Safety of dry needling in stroke patients: a scoping review.

INTRODUCTION: Spasticity is a common problem in stroke patients. Treatments of spasticity often have side effects or are insufficiently effective. Dry needling (DN) has been proposed as a potential additional option to consider in the multimodal treatment of post-stroke spasticity, although questions about its safety remain. The goal of this study is to assess the safety of DN in stroke patients. EVIDENCE ACQUISITION: A systematic search in Medline, Embase, The Cochrane Library, Web of Science, CIHNAL and PEDro was conducted in June 2023. Two reviewers independently screened abstracts according to the eligibility criteria. EVIDENCE SYNTHESIS: Twenty-five articles were included in this review. Only six studies reported adverse events, all of which were considered minor. None of the included studies reported any serious adverse events. In four of the included studies anticoagulants were regarded as contra-indicative for DN. Anticoagulants were not mentioned in the other included studies. CONCLUSIONS: There is a paucity of literature concerning the safety of DN in stroke patients. This review is the first to investigate the safety of DN in stroke patients and based on the results there is insufficient evidence regarding the safety of DN in stroke patients. CLINICAL REHABILITATION IMPACT: Although DN could be a promising treatment in post-stroke spasticity, further research is indicated to investigate its mechanism of action and its effect on outcome. However, before conducting large clinical trials to assess outcome parameters, the safety of DN in stroke patients must be further investigated.

Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

BACKGROUND: The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. OBJECTIVE: To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. METHODS: Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. RESULTS: A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. CONCLUSION: The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Effect of TCM rehabilitation program on activities of daily living in patients with post-stroke limb spasticity: An observational study.

BACKGROUND: Stroke is a neurological disease with many common complications that reduce the activities of daily living and the quality of life of patients. Traditional Chinese medicine (TCM) rehabilitation techniques, scalp acupuncture, and TCM can relieve spasticity symptoms and recovery from physical obstacles is significant. METHODS: Three hundred twenty-one patients with post-stroke limb spasticity were randomly divided into trial and control groups, with 159 and 162 patients in the trial and control groups, respectively. The control group received basic treatment combined with modern rehabilitation techniques, whereas the trial group received basic treatment combined with TCM, Tuina, and scalp acupuncture with kinesiotherapy. The treatment course in both groups was 4 weeks. The Modified Ashworth Scale, magnetic resonance imaging, and Stroke Specific Quality of Life Scale were used to evaluate limb spasticity, activities of daily living, and quality of life, respectively. PASW 18.0 was used for statistical analysis. RESULTS: With a longer treatment period, the improvement in limb spasticity was greater in the trial group than in the control group (P < .05). Similarly, improvements in activities of daily living and quality of life were better in the trial group than in the control group (P < .05). CONCLUSION: The TCM rehabilitation program using Tongjing Tiaoxing combined with scalp acupuncture and kinesiotherapy can effectively treat spasticity symptoms in stroke patients and improve their activities of daily living and quality of life.

HIPPOTHERAPY IN CEREBRAL PALSY - SURVEY RESEARCH.

OBJECTIVE: The aim: To assess the effects of a one-year hippotherapy programme on the physical and mental functioning of children with cerebral palsy. PATIENTS AND METHODS: Materials and methods: The study included 15 children with cerebral palsy whose mean age was 9 years. The children participated in hippotherapy ses¬sions at the Rehabilitation Centre in Rusinowice (one-year observation). The clinical presentation was dominated by manifestations of motor and postural abnormalities caused by central nervous system damage. A survey questionnaire was used in the study to collect information about problems associated with everyday life and functioning. RESULTS: Results: The results obtained in this study showed that spastic CP was the most common form of the disorder, affecting 8 out of 15 children (53%). It was followed by mixed CP (40%, 6 children). Among the respondents, 67% (10 people) were already familiar with hippotherapy whereas 33% did not know this method. CONCLUSION: Conclusions: There was a strong correlation between being familiar with effects of hippotherapy and the level of education of the parent/guardian. This result had a moderate influence on the frequency of hippotherapy sessions. Systematic hippotherapy sessions helped improve physical fitness and everyday functioning in children with cerebral palsy.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.

BACKGROUND: Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke remain uncertain. This is an update of the review published in 2019. OBJECTIVES: To assess the effects of rPMS for improving activities of daily living and functional ability in people after stroke. SEARCH METHODS: We searched the Cochrane Stroke Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); OTseeker: Occupational Therapy Systematic Evaluation of Evidence; the Physiotherapy Evidence Database (PEDro); Ichushi-Web; and six ongoing trial registries on 5 October 2021. We screened reference lists and contacted experts in the field. We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. The following comparisons were eligible for inclusion: 1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); 2) active rPMS only compared with no intervention; 3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and 4) active rPMS plus rehabilitation compared with rehabilitation only. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion in the review. The same review authors assessed methods and risk of bias, undertook data extraction, and evaluated the certainty of the evidence using the GRADE approach. We contacted trial authors to request unpublished information if necessary. Any disagreements were resolved through discussion. MAIN RESULTS: We included four trials (three parallel-group RCTs and one cross-over trial) involving a total of 139 participants. This result was unchanged from the review published in 2019. Blinding of participants and physicians was well reported in three trials, with no information on whether personnel were blinded in one trial. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-certainty evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-certainty evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. We observed a decrease in spasticity of the elbow at the end of follow-up (MD -0.41, 95% CI -0.89 to 0.07; 1 trial; 63 participants; low-certainty evidence) when comparing rPMS plus rehabilitation versus sham rPMS plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-certainty evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the certainty of evidence related to the primary outcome as low, owing to the small sample size of the studies. AUTHORS' CONCLUSIONS: There is insufficient evidence to permit the drawing of any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Immediate effects of transcutaneous electrical nerve stimulation on gait patterns in chronic stroke survivors: A single group, pretest-posttest clinical trial.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) has been used to reduce muscle spasticity and improve locomotion in stroke survivors. We speculate that acute changes in gait performance after TENS mediate functional improvement in the long-term. However, no previous study has investigated the effect of TENS on ankle kinetics and kinematics during walking in stroke survivors. PURPOSE: We aimed to investigate whether TENS applied over the paretic leg could rapidly improve the plantar flexion moment and ankle kinematics in chronic stroke survivors with lower limb paresis. METHODS: Twenty chronic stroke survivors were recruited. They underwent 30 min of TENS over the area innervated by the common peroneal nerve on the paretic leg. Three-dimensional (3D) motion capture was performed and ankle plantar flexor spasticity was assessed before and immediately after stimulation. Ankle kinematics and kinetic and spatiotemporal data were collected using 3D motion capture. Ankle plantar flexor spasticity was assessed using the Modified Tardieu Scale. PRINCIPAL RESULTS: A significant increase in the ankle plantar flexion moment of the paretic side during the pre-swing phase was observed immediately after stimulation (p = 0.009, maximal mean difference = 0.035, 95%CI = 0.0125 to 0.0575). The step length of the paretic limb also increased significantly after stimulation (p = 0.023, mean difference = -0.02, 95%CI = -0.04 to -0.004). TENS had no immediate effect on paretic ankle spasticity, as measured by the Modified Tardieu Scale, or on other temporo-spatial parameters. CONCLUSION: The findings support the use of TENS to improve the motor function and gait pattern in chronic stroke survivors. The study indicated that the application of TENS to the paretic leg before gait training might improve rehabilitation outcomes. Future studies investigating the effects of TENS on functional outcomes, the optimal stimulation duration, and assessing spasticity using more sensitive measures are warranted.

Electrocupuncture combined rehabilitation therapy for upper limb spasticity after stroke: A protocol for systematic review and meta-analysis.

BACKGROUND: The purpose of this study was to evaluate the effectiveness and safety of electroacupuncture combined with rehabilitation in the treatment of spasticity after stroke. METHODS: To collect relevant literature, we will research following databases: Medicine, PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Database, Chongqing VIP Chinese Science and Technology Periodicals Database and China Biomedical Database; the time is from its creation to May 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register and conference papers. Two reviewers will independently complete the literature screen and data extraction, and quality assessment of the included studies will be independently completed by two other researchers. The primary outcomes included the Modified Ashworth scale (MAS) and the simplified Fugl-Meyer Assessment scale (SFMA). The Modified Barthel Index (MBI), the China Stroke Scale (CSS), and adverse reactions as secondary outcomes were assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to assess the quality of evidence. RESULTS: This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of electroacupuncture combined with rehabilitation therapy in the treatment of upper limb spasticity after stroke, providing a reference for the safe and effective treatment of upper limb spasm after stroke. CONCLUSION: This study provides evidence that electroacupuncture combined with rehabilitation therapy is effective. ETHICS AND DISSEMINATION: The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences. SYSTEMATIC REVIEW REGISTRATION: INPLASY202160005.

Rehabilitation in multiple sclerosis in 2021.

Patients with multiple sclerosis, despite advances in therapy, often suffer from locomotor impairment that limits their mobility and affect quality of life. Rehabilitation is part of the treatment of MS and has shown its beneficial effects in numerous studies. While traditional rehabilitation techniques remain in the limelight, new technologies are emerging and make it possible to improve the management of disabling symptoms. The aim of this update is to synthesize the new therapy techniques proposed in rehabilitation for patients with multiple sclerosis according to the symptoms as balance, gait, upper limb disorders, fatigue, spasticity and disease progression published over the past 5 years. With regard to balance and walking disorders, neuromotor rehabilitation, physical exercise, rhythmic auditory stimulation, gait robot training and exergaming are effective. Only physical exercise has shown a positive effect on fatigue management. Spasticity is improved by classic rehabilitation techniques however non-invasive brain stimulation are promising. The rehabilitation of upper limb dysfunctions uses various effective techniques such as the repetition of functional tasks in real or virtual situations. In case of a more severe disability, arm robots can be used to relearn the impaired movement. Action observation training in real or virtual situations is also effective. Finally, under certain conditions the constraint induced movement therapy is proposed. The effects of rehabilitation are not only positive on the pyramidal symptoms and fatigue but also increase neuroplasticity and perhaps a neuroprotective effect as shown in some studies.

Non-pharmacological intervention for rehabilitation of post-stroke spasticity: A protocol for systematic review and network meta-analysis.

BACKGROUND: Post-stroke spasticity (PSS) is a major worldwide health problem, and timely and effective rehabilitation is associated with the risk of diabetes development; there are a variety of non-pharmacological interventions applied to the rehabilitation of PSS in these treatments; however, the relative efficacy and safety of different therapies remain uncertain, and we will conduct a systematic review and network meta-analysis to evaluate different non-pharmacological interventions. The relative efficacy and safety of intervention in PSS rehabilitation, thus providing evidence to support the optimization of the PSS rehabilitation program. METHODS: We searched the following databases electronically, including four English literature databases (i.e., PubMed, Medline, Embase, and Cochrane Library) and two Chinese literature databases (i.e., China National Knowledge Infrastructure and VIP). We will also search for randomized controlled trials on non-pharmacological interventions for post-stroke spasticity, and the search time limit is from its establishment to May 2020. Two reviewers working independently will screen the titles, abstracts, and full papers. Data extraction will be completed by two independent authors. The primary outcome was the motor function. The secondary outcome was the assessment of daily living ability. We will use RevMan V.5.3 software to compute the data synthesis carefully when a meta-analysis is allowed. We will conduct Bayesian network meta-analysis using the Markov Chain Monte Carlo random effects model in Aggregate Data Drug Information System version 1.16.8 (Drugis, Groningen, NL). RESULTS: This study provides a high-quality synthesis to assess the effectiveness and safety of non-pharmacological interventions for patients with PSS. CONCLUSION: The results of this study will provide evidence to judge whether non-pharmacological interventions are effective interventions for patients with post-stroke spasticity. ETHICS AND DISSEMINATION: The results of this meta-analysis and meta-regression will be disseminated through publication in a peer-reviewed journal and presented at a relevant conference. The data used in the network meta-analysis did not contain individual patient data. Therefore, ethical approval was not required. INPLASY REGISTRATION NUMBER: INPLASY202140059.

Análise da ativação muscular em indivíduos com paralisia cerebral através de manuseios do conceito bobath: uma revisão crítica / Analysis of muscle activation in individuals with Cerebral Palsy through handling the Bobath Concept: a critical review

O objetivo desse artigo foi analisar criticamente a literatura a respeito da ativação muscular pelo uso do Conceito Bobath em indivíduos com Paralisia Cerebral. As bases de dados consultadas foram Pubmed, Science Direct, Scielo, Lilacs, PEDro e ResearchGate, não limitando o período de publicação, sendo incluídos artigos publicados até maio de 2020. Foram encontrados na literatura 827 estudos, destes apenas cinco foram incluídos nessa revisão. Os artigos inclusos, a partir de critérios pré-estabelecidos, avaliaram através da eletromiografia diferentes musculaturas pelo uso de manuseios do Conceito Bobath. As musculaturas avaliadas estão relacionadas ao controle de cervical e de tronco, além dos músculos oblíquo interno, transverso do abdome e reto abdominal. A ativação muscular foi avaliada nas posturas de decúbito lateral, decúbito ventral e sedestação. Os artigos revisados identificaram através da eletromiografia que ocorre ativação muscular durante alguns manuseios do Conceito Bobath em indivíduos com paralisia cerebral, contudo as pesquisas são escassas, já que os estudos apresentam limitações nos desenhos experimentais e amostras pequenas. Isso reforça a importância de ampliar a investigação acerca da ativação muscular durante os manuseios com esta abordagem, o que poderá contribuir efetivamente na tomada de decisão dos profissionais que atuam nesta área, visando maior eficácia no tratamento e qualidade de vida desta população.AU)

The aim of this article was to critically analyze the literature on muscle activation by the use of the Bobath Concept in individuals with Cerebral Palsy. The databases consulted were Pubmed, Science Direct, Scielo, Lilacs, PEDro and ResearchGate, not limiting the publication period, including articles published until May 2020. A total of 827 studies were found in the literature, and of these only five were included in this review. The included articles, based on pre-established criteria, evaluated through electromyography different muscles using the Bobath Concept handling. The muscles evaluated are related to cervical and trunk control, in addition to the internal oblique, transverse muscles of the abdomen and rectum. Muscle activation was evaluated in lateral decubitus postures, ventral decubitus and sedestation. The reviewed articles identified, through electromyography, that muscle activation occurs during some handling of the Bobath Concept in individuals with cerebral palsy, however research is scarce, since studies have limitations in experimental designs and small samples. This reinforces the importance of expanding the investigation about muscle activation during handling with this approach, which can effectively contribute to the decision making of professionals working in this area, aiming at greater efficiency in the treatment and quality of life of this population.(AU)

Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial.

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

Comprehensive Use of Dynamic Electrical Neurostimulation and Botulinum Toxin Therapy in Patients with Post-Stroke Spasticity.

BACKGROUND: Acute cerebrovascular accident poses a threat to the health of the nation. Dynamic electric neurostimulation decreases the excitability of the receptor apparatus, optimize microcirculatory processes, analgesic and antispasmodic effects. METHODS: This article discusses the rehabilitation of 96 men and women with post-stroke spasticity, mean age of 60.51 ± 4.9 years, in the early recovery period after ischemic stroke, randomized into 4 equal groups: Group 1 received botulinum toxin therapy in combination with dynamic electric neurostimulation and basic therapy, including massage and therapeutic exercises; Group 2 -botulinum toxin therapy and basic therapy; Group 3 - dynamic electric neurostimulation and basic therapy; Group 4 - basic therapy only. Study methods included the use of the Modified Asworth Scale to assess spasticity, the Rivemead Motor Assessment test, and goniometry to assess the range of joint movements. RESULTS: During a three-week observation, it was found that the inclusion of botulinum toxin therapy and dynamic electrical neurostimulation in the standard therapy of post-stroke spasticity in patients after ischemic stroke in the early recovery period contributed to patients' recovery. CONCLUSIONS: Botulinum toxin therapy and dynamic electrical neurostimulation contributed to a more significant decrease in spasticity in the proximal and distal parts of the paretic upper extremity. It is also increased the amplitude of voluntary movements in the affected shoulder, elbow, and wrist joints, compared to the separate use of botulinum toxin therapy and dynamic electric neurostimulation as part of basic rehabilitation.

Supporting front crawl swimming in paraplegics using electrical stimulation: a feasibility study.

BACKGROUND: Participation in physical and therapeutic activities is usually severely restricted after a spinal cord injury (SCI). Reasons for this are the associated loss of voluntary motor function, inefficient temperature regulation of the affected extremities, and early muscle fatigue. Hydrotherapy or swim training offer an inherent weight relief, reduce spasticity and improve coordination, muscle strength and fitness. METHODS: We present a new hybrid exercise modality that combines functional electrical stimulation (FES) of the knee extensors and transcutaneous spinal cord stimulation (tSCS) with paraplegic front crawl swimming. tSCS is used to stimulate the afferent fibers of the L2-S2 posterior roots for spasticity reduction. By activating the tSCS, the trunk musculature is recruited at a motor level. This shall improve trunk stability and straighten the upper body. Within this feasibility study, two complete SCI subjects (both ASIA scale A, lesion level Th5/6), who have been proficient front crawl swimmers, conducted a 10-week swim training with stimulation support. In an additional assessment swim session nine months after the training, the knee extension, hip extension, and trunk roll angles where measured using waterproof inertial measurement units (IMUs) and compared for different swimming conditions (no stimulation, tSCS, FES, FES plus tSCS). RESULTS: For both subjects, a training effect over the 10-week swim training was observed in terms of measured lap times (16 m pool) for all swimming conditions. Swimming supported by FES reduced lap times by 15.4% and 8.7% on average for Subject A and Subject B, respectively. Adding tSCS support yielded even greater mean decreases of 19.3% and 20.9% for Subjects A and B, respectively. Additionally, both subjects individually reported that swimming with tSCS for 30-45 minutes eliminated spasticity in the lower extremities for up to 4 hours beyond the duration of the session. Comparing the median as well as the interquartile range of all different settings, the IMU-based motion analysis revealed that FES as well as FES+tSCS improve knee extension in both subjects, while hip extension was only increased in one subject. Trunk roll angles were similar for all swimming conditions. tSCS had no influence on the knee and hip joint angles. Both subjects reported that stimulation-assisted swimming is comfortable, enjoyable, and they would like to use such a device for recreational training and rehabilitation in the future. CONCLUSIONS: Stimulation-assisted swimming seems to be a promising new form of hybrid exercise for SCI people. It is safe to use with reusable silicone electrodes and can be performed independently by experienced paraplegic swimmers except for transfer to water. The study results indicate that swimming speed can be increased by the proposed methods and spasticity can be reduced by prolonged swim sessions with tSCS and FES. The combination of stimulation with hydrotherapy might be a promising therapy for neurologic rehabilitation in incomplete SCI, stroke or multiples sclerosis patients. Therefore, further studies shall incorporate other neurologic disorders and investigate the potential benefits of FES and tSCS therapy in the water for gait and balance.

Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy.

BACKGROUND: Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination. AIMS: We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy. METHODS AND PROCEDURES: Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months. OUTCOMES AND RESULTS: Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention. CONCLUSIONS AND IMPLICATIONS: Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.

Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: A case report.

Context: Spasticity in neurological disorders (i.e. stroke patients and cerebral palsy) is positively improved by dry needling. However, reports are scarce regarding the potential effects of dry needling in reducing spasticity and improving functionality in patients with an incomplete spinal cord injury. The aim of this case report was to study the immediate, short-term effects of dry needling treatment (10 weeks) on spasticity, dynamic stability, walking velocity, self-independence, and pain in a single patient with an incomplete spinal cord injury.Findings: The dry needling treatment resulted in immediate, short-time effects on basal spasticity in the upper (reduction from 2 to 0 point median) and lower (reduction from 2 to 0 point median) limbs, as measured by the modified Ashworth Scale. Dynamic-stability, assessed by trunk accelerometry, improved more than 50% (Root Mean Squared of acceleration, Root Mean Squared of Jerk and step variability), and gait speed improved by 24.7 s (i.e. time to walk 20 m). Self-independence and pain were respectively scored by the Spinal Cord Independence Measure (21 points improvement) and visual analog scale (4 points improvement).Conclusions: This case report demonstrates that dry needling treatment can have positive effects on spasticity, dynamic stability, walking velocity, self-independence, and pain in patients with incomplete spinal cord injury. Further research is needed in a larger patient population to deeply understand the mechanism(s) associated with the obtained results and regarding the clinical significances of dry needling treatment for incomplete spinal cord injury.

Immediate effect of horse riding simulator on adductor spasticity in children with cerebral palsy: A randomized controlled trial.

BACKGROUND: Spastic cerebral palsy (CP) is the most common type of CP. Hip adductor spasticity leads to discomfort, stiffness, and difficulties in doing physical activities such as sitting, transfer, and walking. Management of hip adductor spasticity is still a challenge in the field of rehabilitation. Horse riding simulator (HRS) has been reported to have beneficial effects on spasticity, postural control, and motor function in children with spastic CP. OBJECTIVE: The aim of the study was to determine the immediate effect of HRS on adductor spasticity in children with CP. METHODS: Twenty-four children with CP were selected and were divided into two groups: experimental and control (12 children in each group). Experimental group was exposed to HRS and control group to the corner seat placement. Adductor tone and passive hip abduction range of motion were measured before and after the intervention. RESULTS: Post intervention scores in the group of HRS show significant reduction in adductor spasticity and improvement in hip abduction range of motion, whereas no difference have been reported in the control group. HRS has positive effects on reducing spasticity and improving range of motion in hip joint in spastic CP. CONCLUSION: It was concluded that immediate effect of HRS is successful in reducing the adductor spasticity and improving abduction range of motion in hip, which could be incorporated with regular physiotherapy intervention.

Augmented Biofeedback Training with Physical Therapy Improves Visual-Motor Integration, Visual Perception, and Motor Coordination in Children with Spastic Hemiplegic Cerebral Palsy: A Randomised Control Trial.

Aim: The aim of this study is to investigate the efficacy of combining augmented biofeedback training and standard therapy for improving visual-motor integration (VMI), visual perception (VP), and motor coordination (MC) in children with spastic cerebral palsy (CP).Methods: Participants were 45 children, 5-8 years of age, with spastic hemiplegic CP. They were randomized into three groups: group A followed a 3-month specially designed program physical therapy intervention to facilitate VMI and VP. Group B received augmented biofeedback training. Group C received augmented biofeedback training and the physical therapy program provided to group A. The treatment sessions lasted 60 min, three times a week for three months. The Beery-Buktenica Developmental Test of VMI and its supplemental tests were used to evaluate the children before and after the program.Results: After a 3-month treatment, standard scores and age equivalent scores for VMI, VP, and MC were significantly higher in group C compared with group A.Conclusion: The combination of augmented biofeedback and physical therapy could be used to improve VMI, VP, and MC in children with spastic hemiplegic CP.

Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke.

BACKGROUND: Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive treatment method that can penetrate to deeper structures with painless stimulation to improve motor function in people with physical impairment due to brain or nerve disorders. rPMS for people after stroke has proved to be a feasible approach to improving activities of daily living and functional ability. However, the effectiveness and safety of this intervention for people after stroke currently remain uncertain. This is an update of the review published in 2017. OBJECTIVES: To assess the effects of rPMS in improving activities of daily living and functional ability in people after stroke. SEARCH METHODS: On 7 January 2019, we searched the Cochrane Stroke Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE; Embase; the Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; the Allied and Complementary Medicine Database (AMED); Occupational Therapy Systematic Evaluation of Evidence (OTseeker); the Physiotherapy Evidence Database (PEDro); ICHUSHI Web; and six ongoing trial registries. We screened reference lists, and we contacted experts in the field. We placed no restrictions on the language or date of publication when searching electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) conducted to assess the therapeutic effect of rPMS for people after stroke. Comparisons eligible for inclusion were (1) active rPMS only compared with 'sham' rPMS (a very weak form of stimulation or a sound only); (2) active rPMS only compared with no intervention; (3) active rPMS plus rehabilitation compared with sham rPMS plus rehabilitation; and (4) active rPMS plus rehabilitation compared with rehabilitation only. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion. The same review authors assessed methods and risk of bias, undertook data extraction, and used the GRADE approach to assess the quality of evidence. We contacted trial authors to request unpublished information if necessary. We resolved all disagreements through discussion. MAIN RESULTS: We included four trials (three RCTs and one cross-over trial) involving 139 participants. Blinding of participants and physicians was well reported within all trials. We judged the overall risk of bias across trials as low. Only two trials (with 63 and 18 participants, respectively) provided sufficient information to be included in the meta-analysis. We found no clear effect of rPMS on activities of daily living at the end of treatment (mean difference (MD) -3.00, 95% confidence interval (CI) -16.35 to 10.35; P = 0.66; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD -2.00, 95% CI -14.86 to 10.86; P = 0.76; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We found no statistical difference in improvement of upper limb function at the end of treatment (MD 2.00, 95% CI -4.91 to 8.91; P = 0.57; 1 trial; 63 participants; low-quality evidence) and at the end of follow-up (MD 4.00, 95% CI -2.92 to 10.92; P = 0.26; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. We observed a significant decrease in spasticity of the elbow at the end of follow-up (MD -0.48, 95% CI -0.93 to -0.03; P = 0.03; 1 trial; 63 participants; low-quality evidence) when comparing rPMS plus rehabilitation versus sham plus rehabilitation. In terms of muscle strength, rPMS treatment was not associated with improved muscle strength of the ankle dorsiflexors at the end of treatment (MD 3.00, 95% CI -2.44 to 8.44; P = 0.28; 1 trial; 18 participants; low-quality evidence) when compared with sham rPMS. No studies provided information on lower limb function or adverse events, including death. Based on the GRADE approach, we judged the quality of evidence related to the primary outcome as low, owing to the small sample size of the studies. AUTHORS' CONCLUSIONS: Available trials provided insufficient evidence to permit any conclusions about routine use of rPMS for people after stroke. Additional trials with large sample sizes are needed to provide robust evidence for rPMS after stroke.

Robot controlled, continuous passive movement of the ankle reduces spinal cord excitability in participants with spasticity: a pilot study.

Spasticity of the ankle reduces quality of life by impeding walking and other activities of daily living. Robot-driven continuous passive movement (CPM) is a strategy for lower limb spasticity management but effects on spasticity, walking ability and spinal cord excitability (SCE) are unknown. The objectives of this experiment were to evaluate (1) acute changes in SCE induced by 30 min of CPM at the ankle joint, in individuals without neurological impairment and those with lower limb spasticity; and, (2) the effects of 6 weeks of CPM training on SCE, spasticity and walking ability in those with lower limb spasticity. SCE was assessed using soleus Hoffmann (H-) reflexes, collected prior to and immediately after CPM for acute assessments, whereas a multiple baseline repeated measures design assessed changes following 18 CPM sessions. Spasticity and walking ability were assessed using the Modified Ashworth Scale, the 10 m Walk test, and the Timed Up and Go test. Twenty-one neurologically intact and nine participants with spasticity (various neurological conditions) were recruited. In the neurologically intact group, CPM caused bi-directional modulation of H-reflexes creating 'facilitation' and 'suppression' groups. In contrast, amongst participants with spasticity, acute CPM facilitated H-reflexes. After CPM training, H-reflex excitability on both the more-affected and less-affected sides was reduced; on the more affected side H@Thres, H@50 and H@100 all significantly decreased following CPM training by 96.5 ± 7.7%, 90.9 ± 9.2%, and 62.9 ± 21.1%, respectively. After training there were modest improvements in walking and clinical measures of spasticity for some participants. We conclude that CPM of the ankle can significantly alter SCE. The use of CPM in those with spasticity can provide a temporary period of improved walking, but efficacy of treatment remains unknown.

Motor learning with the PNF-concept, an alternative to constrained induced movement therapy in a patient after a stroke; a case report.

INTRODUCTION: Over sixteen million people suffer a stroke each year. Stroke is characterized by a one-sided paresis. Upper extremity and hand function are most limited. The current view on "neuro rehabilitation" advocates a constrained induced movement therapy (CIMT) setting. This case report seeks to illustrate the clinical reasoning and the feasibility of applying an alternative approach in patients who are not accepted or not suitable for the constrained induced movement therapy. CASE DESCRIPTION: A male patient, 68 years of age, developed impairments in his right arm and hand, such as loss of range of motion and strength besides spasticity after a stroke. This resulted in a loss of dexterity in his affected right side and in "disuse" of that arm and hand. PATIENT MANAGEMENT: A therapy was designed based upon the Proprioceptive Neuromuscular Facilitation-concept (PNF-concept) and consisting of PNF pattern exercises in a functional task setting with specified PNF-principles of facilitations and PNF-techniques for motor re-learning activities, over a period of six weeks. This resulted in clinical important improvements of wrist extension, grip strength, spasticity, dexterity and patient satisfaction with specific tasks. DISCUSSION AND CONCLUSION: The provided comprehensive therapy mimics CIMT and robotics. The approach addresses possibly motor learning effects, cortical reorganization and structural impairments. Proprioceptive Neuromuscular Facilitation (PNF) - diagonal movement patterns have been described as: "having beneficial effects in cortical adaptations and cortical organization resulting in motor learning effects". In cases where CIMT is difficult to apply, a specified PNF-based therapy has shown to be a feasible alternative.