Clinical effect of acupoint application with turmeric blistering moxibustion plaster on post-stroke hemiplegic shoulder pain / 中国针灸

OBJECTIVES@#To observe the effects of acupoint application with turmeric blistering moxibustion plaster on pain, shoulder range of motion (ROM) and upper limb motor function in the patients with post-stroke hemiplegic shoulder pain (PSHSP).@*METHODS@#Eighty-two patients with PSHSP were randomly divided into an observation group (41 cases, 1 case was eliminated, 4 cases dropped out) and a control group (41 cases, 2 cases were eliminated and 2 cases dropped out). The routine treatment, nursing care and rehabilitation training were performed in the control group. On the basis of the intervention as the control group, in the observation group, the turmeric blistering moxibustion plaster was applied to bilateral ashi points, Jianyu (LI 15), Jianliao (TE 14), Binao (LI 14), Shousanli (LI 10) and Hegu (LI 4), once a day, remained for 6 hours each time. This moxibustion therapy was operated 5 times weekly, one course of treatment consisted of 2 weeks and 2 courses were required. Separately, before treatment and after 2 and 4 weeks of treatment, the score of visual analogue scale (VAS), shoulder ROM and the score of upper limbs in Fugl-Meyer assessment (U-FMA) were observed in the two groups.@*RESULTS@#VAS scores were lower (P<0.05), ROM in shoulder flexion, abduction, internal rotation and external rotation was larger (P<0.05), and U-FMA scores were higher (P<0.05) after 2 and 4 weeks of treatment when compared with those before treatment in the two groups. After 4 weeks of treatment, VAS score decreased (P<0.05), and ROM in shoulder flexion, abduction, internal rotation, external rotation and U-FMA score increased (P<0.05) in comparison with those after 2 weeks of treatment in either group. In the observation group, VAS scores were dropped (P<0.05) after 2 and 4 weeks of treatment respectively, and ROM of shoulder flexion and abduction enlarged after 2 weeks of treatment (P<0.05) when compared with those in the control group. After 4 weeks of treatment, ROM in shoulder flexion, abduction, internal rotation and external rotation in the observation group was larger (P<0.05) and U-FMA score was higher (P<0.05) than those in the control group.@*CONCLUSIONS@#Acupoint application with turmeric blistering moxibustion plaster may effectively reduce the degree of shoulder pain and improve the shoulder range of motion and the upper limb motor function in the patients with post-stroke hemiplegic shoulder pain.

Interactive scalp acupuncture for hemiplegic upper extremity motor dysfunction in patients with ischemic stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the curative effect between interactive scalp acupuncture and traditional scalp acupuncture on hemiplegic upper extremity motor dysfunction in the patients with ischemic stroke.@*METHODS@#Seventy cases of hemiplegic upper extremity motor dysfunction of ischemic stroke were randomly divided into an interactive scalp acupuncture group (35 cases, 1 case breaked off) and a traditional scalp acupuncture group (35 cases, 1 case dropped off). The patients of the two groups received the secondary prevention medication and routine rehabilitation therapy. Besides, in the interactive scalp acupuncture group, the upper extremity occupational therapy was operated during the needle retaining of scalp acupuncture; and in the traditional scalp acupuncture group, the upper extremity occupational therapy was delivered after the completion of scalp acupuncture. The same points were selected in the two groups such as Fuxiang head area, Fuxiang upper-limb-shoulder point, Fuxiang upper-limb-elbow point and Fuxiang upper-limb-wrist point. The needles were inserted perpendicularly by flying-needle technique and manipulated by triple technique of gentle twisting, heavy pressure and vibrating. The needles were retained for 30 min. Based on the degree of the upper extremity motor impairment, the regimen of the upper extremity occupational therapy was formulated individually and one treatment took 30 min. In the two groups, the therapies were delivered once daily, 5 times a week, lasting 4 weeks. Before and after treatment, the scores of Fugl-Meyer assessment of upper extremity (FMA-UE), Wolf motor function test (WMFT), the modified Barthel index (MBI) and the modified Ashworth scale (MAS) grade in the two groups were observed before and after treatment.@*RESULTS@#After treatment, the scores of FMA-UE, WMFT and MBI were higher than those before treatment (P<0.01), and MAS grade was improved (P<0.05) in the two groups. The scores of FMA-UE, WMFT and MBI in the interactive scalp acupuncture group were higher than those in the traditional scalp acupuncture group (P<0.01, P<0.05), and there was no statistical significance in the difference of MAS grade between the two groups (P>0.05).@*CONCLUSION@#The interactive scalp acupuncture can effectively improve the motor function of the hemiplegic upper extremities and the activities of daily living in the patients with ischemic stroke and its efficacy is better than traditional scalp acupuncture. But these two types of scalp acupuncture obtain the similar effect on spasticity.

Clinical observation of electroacupuncture with different frequencies in treatment of hemiplegic shoulder pain after stroke / 中国针灸

OBJECTIVE@#To observe the clinical efficacy on hemiplegic shoulder pain (HSP) after stroke treated with electroacupuncture (EA) under different frequencies.@*METHODS@#A total of 105 patients with HSP after stroke were randomly divided into a manual acupuncture group (35 cases, 2 cases dropped off), an EA continuous wave group (35 cases, 3 cases dropped off) and an EA disperse-dense wave group (35 cases). The conventional rehabilitation therapy was delivered in the three groups. Additionally, acupuncture was applied to Jianyu (LI 15), Jianzhen (SI 9), Jianliao (TE 14) and Jianqian (Extra) etc. on the affected side in the manual acupuncture group. In the EA continuous wave group and the EA disperse-dense wave group, besides the treatment as the manual acupuncture group, the electric stimulation was attached to two pairs of acupoints, i.e. Jianyu (LI 15) and Jianliao (TE 14), and Quchi (LI 11) and Shousanli (LI 10), with 15 Hz continuous wave, and 2 Hz/ 100 Hz disperse-dense wave, respectively. The treatment was given once daily, 5 times a week, for 4 weeks consecutively. The score of visual analogue scale (VAS) before treatment and after 2 and 4 weeks of treatment, as well as the passive range of motion (PROM) of shoulder forward flexion and PROM of shoulder abduction, muscle strength of the upper limb, the score of modified Barthel index (MBI) and the score of Fugl-Meyer assessment (FMA) before and after treatment were observed in each group.@*RESULTS@#Compared with before treatment, VAS scores were reduced after 2 and 4 weeks of treatment in each group (P<0.05); and VAS scores after 4 weeks of treatment were lower than those after 2 weeks of treatment (P<0.05). After 2 and 4 weeks of treatment, VAS score in either the EA continuous wave group or the EA disperse-dense wave group was lower compared with the manual acupuncture group (P<0.05). After 4 weeks of treatment, VAS score in the EA disperse-dense wave was lower than that of the EA continuous wave group (P<0.05). Compared with before treatment, PROM of the shoulder forward flexion and abduction on the affected side after treatment was enlarged (P<0.05), the muscle strength of the upper limb was increased (P<0.05), and the scores of MBI and FMA were increased (P<0.05) in the patients of each group. After treatment, in the EA continuous wave group and the EA disperse-dense wave group, PROM of the shoulder forward flexion on the affected side was higher (P<0.05), the muscle strength of the upper limb was stronger (P<0.05) when compared with the manual acupuncture group; and the scores of MBI and FMA in the EA disperse-dense wave group were higher than those of the manual acupuncture group (P<0.05).@*CONCLUSION@#Electroacupuncture is superior to manual acupuncture in the analgesic effect and comprehensive rehabilitation effect in the patients with HSP after stroke. The therapeutic effect obtained by electroacupuncture with 2 Hz/100 Hz disperse-dense wave is better than that with 15 Hz continuous wave.

Effects of whole body vibration combined with extracorporeal shock wave therapy on spasticity and balance gait parameters in hemiplegic patients with stroke / 中南大学学报(医学版)

OBJECTIVES@#Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients.@*METHODS@#From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups.@*RESULTS@#After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001).@*CONCLUSIONS@#WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.

Effects of Interactive Dynamic Scalp Acupuncture on Motor Function and Gait of Lower Limbs after Stroke: A Multicenter, Randomized, Controlled Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on motor function and gait of the lower limbs in post-stroke hemiplegia patients.@*METHODS@#A total of 231 patients with post-stroke hemiplegia was randomly divided into IDSA (78 cases), SCT (78 cases), and TSA (75 cases) groups by a random number table. Scalp acupuncture (SA) and lower-limb robot training (LLRT) were both performed in the IDSA and SCT groups. The patients in the TSA group underwent SA and did not receive LLRT. The treatment was administered once daily and 6 times weekly for 8 continuous weeks, each session lasted for 30 min. The primary outcome measures included Fugl-Meyer assessment of the lower extremity (FMA-LE), berg balance scale (BBS), modified barthel index (MBI), and 6-min walking test (6MWT). The secondary outcome measures included stride frequency (SF), stride length (SL), stride width (SW), affected side foot angle (ASFA), passive range of motion (PROM) of the affected hip (PROM-H), knee (PROM-K) and ankle (PROM-A) joints. The patients were evaluated before treatment, at 1- and 2-month treatment, and 1-, and 2-month follow-up visits, respectively. Adverse events during 2-month treatment were observed.@*RESULTS@#Nineteen patients withdrew from the trial, with 8 in the IDSA and 5 in the SCT groups, 6 in the TSA group. The FMA-LE, BBS, 6MWT and MBI scores in the IDSA group were significantly increased after 8-week treatment and 2 follow-up visits compared with the SCT and TSA groups (P<0.05 or P<0.01). Compared with pre-treatment, the grade distribution of BBS and MBI scores in the 3 groups were significantly improved at 1, 2-month treatment and 2 follow-up visits (P<0.05 or P<0.01). The SF, PROM-H, PROM-K and PROM-A in the IDSA group was significantly increased compared with the SCT and TSA groups after 8-week of treatment (P<0.05 or P<0.01). Compared with the SCT group, ASFA of the IDSA group was significantly reduced after 8-week of treatment (P<0.05). SF, SL, PROM-K and PROM-A were significantly increased at the 2nd follow-up visit whereas the ASFA was significantly reduced in the IDSA group compared with the SCT groups at 1st follow-up visit (P<0.05 or P<0.01). The SF was significantly increased in the SCT group compared with the TSA group after 8-week treatment (P<0.05). Compared with the TSA group, PROM-K, PROM-A were significantly increased at the 2nd follow-up visit (P<0.05).@*CONCLUSIONS@#The effects of IDSA on lower-limb motor function and walking ability of post-stroke patients were superior to SCT and TSA. The SCT was comparable to TSA treatment, and appeared to be superior in improving the motion range of the lower extremities. (Registration No. ChiCTR1900027206).

Superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia of stroke in early stage / 中国针灸

OBJECTIVE@#To verify the superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia in early stroke.@*METHODS@#A total of 64 patients of stroke hemiplegia with upper limb flaccid paralysis were randomly divided into an observation group (32 cases, 1 case dropped off ) and a control group (32 cases, 4 cases dropped off ). The observation group was treated with motor imagery acupuncture (both acupuncture and motor imagery therapy at affected upper limb were performed).The control group was treated with acupuncture plus motor imagery therapy at affected lower limb, 2 h later after acupuncture, motor imagery therapy was applied to upper limb. Baihui (GV 20) to Taiyang (EX-HN 5) of healthy side, Fengchi (GB 20) and Jianyu (LI 15), Jianjing (GB 21), Quchi (LI 11), Waiguan (TE 5) on the affected side, ect. were selected in both groups, once a day, 5 times a week for 4 weeks. Before and after treatment, 4, 8 weeks after treatment, the modified Ashworth scale (MAS) grade and Brunnstrom stage were compared in the two groups.@*RESULTS@#Compared before treatment, the muscle tension of shoulder, elbow and wrist each time point after treatment was increased in the two groups (@*CONCLUSION@#Motor imagery acupuncture could promote hemiplegia upper limb muscle tension recovery in patients of stroke hemiplegia with upper limb flaccid paralysis, make the patients gradually shift to the separate fine movement mode, inhibit and relieve the appearance and development of spasm.

Tapping at acupoints along meridian combined with thunder-fire moxibustion for upper-limb hemiplegia after stroke / 中国针灸

OBJECTIVE@#To observe the effect of tapping at acupoints along meridian combined with thunder-fire moxibustion on upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke.@*METHODS@#A total of 140 patients with upper-limb hemiplegia after stroke were randomly divided into a combination group (35 cases, 2 cases dropped off), an acupoint-tapping group (35 cases), a moxibustion group (35 cases, 2 cases dropped off) and a routine group (35 cases). The patients in the routine group were only treated with routine treatment and nursing. On the basis of the treatment in the routine group, the patients in the acupoint-tapping group were treated with tapping along the large intestine meridian of hand @*RESULTS@#Compared before treatment, body mass indexs of shoulder abduction, elbow extension, wrist flexion as well as BI scores in the four groups were significantly increased after treatment (@*CONCLUSION@#Tapping at acupoints along meridian combined with thunder-fire moxibustion could effectively improve the upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke, and its effect is superior to simple tapping at acupoints along meridian or thunder-fire moxibustion.

Materiales para la elaboración de cabestrillos para personas con hemiplejia / Materials to elaborate slings for hemiplegics

Los cabestrillos utilizados actualmente no han incorporado innovaciones significativas en lo que respecta a los materiales de confección. Indudablemente hay carencia de alternativas puestas a prueba que superen los materiales que actualmente se encuentran en uso, pero ello no quiere decir que éstos sean inmejorables. Este trabajo se sostiene en la convicción de que un grupo de trabajo interdisciplinario produce frutos innovadores. Es por ello que aquí, especialistas de distintas disciplinas se proponen el desarrollo de materiales y tecnologías que aporten soluciones eficientes para el mejoramiento de este producto de apoyo (PA) para esta patología específicamente...

Nowadays, there are no significant innovations on the materials used to make slings. Undoubtedly, there is lack of alternatives to exceed the current ones. Nevertheless, it does not mean that these ones cannot be improved. We believe that an interdisciplinary group of work can produce innovative fruits. As a consequence, specialists on different disciplines are decided to develop materials and technologies in order to provide several efficient solutions on the improvement of this supportive product (SP) for this specific pathology...

Oxigenoterapia hiperbárica no acidente aeroembólico no pós-operatóriode cirurgia cardíaca / Hyperbaric oxygen therapy for treating an aeroembolic accident after heart surgery

A embolia aérea sistêmica pode ter várias etiologias. Durante a circulação extracorpórea (CEC) é estimadaem 0,1 %, entretanto a grande maioria das intercorrências não é relatada ou é imperceptível, dependendo do grau de comprometimento neurológico e do tempo em que ocorreu após a cirurgia. Em geral, a embolia aérea pode causar distúrbios cognitivos, danos focais, coma e morte. O presente trabalho relataa experiência do Instituto Estadual de Cardiologia Aloysio de Castro com acidentes semelhantes no pósoperatório,que foram tratados com oxigenoterapiahiperbárica, com recuperação total.

Estimated at 0.1% during extracorporeal circulation, systemic air embolisms may have different etiologies. However, the vast majority ofcomplications are not reported or are imperceptible, depending on neurological involvement and the length of time after surgery. In general, air embolisms may cause cognitive disorders, focal damage, coma and death. This paper reports on the experience of the Aloysio de Castro State Cardiology Institute, treating these accidents during the postoperativeperiod with hyperbaric oxygen therapy,with full recovery.

Side-to-side growth discrepancies in children with hemiplegic cerebral palsy: association with function, activity and social participation / Discrepâncias no crescimento dos dimídios em crianças com paralisia cerebral hemiplégica: associação com a função, atividades e participação social

Objective: Evaluate side-to-side discrepancies in children with hemiplegic cerebral palsy (HCP), and investigate associations of these discrepancies with patients’ age at initiation of physical therapy, motor and cognitive function, and degree of activities and social participation. Method: We obtained eight side-to-side measurements from 24 HCP children with mean age 49.3±5.2 months. Results: Early initiation of physical therapy was associated with lower discrepancy in hand length (p=0.037). Lower foot length discrepancy was associated with lower requirement for caregiver assistance in activities related to mobility. Increased side-to-side discrepancy was associated with reduced wrist extension and increased spasticity. Discrepancy played a larger role in children with hemineglect and in those with right involvement. Conclusion: Increased discrepancy in HCP children was associated with reduced degree of activity/social participation. These results suggest an association between functional use of the extremities and limb growth. .

Objetivo: Avaliar a discrepância entre o crescimento dos lados do corpo em crianças com paralisia cerebral hemiplégica (PCH), e investigar sua associação com a idade de início do tratamento de fisioterapia, função motora e cognitiva, grau de atividades e participação social. Método: Comparamos oito medidas obtidas de 24 crianças com PCH e com média de idade de 49,3±5,2 meses. Resultados: O início precoce da fisioterapia se relacionou à menor discrepância no comprimento da mão (p=0,037). A menor discrepância no comprimento do pé se relacionou à menor necessidade de ajuda do cuidador em atividades de mobilidade. A maior discrepância esteve relacionada à menor extensão de punho e à maior espasticidade. A discrepância foi mais importante em crianças com heminegligência e com envolvimento à direita. Conclusão: Crianças com PCH com maior discrepância apresentaram menor atividade/participação social. Os resultados sugerem associação entre o uso funcional da mão e o crescimento das extremidades. .

Comparison of combination of CIMT and BIM training with CIMT alone on fine motor skills of children with hemiplegic cerebral palsy

This study aimed to compare the combination of CIMT and BIM training with CIMT in Fine Motor Skills of Children with Hemiplegic cerebral palsy. 24 children with hemiplegic cerebral palsy aged between 60 and 120 months participated in this RCT study. They were randomly assigned into CIMT and BIM training [n=12, four males, eight females; mean age+/-standard deviation =93.58+/-14.24] and CIMT alone [n=12, six males, six females; mean age+/-standard deviation = 94.00+/-18.97] groups. The children in the CIMT and BIM group were received a combination of CIMT and bi-manual training in addition to current occupational therapy. Each session was started with restraint on non-involved upper extremity and practicing with the involved upper extremity for three hours. This was followed with bi-manual training for another three hours. The children in CIMT group received CIMT. Each session was started with restraint on non-involved upper extremity and practicing with the involved upper extremity for six hours. This process lasted for 10 out of 12 consecutive days for both groups. Fine motor skills, upper limb function and muscle tone were assessed using Bruininks-Oseretsky Test of Motor Proficiency, Jebsen-Taylor Test of Hand Function and Modified Ashworth Scale respectively. Fine motor skills and upper limb function of these children in CIMT and HABIT and CIMT alone groups had significantly improved [P<0.05]. However, these changes were not significantly different between the two groups before and after intervention [P>0.05]. Results showed that these two treatment approaches improved fine motor skills in the hemiplegic children with cerebral palsy. None of the interventions are better than the other one. Therefore, it is suggested to use a combination of CIMT and BIM training instead of CIMT alone in order to make the tasks more attractive and easier for the children

Functional electrical stimulation improves brain perfusion in cranial trauma patients / A terapia com estímulo elétrico funcional pode melhorar a perfusão cerebral no SPECT em pacientes com trauma craniano

OBJECTIVE: Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES). METHOD: It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. CONCLUSION: FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.

OBJETIVO: Demonstrar mudanças na perfusão cerebral devido à ativação neuronal depois de estimulação elétrica funcional (EEF). MÉTODO: Foram estudados 14 pacientes com hemiplegia submetidos a quatorze semanas de um programa com EEF. O SPECT de perfusão cerebral foi realizado antes e depois da terapia com EEF. Estes pacientes foram separados em 2 grupos com relação à causa da hemiplegia: trauma craniano e acidente vascular cerebral (AVC). As imagens de SPECT foram analisadas usando SPM. RESULTADOS: Houve diferença estatisticamente significativa entre os dois grupos relacionada a idade dos pacientes e extensão da hipoperfusão. Os pacientes com trauma craniano tiveram redução na área de hipoperfusão e pacientes com AVC tiveram aumento na área de hipoperfusão após terapia com EEF. CONCLUSÃO: A terapia com EEF pode levar a melhora na perfusão cerebral em pacientes com lesões cerebrais secundárias a trauma craniano; entretanto, provavelmente não em pacientes com extensas áreas de infarto secundárias a AVC.

Effects of volar static splint on function and spasticity of upper extremity of hemiplegic adults

Stroke, despite recent advances in medical technology is a problem of public health systems. Stroke is a neurological dysfunction by vascular origin and its signs and symptoms corresponding to the damaged areas of the brain. Prevalence of spasticity after stroke has been reported in 39% of patients. The upper limb of 50% of patients with stroke remains without function due to spasticity. The purpose of this study was to determine the effects of volar static splint on function and spasticity of upper extremity in hemiplegic adults. The design of this study was experimental and repeated measurement. Fifteen patients with stroke aging 41-85 years old of both sexes were no randomly selected from rehabilitation clinics and hospitals of Tehran. The patients used a volar static splint [10 degree of wrist extension, full extension of fingers and abduction and opposition of thumb] two mounts [2 hours at day and 4 hours at night]. In this study Modified Ashworth Scale was used to evaluate spasticity. A Goniometre was used to measure passive range of motion. Upper extremity function was evaluated by Fugl-Meyer Test. The results of this study showed significant reduction in wrist and elbow spasticity [p<0.0001], significant increase in wrist and elbow passive range of motion [p<0.0001 and p<0.002, respectively] and upper limb function [p<0.0001]. This study shows that 2 months using of volar static splint in patients with chronic stroke has significant effects on reduction of wrist and elbow spasticity, increasing passive range of motion of these joints and upper limb function. It seems that application of this splint is useful for improvement of upper limb function in chronic hstroke patients

effects and maintenance of constraint-induced therapy on spasticity and function of upper extremity in hemiplegic cerebral palsy children 6 to 12 years old

Cerebral palsy is a non progressive disorder and the most common movement problem in children. Many children with cerebral palsy are of hemiplegic type. One of the important problems of this children is unilateral upper limb dysfunction, that not using the affected side causes forgetfulness and more problems on this side. In this study, effectiveness of Constraint-Induced Therapy [CIT] and the maintainance of this technique on spasticity and performance of upper extremity in hemiplegic cerebral palsy children 6 to 12 years old have been investigated. In this pretest - posttest quasi experimental study, 20 cerebral palsy hemiplegic children 6 to 12 years old [15 boys and 5 girls] with 8.7 years mean age were selected. Interventions were performed about 8 weeks and patients were followed for 4 weeks. Spasticity on the affected side in wrist and elbow were tested by Modified Ashworth Scale and upper extremity function by the Box and Block test. The data were analyzed with the Wilcoxon and paired t- tests. Constraint-Induced Therapy in the affected limb decreases significantly the spasticity of wrist [p = 0.00] and elbow [p = 0.005] and significantly increases performance score [p = 0.00], and the recovery significantly maintained one month after the interventions. Constraint-Induced Therapy of affected upper extremity could possibly decrease limb spasticity and increase function with two mechanisms: Fierstly, The reduction of not using the plegic side and secondly, neuroplasticity in CNS. This improvement may remain viable in the affected limb

Patrones del movimiento pélvico en pacientes con hemiplejía espástica / Pelvic movement patterns in patients with spastic hemiplegia

El tratamiento adecuado de patologías que alteran la marcha normal, como por ejemplo, encefalopatías estáticas tales como la parálisis cerebral infantil, requiere de la identificación precisa de los patrones de movimiento asociados y sus causas, con el propósito de seleccionar el tratamiento más apropiado en términos de efectividad. Identificar y caracterizar patrones cinemáticos de la pelvis en el plano transverso como respuesta compensatoria a deformidades de los miembros inferiores en pacientes pediátricos con hemiplejía espástica. La muestra utilizada fue de 66 pacientes con disfunción motora subtipo hemiplejia espástica secuela de parálisis cerebral infantil, del Hospital Ortopédico Infantil de Caracas, entre los años 1999 y 2004. A cada paciente se le realizó un análisis de marcha siguiendo el protocolo del Laboratorio de Marcha del Hospital Ortopédico Infantil. A los patrones de cinemática obtenidos se les midieron las desviaciones de los movimientos pélvicos en los tres planos así como también la progresión del pie y la rotación de cadera evidenciadas por el examen físico (anteversión femoral). Particular énfasis se realizó en el análisis de las desviaciones en el plano transverso. Se obtuvieron los patrones de movimiento con características propias para cada subgrupo: Tipo I, Tipo II, Tipo III y Tipo IV. Los hallazgos son consistentes con los reportados en la literatura en lo concerniente a los planos sagital y coronal. Sin embargo, en el plano transverso se demostraron patrones consistentes con deformidad ósea presente en el miembro ipsilateral. Las respuestas compensatorias observadas en pelvis en dicho plano tienen como objetivo mantener ambos pies en la línea de progresión.

Adequate treatment of pathologies that alter normal gait, for example, spastic encephalopaties such as cerebral palsy, require precise identification of their movement patterns and causes, in order to select the most effective treatment. To identify and characterize transverse plane kinematic patterns of the pelvis as a compensatory response to lower limb deformities in pediatric patients with spastic hemiplegias. 66 patients with spastic hemiplegia subtype motor dysfunction, from the Hospital Ortopédico Infantil (HOI) at Caracas,Venezuela, were studied between 1999 and 2004. A gait analysis was performed in each patient following the HOI’s protocol. Deviations of pelvic movements were measured on all three planes to the kinematics gait patterns obtained, Measurements of foot progression and hip rotation (femoral anteversion) were achieved via clinical examination. Movement patterns on spatial planes were obtained and characterized in terms of its deviations, then classified in four wellfeatured subtypes: Type I, Type II, Type III y Type IV. Special emphasis was placed on analysis of deviations in the transverse plane. Findings for sagital and coronal planes are consistent with those reported by the literature. However, movement patterns that are consistent with bone deformities in the ipsilateral limb were demonstrated for transverse plane, and the pelvic coping responses for that plane tend to maintain both feet aligned with the gait progression line.

Terapia de Contenção e Uso Induzido (CIT) em crianças com paralisia cerebral do tipo hemiplegia / Constraint-Induced Therapy (CIT) in children with hemiplegic cerebral palsy

Esta revisão foi realizada a partir da seleção e análise crítica de 12 artigos científicos, publicados nas línguas inglesa e portuguesa, entre 1997 e 2006, que investigaram os efeitos da Terapia de Contenção e Uso Induzido (CIT) em crianças com paralisia cerebral do tipo hemiplegia. Os efeitos da intervenção foram analisados a partir da significância estatística dos resultados (p < 0,05) e da estimativa do tamanho dos efeitos (effect size: ES) com a aplicação do coeficiente d de Cohen (sem efeito quando d ≤ 0,2; efeito pequeno quando 0,2 < d ≤ 0,5; efeito regular quando 0,5 < d ≤ 0,8; e efeito grande quando d > 0,8). Seis estudos reportaram significância estatística dos resultados documentados e, desses, quatro disponibilizaram informações que permitiram a estimativa do tamanho dos efeitos da intervenção. A CIT parece contribuir significativamente para a melhora da função manual (0,53 ≤ d < 0,8; d > 2,82), do desempenho motor (d = 0,4) e do autocuidado (d = 2,25) de crianças com paralisia cerebral do tipo hemiplegia, assim como estimular a emergência de novos comportamentos motores (d = 3,04) e da função bimanual (d = 1,16). A análise crítica dos artigos incluídos nesta revisão revela o caráter promissor da CIT e reforça a necessidade de que estudos futuros possam replicar os resultados dessa intervenção e testar, com maior rigor metodológico, a eficácia da Terapia de Contenção e Uso Induzido.

Selection and critical analysis of 12 scientific articles published in English and Portuguese, from 1997 to 2006, investigating the effects of the Constraint Induced Therapy (CIT) in children with hemiplegic cerebral palsy guided this review. The effects from the intervention were analyzed by means of statistical significance of the results (p < 0,05) and effect size (ES) estimates, using Cohen’s d coefficient (no effect when d ≤ 0,2; small effect when 0,2 < d ≤ 0,5; regular effect when 0,5 < d ≤ 0,8 and large effect when d > 0,8). Six studies reported statistical significance of the results and, among those, four provided information that allowed the estimation of their intervention’s effect size. CIT seems to contribute significantly for the improvement of the manual function (0,53 ≤ d < 0,8; d > 2,82), motor performance (d = 0,4) and self-care (d = 2,25) of children with hemiplegic cerebral palsy, as well as to stimulate the emergence of new motor behavior (d = 3,04) and of bimanual function (d = 1,16). The critical analysis of the articles included in this review revealed the promising status of the CIT and reinforces the need for future studies to replicate the observed effects and to test, using more rigorous methodological designs, the effectiveness of the constrained-induced therapy.

Effects of Muscle Strengthening Exercises Using a Thera Band on Lower Limb Function of Hemiplegic Stroke Patients / 간호학회지

PURPOSE: This study was to verify the effect of muscle strengthening exercises using a Thera-Band on the lower limbs. METHODS: The design utilized for this study was a nonequivalent control group pretest-posttest design. A control group (16) and experimental group (16) were selected from stroke patients of K Oriental Medicine Hospital who were hospitalized for 5 months from December 2005 through April 2006. While only acupuncture therapy and physical therapy were used on the control group, acupuncture, physical therapy and additional muscle strengthening exercises using a red thera band were used on the experimental group. Muscle strengthening was performed 20 minutes per session, more than one session a day for 4 weeks. Hypotheses for this study were verified using Two-way repeated ANOVA and ANCOVA using a pre test score as a covariate. RESULTS: The experimental group with thera band muscle strengthening exercises showed a decrease in asymmetry weight loading percentage(F=14.704, P= .010), range of knee (Z=-3.15, P= .001) & deep tendon reflex score(Z=-2.52, P= .012) and moving performance(F=12.328, P= .001)compared to the control group. CONCLUSION: It is confirmed that muscle strengthening exercises using a Thera-Band can be used as an effective nursing intervention to improve the function of the lower limb of hemiplegic stroke patients.

Análise do comportamento de parâmetros cardiovasculares durante a realização de exercícios físicos em hemiplégicos crônicos / Chronic hemiplegics’ cardiovascular parameters behavioral analysis during physical exercises

Objetivo: Analisar o comportamento do sistema cardiovascular de pacientes hemiplégicos crônicos, durante exercícios físicos em grupo, e correlacionar esse comportamento com a intensidade com que são executados.Método: Foram analisados dados de 23 hemiplégicos crônicos, freqüentadores do “Projeto Hemiplegia”desenvolvido na FCT/UNESP. Para coleta dos dados as sessões deste projeto foram divididas em quatro fases: repouso, sentado, em pé e sentado1. A freqüência cardíaca foi registrada batimento a batimento durante toda a sessão por meio de um freqüencímetro Polar S810 e a pressão arterial verificada indiretamente ao final das fases da sessão. A escala de Borg e a reserva de freqüência cardíaca (RCF) foram coletadas nas fases: sentado, em pé e sentado1. A variabilidade da freqüência cardíaca (VFC) foi analisada no domínio do tempo nas quatro fases da sessão. Análise de variância para medidas repetidas seguida da aplicação do teste de Tukey foi utilizada para análise dos dados (p < 0,05). Resultados: Ocorreram diferenças significativas da freqüência cardíaca entre os valores da fase de repouso em comparação com as fases sentado e em pé e da fase sentado1 com a fase em pé. O índice de VFC apresentou diferenças entre as fases sentado e sentado1.Diferenças significativas foram observadas com a pressão arterial sistólica, quando comparada às atividades realizadas na fase em pé com as fases de repouso e sentado, enquanto que a pressão arterial diastólica não apresentou diferença significativa entre as fases. Os valores médios da escala de Borg foram nas fases sentado, em pé e sentado1: 8,0; 10,5 e 9,0, respectivamente, sendo significativos entre as fases sentado e em pé e a RCF apresentou valores significativos comparando a fase em pé com as fases sentado e sentado1.Conclusão: Os resultados permitem concluir que as atividades realizadas, apesar da baixa intensidade,produzem modificações significativas do sistema cardiovascular em hemiplégicos crônicos.