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Kai J, Kitade T, Shigematsu T, Kunieda K, Sugi T, Ohno T, Fujishima I. Effect of a restrictive orthosis on the paralyzed hand in combination with constraint-induced movement therapy in a patient with chronic stroke: a case report. Disabil Rehabil 2024; 46:1911-1915. [PMID: 37154672 DOI: 10.1080/09638288.2023.2208378] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/22/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Many studies have reported the effects of constraint-induced movement therapy (CIMT) with an orthosis on the residual function of the impaired side of post-stroke patients. We encountered a case with left hemiparesis whose functioning of the impaired hand improved by CIMT with an orthosis not to assist as in the past but to restrict the residual function of the paralyzed fingers. METHODS The patient was a 46-year-old woman with left hemiparesis due to cerebral infarction 18 months ago. The patient had resumed work but would easily tire while typing the keyboard. We found that the extrinsic hand muscles were more engaged in compensatory movements than the intrinsic muscles. Therefore, we designed an orthosis that would extend and fixation the distal interphalangeal joint and proximal interphalangeal joint muscles to promote the engagement of the intrinsic muscles and restrict the compensatory movements of the extrinsic muscles. RESULTS The orthosis was used for 8 h/day for 2 weeks; CIMT were performed. Left hemiplegia improved from CIMT and the patient was able to handle the same amount of work as that before onset. CONCLUSION Restrictive orthosis on the paralyzed hand in combination with CIMT was found to be a beneficial rehabilitation approach.
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Affiliation(s)
- Junpei Kai
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Tomoya Kitade
- Department of Rehabilitation, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
- Department of Neurology, Gifu University School of Medicine, Shizuoka, Japan
| | - Takafumi Sugi
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
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Srinivasan S, Kumavor PD, Morgan K. A Pilot Feasibility Study on the Use of Dual-Joystick-Operated Ride-on Toys in Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy. Children (Basel) 2024; 11:408. [PMID: 38671624 PMCID: PMC11048905 DOI: 10.3390/children11040408] [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] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Children with unilateral cerebral palsy (UCP) require task-oriented practice several hours per week to produce meaningful gains in affected upper extremity (UE) motor function. Clinicians find it challenging to provide services at the required intensity and sustain child engagement. This pilot study assessed the acceptance and utility of a child-friendly program using dual-joystick-operated ride-on toys incorporated into an intensive UE rehabilitation camp. Eleven children with UCP between four and 10 years received ride-on-toy navigation training for 20-30 min/day, five days/week, for three weeks as part of camp programming. We report session adherence and percent time children spent in task-appropriate attention/engagement across sessions. The overall effects of camp programming on children's motor function were assessed using the Shriner's Hospital Upper Extremity Evaluation (SHUEE) from pretest to posttest and using training-specific measures of bimanual UE use and navigational accuracy. Children showed excellent adherence and sustained task-appropriate engagement across sessions. The combined program led to improved navigational accuracy (p-values ≤ 0.007) as well as spontaneous affected UE use during bimanual activities outside the training context (p < 0.001). Our pilot study provides promising evidence for using modified, commercially available ride-on toys to incentivize rehabilitation and boost repetitive, task-oriented UE practice among children with UCP.
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Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06269, USA
| | - Patrick D. Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06269, USA; (P.D.K.); (K.M.)
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06269, USA; (P.D.K.); (K.M.)
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Belschner J, Coley C, Kovelman S, Salvador T, Monfaredi R, Schladen M, Fooladi Talari H, Trujillo Rivera EA, Cleary K, Evans SH. PedBotLab: A Novel Video Game-Based Robotic Ankle Platform Created for Therapeutic Exercise for Children With Neurological Impairments. Phys Occup Ther Pediatr 2024:1-19. [PMID: 38419343 DOI: 10.1080/01942638.2024.2316163] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024]
Abstract
AIMS Assess the potential benefits of using PedBotLab, a clinic based robotic ankle platform with integrated video game software, to improve ankle active and passive range of motion, strength, selective motor control, gait efficiency, and balance. METHODS Ten participants with static neurological injuries and independent ambulation participated in a 10-week pilot study (Pro00013680) to assess feasibility and efficacy of PedBotLab as a therapeutic device twice weekly. Isometric ankle strength, passive and active ankle range of motion, plantarflexor spasticity, selective motor control of the lower extremity, balance, and gait speed were measured pre- and post-trial. RESULTS Statistically significant improvements were seen in flexibility, active range of motion, and strength in multiple planes of ankle motion. Ankle dorsiflexion with knee flexion and knee extension demonstrated statistically significant results in all outcome measures. No significant changes were observed in gait speed outcomes. CONCLUSIONS The use of PedbotLab can lead to improvements in ankle strength, flexibility, and active range of motion for children with static neurological injuries. Future studies aim to evaluate the effect on gait quality and work toward developing a home-based device.
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Affiliation(s)
| | | | | | | | | | | | | | - Eduardo A Trujillo Rivera
- Children's National Hospital, Washington DC, USA
- Sheikh Zayed Research Institute, Washington DC, USA
- George Washington University, Washington DC, USA
| | - Kevin Cleary
- Sheikh Zayed Research Institute, Washington DC, USA
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Svensson K, Sundelin H, Eliasson AC. Outcomes of a Parent-Delivered Baby-mCIMT Model for Infants at High Risk of Unilateral Cerebral Palsy Using Remote Coaching in Telerehabilitation. Children (Basel) 2024; 11:101. [PMID: 38255414 PMCID: PMC10814714 DOI: 10.3390/children11010101] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
There is growing evidence of the positive effects of constraint-induced movement therapy (CIMT) for infants at high risk of unilateral cerebral palsy (UCP) when provided by parents with in-person coaching/supervision from occupational therapists during home visits. The aim of this study is to investigate whether Baby-mCIMT (modifiedCIMT) can be as effective if parents are coached/supervised remotely. In this case-control study, we recruited 20 infants and re-used 18 controls, 4-8-month-old infants in both groups at high risk of UCP. The same protocol regarding inclusion criteria, data collection, and training volume was used in both groups. The training was conducted for two 6-week periods, separated by a 6-week break, consisting of daily 30 min sessions conducted by parents, supported by therapist coaching once a week. The primary outcome was measured using the Hand Assessment for Infants (HAI). There was no difference in the change of HAI units (p = 0.803) or that of the affected-hand raw score (p = 0.942) between the two groups. The remote coaching method was well received by parents. In conclusion, this demonstrates that remote coaching/supervision is as effective as the in-person approach, requiring less time and effort for both families and healthcare providers.
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Affiliation(s)
- Katarina Svensson
- Division of Children’s and Women’s Health, Department of Biomedical and Clinical Sciences, Linkoping University, 58183 Linkoping, Sweden;
- Crown Princess Victoria’s Children Hospital, 58185 Linkoping, Sweden
| | - Heléne Sundelin
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, 17177 Stockholm, Sweden;
- Neuropaediatric Research Unit, Astrid Lindgren Children’s Hospital, 17176 Stockholm, Sweden
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institute, 17177 Stockholm, Sweden;
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Abdul-Rahman RS, Radwan NL, El-Nassag BA, Amin WM, Ali MS. Modified-constraint movement induced therapy versus neuro-developmental therapy on reaching capacity in children with hemiplegic cerebral palsy. Physiother Res Int 2024; 29:e2069. [PMID: 38284468 DOI: 10.1002/pri.2069] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/07/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND OBJECTIVE Upper extremity impairment is one of the complications in hemiplegic children. The purpose of modified constraint-induced movement therapy (mCIMT) is to improve the function of impaired arms and hands in these children. This study compared the efficacy of mCIMT and the approach of neurodevelopmental therapy (NDT) on reaching capacity in children with spastic hemiplegia. METHODS Fifty-two spastic hemiplegic children ranging in age from four to 6 years were selected for this study from an outpatient clinic and biomechanical lab (Prince Sattam bin Abdulaziz University, KSA). They were randomly divided into two experimental groups: group I received NDT and group II received mCIMT for the involved upper limb and restriction of the uninvolved arm movements for 12 weeks (three times per week). Both groups received a conventional exercise program in addition to experimental one. Active elbow extension range of motion and three-dimensional motion analysis of the reaching task were measured before and after 3 months of treatment. RESULTS Significant enhancement in all pre-treatment and post-treatment outcomes was observed in both groups by a two-way mixed MANOVA; furthermore, Group II (mCIMT) showed the most significant improvement (elbow extension, percentage of reach to peak velocity, movement time and movement units) when comparing the post-treatment outcomes between the two groups (p < 0.001). IMPLICATION FOR PHYSIOTHERAPY PRACTICE Addition of mCIMT to a conventional exercise was superior to adding NDT exercise therapy in promoting the performance of reaching pattern in hemiplegic children.
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Affiliation(s)
- Radwa S Abdul-Rahman
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Physical Therapy for Pediatrics and Pediatrics Surgery, College of Physical Therapy, Badr University in Cairo, Cairo, Egypt
| | - Nadia L Radwan
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia, Kingdom of Saudi Arabia
| | - Bassam A El-Nassag
- Department of Physical Therapy for Neurology, Cairo University, Cairo, Egypt
| | - Wafaa Mahmoud Amin
- Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Saudi Arabia, Kingdom of Saudi Arabia
| | - Mostafa S Ali
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of physical therapy for Pediatrics, Faculty of Physical Therapy, October 6 University, 6 October City, Giza, Egypt
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Hwang Y, Kwon JY, Na Y. An Exploration of Tri-Axial Accelerometers in Assessing the Therapeutic Efficacy of Constraint-Induced Movement Therapy in Children with Unilateral Cerebral Palsy. Sensors (Basel) 2023; 23:9393. [PMID: 38067766 PMCID: PMC10708848 DOI: 10.3390/s23239393] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
This study aimed to elucidate the role of tri-axial accelerometers in assessing therapeutic interventions, specifically constraint-induced movement therapy (CIMT), in children with unilateral cerebral palsy (UCP). The primary focus was understanding the correlation between the actigraphy metrics recorded during CIMT sessions and the resultant therapeutic outcomes. Children with UCP, aged between 4 and 12 years, participated in this study from July 2021 to December 2022. In conjunction with in-clinic sessions, during which participants wore tri-axial accelerometers on both limbs, we analyzed actigraphy data over three days of routine activities pre- and post-CIMT. While not all metrics derived from the accelerometers indicated significant improvements post-intervention, there was a clear trend towards a more balanced usage of both limbs, particularly evident in Axis 3, associated with vertical movement (p = 0.017). Additionally, a discernible correlation was observed between changes in the magnitude ratio derived from actigraphy data during CIMT (Δweek3-week1) and variations in traditional assessments pre- and post-intervention (ΔT0-T1), specifically the Assisting Hand Assessment grasp and release. Using tri-axial accelerometers has helped clarify the potential impacts of CIMT on children with UCP. The preliminary results suggest a possible link between actigraphy metrics taken during CIMT and the subsequent therapeutic outcomes determined by standardized tests.
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea;
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonju Na
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
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Simis M, Thibaut A, Imamura M, Battistella LR, Fregni F. Neurophysiological biomarkers of motor improvement from Constraint-Induced Movement Therapy and Robot-Assisted Therapy in participants with stroke. Front Hum Neurosci 2023; 17:1188806. [PMID: 37780964 PMCID: PMC10540307 DOI: 10.3389/fnhum.2023.1188806] [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] [Received: 03/17/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Background The mechanism of stroke recovery is related to the reorganization of cerebral activity that can be enhanced by rehabilitation therapy. Two well established treatments are Robot-Assisted Therapy (RT) and Constraint-Induced Movement Therapy (CIMT), however, it is unknown whether there is a difference in the neuroplastic changes induced by these therapies, and if the modifications are related to motor improvement. Therefore, this study aims to identify neurophysiological biomarkers related to motor improvement of participants with chronic stroke that received RT or CIMT, and to test whether there is a difference in neuronal changes induced by these two therapies. Methods This study included participants with chronic stroke that took part in a pilot experiment to compare CIMT vs. RT. Neurophysiological evaluations were performed with electroencephalography (EEG) and transcranial magnetic stimulation (TMS), pre and post rehabilitation therapy. Motor function was measured by the Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment Upper Limb (FMA-UL). Results Twenty-seven participants with chronic stroke completed the present study [mean age of 58.8 years (SD ± 13.6), mean time since stroke of 18.2 months (SD ± 9.6)]. We found that changes in motor threshold (MT) and motor evoked potential (MEP) in the lesioned hemisphere have a positive and negative correlation with WMFT improvement, respectively. The absolute change in alpha peak in the unlesioned hemisphere and the absolute change of the alpha ratio (unlesioned/lesioned hemisphere) is negatively correlated with WMFT improvement. The decrease of EEG power ratio (increase in the lesioned hemisphere and decrease in the unlesioned hemisphere) for high alpha bandwidths is correlated with better improvement in WMFT. The variable "type of treatment (RT or CIMT)" was not significant in the models. Conclusion Our results suggest that distinct treatments (RT and CIMT) have similar neuroplastic mechanisms of recovery. Moreover, motor improvements in participants with chronic stroke are related to decreases of cortical excitability in the lesioned hemisphere measured with TMS. Furthermore, the balance of both EEG power and EEG alpha peak frequency in the lesioned hemisphere is related to motor improvement.
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Affiliation(s)
- Marcel Simis
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Aurore Thibaut
- Coma Science Group, GIGA-Consciousness, University of Liege, Liege, Belgium
| | - Marta Imamura
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Linamara Rizzo Battistella
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
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Gulrandhe P, Acharya S, Patel M, Shukla S, Kumar S. Pertinence of Constraint-Induced Movement Therapy in Neurological Rehabilitation: A Scoping Review. Cureus 2023; 15:e45192. [PMID: 37842361 PMCID: PMC10576160 DOI: 10.7759/cureus.45192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique that aims to restore motor function in patients with central nervous system injuries. Based on behavioral research conducted, CIMT has been found effective in restoring motor function in various conditions including stroke, cerebral palsy, traumatic brain injury (TBI), and more. The therapy combines neurological and behavioral mechanisms to induce neuroplastic changes and overcome learned nonuse. Modified CIMT (mCIMT) is a variant that focuses on sensorimotor functioning in the affected limb. This review summarizes studies on CIMT and mCIMT, with a focus on stroke, cerebral palsy, and other conditions. Results show that CIMT and mCIMT demonstrate significant improvements in motor function and quality of life. The studies underscore the importance of long-term research, comparative or combined therapies, and exploration of less-studied conditions like multiple sclerosis (MS) and brachial plexus injury. Overall, CIMT and mCIMT hold promise for neurorehabilitation, emphasizing the need for further investigation to enhance their effectiveness and application.
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Affiliation(s)
- Purva Gulrandhe
- Department of Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Maharshi Patel
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yang FA, Lee TH, Huang SW, Liou TH, Escorpizo R, Chen HC. Upper limb manual training for children with cerebral palsy: A systematic review and network meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:516-533. [PMID: 36330696 DOI: 10.1177/02692155221137698] [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: 11/06/2022]
Abstract
OBJECTIVE There are different upper limb manual training protocols, namely constraint-induced movement therapy, modified constraint-induced movement therapy, hand-arm bimanual intensive training, hand-arm bimanual intensive training including lower extremity, action observation training, and mirror therapy, available for improving functional outcomes in children with cerebral palsy. However, the effect and priority of these strategies remain unclear. DATA SOURCES We searched the PubMed, Cochrane Library, and Embase databases for relevant articles from inception to October 12, 2022. REVIEW METHODS To assess the effect and priority of different strategies of upper limb manual training protocols through a systematic review and network meta-analysis of randomized controlled trials. RESULTS We included 22 randomized controlled trials in this network meta-analysis. The ranking probability and standard mean differences with 95% credible intervals of the comparison between placebo and other forms of upper limb manual training were as follows: mirror therapy = 2.83 (1.78, 3.88), hand-arm bimanual intensive training including the lower extremity = 0.53 (0.09, 0.96), constraint-induced movement therapy = 0.44 (0.18, 0.71), hand-arm bimanual intensive training = 0.41 (0.15, 0.67), modified constraint-induced movement therapy = 0.39 (0.03, 0.74), and action observation training = 0.18 ( - 0.29, 0.65). No significant inconsistency was noted between the results of direct and indirect comparisons. CONCLUSION We suggest that mirror therapy could be the upper limb manual training protocol of choice for improving functional outcomes in patients with cerebral palsy.
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Affiliation(s)
- Fu-An Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Hsuan Lee
- Department of Family Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, University of Vermont, College of Nursing and Health Sciences, Burlington, VT, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City, Taiwan.,Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Taipei Neuroscience Institute, Taipei Medical University, New Taipei City, Taiwan
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Klevberg GL, Zucknick M, Jahnsen R, Eliasson AC. Development of Hand Use with and Without Intensive Training Among Children with Unilateral Cerebral Palsy in Scandinavia. Dev Neurorehabil 2023; 26:163-171. [PMID: 36945898 DOI: 10.1080/17518423.2023.2193256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
AIM To describe hand use development in children with unilateral cerebral palsy who did/did not participate in constraint-induced movement therapy (CIMT) before 7 years of age. METHOD The study included 334 participants (18 months-12 years) who were assessed with 1,565 Assisting Hand Assessments (AHAs) and categorized into no intensive training (NIT), CIMT (18 months-7 years), and Baby-CIMT (<18 months) groups. RESULTS AHA performance at 18 months (AHA-18) was positively associated with development regardless of training. The CIMT group had lower AHA-18 performance than the NIT group (p = .028), but higher stable limit (p = .076). The age when 90% of development was reached was highest in the CIMT group (p = .014). Although non-significant, the Baby-CIMT group had higher mean curve than NIT and CIMT combined (AHA-18 p = .459, limit p = .477). CONCLUSION The CIMT group improved more over time than the NIT group. Intensive training extended the window of development, and Baby-CIMT might promote early development.
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Affiliation(s)
- Gunvor L Klevberg
- Department of Neurosciences in Children, Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Oslo University Hospital, Oslo, Norway
| | - Manuela Zucknick
- Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Reidun Jahnsen
- Department of Neurosciences in Children, Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP), Oslo University Hospital, Oslo, Norway
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Abdullahi A, Wong TW, Van Criekinge T, Ng SS. Combination of noninvasive brain stimulation and constraint-induced movement therapy in patients with stroke: a systematic review and meta-analysis. Expert Rev Neurother 2023; 23:187-203. [PMID: 36745928 DOI: 10.1080/14737175.2023.2177154] [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: 02/08/2023]
Abstract
INTRODUCTION Constraint-induced movement therapy (CIMT) and noninvasive brain stimulation (NIBS) are used to counteract learned nonuse phenomenon and imbalance in interhemispheric inhibition following stroke. The aim of this study is to summarize the available evidence on the effects of combining NIBS with CIMT in patients with stroke. METHOD PubMed, Embase, Web of Science (WoS), PEDro, OTSeeker, and CENTRAL were searched for randomized controlled trials comparing the use of NIBS+CIMT with sham NIBS+CIMT. Data on variables such as time since stroke and mean scores and standard deviations on outcomes assessed such as motor function were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risk of bias and methodological quality of the included studies. RESULTS The results showed that both NIBS+CIMT and sham NIBS+CIMT improved all outcomes post-intervention and at follow-up. However, NIBS+CIMT is superior to sham NIBS+CIMT at improving level of motor impairment (SMD = 1.75, 95% CI = 0.49 to 3.01, P = 0.007) post-intervention and hand function (SMD = 1.21, 95% CI = 0.07 to 2.35, P = 0.04) at follow-up. CONCLUSIONS The addition of NIBS to CIMT seems to provide additional benefits to the recovery of function following stroke.
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Affiliation(s)
- Auwal Abdullahi
- The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong
| | - Thomson Wl Wong
- The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong
| | | | - Shamay Sm Ng
- The Hong Kong Polytechnic University - Rehabilitation Sciences, Hong Kong
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Zhang J, Xiao X, Jin Q, Li J, Zhong D, Li Y, Qin Y, Zhang H, Liu X, Xue C, Zheng Z, Jin R. The effect and safety of constraint-induced movement therapy for post-stroke motor dysfunction: a meta-analysis and trial sequential analysis. Front Neurol 2023; 14:1137320. [PMID: 37144004 PMCID: PMC10151521 DOI: 10.3389/fneur.2023.1137320] [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: 01/04/2023] [Accepted: 03/13/2023] [Indexed: 05/06/2023] Open
Abstract
Background Due to motor function insufficiency, patients with post-stroke motor dysfunction (PSMD) have limitations in performing an activity, feel restricted during social participation, and feel impaired in their quality of life. Constraint-induced movement therapy (CIMT) is a neurorehabilitation technique, but its effectiveness on PSMD after stroke still remains controversial. Objective This meta-analysis and trial sequential analysis (TSA) aimed to comprehensively evaluate the effect and safety of CIMT for PSMD. Methods Four electronic databases were searched from their inception to 1 January 2023 to identify randomized controlled trials (RCTs) investigating the effectiveness of CIMT for PSMD. Two reviewers independently extracted the data and assessed the risk of bias and reporting quality. The primary outcome was a motor activity log for the amount of use (MAL-AOU) and the quality of movement (MAL-QOM). RevMan 5.4, Statistical Package for Social Sciences (SPSS) 25.0, and STATA 13.0 software were used for statistical analysis. The certainty of the evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. We also performed the TSA to assess the reliability of the evidence. Results A total of 44 eligible RCTs were included. Our results showed that CIMT combined with conventional rehabilitation (CR) was superior to CR in improving MAL-AOU and MAL-QOM scores. The results of TSA indicated that the above evidence was reliable. Subgroup analysis demonstrated that CIMT (≥6 h per day or duration ≤ 20 days) combined with CR was more effective than CR. Meanwhile, both CIMT and modified CIMT (mCIMT) combined with CR were more efficient than CR at all stages of stroke. No severe CIMT-related adverse events occurred. Conclusion CIMT may be an optional and safe rehabilitation therapy to improve PSMD. However, due to limited studies, the optimal protocol of CIMT for PSMD was undetermined, and more RCTs are required for further exploration. Clinical trial registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=143490, identifier: CRD42019143490.
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Affiliation(s)
- Jiaming Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xianjun Xiao
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qizu Jin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yan Qin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Hong Zhang
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Chen Xue
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhong Zheng
- Center for Neurobiological Detection, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- *Correspondence: Zhong Zheng
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- Rongjiang Jin
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13
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Bingol H, Kerem Gunel M, Alkan H. The Efficacy of Two Models of Intensive Upper Limb Training on Health-Related Quality of Life in Children with Hemiplegic Cerebral Palsy Mainstreamed in Regular Schools: A Double-Blinded, Randomized Controlled Trial. Physiother Theory Pract 2023; 39:10-25. [PMID: 34743663 DOI: 10.1080/09593985.2021.1999355] [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: 12/16/2022]
Abstract
BACKGROUND Children with hemiplegic cerebral palsy (CP) are at risk of reduced upper limb function and poorer quality of life than their typically developing peers. Although upper limb impairments have potential negative impact on the health-related quality of life (HRQOL) in children with hemiplegic CP, the efficacy of upper limb rehabilitation approaches aiming to improve upper limb impairments on HRQOL has not been adequately investigated. OBJECTIVE This study compares the efficacy of two modes of activity-based upper limb rehabilitation (modified constraint-induced movement therapy [mCIMT] and bimanual training [BIM]) on HRQOL outcomes in children with hemiplegic CP mainstreamed in regular schools. METHODS Thirty children with hemiplegic CP aged between 7 and 11 years (mean age 8.53 ± 1.54 years) who had functional ability levels of I-III according to the Manual Ability Classification System (MACS), Gross Motor Classification System (GMFCS), and Communication Function Classification System (CFCS) were randomly assigned to receive mCIMT or BIM training. Result: Both mCIMT and BIM yielded statistically significant improvements in all HRQOL domains immediately after the 10-week interventions (P < .001), which were retained at 16 weeks. CONCLUSION While there were some differences in the intervention effects, both of these upper limb rehabilitation approaches based on intensive unimanual or bimanual activity may be beneficial for improving perceived life satisfaction related to physical activity, general mood, family, friends, and school among children with hemiplegic CP mainstreamed in regular schools.
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Affiliation(s)
- Hasan Bingol
- Department of Therapy and Rehabilitation, Vocational School of Health Services, Mus Alparslan University, 49250-Güzeltepe/Mus, Turkey.,Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey
| | - Mintaze Kerem Gunel
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey
| | - Halil Alkan
- Department of Physiotherapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, 06100-Samanpazarı/Ankara, Turkey.,Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mus Alparslan University, 49250-Güzeltepe/Mus, Turkey
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14
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Kuran B, Azrak SD, Dogu B, Yilmaz F, Sirzai H, Oncu J, Terlemez R, Ayyildiz A. The Effect of the Modified Constraint-Induced Movement Therapy on the Upper Extremity Functions of Obstetric Brachial Plexus Palsy Patients. Sisli Etfal Hastan Tip Bul 2022; 56:525-35. [PMID: 36660395 DOI: 10.14744/SEMB.2022.32956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/20/2022] [Accepted: 06/21/2022] [Indexed: 01/22/2023]
Abstract
Objectives Functional limitation of the upper extremity (UE) in obstetrical brachial plexus paralysis (OBPP) restricts a child's participation in daily living and social activities. In treatment, the participation of UE in rehabilitation is important. Constraint-induced movement therapy (CIMT) is a promising rehabilitation approach that is used to improve the UE functions of patients with neurological dysfunctions. Methods This single-blinded randomized controlled clinical trial includes 30 pediatric patients diagnosed with chronic OBPP aged between 2 and 12 years. The patients were divided into two groups as a modified CIMT group and a control group. Patients in both groups underwent classical rehabilitation treatment 4 times a week for 8 weeks. Range of motion (ROM), stretching, strengthening, and proprioceptive exercises were given to both control and CIMT group. The patients in the CIMT group had to wear constraining arm slings 2 h per day and 4 days a week for 8 weeks. The patients were evaluated both before and after treatment using the Mallet classification system and the Melbourne unilateral upper limb assessment-2 (The MA2) scale. Results In both groups, the Mallet and MA2 scores significantly increased after the treatment process. However, the percentage of improvement was higher for the CIMT group. Conclusion Modified CIMT improves the joint ROM and the functional use of the extremity among OBPP-diagnosed children. This improvement is greater in the CIMT group compared to the improvement in the control group. Implementation of CIMT in a routine rehabilitation process may be helpful.
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15
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de Azevedo JA, Barbosa FDS, Seixas VM, da Silva Scipioni KRD, Sampaio PYS, da Cruz DMC, Piscitelli D, Chui KK, de Freitas Zanona A. Effects of constraint-induced movement therapy on activity and participation after a stroke: Systematic review and meta-analysis. Front Hum Neurosci 2022; 16:987061. [PMID: 36545351 PMCID: PMC9760712 DOI: 10.3389/fnhum.2022.987061] [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: 07/05/2022] [Accepted: 10/25/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Hemiparesis is the main sensorimotor deficit after stroke. It can result in limitations in Activities of Daily Living (ADL) and social participation. Hemiparesis can be treated with behavioral techniques of intensive use of the affected arm, such as constraint-induced movement therapy (CIMT), however, it remains unclear whether motor improvement can lead to increases in the domains of activity and participation. Objective Identify whether CIMT is superior to usual techniques to enhance activity and participation outcomes in stroke survivors. Methods A systematic review with meta-analysis was conducted, based on the PRISMA guidelines. Search databases were: PubMed, LILACS, Embase, SciELO, Cochrane Library, Scopus, Medline, and Web of Science, with no language restriction. Meta-analysis was performed with Review Manager (version 5.3), significance level p ≤ 0.05. Results A total of 21 articles were included for analysis. Superior effects were observed on motor function and performance in activities of daily living of individuals treated with CIMT. The outcomes measures utilized were: Fugl-Meyer Assessment (p = 0.00001); Wolf motor function test (p = 0.01); Modified Barthel Index (p = 0.00001); Motor Activity log (MAL) Amount of use (AOU) (p = 0.01); MAL Quality of movement (QOM) (p = 0.00001); Action Research Arm Test-ARAT (p = 0.00001); and FIM (p = 0.0007). Conclusion Our results show that CIMT results in more significant gains in the functional use of the upper limb in ADL and functional independence, demonstrating superior activity and participation results in stroke survivors when compared to conventional therapies.
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Affiliation(s)
- Joyce Araújo de Azevedo
- Department of Occupational Therapy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | - Valquiria Martins Seixas
- Department of Occupational Therapy, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | | | | | - Daniel Marinho Cezar da Cruz
- School of Health, Leeds Beckett University, Leeds, United Kingdom,*Correspondence: Daniel Marinho Cezar da Cruz,
| | - Daniele Piscitelli
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada,School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy,Department of Kinesiology, University of Connecticut, Storrs, CT, United States
| | - Kevin K. Chui
- Department of Physical Therapy, Waldron College of Health and Human Services, Radford University, Roanoke, VA, United States
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16
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Kuo HC, Litzenberger J, Nettel-Aguirre A, Zewdie E, Kirton A. Exploring Clinical and Neurophysiological Factors Associated with Response to Constraint Therapy and Brain Stimulation in Children with Hemiparetic Cerebral Palsy. Dev Neurorehabil 2022; 25:229-238. [PMID: 34392795 DOI: 10.1080/17518423.2021.1964103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined. OBJECTIVE We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial. METHODS PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months. RESULTS Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%. CONCLUSION This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required.
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Affiliation(s)
- Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada
| | | | - Alberto Nettel-Aguirre
- Alberta Children's Hospital Research Institute, Calgary, Canada.,Departments of Pediatrics and Community Health Sciences, Primary Institution is the University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada
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17
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Terranova TT, Simis M, Santos ACA, Alfieri FM, Imamura M, Fregni F, Battistella LR. Robot-Assisted Therapy and Constraint-Induced Movement Therapy for Motor Recovery in Stroke: Results From a Randomized Clinical Trial. Front Neurorobot 2021; 15:684019. [PMID: 34366819 PMCID: PMC8335542 DOI: 10.3389/fnbot.2021.684019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/22/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke is one of the leading causes of adult disability, and up to 80% of stroke survivors undergo upper extremity motor dysfunction. Constraint-Induced Movement Therapy (CIMT) and Robot-Assisted Therapy (RT) are used for upper limb stroke rehabilitation. Although CIMT and RT are different techniques, both are beneficial; however, their results must be compared. The objective is to establish the difference between RT and CIMT after a rehabilitation program for chronic stroke patients. Method: This is a randomized clinical trial, registered at ClinicalTrials.gov (ID number NCT02700061), in which patients with stroke received sessions of RT or CIMT protocol, combined with a conventional rehabilitation program for 12 weeks. The primary outcome was measured by Wolf Motor Function Test (WMFT) and Fugl-Meyer Assessment—Upper Limb (FMA-UL). Activities of daily living were also assessed. Results: Fifty one patients with mild to moderate upper limb impairment were enrolled in this trial, 25 women and 26 men, mean age of 60,02 years old (SD 14,48), with 6 to 36 months after stroke onset. Function significantly improved regardless of the treatment group. However, no statistical difference was found between both groups as p-values of the median change of function measured by WMFT and FMA were 0.293 and 0.187, respectively. Conclusion: This study showed that Robotic Therapy (RT) was not different from Constraint-Induced Movement Therapy (CIMT) regardless of the analyzed variables. There was an overall upper limb function, motor recovery, functionality, and activities of daily living improvement regardless of the interventions. At last, the combination of both techniques should be considered in future studies.
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Affiliation(s)
- Thais Tavares Terranova
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcel Simis
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Artur César Aquino Santos
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fábio Marcon Alfieri
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marta Imamura
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Felipe Fregni
- Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
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18
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Sakabe N, Altukhaim S, Hayashi Y, Sakurada T, Yano S, Kondo T. Enhanced Visual Feedback Using Immersive VR Affects Decision Making Regarding Hand Use With a Simulated Impaired Limb. Front Hum Neurosci 2021; 15:677578. [PMID: 34177496 PMCID: PMC8232051 DOI: 10.3389/fnhum.2021.677578] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
The long-term effects of impairment have a negative impact on the quality of life of stroke patients in terms of not using the affected limb even after some recovery (i.e., learned non-use). Immersive virtual reality (IVR) has been introduced as a new approach for the treatment of stroke rehabilitation. We propose an IVR-based therapeutic approach to incorporate positive reinforcement components in motor coordination as opposed to constraint-induced movement therapy (CIMT). This study aimed to investigate the effect of IVR-reinforced physical therapy that incorporates positive reinforcement components in motor coordination. To simulate affected upper limb function loss in patients, a wrist weight was attached to the dominant hand of participant. Participants were asked to choose their right or left hand to reach toward a randomly allocated target. The movement of the virtual image of the upper limb was reinforced by visual feedback to participants, that is, the participants perceived their motor coordination as if their upper limb was moving to a greater degree than what was occurring in everyday life. We found that the use of the simulated affected limb was increased after the visual feedback enhancement intervention, and importantly, the effect was maintained even after gradual withdrawal of the visual amplification. The results suggest that positive reinforcement within the IVR could induce an effect on decision making in hand usage.
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Affiliation(s)
- Naoko Sakabe
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Samirah Altukhaim
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom.,Physiotherapy Group in Stroke Unit, Alamiri Hospital, Kuwait City, Kuwait
| | - Yoshikatsu Hayashi
- Biomedical Science and Biomedical Engineering, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Takeshi Sakurada
- College of Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Shiro Yano
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
| | - Toshiyuki Kondo
- Department of Computer and Information Sciences, Graduate School of Engineering, Tokyo University of Agriculture and Technology, Tokyo, Japan
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19
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Galvão FR, Silvestre MC, Gomes CL, Pereira NK, Nóbrega VT, Lima WS, Gondim AL, Cacho EW, Cacho RO. Group-based constraint-induced movement therapy in the rehabilitation of chronic poststroke patients. Medicine (Baltimore) 2021; 100:e24864. [PMID: 33663110 PMCID: PMC7909176 DOI: 10.1097/md.0000000000024864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aimed to describe the effects of a 90-minute group-based constraint-induced movement therapy protocol (CIMT) on upper extremity (UE) rehabilitation in poststroke patients. METHOD The study was a case series clinical study with 6 patients with chronic stroke admitted to the institutional integrated clinic. Ten 90-minute CIMT sessions were administered, based on the principles of the original therapy. On completion of the protocol, participants underwent group care once a week, for 1 hour a day. For comparison purposes, the Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and Canadian Occupational Performance Measure (COPM) were applied on admission, shortly after completing the protocol, and 3 months after completion. In addition, the MAL and shaping tasks were applied daily. RESULTS There was a statistically significant difference only in the MAL Amount of Use Scale applied daily between the 2nd (3.56) and 9th (3.31) and 2nd and 10th days (4.49) (P = .004), with a moderate effect size (d' = 0.46), and in the average value of shaping repetitions between the 1st (16.10) and 2nd (6.00) and 1st and 10th tasks (7.00) (P = .014), with a moderate effect size (d' = 0.35). CONCLUSION The 90-minute CIMT protocol resulted in significant improvements in use of the more affected arm in activities of daily living during the 2-week protocol. Additional research with a larger sample and a control group is needed to confirm its effectiveness.
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20
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Al-Hussain F, Nasim E, Iqbal M, Altwaijri N, Asim N, Yoo WK, Bashir S. The effect of transcranial direct current stimulation combined with functional task training on motor recovery in stroke patients. Medicine (Baltimore) 2021; 100:e24718. [PMID: 33578615 PMCID: PMC10545218 DOI: 10.1097/md.0000000000024718] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Motor deficits are common after stroke and are a major contributor to stroke-related disability and the potential for long-lasting neurobiological consequences of stroke remains unresolved. There are only a few treatments available for the improvement of motor function in stroke patients. However, the mechanisms underlying stroke recovery remain poorly understood, and effective neurorehabilitation interventions remain insufficiently proven for widespread implementation. METHODS Herein, we propose to enhance the effects of brain plasticity using a powerful noninvasive technique for brain modulation consisting of navigated transcranial magnetic stimulation (TMS) priming with transcranial direct current stimulation (tDCS) in combination with motor-training-like constraint-induced movement therapy (CIMT). Our hypothesis is that navigated low-frequency rTMS stimulus priming with precise location provided by neuronavigation on the healthy side of the brain and with anodal tDCS on the affected side combined with CIMT will induce a greater motor function improvement than that obtained with sham tDCS combined with CIMT alone. We predict that the application of this technique will result in a large reduction in cortical excitability and dis-inhibition in the affected hemisphere and lead to improvements in behavioral measures of hand function in stroke patients. DISCUSSION The proposed study, therefore, is important for several reasons. The results could potentially lead to improved stroke therapeutics, and the approach makes use of 2 potential pathways to modulate brain function. TRIAL REGISTRATION This study protocol was registered in Clinical Trials Registry (https://clinicaltrials.gov/ct2/show/NCT04646577). ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the King Fahad Specialist Hospital Dammam. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Fawaz Al-Hussain
- Department of Neurology, Faculty of Medicine, King Saud University, Riyadh
| | - Eman Nasim
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Muhammad Iqbal
- Department of Physiology, Faculty of Medicine, King Saud University, Riyadh
| | - Nouf Altwaijri
- Department of Neurology, Faculty of Medicine, King Saud University, Riyadh
| | - Niaz Asim
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital
- Hallym Institute for Translational Genomics & Bioinformatics, Hallym University College of Medicine
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
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21
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Liu LR, Wang YX, He L, Xu YX, Huang JY, Peng TT, Yang XB, Pan J, Tang HM, Xu KS. Constraint-Induced Movement Therapy Promotes Neural Remodeling and Functional Reorganization by Overcoming Nogo-A/NgR/RhoA/ROCK Signals in Hemiplegic Cerebral Palsy Mice. Neurorehabil Neural Repair 2021; 35:145-157. [PMID: 33410385 DOI: 10.1177/1545968320981962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/17/2022]
Abstract
Background. Little is known about the induction of functional and brain structural reorganization in hemiplegic cerebral palsy (HCP) by constraint-induced movement therapy (CIMT). Objective. We aimed to explore the specific molecular mechanism of functional and structural plasticity related to CIMT in HCP. Methods. The mice were divided into a control group and HCP groups with different interventions (unconstraint-induced movement therapy [UNCIMT], CIMT or siRNA-Nogo-A [SN] treatment): the HCP, HCP+UNCIMT, HCP+CIMT, HCP+SN, and HCP+SN+CIMT groups. Rotarod and front-limb suspension tests, immunohistochemistry, Golgi-Cox staining, transmission electron microscopy, and Western blot analyses were applied to measure motor function, neurons and neurofilament density, dendrites/axon areas, myelin integrity, and Nogo-A/NgR/RhoA/ROCK expression in the motor cortex. Results. The mice in the HCP+CIMT group had better motor function, greater neurons and neurofilament density, dendrites/axon areas, myelin integrity, and lower Nogo-A/NgR/RhoA/ROCK expression in the motor cortex than the HCP and HCP+UNCIMT groups (P < .05). Moreover, the expression of Nogo-A/NgR/RhoA/ROCK, the improvement of neural remodeling and motor function of mice in the HCP+SN group were similar to those in the HCP+CIMT group (P > .05). The neural remodeling and motor function of the HCP+SN+CIMT group were significantly greater than those in the HCP+SN and HCP+CIMT groups (P < .05). Motor function were positively correlated with the density of neurons (r = 0.450 and 0.309, respectively; P < .05) and neurofilament (r = 0.717 and 0.567, respectively; P < .05). Conclusions. CIMT might promote the remodeling of neurons, neurofilament, dendrites/axon areas, and myelin in the motor cortex by partially inhibiting the Nogo-A/NgR/RhoA/ROCK pathway, thereby promoting the improvement of motor function in HCP mice.
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Affiliation(s)
- Li-Ru Liu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yu-Xin Wang
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lu He
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yun-Xian Xu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing-Yu Huang
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ting-Ting Peng
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xu-Bo Yang
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jing Pan
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hong-Mei Tang
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kai-Shou Xu
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
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Palomo-Carrión R, Romay-Barrero H, Romero-Galisteo RP, Pinero-Pinto E, López-Muñoz P, Martínez-Galán I. Modified Constraint-Induced Movement Therapy at Home-Is It Possible? Families and Children's Experience. Children (Basel) 2020; 7:E248. [PMID: 33266393 DOI: 10.3390/children7110248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
Modified constraint-induced movement therapy (mCIMT) is efficient at improving upper limb non-use. The experiences of families and children with mCIMT could allow researchers to understand how it influences their day-to-day life and to improve the function of the affected upper limb without altering family life and avoiding frustration. In this qualitative study, we aimed to collect the experiences of parents and their children (aged 4-8 years) who did mCIMT at home regarding the application of low-intensity modified constraint-induced movement therapy to improve the affected upper limb functionality in infantile hemiplegia with moderate manual ability. Individual semi-structured interviews were performed to obtain insights into their experience with mCIMT. The experiences of parents and children were described in thematic sections. Eight children with hemiplegia (six years, standard deviation, SD: 1.77) and their parents were asked about their experiences after applying 50 h of mCIMT at home. Three main themes emerged from the children's interview data: (1) the experience of wearing the containment in the modified constraint-induced movement therapy (CIMT) intervention, (2) the reaction to performing the therapy at home with his/her family, and (3) learning of the affected upper limb. In the parents' interview data, there were two main themes: (1) the difficulty of executing an intensive therapy protocol (mCIMT: 50 h) at home and (2) the feeling of not wanting to finish the intervention. The experiences of the parents and their children regarding mCIMT allowed us to understand the facilitators and barriers that affect the execution of mCIMT at home, and this understanding allows us to improve its future application.
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Mallory K, Barton K, Woodhouse J, Bernstein J, Greenspoon D, Reed N. Occupational Performance Issues of Children with Hemiplegia after Acquired Brain Injury. Phys Occup Ther Pediatr 2020; 40:279-293. [PMID: 31608806 DOI: 10.1080/01942638.2019.1675845] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aims: This retrospective, exploratory study aimed to examine the categories and frequency of occupational performance issues (OPIs) identified by children (or their caregivers), who participated in a two-week, group-based modified constraint induced movement therapy program, Helping Hand. The effect of participant age on the OPIs identified was also explored.Methods: OPIs were identified using the Canadian Occupational Performance Measure for 46 Helping Hand participants, prior to program participation. Descriptive statistics including the frequency of identified OPIs were used to categorize the 236 OPIs into occupational areas. Descriptive statistics were also used to determine how the categories of OPIs and relative frequencies differed based on participant age.Results: The identified OPIs were diverse, and differed in frequency of identification and level of specificity. The OPIs identified varied based on participant age, with age groups showing developmentally appropriate differences in OPIs.Conclusions: Identification of OPIs should balance client-centredness with probing for specificity, in order for OPIs to be understood by clinicians. This will guide future program development and interventions that target age-appropriate occupational priorities.
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Affiliation(s)
- Kylie Mallory
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Barton
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Janet Woodhouse
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Janet Bernstein
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Dayna Greenspoon
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Bloorview Research Institute, Toronto, Ontario, Canada
| | - Nick Reed
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada.,Bloorview Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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24
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Nasb M, Li Z, S.A. Youssef A, Dayoub L, Chen H. Comparison of the effects of modified constraint-induced movement therapy and intensive conventional therapy with a botulinum-a toxin injection on upper limb motor function recovery in patients with stroke. Libyan J Med 2019; 14:1609304. [PMID: 31032717 PMCID: PMC6493286 DOI: 10.1080/19932820.2019.1609304] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/15/2019] [Indexed: 12/04/2022] Open
Abstract
Stroke is the second leading cause of mortality worldwide and one of the main causes of adult disability. Many studies have suggested that combination therapies provide better outcomes in patients with stroke than monotherapies. The combination of botulinum-A toxin (BTX) injection with rehabilitation methods, such as modified constraint-induced movement therapy (BTX-mCIMT), has emerged as a highly promising intervention for promoting motor recovery after stroke. Thus, the present study compared the effectiveness of the combination of BTX with high-dose conventional therapy (BTX-ICT) and BTX-mCIMT for improving motor recovery and reducing spasticity of the upper limb in patients with stroke. This study recruited 64 patients with stroke. The patients were randomly allocated to two groups, namely, BTX-ICT and BTX-mCIMT. Modified Ashworth scale (MAS), Fugl-Meyer assessment (FMA), and Barthel index (BI) assessment scores were determined for the patients in both the groups before and at 4 weeks after the BTX injection. After four weeks of treatment, the MAS, FMA, and BI assessment scores of the patients in both groups were significantly higher than the scores before the treatments (P < 0.05). At the end of 4 weeks, the patients in the BTX-mCIMT group showed significantly higher mean FMA and BI assessment scores than the patients in the BTX-ICT group (P < 0.05). However, no significant statistical difference was observed in the MAS score of the patients in the two groups (P > 0.05). Our results indicated that while both BTX-mCIMT and BTX-ICT promoted motor function recovery in patients with stroke, BTX-mCIMT exerted higher therapeutic effects than BTX-ICT on motor function recovery and in the activities of daily living of patients with stroke.
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Affiliation(s)
- Mohammad Nasb
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Zhenlan Li
- Department of Rehabilitation Medicine and Physical Therapy, First Hospital of Jilin University, Jilin University, Changchun, PR China
| | - Ahmed S.A. Youssef
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Lamis Dayoub
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Hong Chen
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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25
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de Sire A, Bigoni M, Priano L, Baudo S, Solaro C, Mauro A. Constraint-Induced Movement Therapy in multiple sclerosis: Safety and three-dimensional kinematic analysis of upper limb activity. A randomized single-blind pilot study. NeuroRehabilitation 2019; 45:247-254. [PMID: 31498137 DOI: 10.3233/nre-192762] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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 There are few evidences on safety of Constraint-Induced Movement Therapy (CIMT), as well as its effects in neurological conditions, including multiple sclerosis (MS). OBJECTIVE To evaluate safety and effectiveness of a 2-week CIMT protocol on upper limb activity of progressive MS patients through a three-dimensional (3D) kinematic analysis. METHODS In this randomized single-blind pilot study, we randomly allocated patients affected by progressive MS reporting a reduced use of one upper limb into two different groups: CIMT group (less affected limb blocked by a splint) and control group (undergoing bi-manual treatment). Primary outcome was CIMT safety. Furthermore, we assessed CIMT effects through clinical outcomes (hand grip strength, HGS, and 9 Hole Peg Test, 9HPT) and 3D kinematic analysis (normalized jerk, number of movement units, going phase duration, mean velocity, endpoint error). All evaluations were performed at baseline (T0) and after 2 weeks of treatment (T1) for both arms in both groups. RESULTS Ten MS patients, mean aged 51.0±7.7 years, were randomly allocated in the 2 groups. After treatment, no differences were found in the blocked arm. Furthermore, CIMT group showed significant improvements in clinical and kinematic parameters. CONCLUSIONS CIMT might be considered a safe and effective technique in MS patients.
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Affiliation(s)
- Alessandro de Sire
- Rehabilitation Unit, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy.,Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Matteo Bigoni
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation S. Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Lorenzo Priano
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation S. Giuseppe Hospital, Piancavallo, Verbania, Italy.,Department of Neurosciences, University of Turin, Turin, Italy
| | - Silvia Baudo
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation S. Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Claudio Solaro
- Rehabilitation Unit, "Mons. L. Novarese" Hospital, Moncrivello, Vercelli, Italy
| | - Alessandro Mauro
- Istituto Auxologico Italiano, IRCCS, Department of Neurology and Neurorehabilitation S. Giuseppe Hospital, Piancavallo, Verbania, Italy.,Department of Neurosciences, University of Turin, Turin, Italy
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26
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Okabe N, Himi N, Nakamura-Maruyama E, Hayashi N, Sakamoto I, Hasegawa T, Miyamoto O. Very Early Initiation Reduces Benefits of Poststroke Rehabilitation Despite Increased Corticospinal Projections. Neurorehabil Neural Repair 2019; 33:538-552. [PMID: 31140375 DOI: 10.1177/1545968319850132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 12/19/2022]
Abstract
Background. Although the effect of rehabilitation is influenced by aspects of the training protocol, such as initiation time and intensity of training, it is unclear whether training protocol modifications affect the corticospinal projections. Objective. The present study was designed to investigate how modification of initiation time (time-dependency) and affected forelimb use (use-dependency) influence the effects of rehabilitation on functional recovery and corticospinal projections. Methods. The time-dependency of rehabilitation was investigated in rats forced to use their impaired forelimb immediately, at 1 day, and 4 days after photothrombotic stroke. The use-dependency of rehabilitation was investigated by comparing rats with affected forelimb immobilization (forced nonuse), unaffected forelimb immobilization (forced use), and a combination of forced use and skilled forelimb training beginning at 4 days after stroke. Results. Although forced use beginning 1 day or 4 days after stroke caused significant functional improvement, immediate forced limb use caused no functional improvement. On the other hand, a combination of forced use and skilled forelimb training boosted functional recovery in multiple tasks compared to simple forced use treatment. Histological examination showed that no treatment caused brain damage. However, a retrograde tracer study revealed that immediate forced use and combination training, including forced use and skilled forelimb training, increased corticospinal projections from the contralesional and ipsilesional motor cortex, respectively. Conclusions. These results indicate that although both very early initiation time and enhanced skilled forelimb use increased corticospinal projections, premature initiation time hampers the functional improvement induced by poststroke rehabilitation.
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Affiliation(s)
- Naohiko Okabe
- 1 Kawasaki Medical School, Kurashiki City, Okayama, Japan.,2 David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Naoyuki Himi
- 1 Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | | | - Norito Hayashi
- 1 Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Issei Sakamoto
- 1 Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Toru Hasegawa
- 1 Kawasaki Medical School, Kurashiki City, Okayama, Japan
| | - Osamu Miyamoto
- 1 Kawasaki Medical School, Kurashiki City, Okayama, Japan
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Stark A, Färber C, Tetzlaff B, Scherer M, Barzel A. Stroke patients' and non-professional coaches' experiences with home-based constraint-induced movement therapy: a qualitative study. Clin Rehabil 2019; 33:1527-1539. [PMID: 31104476 PMCID: PMC6716206 DOI: 10.1177/0269215519848813] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
Objective: To investigate the experiences of chronic stroke patients and
non-professional coaches with home-based constraint-induced movement therapy
(homeCIMT). Design: Qualitative study embedded within a cluster randomized controlled trial
investigating the efficacy of homeCIMT to improve the use of the affected
arm in daily activities. Setting: Patients’ home environment. Participants: 13 stroke patients and 9 non-professional coaches’ alias family members who
had completed the four-week homeCIMT programme in the context of the
HOMECIMT trial. Interventions: Semi-structured interviews; qualitative data were analysed using the
methodology of the hermeneutic phenomenological data analysis. Results: We identified six themes in the qualitative analysis describing the
experiences of patients and non-professional coaches with homeCIMT: (1)
homeCIMT can be integrated into everyday life with varying degrees of
success; (2) training together may produce positive experiences as well as
strain; (3) self-perceived improvements during and following homeCIMT; (4)
using the affected arm in everyday life is challenging; (5) subjective
evaluation of and experiences with homeCIMT-specific exercises; and (6)
impact of professional therapists’ guidance and motivation during homeCIMT.
Statements regarding theme five and six were only provided by patients,
whereas the other themes contain both, the experiences of stroke patients
and non-professional coaches. Conclusion: Patients’ and non-professional coaches’ narratives offer a detailed insight
into the manifold experiences with the practical implementation of homeCIMT
that may help improve implementing the homeCIMT programme and similar
approaches involving increased training duration and intensity and/or
involvement of family members.
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Affiliation(s)
- Anne Stark
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Färber
- 2 Department of Health Sciences, Faculty of Life Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Britta Tetzlaff
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Barzel
- 1 Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,3 Department of Innovation and Collaboration in Ambulatory Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
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28
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Barghi A, Allendorfer JB, Taub E, Womble B, Hicks JM, Uswatte G, Szaflarski JP, Mark VW. Phase II Randomized Controlled Trial of Constraint-Induced Movement Therapy in Multiple Sclerosis. Part 2: Effect on White Matter Integrity. Neurorehabil Neural Repair 2019; 32:233-241. [PMID: 29668401 DOI: 10.1177/1545968317753073] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/29/2022]
Abstract
BACKGROUND Constraint-induced movement therapy (CIMT) is a method of physical rehabilitation that has demonstrated clinical efficacy in patients with chronic stroke, cerebral palsy, and multiple sclerosis (MS). OBJECTIVE This pilot randomized controlled trial tested whether CIMT can also induce increases in white matter integrity in patients with MS. METHODS Twenty adults with chronic hemiparetic MS were randomized to receive either CIMT or complementary and alternative medicine (CAM) treatment (reported in the first article of this pair). Structural white matter change was assessed by tract-based spatial statistics (TBSS); measures included fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). RESULTS CIMT and CAM groups did not differ in pretreatment disability or expectancy to benefit. As noted in the companion paper, the motor activity log (MAL) improved more after CIMT than CAM ( P < .001); the within-group effect size for CIMT was 3.7 (large d' = 0.57), while for CAM it was just 0.7. Improvements in white matter integrity followed CIMT and were observed in the contralateral corpus callosum (FA, P < .05), ipsilateral superior occipital gyrus (AD, P < .05), ipsilateral superior temporal gyrus (FA, P < .05), and contralateral corticospinal tract (MD and RD, P < .05). CONCLUSION CIMT produced a very large improvement in real-world limb use and induced white matter changes in patients with hemiparetic MS when compared with CAM. The findings suggest in preliminary fashion that the adverse changes in white matter integrity induced by MS might be reversed by CIMT. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT01081275).
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Affiliation(s)
| | | | - Edward Taub
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brent Womble
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarrod M Hicks
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Victor W Mark
- 2 University of Alabama at Birmingham, Birmingham, AL, USA
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Jin Y, Jin X, Li J. Fu's subcutaneous needling and constraint-induced movement therapy for a patient with chronic stroke: One-year follow-up case report. Medicine (Baltimore) 2019; 98:e13918. [PMID: 30813122 PMCID: PMC6408031 DOI: 10.1097/md.0000000000013918] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Spasticity is a common issue in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of Fu's subcutaneous needling in combination with constraint-induced movement therapy in chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS The patient suffered an infarction in the right posterior limb of the internal capsule 1 year ago, which resulted in hemiparesis in his left (nondominant) hand and arm. The only limitation for constraint-induced movement therapy was insufficient finger extension. The patient was unable to voluntarily extend his interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. However, his muscle tension did not change after the BTX type A injection. DIAGNOSES A 35-year-old male experienced arm paresis after an infarction in the right posterior limb of the internal capsule 1 year before the intervention. INTERVENTIONS The BTX type A injection did not work, so the patient received Fu's subcutaneous needling as an alternative therapy before 5 h of constraint-induced movement therapy for 12 weekdays. OUTCOMES All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, and Motor Activity Log) substantially improved over the 1-year period. Moreover, during the observation period, the patient's muscle tone and arm function did not worsen. LESSONS As a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combined therapy, the arm functions include volitional movements, and coordination or speed of movements in the paretic arm have been improved. However, we cannot rule out the possibility of an influence of the passage of time or the Hawthorne effect. The costs of the treatment of stroke may be reduced, if this combined therapy proved useful in future controlled studies.
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Affiliation(s)
- Yuanyuan Jin
- Department of Acupuncture and Moxibustion, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, China
| | - Xiaoqing Jin
- Department of Acupuncture and Moxibustion, Zhejiang Hospital, No. 12, Lingyin Road, Xihu District, Hangzhou, China
| | - Jiangru Li
- Department of Rehabilitation Medicine, The Shanghai International Medical Center, No. 4358, Kangxin Road, Pudong New District, Shanghai, China
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30
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Abstract
Constraint-induced movement therapy after cerebral ischemia stimulates axonal growth by decreasing expression levels of Nogo-A, RhoA, and Rho-associated kinase (ROCK) in the ischemic boundary zone. However, it remains unclear if there are any associations between the Nogo-A/RhoA/ROCK pathway and angiogenesis in adult rat brains in pathological processes such as ischemic stroke. In addition, it has not yet been reported whether constraint-induced movement therapy can promote angiogenesis in stroke in adult rats by overcoming Nogo-A/RhoA/ROCK signaling. Here, a stroke model was established by middle cerebral artery occlusion and reperfusion. Seven days after stroke, the following treatments were initiated and continued for 3 weeks: forced limb use in constraint-induced movement therapy rats (constraint-induced movement therapy group), intraperitoneal infusion of fasudil (a ROCK inhibitor) in fasudil rats (fasudil group), or lateral ventricular injection of NEP1–40 (a specific antagonist of the Nogo-66 receptor) in NEP1–40 rats (NEP1–40 group). Immunohistochemistry and western blot assay results showed that, at 2 weeks after middle cerebral artery occlusion, expression levels of RhoA and ROCK were lower in the ischemic boundary zone in rats treated with NEP1–40 compared with rats treated with ischemia/reperfusion or constraint-induced movement therapy alone. However, at 4 weeks after middle cerebral artery occlusion, expression levels of RhoA and ROCK in the ischemic boundary zone were markedly decreased in the NEP1–40 and constraint-induced movement therapy groups, but there was no difference between these two groups. Compared with the ischemia/reperfusion group, modified neurological severity scores and foot fault scores were lower and time taken to locate the platform was shorter in the constraint-induced movement therapy and fasudil groups at 4 weeks after middle cerebral artery occlusion, especially in the constraint-induced movement therapy group. Immunofluorescent staining demonstrated that fasudil promoted an immune response of nerve-regeneration-related markers (BrdU in combination with CD31 (platelet endothelial cell adhesion molecule), Nestin, doublecortin, NeuN, and glial fibrillary acidic protein) in the subventricular zone and ischemic boundary zone ipsilateral to the infarct. After 3 weeks of constraint-induced movement therapy, the number of regenerated nerve cells was noticeably increased, and was accompanied by an increased immune response of tight junctions (claudin-5), a pericyte marker (α-smooth muscle actin), and vascular endothelial growth factor receptor 2. Taken together, the results demonstrate that, compared with fasudil, constraint-induced movement therapy led to stronger angiogenesis and nerve regeneration ability and better nerve functional recovery at 4 weeks after cerebral ischemia/reperfusion. In addition, constraint-induced movement therapy has the same degree of inhibition of RhoA and ROCK as NEP1–40. Therefore, constraint-induced movement therapy promotes angiogenesis and neurogenesis after cerebral ischemia/reperfusion injury, at least in part by overcoming the Nogo-A/RhoA/ROCK signaling pathway. All protocols were approved by the Institutional Animal Care and Use Committee of China Medical University, China on December 9, 2015 (approval No. 2015PS326K).
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Affiliation(s)
- Zhi-Yong Zhai
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
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31
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Liu XH, Bi HY, Cao J, Ren S, Yue SW. Early constraint-induced movement therapy affects behavior and neuronal plasticity in ischemia-injured rat brains. Neural Regen Res 2019; 14:775-782. [PMID: 30688263 PMCID: PMC6375040 DOI: 10.4103/1673-5374.249225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 12/24/2022] Open
Abstract
Constraint-induced movement therapy is an effective rehabilitative training technique used to improve the restoration of impaired upper extremity movement after stroke. However, whether constraint-induced movement therapy is more effective than conventional rehabilitation in acute or sub-acute stroke remains controversial. The aim of the present study was to identify the optimal time to start constraint-induced movement therapy after ischemic stroke and to explore the mechanisms by which constraint-induced movement therapy leads to post-stroke recovery. Sixty-four adult male Sprague-Dawley rats were randomly divided into four groups: sham-surgery group, cerebral ischemia/reperfusion group, early constraint-induced movement therapy group, and late constraint-induced movement therapy group. Rat models of left middle cerebral artery occlusion were established according to the Zea Longa line embolism method. Constraint-induced movement therapy was conducted starting on day 1 or day 14 in the early constraint-induced movement therapy and late constraint-induced movement therapy groups, respectively. To explore the effect of each intervention time on neuromotor function, behavioral function was assessed using a balance beam walking test before surgery and at 8 and 21 days after surgery. The expression levels of brain-derived neurotrophic factor, nerve growth factor and Nogo receptor were evaluated using real time-polymerase chain reaction and western blot assay to assess the effect of each intervention time. The results showed that the behavioral score was significantly lower in the early constraint-induced movement therapy group than in the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. At 21 days, the scores had significantly decreased in the early constraint-induced movement therapy and late constraint-induced movement therapy groups. At 8 days, only mild pyknosis appeared in neurons of the ischemic penumbra in the early constraint-induced movement therapy group, which was distinctly better than in the cerebral ischemia/reperfusion group. At 21 days, only a few vacuolated cells were observed and no obvious inflammatory cells were visible in late constraint-induced movement therapy group, which was much better than at 8 days. The mRNA and protein expression levels of brain-derived neurotrophic factor and nerve growth factor were significantly higher, but expression levels of Nogo receptor were significantly lower in the early constraint-induced movement therapy group compared with the cerebral ischemia/reperfusion and late constraint-induced movement therapy groups at 8 days. The changes in expression levels at 21 days were larger but similar in both the early constraint-induced movement therapy and late constraint-induced movement therapy groups. Besides, the protein nerve growth factor level was higher in the late constraint-induced movement therapy group than in the early constraint-induced movement therapy group at 21 days. These results suggest that both early (1 day) and late (14 days) constraint-induced movement therapy induces molecular plasticity and facilitates functional recovery after ischemic stroke, as illustrated by the histology. The mechanism may be associated with downregulation of Nogo receptor expression and upregulation of brain-derived neurotrophic factor and nerve growth factor expression.
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Affiliation(s)
- Xi-Hua Liu
- Department of Physical Medicine & Rehabilitation, Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, Shandong Province, China
| | - Hong-Yan Bi
- Department of Physical Medicine & Rehabilitation, Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, Shandong Province, China
| | - Jie Cao
- Maternal and Child Health Development Research Center, Shandong Maternal and Child Health Hospital, Jinan, Shandong Province, China
| | - Shuo Ren
- Department of Physical Medicine & Rehabilitation, Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, Shandong Province, China
| | - Shou-Wei Yue
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
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32
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Takebayashi T, Takahashi K, Amano S, Uchiyama Y, Gosho M, Domen K, Hachisuka K. Assessment of the Efficacy of ReoGo-J Robotic Training Against Other Rehabilitation Therapies for Upper-Limb Hemiplegia After Stroke: Protocol for a Randomized Controlled Trial. Front Neurol 2018; 9:730. [PMID: 30210446 PMCID: PMC6121101 DOI: 10.3389/fneur.2018.00730] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 05/21/2018] [Accepted: 08/10/2018] [Indexed: 11/23/2022] Open
Abstract
Background: Stroke patients experience chronic hemiparesis in their upper extremities leaving negative effects on quality of life. Robotic therapy is one method to recover arm function, but its research is still in its infancy. Research questions of this study is to investigate how to maximize the benefit of robotic therapy using ReoGo-J for arm hemiplegia in chronic stroke patients. Methods: Design of this study is a multi-center parallel group trial following the prospective, randomized, open-label, blinded endpoint (PROBE) study model. Participants and setting will be 120 chronic stroke patients (over 6 months post-stroke) will be randomly allocated to three different rehabilitation protocols. In this study, the control group will receive 20 min of standard rehabilitation (conventional occupational therapy) and 40 min of self-training (i.e., sanding, placing and stretching). The robotic therapy group will receive 20 min of standard rehabilitation and 40 min of robotic therapy using ReoGo®-J device. The combined therapy group will receive 40 min of robotic therapy and 20 min of constraint-induced movement therapy (protocol to improve upper-limb use in ADL suggests). This study employs the Fugl-Meyer Assessment upper-limb score (primary outcome), other arm function measures and the Stroke Impact Scale score will be measured at baseline, 5 and 10 weeks of the treatment phase. In analysis of this study, we use the mixed effects model for repeated measures to compare changes in outcomes between groups at 5 and 10 Weeks. The registration number of this study is UMIN000022509. Conclusions: This study is a feasible, multi-site randomized controlled trial to examine our hypothesis that combined training protocol could maximize the benefit of robotic therapy and best effective therapeutic strategy for patients with upper-limb hemiparesis.
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Affiliation(s)
- Takashi Takebayashi
- Department of Occupational Therapy, School of Health Science and Social Welfare, Kibi International University, Takahashi, Japan
| | - Kayoko Takahashi
- Department of Rehabilitation, School of Allied Health Science, Kitasato University, Sagamihara-shi, Japan
| | - Satoru Amano
- Department of Rehabilitation, The Hospital of Hyogo College of Medicine, Nishinomiya-shi, Japan
| | - Yuki Uchiyama
- Department of Rehabilitation, Hyogo College of Medicine, Nishinomiya-shi, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kenji Hachisuka
- Kyushu Rosai Hospital, Moji Medical Center, Kita-kyushu-shi, Japan
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Shikako-Thomas K, Fehlings D, Germain M, Gordon AM, Maynard D, Majnemer A. Current Practice "Constraints" in the Uptake and Use of Intensive Upper Extremity Training: A Canadian Perspective. Phys Occup Ther Pediatr 2018; 38:143-156. [PMID: 28509591 DOI: 10.1080/01942638.2017.1303802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. AIMS To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. METHODS Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. RESULTS Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. CONCLUSIONS Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET.
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Affiliation(s)
- Keiko Shikako-Thomas
- a School of Physical & Occupational Therapy , McGill University , Montreal , Quebec , Canada.,b Center for Interdisciplinary Research of Greater Montreal , Montreal , Quebec , Canada.,c Montreal Children's Hospital-McGill University Health Centre , Westmount , Quebec , Canada
| | - Darcy Fehlings
- d Holland Bloorview Kids Rehabilitation Centre, University of Toronto , Toronto , Ontario , Canada
| | - Manon Germain
- e Centre de Réadaptation Marie-Enfant , Montreal , Quebec , Canada
| | - Andrew M Gordon
- f Teachers College, Columbia University , New York , New York , USA
| | - Doug Maynard
- g Canadian Association of Pediatric Health Centers , Ottawa , Ontario , Canada
| | - Annette Majnemer
- a School of Physical & Occupational Therapy , McGill University , Montreal , Quebec , Canada.,b Center for Interdisciplinary Research of Greater Montreal , Montreal , Quebec , Canada.,c Montreal Children's Hospital-McGill University Health Centre , Westmount , Quebec , Canada
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Christmas PM, Sackley C, Feltham MG, Cummins C. A randomized controlled trial to compare two methods of constraint-induced movement therapy to improve functional ability in the affected upper limb in pre-school children with hemiplegic cerebral palsy: CATCH TRIAL. Clin Rehabil 2018; 32:909-918. [PMID: 29552921 DOI: 10.1177/0269215518763512] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/17/2022]
Abstract
OBJECTIVE To determine the feasibility and short-term efficacy of caregiver-directed constraint-induced movement therapy to improve upper limb function in young children with hemiplegic cerebral palsy. DESIGN Randomized controlled trial with masked assessment. SETTING Community paediatric therapy services. SUBJECTS Pre-school children with hemiplegic cerebral palsy. INTERVENTIONS Caregiver-directed constraint-induced movement therapy administered using either 24-hour short-arm restraint device (prolonged) or intermittent holding restraint during therapy (manual). MAIN MEASURES Primary measures include Assisting Hand Assessment (AHA) at 10 weeks. Secondary measures include adverse events, Quality of Upper Extremity Skills Test and Pediatric Quality of Life Inventory. Feasibility measures include recruitment, retention, data completeness and adherence. RESULTS About 62/81 (72%) of eligible patients in 16 centres were randomized (prolonged restraint n = 30; manual restraint n = 32) with 97% retention at 10 weeks. The mean change at 10 weeks on the AHA logit-based 0-100 unit was 9.0 (95% confidence interval (CI): 5.7, 12.4; P < 0.001) for prolonged restraint and 5.3 (95% CI: 1.3, 9.4; P = 0.01) for manual restraint with a mean group difference of 3.7 (95% CI: -1.5, 8.8; P = 0.156) (AHA smallest detectable difference = 5 units). No serious related adverse events were reported. There were no differences in secondary outcomes. More daily therapy was delivered with prolonged restraint (60 vs 30 minutes; P < 0.001). AHA data were complete at baseline and 10 weeks. CONCLUSION Caregiver-directed constraint-induced movement therapy is feasible and associated with improvement in upper limb function at 10 weeks. More therapy was delivered with prolonged than with manual restraint, warranting further testing of this intervention in a longer term trial.
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Affiliation(s)
- Pauline M Christmas
- 1 Moseley Hall Hospital, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Catherine Sackley
- 2 School of Population and Environmental Sciences, King's College London, London, UK
| | - Max G Feltham
- 3 Birmingham Clinical Trials Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- 4 Murray Learning Centre, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Blanton S, Dunbar S, Clark PC. Content validity and satisfaction with a caregiver-integrated web-based rehabilitation intervention for persons with stroke. Top Stroke Rehabil 2018; 25:168-173. [PMID: 29334344 DOI: 10.1080/10749357.2017.1419618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/18/2022]
Abstract
Background Family members provide valuable contributions during rehabilitation after stroke, but frequently report higher incidences of burden, depression, and social isolation during caregiving. Thus, effective interventions to reduce stroke impact on the family are needed. Objectives To evaluate the content validity and satisfaction of a caregiver-focused web-based intervention designed to improve stroke survivor physical function while reducing caregiver negative outcomes. Methods Caregivers of individuals with stroke (N = 6) and expert rehabilitation researchers (N = 4) were presented with a novel, web-based intervention (CARE-CITE) designed to foster problem-solving and skill-building while facilitating caregiver involvement during constraint-induced movement therapy. Caregivers rated CARE-CITE for usefulness, ease of use, acceptability, and time to complete. Rehabilitation experts evaluated content for accuracy, feasibility, acceptability, problem relevance and ease of use. Ratings were assessed using a five-point Likert-type response scales (1 = strongly disagree to 5 = strongly agree). Results On average, all caregivers agreed or strongly agreed that the modules were useful (4.42), easy to use (4.60), and acceptable (4.41). Mean total satisfaction score was 4.45, and average review time was 15 min per module. Expert reviewers agreed or strongly agreed that each module was accurate (4.95), feasible (4.8), easy to use (4.86), acceptable (4.96), and had appropriate problem relevance (4.65). Conclusions The CARE-CITE intervention may be a viable program for caregivers of patients with stroke. Currently a pilot study is underway to evaluate the impact of the intervention on caregiver mental health, family conflict around stroke recovery and stroke survivor upper extremity function.
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Affiliation(s)
- Sarah Blanton
- a Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine , Emory University , Atlanta , GA , USA
| | - Sandra Dunbar
- b Nell Hodgson Woodruff School of Nursing , Emory University , Atlanta , GA , USA
| | - Patricia C Clark
- c Byrdine F. Lewis School of Nursing , Georgia State University , Atlanta , GA , USA
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Abstract
RATIONALE Spasticity is a widespread problem in chronic stroke. To date, no study has reported the long-term (up to 1 year) outcomes of acupuncture in combination with constraint-induced movement therapy in patients with chronic stroke. This report describes the successful addition of acupuncture on spasticity and arm function in a patient with chronic stroke and arm paresis. PATIENT CONCERNS At screening, the patient was unable to voluntarily extend her interphalangeal or metacarpophalangeal joints beyond the 10 degrees required for constraint-induced movement therapy. However, the BTX type A injection couldn't be used as she had ever suffered a severe allergic reaction in the injection of BTX type A for facial anti-wrinkle. DIAGNOSES A 40-year-old female experienced arm paresis after an infarction in the right posterior limb of the internal capsule 2 years before the intervention. INTERVENTIONS The BTX type A injection couldn't be used as she had ever suffered a severe allergic reaction in the injection of BTX type A for facial anti-wrinkle, so the patient received 1 hour of acupuncture as an alternative therapy before 5 hours of constraint-induced movement therapy for 12 weekdays. OUTCOMES All outcome measures (Modified Ashworth Scale, Fugl-Meyer Assessment, Action Research Arm Test, Motor Activity Log) substantially improved over the 1-year period. Moreover, during the observation period, the patient's muscle tone and arm function did not worsen. LESSONS As a result of a reduction in spasticity, a reduction of learned nonuse behaviors, or use-dependent plasticity after the combined therapy, the arm functions include volitional movements and coordination or speed of movements in the paretic arm have been improved. However, we can not rule out the possibility of an influence of the passage of time or the Hawthorne effect. The costs of the treatment of stroke may be reduced, if this combined therapy proved useful in future controlled studies.
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Takebayashi T, Takahashi K, Moriwaki M, Sakamoto T, Domen K. Improvement of Upper Extremity Deficit after Constraint-Induced Movement Therapy Combined with and without Preconditioning Stimulation Using Dual-hemisphere Transcranial Direct Current Stimulation and Peripheral Neuromuscular Stimulation in Chronic Stroke Patients: A Pilot Randomized Controlled Trial. Front Neurol 2017; 8:568. [PMID: 29163334 PMCID: PMC5670104 DOI: 10.3389/fneur.2017.00568] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 05/31/2017] [Accepted: 10/11/2017] [Indexed: 01/10/2023] Open
Abstract
In this study, we investigated the effects of dual-hemisphere transcranial direct current stimulation (dual-tDCS) of both the affected (anodal tDCS) and non-affected (cathodal tDCS) primary motor cortex, combined with peripheral neuromuscular electrical stimulation (PNMES), on the effectiveness of constraint-induced movement therapy (CIMT) as a neurorehabilitation intervention in chronic stroke. We conducted a randomized controlled trial of feasibility, with a single blind assessor, with patients recruited from three outpatient clinics. Twenty chronic stroke patients were randomly allocated to the control group, receiving conventional CIMT, or the intervention group receiving dual-tDCS combined with PNMES before CIMT. Patients in the treatment group first underwent a 20-min period of dual-tDCS, followed immediately by PNMES, and subsequent CIMT for 2 h. Patients in the control group only received CIMT (with no pretreatment stimulation). All patients underwent two CIMT sessions, one in the morning and one in the afternoon, each lasting 2 h, for a total of 4 h of CIMT per day. Upper extremity function was assessed using the Fugl-Meyer Assessment (primary outcome), as well as the amount of use (AOU) and quality of movement (QOM) scores, obtained via the Motor Activity Log (secondary outcome). Nineteen patients completed the study, with one patient withdrawing after allocation. Compared to the control group, the treatment improvement in upper extremity function and AOU was significantly greater in the treatment than control group (change in upper extremity score, 9.20 ± 4.64 versus 4.56 ± 2.60, respectively, P < 0.01, η2 = 0.43; change in AOU score, 1.10 ± 0.65 versus 0.62 ± 0.85, respectively, P = 0.02, η2 = 0.52). There was no significant effect of the intervention on the QOM between the intervention and control groups (change in QOM score, 1.00 ± 0.62 versus 0.71 ± 0.72, respectively, P = 0.07, η2 = 0.43; treatment versus control). Our findings suggest a novel pretreatment stimulation strategy based on dual-tDCS and PNMES may enhance the therapeutic benefit of CIMT.
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Affiliation(s)
- Takashi Takebayashi
- Graduate Course of Rehabilitation Science, Hyogo College of Medicine, Nishinomiya, Japan.,Department of Occupational Therapy, School of Health Science and Social Welfare, Kibi International University, Takahashi, Japan
| | - Kayoko Takahashi
- Department of Rehabilitation, School of Allied Health Science, Kitasato University, Sagamihara-shi, Japan
| | - Misa Moriwaki
- Department of Rehabilitation Medicine, Midorigaoka Hospital, Takatsuki, Japan
| | - Tomosaburo Sakamoto
- Department of Rehabilitation, Kansai Rehabilitation Hospital, Toyonaka, Japan
| | - Kazuhisa Domen
- Department of Rehabilitation Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Yu C, Wang W, Zhang Y, Wang Y, Hou W, Liu S, Gao C, Wang C, Mo L, Wu J. The Effects of Modified Constraint-Induced Movement Therapy in Acute Subcortical Cerebral Infarction. Front Hum Neurosci 2017; 11:265. [PMID: 28572764 PMCID: PMC5435756 DOI: 10.3389/fnhum.2017.00265] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 07/13/2016] [Accepted: 05/04/2017] [Indexed: 01/17/2023] Open
Abstract
Background: Constraint-induced movement therapy (CIMT) promotes upper extremity recovery post stroke, however, it is difficult to implement clinically due to its high resource demand and safety of the restraint. Therefore, we propose that modified CIMT (mCIMT) be used to treat individuals with acute subcortical infarction. Objective: To evaluate the therapeutic effects of mCIMT in patients with acute subcortical infarction, and investigate the possible mechanisms underlying the effect. Methods: The role of mCIMT was investigated in 26 individuals experiencing subcortical infarction in the preceding 14 days. Patients were randomly assigned to either mCIMT or standard therapy. mCIMT group was treated daily for 3 h over 10 consecutive working days, using a mitt on the unaffected arm for up to 30% of waking hours. The control group was treated with an equal dose of occupational therapy and physical therapy. During the 3-month follow-up, the motor functions of the affected limb were assessed by the Wolf Motor Function Test (WMFT) and Motor Activity Log (MAL). Altered cortical excitability was assessed via transcranial magnetic stimulation (TMS). Results: Treatment significantly improved the movement in the mCIMT group compared with the control group. The mean WMF score was significantly higher in the mCIMT group compared with the control group. Further, the appearance of motor-evoked potentials (MEPs) were significantly higher in the mCIMT group compared with the baseline data. A significant change in ipsilesional silent period (SP) occurred in the mCIMT group compared with the control group. However, we found no difference between two groups in motor function or electrophysiological parameters after 3 months of follow-up. Conclusions: mCIMT resulted in significant functional changes in timed movement immediately following treatment in patients with acute subcortical infarction. Further, early mCIMT improved ipsilesional cortical excitability. However, no long-term effects were seen.
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Affiliation(s)
- Changshen Yu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Wanjun Wang
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Yue Zhang
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Yizhao Wang
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Weijia Hou
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Shoufeng Liu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Chunlin Gao
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Chen Wang
- Neurological Disease Biobank, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Lidong Mo
- Neurological Disease Biobank, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
| | - Jialing Wu
- Department of Neurorehabilitation, Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative DiseasesTianjin, China
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Kim H, Kim MJ, Koo YS, Lee HI, Lee SW, Shin MJ, Kim SY, Shin YB, Shin YI, Choi BT, Yun YJ, Shin HK. Histological and functional assessment of the efficacy of constraint-induced movement therapy in rats following neonatal hypoxic-ischemic brain injury. Exp Ther Med 2017; 13:2775-2782. [PMID: 28587341 PMCID: PMC5450637 DOI: 10.3892/etm.2017.4371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 09/07/2016] [Accepted: 03/16/2017] [Indexed: 01/08/2023] Open
Abstract
Constraint-induced movement therapy (CIMT) is used in stroke rehabilitation to promote recovery of upper limb motor function. However, its efficacy in improving functional outcomes in children with hemiplegic cerebral palsy has not been clearly determined in clinical or experimental research. The aim of our study was to assess the efficacy of a new experimental model of CIMT, evaluated in terms of mortality, stress, motor and cognitive function in rats having undergone a neonatal hypoxic-ischemic (HI) brain injury. Neonatal HI injury was induced at post-natal day 7 through unilateral ligation of the common carotid artery followed by exposure to hypoxia for 2 h. CIMT was implemented at 3 weeks, post-HI injury, using a pouch to constrain the unimpaired forelimb and forcing use of the affected forelimb using a motorized treadmill. After HI injury, animals demonstrated motor and cognitive deficits, as well as volumetric decreases in the ipsilateral hemisphere to arterial occlusion. CIMT yielded a modest recovery of motor and cognitive function, with no effect in reducing the size of the HI lesion or post-HI volumetric decreases in brain tissue. Therefore, although animal models of stroke have identified benefits of CIMT, CIMT was not sufficient to enhance brain tissue development and functional outcomes in an animal model of hemiplegic cerebral palsy. Based on our outcomes, we suggest that CIMT can be used as an adjunct treatment to further enhance the efficacy of a program of rehabilitation in children with hemiplegic cerebral palsy.
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Affiliation(s)
- Hyunha Kim
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Korean Medical Science Research Center for Healthy-Aging, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Min Jae Kim
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Korean Medical Science Research Center for Healthy-Aging, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Young Soo Koo
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Korean Medical Science Research Center for Healthy-Aging, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Hae In Lee
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Sae-Won Lee
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Korean Medical Science Research Center for Healthy-Aging, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Myung Jun Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Byung Tae Choi
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Korean Medical Science Research Center for Healthy-Aging, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Division of Meridian and Structural Medicine, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Young Ju Yun
- Department of Integrative Medicine, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
| | - Hwa Kyoung Shin
- Department of Korean Medical Science, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Korean Medical Science Research Center for Healthy-Aging, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea.,Division of Meridian and Structural Medicine, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 50612, Republic of Korea
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Abstract
BACKGROUND There is high-level evidence supporting constraint-induced movement therapy (CIMT) and bimanual therapy for children with unilateral cerebral palsy. Evidence-based intervention includes time-limited, goal-directed, skills-based, intensive blocks of practice based on motor learning theory. AIM AND METHODS Using supporting literature and clinical insight, we provide a theoretical rationale to highlight previously unreported differences between CIMT and bimanual therapy. DISCUSSION The current emphasis on total dosage of practice for achieving positive outcomes fails to recognise the influence of other critical concepts within motor learning. Limitations exist in the application of motor learning principles using CIMT due to its unimanual nature. CIMT is effective for development of unimanual actions brought about by implicit learning, however it is difficult to target explicit learning that is required for learning how to use two hands together. Using bimanual therapy, object properties can be adapted to trigger goal-related perceptual and cognitive processes required for children to learn to recognise when two hands are required for task completion. CONCLUSION CIMT and bimanual should be viewed as complementary. CIMT could be used to target unimanual actions. Once these actions are established, bimanual therapy could be used for children to learn how to use these actions for bimanual skill development.
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Affiliation(s)
- Brian Hoare
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,CPtherapy, Australian Catholic University, Victoria, Australia
| | - Susan Greaves
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia.,Occupational Therapy Department, The Royal Children's Hospital, Victoria, Australia
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DeLuca SC, Trucks MR, Wallace DA, Ramey SL. Practice-based evidence from a clinical cohort that received pediatric constraint- induced movement therapy. J Pediatr Rehabil Med 2017; 10:37-46. [PMID: 28339409 DOI: 10.3233/prm-170409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Constraint-Induced Movement Therapy (CIMT) is now designated a highly efficacious treatment for children with cerebral palsy, based on rigorous clinical trials. Yet virtually no evidence confirms that these moderate to large size effects can be replicated in clinical practice for a more heterogeneous clinical population. Thus there is a need to collect and report treatment outcome data based on actual clinical practice as a critical next step for implementation. METHODS This study presents results from a prospective study conducted on a clinical cohort of 88 children, 18 months to 12 years old (M = 55 months, SD = 5 months), who received high-intensity CIMT known as ACQUIREc. The children varied in severity and etiology of their hemiparesis and a subset was diagnosed with asymmetric quadriparesis. RESULTS Pre- to post-CIMT assessments confirmed highly significant and clinically meaningful changes based on both parental report (Pediatric Motor Activity Log, p< 0.0001) and standardized measures (The Assisting Hand Assessment, p= 0.04). CONCLUSIONS Clinical practice of high-intensity CIMT (120 hours in 4 weeks) with full-time casting of the less-impaired upper extremity produced benefits of comparable magnitude to those from rigorous randomized controlled trials (RCTs). Therapists were highly trained and actively monitored. Children across a wide range of etiologies and severity levels realized positive outcomes.
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Affiliation(s)
- Stephanie C DeLuca
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA.,Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Department of Psychology, Virginia Tech, Blacksburg, VA, USA.,Department of Rehabilitation and Wellness, Jefferson College of Health Sciences, Roanoke, VA, USA
| | | | | | - Sharon L Ramey
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA.,Department of Pediatrics, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.,Department of Psychology, Virginia Tech, Blacksburg, VA, USA.,Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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Liu XH, Huai J, Gao J, Zhang Y, Yue SW. Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials. Neural Regen Res 2017; 12:1443-1450. [PMID: 29089989 PMCID: PMC5649464 DOI: 10.4103/1673-5374.215255] [Citation(s) in RCA: 11] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke. DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, WanFang, Weipu Information Resources System, Chinese Biomedical Literature Database, PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy (traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index. RESULTS: A total of 16 prospective randomized controlled trials (379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm (weighted mean difference (WMD) = 10.822; 95% confidence intervals (95% CI): 7.419–14.226), the action research-arm test (WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement (WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index (WMD = 10.706; 95% CI: 4.417–16.966). CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.
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Affiliation(s)
- Xi-Hua Liu
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China.,Department of Physical Medicine & Rehabilitation, The Affiliated Hospital of Shandong Traditional Chinese Medicine University, Jinan, Shandong Province, China
| | - Juan Huai
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Jie Gao
- Shandong Institute of Prevention and Control for Endemic Disease, Jinan, Shandong Province, China
| | - Yang Zhang
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
| | - Shou-Wei Yue
- Department of Physical Medicine & Rehabilitation, Qilu Hospital, Shandong University, Jinan, Shandong Province, China
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Cunningham DA, Varnerin N, Machado A, Bonnett C, Janini D, Roelle S, Potter-Baker K, Sankarasubramanian V, Wang X, Yue G, Plow EB. Stimulation targeting higher motor areas in stroke rehabilitation: A proof-of-concept, randomized, double-blinded placebo-controlled study of effectiveness and underlying mechanisms. Restor Neurol Neurosci 2016; 33:911-26. [PMID: 26484700 DOI: 10.3233/rnn-150574] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 12/16/2022]
Abstract
PURPOSE To demonstrate, in a proof-of-concept study, whether potentiating ipsilesional higher motor areas (premotor cortex and supplementary motor area) augments and accelerates recovery associated with constraint induced movement. METHODS In a randomized, double-blinded pilot clinical study, 12 patients with chronic stroke were assigned to receive anodal transcranial direct current stimulation (tDCS) (n = 6) or sham (n = 6) to the ipsilesional higher motor areas during constraint-induced movement therapy. We assessed functional and neurophysiologic outcomes before and after 5 weeks of therapy. RESULTS Only patients receiving tDCS demonstrated gains in function and dexterity. Gains were accompanied by an increase in excitability of the contralesional rather than the ipsilesional hemisphere. CONCLUSIONS Our proof-of-concept study provides early evidence that stimulating higher motor areas can help recruit the contralesional hemisphere in an adaptive role in cases of greater ipsilesional injury. Whether this early evidence of promise translates to remarkable gains in functional recovery compared to existing approaches of stimulation remains to be confirmed in large-scale clinical studies that can reasonably dissociate stimulation of higher motor areas from that of the traditional primary motor cortices.
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Affiliation(s)
- David A Cunningham
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.,School of Biomedical Sciences, Kent State University, Kent, OH, USA
| | - Nicole Varnerin
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Andre Machado
- Center for Neurological Restoration, Neurosurgery, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Corin Bonnett
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Janini
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Roelle
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Kelsey Potter-Baker
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | | | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Guang Yue
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, West Orange, NJ, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.,Center for Neurological Restoration, Neurosurgery, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA.,Department of Physical Medicine & Rehab, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA
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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] [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: 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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Manning KY, Menon RS, Gorter JW, Mesterman R, Campbell C, Switzer L, Fehlings D. Neuroplastic Sensorimotor Resting State Network Reorganization in Children With Hemiplegic Cerebral Palsy Treated With Constraint-Induced Movement Therapy. J Child Neurol 2016; 31:220-6. [PMID: 26078420 DOI: 10.1177/0883073815588995] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 04/28/2015] [Indexed: 11/15/2022]
Abstract
Using resting state functional magnetic resonance imaging (MRI), we aim to understand the neurologic basis of improved function in children with hemiplegic cerebral palsy treated with constraint-induced movement therapy. Eleven children including 4 untreated comparison subjects diagnosed with hemiplegic cerebral palsy were recruited from 3 clinical centers. MRI and clinical data were gathered at baseline and 1 month for both groups, and 6 months later for the case group only. After constraint therapy, the sensorimotor resting state network became more bilateral, with balanced contributions from each hemisphere, which was sustained 6 months later. Sensorimotor resting state network reorganization after therapy was correlated with a change in the Quality of Upper Extremity Skills Test score at 1 month (r = 0.79, P = .06), and Canadian Occupational Performance Measure scores at 6 months (r = 0.82, P = .05). This clinically correlated resting state network reorganization provides further evidence of the neuroplastic mechanisms underlying constraint-induced movement therapy.
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Affiliation(s)
- Kathryn Y Manning
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Ravi S Menon
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Ronit Mesterman
- CanChild Centre for Childhood Disability Research, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Craig Campbell
- Department of Paediatrics and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Lauren Switzer
- Department of Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Department of Paediatrics, University of Toronto, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
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Zhu Y, Zhou C, Liu Y, Liu J, Jin J, Zhang S, Bai Y, Huang D, Zhu B, Xu Y, Wu Y. Effects of modified constraint-induced movement therapy on the lower extremities in patients with stroke: a pilot study. Disabil Rehabil 2016; 38:1893-9. [PMID: 26728501 DOI: 10.3109/09638288.2015.1107775] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 11/13/2022]
Abstract
PURPOSE This study aimed to qualify the improvements of modified constraint-induced movement therapy (m-CIMT) on the lower limb of stroke patients via assessing the centre of mass (COM) displacement and the basic gait parameters. METHODS A total of 22 hemiplegic patients after stroke with first-time clinical cerebral infarction or haemorrhagic cerebrovascular accident were included in this study from May to December, 2014. The patients were randomly divided into m-CIMT group and the conventional therapy group (control group), and received corresponding training for five days/week for four weeks. The COM displacement and gait parameters were assessed by three-dimensional segmental kinematics method in pre-intervention and post- intervention therapy. RESULTS After four weeks of m-CIMT, the COM displacement on sagittal plane of paretic leg during stance phase was increased (pre: 91.04 ± 4.39 cm, post: 92.38 ± 4.58 cm, p < 0.05) and swing range of frontal plane was remarkably decreased (pre: 10.15 ± 3.05 cm, post: 7.83 ± 1.90 cm, p < 0.001). Meantime, the normalised swing range of COM in m-CIMT was superior to that in control group. Moreover, the gait parameters, including velocity (0.27 m/s), step width (0.10 m), step length (0.22 m) and swing time percentage (29.80%), were significantly improved by post-interventions of m-CIMT (p < 0.05). CONCLUSION The m-CIMT intervention improves the COM displacement in sagittal and frontal plane, as well as gait parameters. These suggest that m-CIMT intervention may be feasible and effective for the rehabilitation of hemiplegic gait. Implications for Rehabilitation Segmental kinematics method was used to estimate the displacement of the COM. m-CIMT interventions improved the COM displacement of patients after stroke. m-CIMT interventions improved the hemiplegic gait parameters.
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Affiliation(s)
- Yulian Zhu
- a Key Laboratory of Exercise and Health Sciences , Shanghai University of Sport , Shanghai , China ;,b Department of Rehabilitation Medicine , Huashan Hospital, Fudan University , Shanghai , China
| | - Chaosheng Zhou
- a Key Laboratory of Exercise and Health Sciences , Shanghai University of Sport , Shanghai , China ;,c Department of Rehabilitation Medicine , Affiliated Tenth People's Hospital of Tongji University , Shanghai , China
| | - Yu Liu
- a Key Laboratory of Exercise and Health Sciences , Shanghai University of Sport , Shanghai , China
| | - Jue Liu
- a Key Laboratory of Exercise and Health Sciences , Shanghai University of Sport , Shanghai , China
| | - Jiaran Jin
- a Key Laboratory of Exercise and Health Sciences , Shanghai University of Sport , Shanghai , China
| | - Shengnian Zhang
- a Key Laboratory of Exercise and Health Sciences , Shanghai University of Sport , Shanghai , China
| | - Yulong Bai
- b Department of Rehabilitation Medicine , Huashan Hospital, Fudan University , Shanghai , China
| | - Dequan Huang
- d Department of Rehabilitation Medicine , Tianshan Zhongyi Hospital , Shanghai , China
| | - Bing Zhu
- b Department of Rehabilitation Medicine , Huashan Hospital, Fudan University , Shanghai , China
| | - Yiming Xu
- b Department of Rehabilitation Medicine , Huashan Hospital, Fudan University , Shanghai , China
| | - Yi Wu
- b Department of Rehabilitation Medicine , Huashan Hospital, Fudan University , Shanghai , China
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Komar A, Ashley K, Hanna K, Lavallee J, Woodhouse J, Bernstein J, Andres M, Reed N. Retrospective Analysis of an Ongoing Group-Based Modified Constraint-Induced Movement Therapy Program for Children with Acquired Brain Injury. Phys Occup Ther Pediatr 2016; 36:186-203. [PMID: 26565125 DOI: 10.3109/01942638.2015.1076557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM A pretest-posttest retrospective design was used to evaluate the impact of a group-based modified constraint-induced movement therapy (mCIMT) program on upper extremity function and occupational performance. METHODS 20 children ages 3 to 18 years with hemiplegia following an acquired brain injury participated in a 2-week group mCIMT program. Upper extremity function was measured with the Assisting Hand Assessment (AHA) and subtests from the Quality of Upper Extremity Skills Test (QUEST). Occupational performance and satisfaction were assessed using the Canadian Occupational Performance Measure (COPM). Data were analyzed using a Wilcoxon signed-ranks test. RESULTS Group-based analysis revealed upper extremity function and occupational performance attained statistically significant improvements from pre- to postintervention on all outcome measures (AHA: Z = -3.63, p = <.001; QUEST Grasps: Z = -3.10, p = .002; QUEST Dissociated Movement: Z = -2.51, p = .012; COPM Performance: Z = -3.64, p = <.001; COPM Satisfaction: Z = -3.64, p = <.001). Across individuals, clinically significant improvements were found in 65% of participants' AHA scores. 80% of COPM Performance scores and 70% of COPM Satisfaction scores demonstrated clinically significant improvements in at least one identified goal. CONCLUSIONS This study is an initial step in evaluating and providing preliminary evidence supporting the effectiveness of a group-based mCIMT program for children with hemiplegia following an acquired brain injury.
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Affiliation(s)
- Alyssa Komar
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Kelsey Ashley
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Kelly Hanna
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Julia Lavallee
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Janet Woodhouse
- b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Janet Bernstein
- b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Matthew Andres
- b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,c Bloorview Research Institute , Toronto , Ontario , Canada
| | - Nick Reed
- a Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada.,b Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,c Bloorview Research Institute , Toronto , Ontario , Canada.,d Rehabilitation Sciences Institute , University of Toronto , Toronto , Ontario , Canada
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48
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Combs HL, Jones TA, Kozlowski DA, Adkins DL. Combinatorial Motor Training Results in Functional Reorganization of Remaining Motor Cortex after Controlled Cortical Impact in Rats. J Neurotrauma 2015; 33:741-7. [PMID: 26421759 DOI: 10.1089/neu.2015.4136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 01/12/2023] Open
Abstract
Cortical reorganization subsequent to post-stroke motor rehabilitative training (RT) has been extensively examined in animal models and humans. However, similar studies focused on the effects of motor training after traumatic brain injury (TBI) are lacking. We previously reported that after a moderate/severe TBI in adult male rats, functional improvements in forelimb use were accomplished only with a combination of skilled forelimb reach training and aerobic exercise, with or without nonimpaired forelimb constraint. Thus, the current study was designed to examine the relationship between functional motor cortical map reorganization after experimental TBI and the behavioral improvements resulting from this combinatorial rehabilitative regime. Adult male rats were trained to proficiency on a skilled reaching task, received a unilateral controlled cortical impact (CCI) over the forelimb area of the caudal motor cortex (CMC). Three days post-CCI, animals began RT (n = 13) or no rehabilitative training (NoRT) control procedures (n = 13). The RT group participated in daily skilled reach training, voluntary aerobic exercise, and nonimpaired forelimb constraint. This RT regimen significantly improved impaired forelimb reaching success and normalized reaching strategies, consistent with previous findings. RT also enlarged the area of motor cortical wrist representation, derived by intracortical microstimulation, compared to NoRT. These findings indicate that sufficient RT can greatly improve motor function and improve the functional integrity of remaining motor cortex after a moderate/severe CCI. When compared with findings from stroke models, these findings also suggest that more intense RT may be needed to improve motor function and remodel the injured cortex after TBI.
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Affiliation(s)
- Hannah L Combs
- 1 Department of Psychology, University of Texas at Austin , Austin, Texas
| | - Theresa A Jones
- 1 Department of Psychology, University of Texas at Austin , Austin, Texas.,2 Institute for Neuroscience, University of Texas at Austin , Austin, Texas
| | | | - DeAnna L Adkins
- 4 Department of Neuroscience, Department of Health Sciences and Research, and Center for Biomedical Imaging, Medical University of South Carolina , Charleston, South Carolina
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Manning KY, Fehlings D, Mesterman R, Gorter JW, Switzer L, Campbell C, Menon RS. Resting State and Diffusion Neuroimaging Predictors of Clinical Improvements Following Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy. J Child Neurol 2015; 30:1507-14. [PMID: 25762587 DOI: 10.1177/0883073815572686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/15/2015] [Indexed: 11/17/2022]
Abstract
The aim was to identify neuroimaging predictors of clinical improvements following constraint-induced movement therapy. Resting state functional magnetic resonance and diffusion tensor imaging data was acquired in 7 children with hemiplegic cerebral palsy. Clinical and magnetic resonance imaging (MRI) data were acquired at baseline and 1 month later following a 3-week constraint therapy regimen. A more negative baseline laterality index characterizing an atypical unilateral sensorimotor resting state network significantly correlated with an improvement in the Canadian Occupational Performance Measure score (r = -0.81, P = .03). A more unilateral network with decreased activity in the affected hemisphere was associated with greater improvements in clinical scores. Higher mean diffusivity in the posterior limb of the internal capsule of the affect tract correlated significantly with improvements in the Jebsen-Taylor score (r = -0.83, P = .02). Children with more compromised networks and tracts improved the most following constraint therapy.
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Affiliation(s)
- Kathryn Y Manning
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ronit Mesterman
- CanChild Centre for Childhood Disability Research, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lauren Switzer
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Craig Campbell
- Department of Paediatrics, University of Western Ontario, London, Ontario, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada Centre for Functional and Metabolic Mapping, the University of Western Ontario, London, Ontario, Canada
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Coker-Bolt P, DeLuca SC, Ramey SL. Training Paediatric Therapists to Deliver Constraint-Induced Movement Therapy (CIMT) in Sub-Saharan Africa. Occup Ther Int 2015; 22:141-51. [PMID: 26010006 DOI: 10.1002/oti.1392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/18/2015] [Revised: 03/23/2015] [Accepted: 04/01/2015] [Indexed: 11/11/2022] Open
Abstract
Hospitals and therapists in developing countries often seek to learn how to deliver new forms of evidenced-based practice (EBP), including paediatric constraint-induced movement therapy (CIMT). This study examines a partnership implemented in Ethiopia, which trained therapists in CIMT and proposes a framework for sustainable EBP training. The aim of this study is to apply a translational and implementation framework to build capacity for CIMT in Addis Ababa, Ethiopia, that included intensive in-country training and hands-on delivery with patients, followed by clinical implementation and feedback. A goal was to develop a locally feasible, culturally relevant form of CIMT. We framed our partnership model in terms of an implementation science model for therapists from multiple hospitals in Addis Ababa. Measures included workshop attendance, delivery of the curriculum and assessment of therapist's knowledge, skills and feedback postworkshop. We established a successful partnership with a lead hospital and completed training for 12 therapists from five hospitals who demonstrated increases in knowledge and skills following training. We developed a new, practically useful, culturally appropriate form of CIMT for later implementation. This partnership was limited to training of paediatric therapists in sub-Saharan Africa. Future studies will report on therapists' ability to integrate this EBP training into clinical practice as well as future training.
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Affiliation(s)
| | | | - Sharon L Ramey
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA
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