale, Motricity Index (arm and leg motor), Trunk Control Test, Barthel Index, and Lawton Instrumental Activities of Daily Living. Demographics and clinical data including educational level, marital status, limb affected, cigarette smoking habits, diabetes mellitus, cardiac diseases, and blood pressure were also collected.

RESULTS

Multivariate logistic regression revealed that college level of education (OR = 8.78, 95% CI: 2.65-29.11, P < 0.001) and cardiac diseases (OR = 3.11, 95% CI: 1.19-8.13, P < 0.001) were significant demographic and clinical predictors of post stroke depression. Using stepwise discriminant function analysis, basic activities of daily living and trunk control with 88.0% classification accuracy, 81.1% sensitivity, and 95.7% specificity were as the best discriminators of post stroke depression.

CONCLUSIONS

Rehabilitation experts working with patients with stroke should pay special attention to trunk control and basic activities of daily living for preventing consequences of PSD particularly in those with higher educational level and cardiac diseases.

The effects of neurofeedback training on short-term memory and quality of life in women with breast cancer

Background/Aims

Breast cancer, one of the most common cancers among Iranian women, affects the physical, psychological and cognitive dimensions of patients' lives. The aim of the present study was to investigate the effects of neurofeedback training on short-term memory and quality of life in patients with breast cancer.

Methods

In a randomised, controlled pilot trial, a convenient sample of 20 Iranian women with breast cancer who had received chemotherapy and radiotherapy were randomly allocated to an intervention or control group. The intervention group received 4 weeks of neurofeedback training. Assessment tools in pre- and post-test sessions included the Wechsler short-term memory scale and SF-36 quality of life questionnaire. Data were analysed by a biostatistician blinded to the study.

Results

Short-term memory and quality of life scores improved significantly in the intervention group after neurofeedback training compared to the control group (P=0.001).

Conclusions

Findings indicate that neurofeedback training is an effective technique for improving short-term memory and quality of life alongside occupational therapy interventions in women after breast cancer treatment.

Occupational performance in mothers of children with cerebral palsy

Background/Aims

Caring for children with cerebral palsy may affect different domains in the caregiver's life. This study aimed to compare the occupational performance of mothers of a child who has cerebral palsy with mothers of a typically developing child.

Methods

A total of 41 mothers with a child who has cerebral palsy and 45 mothers with a typically developing child were recruited in this cross-sectional study. The age-matched mothers had only one child. The Canadian Occupational Performance Measure was used to collect data on the occupational performance and satisfaction of mothers.

Findings

There was a statistically significant between-group difference in maternal occupational performance and occupational satisfaction (P<0.05), with mothers of children with cerebral palsy reporting lower scores for both. There were no relationships between demographic variables and the occupational performance and satisfaction of mothers with a child with cerebral palsy (P>0.05). The age of children with cerebral palsy had a direct positive relationship with the mothers' level of occupational satisfaction (P<0.05).

Conclusion

Mothers who take care of a child with cerebral palsy face significant reductions in occupational performance and satisfaction compared to mothers with a typically developing child, and therefore may need help and education in performing and organising their daily activities and roles.

Validation of Persian Caregivers' Report of Quality of Life questionnaire for adolescents with cerebral palsy

Background/Aims:

There is no tool in Persian to examine quality of life for adolescents with cerebral palsy based on their specific conditions. Therefore, the purpose of this study was to assess the psychometric properties of the Persian version of the caregivers' report of the Quality of Life questionnaire for adolescents with cerebral palsy (CP QOL).

Methods:

In this psychometric measurement study, the CP QOL (caregivers' report) was translated into Persian, and then its content validity, and construct validity were examined. A convenience sample of subjects including 82 parents of adolescents with cerebral palsy (13–18 years) were recruited for this study. Then, the relationship between the participants' quality of life and their level of gross motor and hand function was assessed.

Findings:

Internal consistency for all the questions of the questionnaire were high (0.78–0.92). There was also a significant and weak correlation between all domains of quality of life and the adolescents' gross motor function and manual abilities.

Conclusions:

The Persian version of the caregivers' report of the CP QOL-Teen has acceptable content validity. It is a useful tool for evaluating the quality of life of adolescents with cerebral palsy.

Dexterity and two-point discrimination of the hand in school-aged children with dysgraphia

Background: Dysgraphia as a problem with handwriting, affects student's performance in school activities and participation. The purpose of the study was to compare dexterity and two-point discrimination of the hand between learning disabled students with dysgraphia and healthy students. Methods: Forty-three students with developmental dysgraphia and 55 normal students in grade two to four from special and regular schools participated in this study. Hand dexterity and static/dynamic discriminative touch were assessed via Purdue Pegboard and Two-Point Discriminator respectively. Results: Significant differences were found in Purdue Pegboard scores between two groups except in doing the test with the left hand (p<0.05). Purdue Pegboard scores were significantly lower in left-handed children with dysgraphia compared to healthy children (p<0.05). There was no significant difference in dynamic two point discrimination between two groups of children (p>0.05). Static two-point discrimination of the thumb finger was significantly higher in children with dysgraphia (p<0.05). Conclusion: Hand dexterity affects handwriting performance in children with dysgraphia. There were no correlations between two-point discrimination and Purdue Pegboard scores of children with dysgraphia. Intervention should focus on other aspects of dexterity rather than sensory components. Hand dominancy also may be a factor influencing hand performance in dysgraphia.

Occupation-based intervention versus rote exercise in modified constraint-induced movement therapy for patients with median and ulnar nerve injuries: a randomized controlled trial

Objective:

To investigate effect of practice type during modified constraint-induced movement therapy on hand function in patients with chronic median and ulnar nerve injuries.

Design:

A prospective, single-blinded, randomized controlled clinical trial.

Setting:

Participants’ private home.

Subjects:

A convenience sample of 36 outpatient participants allocated randomly to three equal groups.

Interventions:

Intervention groups underwent 3-hour intensive training of affected hand each day, 3-day a week, 4-week in association with immobilisation of healthy hand: occupation-based group practiced meaningful occupations while rote exercise-based group performed rote exercises during constraint-induced movement therapy. Control group performed different activities with affected hand for 1.5-hour each day during 4-week without restriction of healthy hand.

Main measures:

A blinded assessor tested Canadian occupational performance measure, box and block, Static two-point discrimination, disabilities of arm, shoulder, hand questionnaire, and self-assessment manikin in a random order across sessions 3-time as baseline (pre-test), after 4-week intervention (post-test), and 1-month after intervention period (follow up).

Results:

Scores significantly changed in intervention groups compared to control. Despite significantly more improvement in occupation-based than rote exercise-based group in subjective measures at post-test and follow up (Canadian occupational performance measure: mean change 4.7 vs. 2.1 for performance, P< 0.001 and mean change 5.3 vs. 2.6 for satisfaction, P< 0.001), it was significant just at follow up for box and block and static two-point discrimination.

Conclusions:

Practice content of constraint-induced movement therapy is a critical part of its effectiveness on improving outcomes following peripheral nerve repair in favour of occupation-based intervention in present study.

Feasibility of the modified constraint-induced movement therapy in patients with median and ulnar nerve injuries: a single-subject A-B-A design

OBJECTIVE

The present study aimed to determine feasibility and efficacy of the modified constraint-induced movement therapy on upper limb function in patients with median and ulnar nerve injuries.

DESIGN

Single subject, A1-B-A2 design.

SETTING

Occupational therapy outpatient clinic.

SUBJECTS

A convenience sample including three patients with median and ulnar nerve injuries.

INTERVENTIONS

Modified constraint-induced movement therapy as follows: an intensive practice with affected hand for one hour daily, five days per week, for four weeks while the healthy hand was immobilised using a splint during waking hours.

MAIN MEASURES

Semmes-Weinstein monofilaments, Box and block test, and Disabilities of the arm, shoulder, and hand questionnaire. A blinded assessor administered the assessments in a random order across sessions, six times for the baseline phase (A1), four times for the intervention phase (B), and four times for the withdrawal phase (A2).

RESULTS

Touch perception did not occur after the intervention phase at the pulp of the index and little fingers. Manual dexterity and motor ability significantly improved (Box and block change scores exceeded the minimal detectable change of 5.5 blocks), as well performance in activities of daily living during real life (Disabilities of the arm, shoulder, and hand questionnaire change scores exceeded the clinically important change value of 20.9 points). These improvements maintained and even enhanced during the withdrawal phase.

CONCLUSIONS

Modified constraint-induced movement therapy is a feasible and useful adjunct to rehabilitation of the patients with median and ulnar nerve injuries that warrants further research.