NeuroRehabilitation - Volume 31, issue 2

Authors: Park, Hae-Yean | Yoo, Eun-Young | Park, Soo Hyun | Park, Ji-Hyuk | Kang, Dae-Hyuk | Chung, Bo-In | Jung, Min-Ye

Article Type: Research Article

Abstract: Objectives: The aims of this study were to 1) investigate the effects of forced use combined with scheduled home exercise program compared to forced use only on increasing upper extremity functioning, 2) examine whether increased upper extremity functioning generalized to activities of daily living (ADL) functioning, and 3) explore participants’ psychosocial functioning. Methods: A single-subject A-B-A’-C research design was employed in this study. The intervention consisted of two conditions: forced use only (intervention period B), and forced use in addtion to scheduled home exercise program (intervention period C). Results: The results were as follows: 1) Forced …use combined with scheduled home exercise program compared to forced use only allowed individuals with stroke to take part in exercise programs on their own within their home setting, ultimately improving their upper extremity functioning. 2) The program’s promotion of performance in ADL tasks have the advantage of keeping participants focused so that a number of exercises can be maintained throughout the intervention. 3) Finally, forced use combined with scheduled home exercise program showed partial effects on improving the participants’ psychosocial functioning. Conclusion: The results of the present study suggest that forced use combined with scheduled home exercise program compared to forced use only has the potential to be a cost- and resource-efficient method for intensifying rehabilitation. Show more

Keywords: Activity of daily living, forced use, home exercise program, stroke, psychosocial functioning, upper extremity functioning

DOI: 10.3233/NRE-2012-0788

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 185-195, 2012

Authors: Kang, Tae-Woo | Oh, Duck-Won

Article Type: Research Article

Abstract: Purpose: To investigate the effect of whole-body tilt exercise for treating hemispatial neglect and to identify the effects of incorporating mental practice into the exercise. Methods: We used a single-subject experimental design alternating with multiple baselines. Three stroke patients with hemispatial neglect participated in this study. The severity of hemispatial neglect and balance function were measured during baseline and intervention sessions. The whole-body tilt exercise was performed by using a device that allows the body to tilt 20° from the neutral upright position. Mental practice consisted of 5 min of relaxation, main whole-body tilt imagination, and normalization phases. …Results: When the whole-body tilt exercise alone was performed, the average severity score of hemispatial neglect in subjects 1, 2, and 3 decreased by 7.54, 10.02, and 8.24, respectively; their respective average balance function score increased by 35.95%, 28.13%, and 15.33% under the open-eye condition and 34.66%, 20.33%, and 13.77% under the closed-eye condition. For subjects 1, 2, and 3, the respective average hemispatial neglect score decreased by 9.07, 11.35, and 10.13 after the whole-body tilt exercise with mental practice; their average balance function scores increased by 40.15%, 33.38%, and 24.22% under the open-eye condition and by 38.93%, 27.08%, and 11.88% under the closed-eye condition, respectively. Conclusion: These findings suggest that a whole-body tilt exercise alone may be beneficial in enhancing hemispatial neglect symptoms but the addition of mental practice produces a greater positive effect. Show more

Keywords: Mental practice, whole-body tilt exercise, hemispatial neglect, balance

DOI: 10.3233/NRE-2012-0789

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 197-206, 2012

Authors: Jo, Hae Min | Choi, Byung Yeon | Chang, Chul Hoon | Kim, Seong Ho | Lee, Jun | Chang, Min Cheol | Son, Su Min | Jang, Sung Ho

Article Type: Research Article

Abstract: Clarification of the clinical characteristics of motor function in stroke patients with complete corticospinal tract (CST) injury would be of importance in stroke rehabilitation. However, this topic has not been clearly elucidated. We conducted an investigation of the clinical characteristics of motor function in chronic hemiparetic stroke patients with complete CST injury, as confirmed by transcranial magnetic stimulation and diffusion tensor imaging. Forty-one consecutive chronic hemiparetic stroke patients who showed an absence of motor evoked potential in muscles of the upper and lower extremities upon transcranial magnetic stimulation and in whom the integrity of the CST discontinued around stroke lesion …on diffusion tensor imaging tractography were recruited. Mean Medical Research Council scores for distal musculature were lower than those for proximal musculature (P < 0.001). Mean Medical Research Council scores for upper extremity muscles were lower than those for lower extremity muscles (P < 0.001). The mean Motricity Index score for muscles of the upper extremities was lower than that for muscles of the lower extremities (P < 0.001). None of the patients had a functional hand; in contrast, 56% of patients were able to walk independently. We found that motor weaknesses of distal joint musculature and upper extremities were more severe than those of proximal joint musculature and lower extremities following complete injury of the CST in stroke, respectively. As a result, despite the absence of a functional hand in all patients, more than half were able to walk independently. Show more

Keywords: Corticospinal tract, motor function, stroke, diffusion tensor tractography

DOI: 10.3233/NRE-2012-0790

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 207-213, 2012

Authors: Ansari, Noureddin Nakhostin | Naghdi, Soofia | Mashayekhi, Masoud | Hasson, Scott | Fakhari, Zahra | Jalaie, Shohreh

Article Type: Research Article

Abstract: The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was …recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw = 0.84). Intra-rater reliability was good for shoulder adductors (κw = 0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the weighted kappa values for muscle groups (p > 0.05). The intra-rater reliability was also good in the presence of pain or contracture. The MMAS had very good intra-rater reliability in the assessment of upper limb spasticity in patients with hemiparesis. The presence of pain during shoulder abduction or contracture of the shoulder adductors had no influence on the reliability of the MMAS (κw = 0.75, 0.77, respectively). Show more

Keywords: Spasticity, reliability, pain, contracture, Modified Modified Ashworth Scale

DOI: 10.3233/NRE-2012-0791

Citation: NeuroRehabilitation, vol. 31, no. 2, pp. 215-222, 2012