Hemispheric Differences in Self-evaluation Errors of Upper Extremity Movement in Patients with Chronic Stroke.

OBJECTIVE: There is growing evidence that the side of brain lesions results in distinct upper extremity deficits in motor control, movement behavior, and emotional and cognitive function poststroke. We investigated self-evaluation errors, which are the differences in scores between patient self-evaluation and clinician evaluations, and compared patients with left hemisphere damage (LHD) and right hemisphere damage (RHD) poststroke. METHOD: Twenty-eight patients with chronic stroke (LHD = 16) performed the actual amount of the test twice with a one-week interval. We videotaped the participants' movements, and participants with stroke and evaluators graded the quality of movement scores by watching video recordings. RESULTS: Self-evaluation errors were significantly lower in patients with LHD than in those with RHD (t = 2.350, p = .019). Interestingly, this error did not change after the clinician provided the correct score as feedback. Chi-squared analysis revealed that more patients with LHD underestimated their movements (χ2 = 9.049, p = .002), while more patients with RHD overestimated (χ2 = 7.429, p = .006) in the send evaluation. Furthermore, there were no correlations between self-evaluation error and age, cognitive function, physical impairment, ability to control emotions, or onset months poststroke. CONCLUSIONS: Patients with stroke and therapists evaluated the same movements differently, and this can be dependent on hemispheric damage. Therapists might need to encourage patients with LHD who underestimate their movement to ensure continuous use of their more-affected arm. Patients with RHD who overestimate their movement might need treatment to overcome impaired self-awareness, such as video recordings, to protect from unexpected dangerous situations.

The effects of task-oriented training with altered sensory input on balance in patients with chronic stroke.

[Purpose] The purpose of this study was to identify the effects of task-oriented training with altered somatosensory input on the balance ability of chronic stroke patients. [Subjects and Methods] Twenty-six subjects with chronic stroke were divided into an experimental group (n=14) and a control group (n=12). Both groups attended physical therapy sessions five times a week for four weeks. The experimental group performed additional, task-oriented training with altered sensory input three times a week for four weeks. Limit-of-stability tests were conducted before and after the intervention. In addition, all subjects were evaluated using the Berg Balance Scale (BBS) and Korean Activities-Specific Balance Confidence Scale before and after the intervention. [Results] There was a significant interaction between time and group on BBS scores, on the total surface area of the limit of stability, and on the surface area of the limit of stability of the affected side. However, an analysis of covariance in which the baseline values of each variable served as the covariates showed that only the post-intervention BBS score of the experimental group was significantly higher than that of the control group. [Conclusion] Task-oriented training with altered somatosensory input can improve functional balance in patients with chronic stroke.

Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study.

[Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion.

Immediate effects of insoles applied to the sound side lower extremity of patients with chronic hemiplegia during walking.

Background: Asymmetric gait patterns are mostly observed in hemiplegic stroke patients. These abnormal gait patterns resulting in abnormal speed, and decreased ability in daily of activity living. Objective: This study aimed to determine the immediate changes in gait parameters and plantar pressure during elevation by wearing an insole on the sound side lower extremity of patients with hemiplegia. Methods: Thirty-six participants were recruited, comprising those with a post-stroke follow-up of ≥3 months and a functional ambulation category score of ≥2. The participants were asked to walk with and without a 1 cm insole in the shoe of their sound side, and the order of wearing or not wearing the insole was randomized. Gait parameters, bilateral gait parameters, and dynamic plantar pressure were measured using the GAITRite Walkway System. Results: Paired t-test was used to examine immediate changes in gait parameters and plantar pressure with and without insoles during walking in the same group. Overall, gait velocity and step length significantly decreased (p < 0.05), whereas step time significantly increased (p < 0.05). The swing phase of the affected sidelower extremities significantly increased (p < 0.05), and the stance phase significantly decreased (p < 0.05). Double-support unloading phase (pre-swing phase) significantly increased (p < 0.05). The changes in plantar pressure were significantly increased in some lateral zones and significantly decreased in the medial zone of the mid-hindfoot, both in terms of pressure per time and peak pressure (p < 0.05). Conclusion: Although this study did not show immediate positive effects on gait parameters and gait cycle, it is expected that sensory input from the sole of the foot through changes in plantar pressure may help improve gait asymmetry and regulate postural symmetry.