NeuroRehabilitation - Volume 40, issue 3

Authors: Ahn, Si-nae | Yoo, Eun-young | Jung, Min-ye | Park, Hae-yean | Lee, Ji-yeon | Choi, Yoo-im

Article Type: Research Article

Abstract: BACKGROUND: Cognitive Orientation to daily Occupational Performance (CO-OP) approach based on cognitive strategy in occupational therapy. OBJECTIVES: To investigate the effects of CO-OP approach on occupational performance in individuals with hemiparetic stroke. METHODS: This study was designed as a 5-week, randomized, single-blind. Forty-three participants who had a diagnosis of first stroke were enrolled in this study. The participants were randomly assigned to the experimental group (n  = 20) or the control group (n  = 23). The experimental group conducted CO-OP approach while the control group conducted conventional occupational therapy based on occupational performance components. This study measured …Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Outcome measurements were performed at baseline and post-intervention. RESULTS: After training, the scores of COPM and PQRS in trained task were significantly higher for the score in the experimental group than the control group. In addition, the non-trained task was significantly higher for the score in the experimental group than the control group in COPM and the PQRS. CONCLUSIONS: This study suggests that the CO-OP approach is beneficial effects on the occupational performance to improvement in individuals with hemiparetic stroke, and have positive effects on generalization and transfer of acquired skills. Show more

Keywords: Cognitive Orientation to daily Occupational Performance (CO-OP), occupational therapy, stroke, transfer

DOI: 10.3233/NRE-161416

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 285-292, 2017

Authors: Bae, Seahyun | Kim, Kyung-Yoon

Article Type: Research Article

Abstract: BACKGROUND: Stimulation through afferent sensory input is necessary to improve voluntary functional movement in stroke patients. OBJECTIVES: Dual-afferent sensory input, which combines electromyography-triggered functional electric stimulation (ETFES) and action observation, was investigated to determine its effects on voluntary movements in stroke patients. METHODS: This study was conducted on 18 patients with left hemiplegia diagnosed between 6 and 24 months prior. The 9 subjects in the dual-afferent sensory input (DASI) group underwent ETFES with action observation training for 4 weeks (20 min/d, 5 d/wk), while the 9 control group subjects underwent functional electric stimulation (FES) for the same …duration. The outcome measures were the movement-related cortical potential (MRCP), H-reflex, electromyography (EMG), and balance. RESULTS: The control and DASI groups showed significant increases in MRCP, muscle activity, and balance, while H-reflex was significantly decreased. MRCP and balance showed significant differences between DASI and control groups. CONCLUSIONS: DASI stimulates voluntary movement in patients, causes rapid activation of the cerebral cortex, and reduces excessive excitation of spinal motor neurons. Therefore, DASI, which stimulates voluntary movement, has a greater effect on brain activation in stroke patients. Show more

Keywords: Action observation, afferent sensory input, electromyography-triggered functional electric stimulation, stroke rehabilitation

DOI: 10.3233/NRE-161417

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 293-300, 2017

Authors: Lee, Yejin | Kim, Moon Young | Park, Ji-Hyuk | Park, Hae Yean

Article Type: Research Article

Abstract: BACKGROUND: The differential effects of bilateral and unilateral training on upper extremity (UE) function remain unclear. OBJECTIVE: To compare the effectiveness of bilateral and unilateral training on UE function and activities of daily living (ADL) after stroke. METHODS: Randomized controlled trials (RCTs) were selected for inclusion by two reviewers after searching the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. Methodological qualities were assessed using the PEDro scale. Effect size was estimated by calculating the standardized mean difference (SMD). RESULTS: Eleven RCTs of sufficient quality were included in …our meta-analysis. The effect size on UE capacity was statistically significant in favor of the Constraint-Induced Movement Therapy (CIMT) groups (SMD [fixed], g: – 0.34; 95% CI: – 0.59–0.08; p  = 0.01; I2  = 0%). No other SMDs were significant. CONCLUSION: The CIMT tasks were more effective than bilateral training with regard to increased UE capacity; however, this result should be cautiously interpreted since the evaluation tools were designed for assessment of unilateral UE function, not bilateral UE function. Further, the effect of the CIMT tasks on UE capacity was not translated into ADL. Considering the disadvantages of CIMT such as fatigue, bilateral training may be more appropriate for improving ADL. Show more

Keywords: Bilateral training, unilateral training, CIMT, upper extremity, stroke, meta-analysis

DOI: 10.3233/NRE-161418

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 301-313, 2017

Authors: Jung, Kyoungsim | Jung, Jinhwa | In, Taesung | Kim, Taehoon | Cho, Hwi-young

Article Type: Research Article

Abstract: OBJECTIVES: This study investigated the efficacy of Task-Related Training (TRT) Combined with Transcutaneous Electrical Nerve Stimulation (TENS) on the improvement of upper limb muscle activation in chronic stroke survivors with mild or moderate paresis. METHODS: A single-blind, randomized clinical trial was conducted with 46stroke survivors with chronic paresis. They were randomly allocated two groups: the TRT+TENS group (n  = 23) and the TRT+ placebo TENS (TRT+PLBO) group (n  = 23). The TRT+TENS group received 30 minutes of high-frequency TENS on wrist and elbow extensors, while the TRT+PLBO group received placebo TENS that was not real ES. Both groups did …30 minutes of TRT after TENS application. Intervention was given five days a week for four weeks. The primary outcomes of upper limb muscle activation were measured by integrated EMG (IEMG), a digital manual muscle tester for muscle strength, active range of motion (AROM) and Fugl-Meyer Assessment of the upper extremity (FMA-UE). The measurements were performed before and after the 4 weeks intervention period. RESULTS: Both groups demonstrated significant improvements of outcomes in IEMG, AROM, muscle strength and FMA-UE during intervention period. When compared with the TRT+PLBO group, the TRT+TENS group showed significantly greater improvement in muscle activation (wrist extensors, P  = 0.045; elbow extensors, P  = 0.004), muscle strength (wrist extensors, P  = 0.044; elbow extensors, P  = 0.012), AROM (wrist extension, P  = 0.042; elbow extensors, P  = 0.040) and FMA-UE (total, P  < 0.001; shoulder/elbow/forearm, P  = 0.001; wrist, P  = 0.002; coordination, P  = 0.008) at the end of intervention. CONCLUSIONS: Our findings indicate that TRT Combined with TENS can improve paretic muscle activity in upper limb paresis, highlighting the benefits of somatosensory stimulation from TENS. Show more

Keywords: Transcutaneous Electrical Nerve Stimulation (TENS), arm motor function, Task–Related Training

DOI: 10.3233/NRE-161419

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 315-323, 2017

Authors: Fakhari, Zahra | Ansari, Noureddin Nakhostin | Naghdi, Soofia | Mansouri, Korosh | Radinmehr, Hojjat

Article Type: Research Article

Abstract: BACKGROUND: Spasticity is a common complication after stroke. Dry needling (DN) is suggested as a novel method for treatment of muscle spasticity. OBJECTIVE: To explore the effects of DN on wrist flexors spasticity poststroke. METHODS: A single group, pretest-posttest clinical trial was used. Twenty nine patients with stroke (16 male; mean age 54.3 years) were tested at baseline (T0), immediately after DN (T1), and one hour after DN (T2). DN was applied for flexor carpi radialis (FCR) and flexor carpi ulnaris on the affected arm for single session, one minute per muscle. The Modified Modified …Ashworth Scale (MMAS), passive resistance force, wrist active and passive range of motion, Box and Block Test, and FCR H-reflex were outcome measures. RESULTS: Significant reductions in MMAS scores were seen both immediately after DN and at 1-hour follow-up (median 2 at T0 to 1 at T1 and T2). There were significant improvements in other measures between the baseline values at T0 and those recorded immediately after the DN at T1 or one hour later at T2. CONCLUSIONS: This study suggests that DN reduced wrist flexors spasticity and alpha motor neuron excitability in patients with stroke, and improvements persisted for one hour after DN. Show more

Keywords: Dry needling, spasticity, stroke, H-reflex

DOI: 10.3233/NRE-161420

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 325-336, 2017

Authors: Dell’Uomo, Daniela | Morone, Giovanni | Centrella, Antonio | Paolucci, Stefano | Caltagirone, Carlo | Grasso, Maria Grazia | Traballesi, Marco | Iosa, Marco

Article Type: Research Article

Abstract: BACKGROUND: Despite upper limb rehabilitation is widely investigated in patients with stroke, the effects of scapulohumeral rehabilitation on trunk stabillization are mainly unknown. OBJECTIVE: To test the effects of scapulohumeral rehabilitation protocol on trunk control recovery in patients with subacute stroke. METHODS: A pilot randomized controlled trial with two groups of 14 patients each one performing 20 minutes per day, 5 days a week, for 6 weeks in add on to standard therapy. Experimental group performed a specific scapulohumeral rehabilitation protocol aiming to improve trunk competencies whereas control group performed conventional arm rehabilitation. Clinical scale …tests and accelerometric evaluations were performed pre- and post-treatment. RESULTS: Experimental groups showed better scores at discharge at Trunk impairment Scale (p  < 0.001), Barthel Index (p  = 0.024), Trunk Control Test (p  = 0.002), Sitting Balance Scale (p  = 0.002), but neither at Fugl-Meyer Scale (p  = 0.194) nor Modified Ashworth Scale (p  = 0.114). Accelerometric analysis showed higher stability of trunk for experimental group especially during static and dynamic items. CONCLUSIONS: The recovery of scapulohumeral functions also acts on trunk stabilization post-stroke. Show more

Keywords: Scapulohumeral rehabilitation, trunk stability, stroke, rehabilitation, accelerometry

DOI: 10.3233/NRE-161421

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 337-343, 2017

Authors: Ribeiro, Tatiana Souza | Chaves da Silva, Tállyta Camyla | Carlos, Renata | de Souza e Silva, Emília Márcia Gomes | Lacerda, Matheus Oliveira | Spaniol, Ana Paula | Lindquist, Ana Raquel Rodrigues

Article Type: Research Article

Abstract: BACKGROUND: Although exercises involving both lower limbs are indicated for aerobic training, stroke patients have shown expressive asymmetry between the paretic and non-paretic lower limb (NPLL). Performing activities that stimulate the paretic limb during aerobic exercise may optimize training results. OBJECTIVE : To evaluate if there is influence of load addition on NPLL during treadmill training on cardiovascular parameters and gait performance of subacute stroke patients. METHODS: Thirty-eight stroke subjects with gait deficits were randomized into experimental group, which underwent treadmill training with a mass attached on NPLL, and control group, which underwent only treadmill training. …Interventions lasted 2 weeks (9 sessions). Main outcomes were heart rate, arterial blood pressure, gait speed and distance covered. Assessments occurred at rest, 10th and 20th minutes of the session and immediately after each session. RESULTS: There was improvement in speed and walking distance in both groups. All cardiovascular parameters had showed no changes compared to 1st and 9th sessions and there were no differences between groups within each session. CONCLUSIONS: Load addition on NPLL did not alter cardiovascular parameters and gait training provide better gait performance of subacute stroke patients, which indicates this therapy can be considered useful and safe for these patients. Show more

Keywords: Gait, aerobic exercise, cardiovascular system, rehabilitation

DOI: 10.3233/NRE-161422

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 345-354, 2017

Authors: Joshua, Abraham M. | Karnad, Shreekanth D. | Nayak, Akshatha | Suresh, B.V. | Mithra, Prasanna | Unnikrishnan, B.

Article Type: Research Article

Abstract: BACKGROUND & OBJECTIVE: Timed up and go (TUG) test is been used as a screening tool for the assessment of risk of falling in individuals following stroke. Though TUG test is a quick test, it has fair sensitivity compared to other tests. This study was carried out to obtain and compare test scores for different types of foot placements during sit to stand transition in stroke subjects. METHOD: A Cross-sectional study with purposive sampling included 28 post stroke subjects who were able to walk 6 meter with or without assistance. Timed Up and Go test was carried …out with four different types of foot placements and scores were recorded. The data were compared using Kruskal-Wallis One way analysis of variance and Wilcoxon signed ranks test. RESULT: There were comparable differences between asymmetric 1 test strategy which involved affected extremity to be placed behind the unaffected and other test strategies (Z  = –4.457,–3.848,–4.458; p  = 0.000). CONCLUSION: The initial foot placements during sit to stand transition influenced the time taken to complete the test which was significantly higher in asymmetric 1 strategy, Incorporation of the initial foot placement mainly asymmetric 1 strategy into conventional TUG test would help in identifying accurately the subject’s functional mobility and postural stability. Show more

Keywords: TUG, foot placement, stroke

DOI: 10.3233/NRE-161423

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 355-362, 2017

Authors: Watanabe, Hiroki | Goto, Ryohei | Tanaka, Naoki | Matsumura, Akira | Yanagi, Hisako

Article Type: Research Article

Abstract: BACKGROUND: Gait training using the Hybrid Assistive Limb® (HAL® ) may have beneficial effects on post-stroke gait function and independent walking. However, the long-term and medium-term efficacies of gait training using HAL® in stroke patients remain unclear. OBJECTIVE: To compare the medium-term efficacy of gait training using a single-leg version of the Hybrid Assistive Limb® (HAL® ) on the paretic side with conventional gait training (CGT) in recovery-phase stroke patients. METHODS: Twenty-four post-stroke participants (HAL® group: n  = 12, CGT group: n  = 12) completed the trial. Over 4 weeks, all participants received …twelve 20-min sessions of either HAL® (using the single-leg version of HAL® on the paretic side) or conventional (performed by skilled and experienced physical therapists) gait training. Outcome measures were evaluated prior to training, after 12 sessions, and at 8 and 12 weeks after intervention initiation. Functional Ambulation Category (FAC) was the primary outcome measure. RESULTS: The HAL® group showed significant improvement in FAC after 12 sessions, and at 8 and 12 weeks compared to the conventional group (P  = 0.02). CONCLUSIONS: The results suggested that a gait training program based on HAL® may improve independent walking more efficiently than CGT at 1 and 2 months after intervention. Show more

Keywords: Exoskeleton device, rehabilitation, robotics, stroke, walking

DOI: 10.3233/NRE-161424

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 363-367, 2017

Authors: Bindawas, Saad M. | Vennu, Vishal | Moftah, Emad

Article Type: Research Article

Abstract: BACKGROUND: to examine the effects of inpatient rehabilitation programs on function and length of stay in older adults with stroke METHODS: A total of five electronic databases were searched for relevant randomized controlled trials that examined the effects of inpatient rehabilitation programs on functional recovery, as measured by the functional independence measure and length of stay, which was measured in days. We included full-text articles written in English, and no time limit. The methodological quality and risk of bias were assessed using the Physiotherapy Evidence Database Scale and the Cochrane collaboration tools respectively. The effect sizes and …confidence intervals were estimated using fixed-effect models RESULTS: Eight randomized controlled trials involving 1,910 patients with stroke were included in the meta-analysis showed that patients who participated in the inpatient rehabilitation programs had significantly (p less than 0.05) higher functional independence measure scores (effect size = 0.10; 95 percent confidence interval = 0.01, 0.22) and shorter length of stay (effect size = 0.14; 95 percent confidence interval = 0.03, 0.22). CONCLUSIONS: This systematic review provided evidence that inpatient rehabilitation programs have beneficial effects, improving functionality and reducing length of stay for older adults with stroke. Show more

Keywords: Stroke, length of stay, rehabilitation

DOI: 10.3233/NRE-161425

Citation: NeuroRehabilitation, vol. 40, no. 3, pp. 369-390, 2017