The effects of mental practice combined with modified constraint-induced therapy on corticospinal excitability, movement quality, function, and activities of daily living in persons with stroke.

PURPOSE: Studies on to what extent the combined therapy of modified constraint-induced movement therapy and mental practice is more effective than modified constraint-induced movement therapy alone are lacking. This study aims to compare the effects of the combined therapy with modified constraint-induced movement therapy alone on corticospinal excitability, quality of the movement of the affected upper extremity, upper motor functions, and performance of the affected arm in daily life of hemiplegic stroke patients. METHODS: The participants comprised 14 people who had suffered stroke and were randomly divided into two groups. All participants participated in modified constraint-induced movement therapy, while only the experimental group partook in additional mental practice. Both groups were tested for corticospinal excitability, quality of movement, hand function, and activities of daily living. RESULTS: Both groups showed significant improvement in the movement quality of reaching and performance of activities of daily living. In the experimental group, functional improvement of the upper limb was also observed. The improvements in corticospinal excitability, upper extremity function, and performance in daily activities were significantly greater in the experimental group compared to the control group. CONCLUSIONS: This study confirmed that the combined therapy produces more effective improvement in corticospinal excitability, upper limb function, and performance in daily activities. The combined therapy of mental practice and modified constraint-induced movement therapy could be used as a clinically useful intervention. Implications for rehabilitation Modified constraint-induced movement therapy could be used as an intervention method for people with stroke to make improvements in the quality of movement and performance in activities of daily livings with the affected side. With additional mental practice, upper extremity functions improve, and changes in neurological, functional and performance in daily lives are greater compared to modified constraint-induced movement therapy without mental practice. Impact of mental practice has on rehabilitation should not be underestimated.

Effects of Task-Oriented Training as an Added Treatment to Electromyogram-Triggered Neuromuscular Stimulation on Upper Extremity Function in Chronic Stroke Patients.

The purpose of the present study was to investigate the effects of electromyogram-triggered neuromuscular stimulation (EMG-stim) combined with task-oriented training (TOT) on upper extremity function in chronic stroke patients. Twenty chronic stroke patients were randomly assigned to either the intervention (n = 10) or control (n = 10) group. The intervention group conducted TOT with EMG-stim on the wrist and finger extensor of the affected arm for 30 minutes per day, 5 days per week, for 4 weeks. The control group was provided EMG-stim for 20 minutes per day for the same duration. The intervention group exhibited significant improvement relative to the control group in muscle activation, motor recovery (Fugl-Meyer assessment) and dexterity (Box and Block Test) (p < 0.05). Significant differences in hand function between the groups were detected in the writing of short sentences and in stacking checkers (p < 0.05). It is concluded that EMG-stim in combination with TOT may be better than EMG-stim alone for the treatment of arm paresis in stroke patients. Further research with a larger sample is recommended to examine neurologic changes or cerebral cortex reorganization. Copyright © 2016 John Wiley & Sons, Ltd.

Effect of motor imagery training on symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks in post-stroke hemiparesis.

OBJECTIVE: To investigate the effect of motor imagery training (MIT) on the symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks. METHODS: We measured the electromyographic (EMG) data in the knee extensor on the affected side of 3 volunteers with post-stroke hemiparesis. We used a single-subject multiple-baseline research design across individuals. The EMG data were collected from knee extensors while performing the sit-to-stand and stand-to-sit tasks. The EMG activation and onset time ratios for the knee extensors were calculated by dividing the EMG activation and onset time of knee extensor action on the affected side by these on the unaffected side. MIT consisted of a 10-min detailed description of 5 stages: preparation, sit-to-stand tasks, weight shifting during standing, stand-to-sit tasks, and completion. RESULTS: During MIT, the EMG activation ratios of participants 1, 2, and 3 increased by 11.24%, 18.07%, and 26.91%, respectively, in the sit-to-stand task and by 12.11%, 14.31%, and 25.92%, respectively, in the stand-to-sit task. During MIT, the onset time of participants 1, 2, and 3 decreased by 36.09%, 24.27%, and 25.61%, respectively, in the sit-to-stand task and by 26.81%, 27.20%, and 22.83%, respectively, for the stand-to-sit task. CONCLUSION: These findings suggest that MIT has a positive effect on the symmetrical use of knee extensors during sit-to-stand and stand-to-sit tasks.