Shoulder function after constraint-induced movement therapy assessed with 3D kinematics and clinical and patient reported outcomes: A prospective cohort study.

INTRODUCTION: We hypothesised that reduced shoulder function post stroke improves during constraint-induced movement therapy and that improvement in scapula upward rotation measured with three-dimensional kinematics is associated with improvements in clinical and patient reported outcomes. METHODS: Thirty-seven patients were tested pre and post constraint-induced movement therapy and again at three-month follow-up. Kinematic outcome measures - with scapula upward rotation as the primary outcome - during tasks 5 (ReachLow) and 6 (ReachHigh) from the Wolf Motor Function Test were included together with clinical and patient reported outcomes. Changes in outcome measures were analysed with linear mixed models and logistic regression analysis. FINDINGS: Scapula upward rotation was reduced from 16.2° pre intervention through 15.9° post intervention to 15.6° at three-month follow-up during ReachHigh. Statistically significant reductions of <2° were also found for shoulder flexion during ReachLow and trunk lateral flexion during ReachHigh. The clinical and patient reported outcomes showed improvements post constraint-induced movement therapy, and at follow-up, the outcomes resembled post values. INTERPRETATION: The minimal improvements in selected 3D kinematic measures of upper extremity movements did not reflect any clinically meaningful changes. Therefore, the clinical and patient reported improvements could not be related to restitution of shoulder function.

Patients' and Health Professionals' Experiences of Group Training to Increase Intensity of Training after Acquired Brain Injury: A Focus Group Study.

BACKGROUND: Increased intensity of training in the subacute phase after acquired brain injury facilitates plasticity and enhances better function. Group training can be a motivating factor and an effective means of increasing intensity. Reports on patients' and health care professionals' experiences on increasing the amount of active practice through group training during in-patient rehabilitation after acquired brain injury have been limited. METHODS: Two focus groups, patients and health care professionals, participated each in two interviews, before and after implementation of the Activity block, i.e., 2-hour daily intensive group training. The data from the interviews were analyzed from a phenomenological perspective. RESULTS: Three categories emerged from the data analyzes (i) training intensity, (ii) motivation and meaningfulness, and (iii) expectations and concerns. Both groups experienced that the training after implementation of the Activity block had become more intense and that motivation was increased induced by the group setting. Also, both groups found self-management enhanced. Some challenges were also reported. Patients expressed concerns to finding a balance between rest and activity, while the health professionals mentioned practical challenges, i.e., planning the content of the day and finding their role in the Activity block. CONCLUSION: Activity block benefitted a heterogeneous group of patients with acquired brain injury and was perceived as an overall positive experience by patients and health personnel. Matching the training to the individuals' need for support, finding a balance between rest and activity and using tasks that support patients' motivation, appeared important.

Neuromuscular effects of dorsiflexor training with and without blood flow restriction.

Blood flow restriction training (BFRT) has been proposed for elderly and clinical populations with weakness. Before being used in these populations it is important to understand the neurological effects of, and subject perceptions to, BFRT. Seventeen healthy subjects were recruited and performed 2 experimental sessions, BFRT and training without blood flow restriction (TR-only), on separate days. Four sets of concentric/eccentric dorsiflexion contractions against theraband resistance were performed. Surface electromyography of the tibialis anterior was recorded during exercise and for the electrophysiological measures. At baseline, immediately-post, 10-min-post and 20-min-post exercise, motor evoked potentials (MEPs) from single pulse transcranial magnetic stimulation (TMS), paired-pulse TMS with interstimulus intervals of 2-ms (SICI) and 15-ms (ICF), and the M-max amplitude were recorded in the resting TA. Following training, subjects provided a numerical rating of the levels of pain, discomfort, fatigue, focus and difficulty during training. Muscle activation was higher in the last 20 contractions during BFRT compared to TR. There was no difference (time × condition interaction) between BFRT and TR for single-pulse MEP, SICI, ICF or M-max amplitude. There was a significant main effect of timepoint for single-pulse MEP and M-max amplitudes with both significantly reduced for 20-min-post exercise. No reductions were observed for SICI and ICF amplitudes. Taken together, BFRT and TR-only were only different during exercise and both regimes induced similar significant reductions in M-Max and MEP-amplitude post-training. Due to the lack of changes in SICI and ICF, it is unlikely that changes occurred in cortical sites related to these pathways. The increased surface electromyography activity in the last 20 contractions, indicate that the training regimes are different and that BFRT possibly induces more fatigue than TR. As such, BFRT could be used as an adjunct to conventional training. However, as subjects perceived BFRT as more painful, difficult and uncomfortable than TR-only, people should be selected carefully to undertake BFRT.

Patients' and Health Professionals' Experiences of Using Virtual Reality Technology for Upper Limb Training after Stroke: A Qualitative Substudy.

BACKGROUND: In recent years, virtual reality (VR) therapy systems for upper limb training after stroke have been increasingly used in clinical practice. Therapy systems employing VR technology can enhance the intensity of training and can also boost patients' motivation by adding a playful element to therapy. However, reports on user experiences are still scarce. METHODS: A qualitative investigation of patients' and therapists' perspectives on VR upper limb training. Semistructured face-to-face interviews were conducted with six patients in the final week of the VR intervention. Therapists participated in two focus group interviews after the completion of the intervention. The interviews were analyzed from a phenomenological perspective emphasizing the participants' perceptions and interpretations. RESULTS: Five key themes were identified from the patients' perspectives: (i) motivational factors, (ii) engagement, (iii) perceived improvements, (iv) individualization, and (v) device malfunction. The health professionals described the same themes as the patients but less positively, emphasizing negative technical challenges. CONCLUSION: Patients and therapists mainly valued the intensive and motivational character of VR training. The playful nature of the training appeared to have a significant influence on the patients' moods and engagement and seemed to promote a "gung-ho" spirit, so they felt that they could perform more repetitions.

Predicting shoulder function after constraint-induced movement therapy: a retrospective cohort study.

Background Several predictors have been associated with upper extremity (UE) recovery after stroke, but characteristics that predict shoulder function after constraint-induced movement therapy (CIMT) have not yet been identified. Objectives To identify predictors associated with satisfactory shoulder function in patients with reduced shoulder function at admission to CIMT. Methods One hundred and seventy five patients were treated using CIMT while in a specialized inpatient hospital. Satisfactory shoulder function was defined according to the functional ability scale of the Wolf Motor Function test. Predictors of satisfactory shoulder function after CIMT were identified using multivariable logistic regression. Results Better distal arm function and good proximal shoulder function on admission to CIMT were strong predictors of satisfactory shoulder function, while age and time of admission to CIMT since stroke were not. Seventeen percent of all CIMT-participants with reduced shoulder function pre-CIMT reached a level of satisfactory shoulder function after CIMT. Discussion A substantial part of patients with reduced shoulder function reached a level of satisfactory shoulder function after CIMT. Intensive CIMT training, comprising tasks that require both distal and proximal UE function, may increase shoulder function in patients with a potential functional reserve.