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BACKGROUND: Unilateral spatial neglect (USN) is a commonly occurring neurocognitive disability after a stroke. The neglect may affect the motor recovery of the upper and lower limbs and functional performances. Mirror therapy, a simple and economical approach has the potential to reduce the USN and related impairments. AIM: The primary objective of this study is to determine the effectiveness of task-based and magnified mirror therapy on the USN and on the motor recovery of the post-stroke subjects. The secondary objective is to investigate the effectiveness of the intervention on the function and disability of the subjects. METHODS: In this randomized controlled, assessor-blinded trial, 86 post-stroke subjects will be recruited from the neuro-rehabilitation laboratory of a rehabilitation institute, located in northern India. The participants,aged20 to 80 years, with 1 to 36 months of stroke onset, hemiparesis, and the USN, will be considered eligible for the study. In addition to the conventional rehabilitation, the experimental group(n = 43) will receive 40 sessions (8 weeks) of Task-based and MAGnified Mirror Therapy for Unilateral Spatial Neglect (T-MAGUSN). The control group (n = 43) will undergo a dose-matched conventional program only. The participants will be assessed at baseline, post-intervention and 4-week follow-up using primary (Line Bisection Test, Letter Cancellation Test, and Fugl-Myer Assessment) and secondary (Catherine Bergego Scale, Berg Balance Scale, Functional Ambulation Classification, Modified Rankin Scale) outcome measures. DISCUSSION: This proposed study will lead to the development of a novel rehabilitation protocol for the management of USN, aiming to enhance motor and functional recovery. The investigation will consider both the upper and lower limbs for the intervention, reducing the impact of cognitive disability in stroke. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI) as CTRI/2023/05/053184 (www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=74659).
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Trastornos de la Percepción , Accidente Cerebrovascular , Humanos , Terapia del Movimiento Espejo , Trastornos de la Percepción/etiología , Academias e Institutos , Grupos Control , India , Accidente Cerebrovascular/complicaciones , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Post stroke, motor paresis has usually been considered to be a crucial factor responsible for the disability; other impairments such as somatosensory deficits may also play a role. OBJECTIVE: To determine the relation between the sensory deficits (paretic and non-paretic upper limbs) and the motor recovery of the paretic upper limb and to predict the potential of motor recovery based on the sensory deficits among stroke subjects. METHODS: The study was a cross-sectional study conducted in a rehabilitation institute. Ninety-five poststroke hemiparetic subjects having sensory impairment in any of the modalities were considered for this study. Sensory deficits were assessed on both the upper limbs (paretic and non-paretic) primarily using Erasmus MC modification of the revised version of Nottingham Sensory Assessment (Em-NSA) and Nottingham Sensory Assessment (Stereognosis) (NSA-S). The motor recovery was assessed using the Fugl-Meyer assessment (FMA). RESULTS: The measures of sensory deficits exhibited weak but significant correlation [the paretic (Em-NSA and NSA; r = .38 to .58; p < .001) and the non-paretic (Em-NSA and NSA; r = .24 to .38; p = .03 to .001)] with the motor recovery of the paretic upper limb as measured by FMA. The potential of favorable recovery of the paretic upper limb may be predicted using the cutoff scores of Em-NSA (30, 21, and 24) and NSA-S (5, 8, and 5) of the paretic side. CONCLUSION: In stroke, sensory deficits relate weakly with the recovery of the paretic upper limb and can predict recovery potential of the paretic upper limb.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Accidente Cerebrovascular/complicaciones , Estudios Transversales , Extremidad Superior , Paresia/etiología , Paresia/rehabilitaciónRESUMEN
Background: In stroke, sensory deficits may affect the motor recovery of the subjects. The evidence for the active sensory intervention to enhance motor recovery is sparsely available. Purpose: To systematically review the available evidence from the studies on active sensory therapies augmenting upper limb recovery among poststroke subjects. Methods: The following databases were searched for the desired articles: PubMed, the Cochrane Central Register of Trials (CENTRAL), DORIS, PEDro, and OTseeker. The primary search keywords were stroke, sensory, and motor. The articles published in English up to August 2021 were considered for the review. Only investigations that studied active sensory interventions to enhance motor recovery were considered for the review. The studies of robotic training, virtual reality, electrical stimulation, and acupuncture were excluded. Motor recovery and sensory recovery were considered as primary and secondary measures, respectively. Results: Out of 3528 screened studies, eight studies were found eligible for the present systematic review. Active sensory interventions in the form of sensory discrimination, mirror therapy, motor imagery, and specific somatosensory training were utilized in the selected studies. The interventions through mirror therapy and mental imaging have some promising roles in enhancing upper limb recovery. However, there is a lack of strong evidence for the effectiveness of the intervention enhancing motor improvement among the stroke subjects. Conclusion: A comprehensive active sensory protocol should be developed having components of cognitive, sensory, motor, and functional demand. There is a need to conduct good quality randomized trials to support the existing active sensory therapies.
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Background Synergy is an outcome of multiple muscles acting in a synchronized pattern, controlled by the central nervous system. After brain insult, a set of deviated movement pattern emerges in the affected limb. The methods to train synchronization of muscles may diminish the deviated movement augmenting neuromotor control. The purpose of this investigation was to develop a synergy-based motor therapy (SBMT) protocol for the paretic upper limb in poststroke subjects. Further, the feasibility and effectiveness of the program was evaluated. . Methods The design was Pretest-posttest single-group assessor-blinded trial. Department of occupational therapy of a national institute for persons with physical disabilities was the study site. There were 40 study subjects (23 men, ranging from 40 to 60 years, 18 subjects with hemorrhagic cerebrovascular accident, and > 6 months after the accident) exhibiting motor paresis of half side of the body. SBMT is a stage-specific regime based on the linkage between the deviated and usual muscle action. SBMT items were selected considering the strength and magnitude of the deviated motor components. The movement linkages were utilized to dissociate strong coupled components; for instance, forearm pronation-supination with elbow 90-degree flexion. Fugl-Meyer Assessment (upper extremity) (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI) were applied to quantify the motor status, motor functional ability of the upper extremity, and self-care activities, respectively. Results All the enrolled subjects could perform their corresponding SBMT sessions. Posttreatment, FMA-UE improved significantly ( p < 0.001) from mean of 26.30 (standard deviation [SD] 15.02) to 35.20 (SD 17.64). Similarly, the WMFT both time (in seconds) and quality also positively improved significantly ( p < .001) from mean of 76.77 (SD 54.73) to 64.07 (SD 56.99) and 1.34 (SD 1.06) to 1.87 (SD 1.34), respectively. BI improved from 79.88 (SD 17.07) to 92.62 (SD 21.2) after the intervention ( p < 0.001). Conclusion SBMT protocol was a feasible and effective intervention to facilitate motor function components in chronic hemiparetic subjects. The regime could be considered as a potential intervention for stroke rehabilitation. Further trials and use of sophisticated measures are recommended to authenticate the outcome of this investigation. Clinical Trial Registration Clinical Trial Registry of India as CTRI/2017/10/010162 on October 23, 2017 (retrospectively).
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BACKGROUND: Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. OBJECTIVES: To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. MATERIALS AND METHODS: Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. RESULTS: Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. CONCLUSION: The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.
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Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Recuperación de la Función , Hombro , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Ultrasonografía , Extremidad SuperiorRESUMEN
INTRODUCTION: Up to 2/3rd of the stroke subjects may experience impairment in any of the somatosensory modalities such as light touch, proprioception, and stereognosis. The sensory recovery is strongly associated with the level of motor recovery. Very negligible sensory-based interventions have been developed and found to be evident in enhancing the sensory deficit and associated motor recovery. The possible factor for the ineffectiveness of these sensory interventions could be lack of the neuroscientific basis in formulation of the program. Thus, the objective of the study is to determine the effectiveness of a neuralplasticity-principles-based sensory-rehabilitation protocol on motor and sensory recovery, and disability of the post-stroke hemiparetic subjects. METHODS: We propose to recruit 122 poststroke subjects in a randomized controlled, assessor blinded trial to be conducted in a rehabilitation-institute. The key eligibility criteria is age between 20 to 80 years, hemiparesis (right or left), ischemic or hemorrhagic stroke, 1 to 12 months poststroke, and impairment in any of the sensory modalities. The participants in the experimental group will receive NEuroplasticity-Principles-based SEnsory-Rehabilitation (NEPSER) protocol comprising active, repetitive, and meaningful training of the specific sensory modalities utilizing visuo-perceptual, cognitive, motor, and functional tasks will be imparted for 8 weeks, 5 sessions / week, each of 2 h. The control subjects will undergo only standard rehabilitation based on neurophysiological, biomechanical, and rehabilitative approaches. All the participants will be assessed for motor (Fugl-Meyer assessment, upper extremity section) and sensory recovery [Nottingham Sensory assessment (Erasmus MC modification of the revised version)] at baseline, 8-week, and 12-week follow-up. The Semmes weinstein monofilament, two-point discrimination test and modified rankin scale (disability) will be applied as secondary measures. A repeated-measures 2-way ANOVA will be used to estimate difference for the post intervention and follow-up scores between the groups. PERSPECTIVE: The proposed study will lead to development of a novel rehabilitation protocol that will not only enhance the sensory recovery but also the motor and functional recovery. This may reduce the impact of stroke disability and enhance the quality of life. TRIAL REGISTRATION: The trial has been registered under Clinical Trial Registry of India (CTRI) as CTRI/2019/09/021442 on 30th September 2019.
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Background: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 - 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 - 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.
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Extremidades , Paresia/rehabilitación , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Adulto , Anciano , Extremidades/fisiopatología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Paresia/etiología , Proyectos Piloto , Accidente Cerebrovascular/complicacionesRESUMEN
BACKGROUND: Visual gait assessment is a cost-effective clinical method to assess post-stroke gait deviations. The Rivermead Visual Gait Assessment (RVGA) is a one such measure that assesses the kinematic aspect of the gait deviations in stroke. However, the available information on psycho-clinocometric properties of the measure is not adequate. OBJECTIVE: To establish reliability and validity of RVGA using walking-videos of the post-stroke subjects. METHODS: Design: Observational study. SETTING: A rehabilitation institute Participants: A convenience sample of 40 chronic stroke patients. OUTCOME MEASURES: RVGA, Fugl-Meyer assessment (lower extremity), 10-m walk test, Time up and go test, and Berg balance scale (BBS). PROCEDURE: Walking was video-taped from the anterior aspect, posterior aspect, affected side, and less-affected side. After coding the tapes, a research staff member provided them to four different raters in a random order. Each rater scored the coded video on the RVGA data collection sheet twice: one at the baseline and another after 1 month to eliminate any recollection of the initial assessment. RESULTS: The findings exhibit that there was good-to-excellent agreement between the scores of the raters and also between the assessments (correlation coefficient = 0.94 to 0.95; P < 0.001). The measure also exhibits acceptable validity when correlated with scores of BBS (r = 0.4; P < 0.001). CONCLUSION: Video-based RVGA is a reliable and valid tool to assess gait-related impairment in post-stroke hemiparesis. This cost-effective measure may be incorporated in the clinical and research practice to discern and quantify complex phenomenon of the gait deviation. RVGA may be considered as a useful tool, especially in developing countries where expensive gait analyzer is usually not available.
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Trastornos Neurológicos de la Marcha/diagnóstico , Examen Neurológico/normas , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/diagnóstico , Caminata/fisiología , Adulto , Anciano , Análisis Costo-Beneficio , Países en Desarrollo , Femenino , Trastornos Neurológicos de la Marcha/etiología , Humanos , Masculino , Persona de Mediana Edad , Observación , Psicometría/normas , Reproducibilidad de los Resultados , Accidente Cerebrovascular/complicaciones , Grabación en VideoRESUMEN
Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects. Design: A randomised, controlled, assessor-blinded trial. Setting: Rehabilitation institute. Participants: Thirty-six chronic poststroke (15.89 ± 9.01 months) hemiparetic subjects (age: 46.44 ± 7.89 years, 30 men and functional ambulation classification of median level 3). Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management. Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT). Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference = 3.29, 95% CI = 1.23-5.35, p = .003) and RVGA (mean difference = 5.41, 95% CI = 1.12-9.71, p = .015) in comparison to the control group. No considerable changes were observed on 10-MWT. Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.
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Marcha , Extremidad Inferior , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular , Adulto , Isquemia Encefálica/complicaciones , Isquemia Encefálica/fisiopatología , Isquemia Encefálica/rehabilitación , Femenino , Humanos , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Actividad Motora/fisiología , Paresia/etiología , Paresia/fisiopatología , Paresia/rehabilitación , Estimulación Luminosa , Proyectos Piloto , Método Simple Ciego , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente Cerebrovascular/métodos , Resultado del Tratamiento , Percepción VisualRESUMEN
BACKGROUND: Poststroke, sensory deficits are not uncommon. In spite of the close association between the sensory and motor recovery, the deficits are usually underemphasized. Mirror therapy (MT), a neural-based approach for the motor deficit has not been explored for the sensory impairment. The objective of the present study was to develop and determine the effect of a MT program for sensori-motor impairment among poststroke subjects. METHODS DESIGN: Randomized controlled trial. SETTING: Functional therapy laboratory of Rehabilitation Institute. PARTICIPANTS: Thirty-one chronic poststroke subjects (17 experimental and 14 controls), aged between 30 and 60years, with ≤ diminished light touch in the hand. OUTCOME MEASURE: Semmes Weinstein Monofilament (cutaneous threshold), 2-Point discrimination test (touch discrimination) and Fugl-Meyer Assessment (hand motor recovery). INTERVENTION: The experimental group received sensory stimulus such as tactile perception and motor tasks on the less-affected hand using mirror box. The control counterparts underwent only dose-matched conventional program. 30 sessions with a frequency of 5/week were imparted to the groups. RESULTS: Post intervention, there was a significant (P < .004) increase up to 30% positive touch-response for the hand quadrants among the experimental group in comparison to only 13.5% rise for the same among the controls. The cutaneous threshold of the less-affected palm also improved significantly among the experimental subjects in comparison to the controls (P = .04). CONCLUSION: MT may be considered as a promising regime for enhancing cutaneous sensibility in stroke. The mirror illusion induced by MT may be utilized for sensory and motor deficits as well as for the more-affected and less-affected hands.
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Mano/inervación , Actividad Motora , Trastornos de la Sensación/terapia , Umbral Sensorial , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Percepción del Tacto , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Recuperación de la Función , Trastornos de la Sensación/diagnóstico , Trastornos de la Sensación/fisiopatología , Trastornos de la Sensación/psicología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Accidente Cerebrovascular/psicología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Background Shoulder subluxation is a common post-stroke complication affecting up to 80% of the stroke subjects. The pathomechanics at the skeletal level does not provide the structural base for the neural-motor recovery. The management of subluxed shoulder has always been a challenge, complicating the motor and functional recovery. Objective To review the available studies of rehabilitation interventions for reduction of subluxed shoulder and to explore the evidence for impact of subluxation on motor recovery. Method PubMed, the Cochrane Central Register of Controlled Trials, DORIS, PEDro, and OTseeker databases were searched using the keywords: Stroke and Shoulder and Subluxation. The experimental, quasi-experimental, and single group studies investigated the rehabilitation methods to reduce the subluxation were selected. A narrative synthesis of the findings from the selected studies was carried out. Result 2717 studies were identified and 22 studies (14 RCTs or controlled trials and 8 pre-post-single group studies) were finally selected for the review. The rehabilitation intervention: Functional electrical stimulation (FES)/electrical stimulation (11), orthosis/support (07), taping (02), and robotic training and other methods (02) were reviewed. FES is effective in reducing subluxation in acute stage. Shoulder support or orthosis while in situ may reduce the subluxation temporarily. X-ray was the most commonly used assessment tool for the subluxation. Implication of the rehabilitation technique on motor recovery has not been investigated. Conclusion No technique could effectively reduce the subluxation and facilitate the upper limb recovery. Further studies integrating the usual motor training and the subluxation rehabilitation are warranted. Future trials using more precise and valid tool such as ultrasonography are also needed.
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Paresia/etiología , Paresia/rehabilitación , Hombro/fisiopatología , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/complicaciones , Bases de Datos Bibliográficas , Humanos , Recuperación de la FunciónRESUMEN
OBJECTIVE: To examine the effect of Mirror therapy (MT) on dexterity, coordination, and muscle strength of the less-affected upper limb in stroke. DESIGN: Pre-test post-test, single group, experimental design. SETTING: Rehabilitation institute. PARTICIPANTS: Post-stroke hemiparetic chronic subjects (N = 21). INTERVENTIONS: Forty sessions of MT using various tasks in addition to the conventional rehabilitation. Tasks such as lifting a glass, ball-squeezing, and picking-up objects were performed by the less-affected side in front of the mirror-box creating an illusion for the affected side. MAIN OUTCOME MEASURES: Minnesota Manual Dexterity Test (MMDT), Purdue Peg Board Test (PPBT), and Manual Muscle Testing (MMT) were used to measure the deficits of the less-affected side. RESULT: Post-intervention, the less-affected side of the participants exhibited significant improvement on MMDT (p < 0.001), PPBT (p < 0.001), and MMT (shoulder flexors, wrist extensors and deviators, and finger flexors-extensors; p = 0.005-0.046). CONCLUSION: In post-stroke hemiparesis, MT also led to the improvement in dexterity, coordination, and strength of the less-affected side. In addition to the affected side, the technique may augment the subtle motor deficits of the less-affected side.
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Paresia/rehabilitación , Modalidades de Fisioterapia , Rehabilitación de Accidente Cerebrovascular/métodos , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fuerza Muscular/fisiología , Proyectos Piloto , Desempeño Psicomotor/fisiología , Recuperación de la Función , Extremidad Superior/fisiologíaRESUMEN
BACKGROUND & OBJECTIVE: Abnormal synergisitic linkage exists between the upper and lower limbs. The relation may persist till the last stage of motor recovery. The objective of the present study was to analyze the relation between the motor components of the upper extremity and lower extremity in stroke subjects. DESIGN: A cross-sectional and correlational design. SETTING: Rehabilitation Institute. PARTICIPANTS: Fifty-nine poststroke chronic hemiparetic subjects (39 men; Mean age = 48.81 years; Mean poststroke duration = 11.22 months and 34 right-side paresis). INTERVENTIONS: Not-applicable. OUTCOME MEASURES: Fugl-Meyer Assessment (FMA): upper extremity (FMA-UE) and lower extremity (FMA-LE). RESULTS: A moderate positive correlation (r = .65, p < .001) was found between FMA-UE and FMA-LE. FMA-UE (51%) was found to be significantly inferior (p < .001; 95% CI = 6 to 17) in comparison to FMA-LE (63%). CONCLUSION: In poststroke subjects, there is a moderate positive relation between the recovery components of affected upper limb and lower limb. Stroke rehabilitation should consider hierarchical motor components of the lower limb and upper limb simultaneously.
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Extremidad Inferior/fisiopatología , Paresia/fisiopatología , Recuperación de la Función/fisiología , Accidente Cerebrovascular/fisiopatología , Extremidad Superior/fisiopatología , Adulto , Anciano , Enfermedad Crónica , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paresia/etiología , Accidente Cerebrovascular/complicacionesRESUMEN
BACKGROUND: The Minimal Clinically Important Difference (MCID), the smallest difference in the treatment outcome, augments both clinical and research practice. The MCID of the Fugl-Meyer assessment: Lower extremity (FMA-LE), an important motor measure in stroke, is not known. OBJECTIVE: To estimate MCID score of FMA-LE using an anchor-based approach in chronic poststroke hemiparetic (>6 months) stroke subjects. DESIGN: A prospective, observational study. SETTING: Occupational therapy department of a rehabilitation institute. PARTICIPANTS: Sixty-five poststroke hemiparetic subjects (Mean age = 44.22 years, 42 men, Mean poststroke duration = 16.42 months). INTERVENTION: The conventional motor therapy based on neurophysiological approaches was provided for the affected lower extremity (30 sessions, 45 min each, 3/week). OUTCOME MEASURES: FMA-LE, Functional ambulation classification (FAC), and global rating of patient-perceived changes (GRPPC). RESULT: The estimated MCID of FMA-LE was found to be a score of 6 using both FAC (sensitivity 90, specificity 94) and GRPPC (sensitivity 87, specificity 91). CONCLUSION: In chronic poststroke hemiparetic subjects, the computed MCID of FMA-LE is a score of 6. The subjects who achieve a change in a score of 6 on FMA-LE would perceive a meaningful recovery of lower-extremity function than those who do not. The reference value may be utilized in stroke rehabilitation.
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Extremidad Inferior/fisiopatología , Diferencia Mínima Clínicamente Importante , Paresia/terapia , Índice de Severidad de la Enfermedad , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/terapia , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paresia/etiología , Estudios Prospectivos , Accidente Cerebrovascular/complicacionesRESUMEN
Mirror therapy (MT) is a valuable method for enhancing motor recovery in poststroke hemiparesis. The technique utilizes the mirror-illusion created by the movement of sound limb that is perceived as the paretic limb. MT is a simple and economical technique than can stimulate the brain noninvasively. The intervention unquestionably has neural foundation. But the underlying neural mechanisms inducing motor recovery are still unclear. In this review, the neural-modulation due to MT has been explored. Multiple areas of the brain such as the occipital lobe, dorsal frontal area and corpus callosum are involved during the simple MT regime. Bilateral premotor cortex, primary motor cortex, primary somatosensory cortex, and cerebellum also get reorganized to enhance the function of the damaged brain. The motor areas of the lesioned hemisphere receive visuo-motor processing information through the parieto-occipital lobe. The damaged motor cortex responds variably to the MT and may augment true motor recovery. Mirror neurons may also play a possible role in the cortico-stimulatory mechanisms occurring due to the MT.
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Neuronas Espejo/fisiología , Rehabilitación de Accidente Cerebrovascular , Encéfalo/fisiopatología , Lateralidad Funcional , Humanos , Ilusiones , Corteza Motora/fisiopatología , Movimiento , Recuperación de la FunciónRESUMEN
BACKGROUND: To establish the effect of the task-based mirror therapy (TBMT) on the upper limb recovery in stroke. METHODS: A pilot, randomized, controlled, assessor-blinded trial was conducted in a rehabilitation institute. A convenience sample of 33 poststroke (mean duration, 12.5 months) hemiparetic subjects was randomized into 2 groups (experimental, 17; control, 16). The subjects were allocated to receive either TBMT or standard motor rehabilitation-40 sessions (5/week) for a period of 8 weeks. The TBMT group received movements using various goal-directed tasks and a mirror box. The movements were performed by the less-affected side superimposed on the affected side. The main outcome measures were Brunnstrom recovery stage (BRS) and Fugl-Meyer assessment (FMA)-FMA of upper extremity (FMA-UE), including upper arm (FMA-UA) and wrist-hand (FMA-WH). RESULTS: The TBMT group exhibited highly significant improvement on mean scores of FMA-WH (P < .001) and FMA-UE (P < .001) at postassessment in comparison to the control group. Furthermore, there was a 12% increase in the number of subjects at BRS stage 5 (out of synergy movement) in the experimental group as compared to a 0% rise at the same stage in the control group. CONCLUSIONS: This pilot trial confirmed the role of TBMT in improving the wrist-hand motor recovery in poststroke hemiparesis. MT using tasks may be used as an adjunct in stroke rehabilitation.
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Imágenes en Psicoterapia/métodos , Evaluación de Resultado en la Atención de Salud , Paresia/rehabilitación , Desempeño Psicomotor/fisiología , Recuperación de la Función , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Paresia/etiología , Proyectos Piloto , Método Simple Ciego , Estadísticas no Paramétricas , Accidente Cerebrovascular/complicaciones , Tomógrafos Computarizados por Rayos XRESUMEN
INTRODUCTION: Poststroke, less-severe motor impairment occurs on the ipsilesional side of body. The objective of the present study was to evaluate the effectiveness of the motor training involving the less-affected side (MTLA) in stroke. METHODS: This was a randomized, controlled, double-blinded pilot study conducted in the occupational therapy unit of a rehabilitation Institute. A convenience sample of 35 stroke subjects (mean poststroke duration, 28.76 weeks) was randomized into two groups (the experimental group: 17 and control group: 18). Thirty-two participants completed the entire study protocol. The experimental group and control group were provided MTLA and neurophysiological-based conventional therapy respectively. Both the groups received 24 treatment sessions (60 minutes each) over the period of two months. The Affected side was assessed using Brunnstrom recovery stage (BRS) and Fugl-Meyer assessment (FMA) whereas the less-affected side was evaluated by Minnesota manual dexterity test (MMDT), Purdue peg board test (PPBT) and Manual Muscle Testing (MMT). RESULTS: Postintervention, the less-affected side of experimental group demonstrated significant improvement for MMDT (P = 0.003), PPBT (P = 0.01) and MMT (P < 0.001 to 0.043) in comparison to the control group. Further, as compared to the control group, the experimental group exhibited positive significant change for the measure of affected side [BRS (P < 0.001) and FMA (P < 0.001 to 0.03)] at post assessment. CONCLUSION: MTLA enhanced the muscle strength, dexterity and coordination of the less-affected side as well as the motor recovery of the affected side in poststroke hemiparetic subjects.
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Educación y Entrenamiento Físico/métodos , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Método Doble Ciego , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Destreza Motora , Contracción Muscular , Fuerza Muscular , Músculo Esquelético/fisiopatología , Terapia Ocupacional , Proyectos Piloto , Recuperación de la Función , Accidente Cerebrovascular/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: Balance and functional abilities are controlled by both sides of the body. The role of nonparetic side has never been explored for such skills. OBJECTIVE: The objective of the present study was to examine the effect of a motor therapy program primarily involving the nonparetic side on balance and function in chronic stroke. METHOD: A randomized controlled, double blinded trial was conducted on 39 poststroke hemiparetic subjects (21, men; mean age, 42 years; mean poststroke duration, 13 months). They were randomly divided into the experimental group (n = 20) and control group (n = 19). The participants received either motor therapy focusing on the nonparetic side along with the conventional program or conventional program alone for 8 weeks (3 session/week, 60 minutes each). The balance ability was assessed using Berg Balance Scale (BBS) and Functional Reach Test (FRT) while the functional performance was measured by Barthel Index (BI). RESULT: After intervention, the experimental group exhibited significant (P < 0.05) change on BBS (5.65 versus 2.52) and BI (12.75 versus 2.16) scores in comparison to the control group. CONCLUSION: The motor therapy program incorporating the nonparetic side along with the affected side was found to be effective in enhancing balance and function in stroke.