Effect of task-oriented training assisted by force feedback hand rehabilitation robot on finger grasping function in stroke patients with hemiplegia: a randomised controlled trial.

BACKGROUND: Over 80% of patients with stroke experience finger grasping dysfunction, affecting independence in activities of daily living and quality of life. In routine training, task-oriented training is usually used for functional hand training, which may improve finger grasping performance after stroke, while augmented therapy may lead to a better treatment outcome. As a new technology-supported training, the hand rehabilitation robot provides opportunities to improve the therapeutic effect by increasing the training intensity. However, most hand rehabilitation robots commonly applied in clinics are based on a passive training mode and lack the sensory feedback function of fingers, which is not conducive to patients completing more accurate grasping movements. A force feedback hand rehabilitation robot can compensate for these defects. However, its clinical efficacy in patients with stroke remains unknown. This study aimed to investigate the effectiveness and added value of a force feedback hand rehabilitation robot combined with task-oriented training in stroke patients with hemiplegia. METHODS: In this single-blinded randomised controlled trial, 44 stroke patients with hemiplegia were randomly divided into experimental (n = 22) and control (n = 22) groups. Both groups received 40 min/day of conventional upper limb rehabilitation training. The experimental group received 20 min/day of task-oriented training assisted by a force feedback rehabilitation robot, and the control group received 20 min/day of task-oriented training assisted by therapists. Training was provided for 4 weeks, 5 times/week. The Fugl-Meyer motor function assessment of the hand part (FMA-Hand), Action Research Arm Test (ARAT), grip strength, Modified Ashworth scale (MAS), range of motion (ROM), Brunnstrom recovery stages of the hand (BRS-H), and Barthel index (BI) were used to evaluate the effect of two groups before and after treatment. RESULTS: Intra-group comparison: In both groups, the FMA-Hand, ARAT, grip strength, AROM, BRS-H, and BI scores after 4 weeks of treatment were significantly higher than those before treatment (p < 0.05), whereas there was no significant difference in finger flexor MAS scores before and after treatment (p > 0.05). Inter-group comparison: After 4 weeks of treatment, the experimental group's FMA-Hand total score, ARAT, grip strength, and AROM were significantly better than those of the control group (p < 0.05). However, there were no statistically significant differences in the scores of each sub-item of the FMA-Hand after Bonferroni correction (p > 0.007). In addition, there were no statistically significant differences in MAS, BRS-H, and BI scores (p > 0.05). CONCLUSION: Hand performance improved in patients with stroke after 4 weeks of task-oriented training. The use of a force feedback hand rehabilitation robot to support task-oriented training showed additional value over conventional task-oriented training in stroke patients with hand dysfunction. CLINICAL TRIAL REGISTRATION INFORMATION: NCT05841108.

A Sensor-Based Upper Limb Treatment in Hemiplegic Patients: Results from a Randomized Pilot Study.

In post-stroke patients, the disabling motor deficit mainly affects the upper limb. The focus of rehabilitation is improving upper limb function and reducing long-term disability. This study aims to evaluate the feasibility of using the Gloreha Aria (R-Lead), a sensor-based upper limb in-hospital rehabilitation, compared with conventional physiotherapist-led training in subacute hemiplegic patients. Twenty-one patients were recruited and randomised 1:1 to a sensor-based group (treatment group TG) or a conventional group (control group, CG). All patients performed 30 sessions of 30 min each of dedicated upper limb rehabilitation. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE) was the primary evaluation., both as a motor score and as individual items. Secondary evaluations were Functional Independence Measure; global disability assessed with the Modified Barthel Index; Motor Evaluation Scale for UE in stroke; power grip; and arm, shoulder, and hand disability. All the enrolled patients, 10 in the TG and 11 in the CG, completed all hand rehabilitation sessions during their hospital stay without experiencing any adverse events. FMA-UE scores in upper limb motor function improved in both groups [delta change CG (11.8 ± 9.2) vs. TG (12.7 ± 8.6)]. The score at T1 for FMA joint pain (21.8 vs. 24 best score) suggests the use of the Gloreha Aria (R-Lead) as feasible in improving arm function abilities in post-stroke patients.

Increased trailing limb angle in hemiplegic patients after training with a knee orthosis: A randomized controlled trial.

BACKGROUND: Stroke often induces gait abnormality, such as buckling knee pattern, compromising walking ability. Previous studies indicated that an adequate trailing limb angle (TLA) is critical for recovering walking ability. OBJECTIVE: We hypothesized that correcting gait abnormality by immobilizing the knee joint using a knee orthosis (KO) would improve walking patterns and increase the TLA, and investigated whether walking training using a KO would increase the TLA in post-stroke patients. METHODS: In a randomized controlled trial, thirty-four participants were assigned to KO (walking training using a KO) and non-KO (without using a KO) groups. Twenty-nine completed the three-week gait training protocol. TLA was measured at baseline and after training. A two-way repeated ANOVA was performed to evaluate TLA increases with training type and time as test factors. A t-test compared TLA changes (ΔTLA) between the two groups. RESULTS: ANOVA showed a main effect for time (F = 64.5, p < 0.01) and interaction (F = 15.4, p < 0.01). ΔTLA was significantly higher in the KO group (14.6±5.8) than in the non-KO group (5.0±7.0, p < 0.001). CONCLUSION: Walking training using a KO may be practical and effective for increasing TLA in post-stroke patients.

Clinical effects of a novel deep learning-based rehabilitation application on cardiopulmonary function, dynamic and static balance, gait function, and activities of daily living in adolescents with hemiplegic cerebral palsy.

BACKGROUND: Adolescents with hemiplegic cerebral palsy undergo conventional physical therapy (CPT) to improve static and dynamic balance, activities of daily living and cardiopulmonary function. To overcome this problem, we developed an innovative deep learning-based rehabilitation application (DRA) to provide a motivational and chaffed platform for such individuals. DRA evaluates the patients' functional abilities and diagnosis an appropriate therapeutic intervention like CPT. METHODS: We compared the effects of DRA and CPT on 6-minute walking test (6 MWT), Borg rating of perceived exertion scale, Berg balance scale, functional ambulation category, and modified Barthel index in adolescents with hemiplegic cerebral palsy. A convenience sample of 30 adolescents with hemiplegic cerebral palsy was randomized into either the DRA or CPT group. DRA and CPT were administered to the participants, with each session lasting 30 minutes and apportioned thrice a week for a total of 4 weeks. RESULTS: Analysis of variance was performed and the level of significance was set at P < .05. The analysis indicated that DRA showed therapeutic effects on 6 MWT, Berg balance scale, and modified Barthel index compared to CPT. CONCLUSION: Our results provide evidence that DRA can improve cardiopulmonary function, balance, and activities of daily living more effectively than CPT in adolescents with hemiplegic cerebral palsy.

Effect of acupuncture combined with lower limb gait rehabilitation robot on improving walking function in stroke patients with hemiplegia.

BACKGROUND: No study has yet demonstrated the effect of lower limb gait rehabilitation robot treatment combined with acupuncture on stroke patients. OBJECTIVE: To explore the effect of acupuncture combined with lower limb gait rehabilitation robot on walking function in patients with hemiplegia after stroke. METHODS: Fifty-six patients with hemiplegia after stroke were enrolled and randomly divided into two groups. The control group received regular rehabilitation training and acupuncture therapy; the intervention group was additionally trained by AiWalker-I lower limb gait robot. Both groups received 5 sessions a week for 4 weeks. Walking function parameters were assessed before and after the 4-week treatment. RESULTS: There was no significant difference in all parameters between the two groups in baseline (P > 0.05). After 4 weeks of treatment, all parameters including the effectiveness of functional ambulation category (FAC), time up and go test (TUGT) time, Wisconsin gait scale (WGS) score, walking spatiotemporal parameters were all significantly improved in both groups with a significant better effect in the intervention group (P < 0.05). CONCLUSION: Acupuncture combined with lower limb gait rehabilitation robot training has a positive effect on correction of abnormal gait and improvement of walking ability of hemiplegic patients after stroke.

Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia.

BACKGROUND: Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care. OBJECTIVE: This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia. METHODS: The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed. RESULTS: The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group. CONCLUSION: HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.

Constraint-Induced Movement Therapy Promotes Myelin Remodeling and Motor Function by Mediating Sox2/Fyn Signals in Rats With Hemiplegic Cerebral Palsy.

OBJECTIVE: Hypoxic-ischemic brain injury in infants often leads to hemiplegic motor dysfunction. The mechanism of their motor dysfunction has been attributed to deficiencies of the transcription factor sex-determining region (SRY) box 2 (Sox2) or the non-receptor-type tyrosine kinase Fyn (involved in neuronal signal transduction), which causes a defect in myelin formation. Constraint-induced movement therapy (CIMT) following cerebral hypoxia-ischemia may stimulate myelin growth by regulating Sox2/Fyn, Ras homolog protein family A (RhoA), and rho-associated kinase 2 (ROCK2) expression levels. This study investigated how Sox2/Fyn regulates myelin remodeling following CIMT to improve motor function in rats with hemiplegic cerebral palsy (HCP). METHODS: To investigate the mechanism of Sox2 involvement in myelin growth and neural function in rats with HCP, Lentivirus (Lenti)-Sox2 adeno-associated virus and negative control-Lenti-Sox2 (LS) adeno-associated virus were injected into the lateral ventricle. The rats were divided into a control group and an HCP group with different interventions (CIMT, LS, or negative control-LS [NS] treatment), yielding the HCP, HCP plus CIMT (HCP + CIMT), HCP + LS, HCP + LS + CIMT, HCP + NS, and HCP + NS + CIMT groups. Front-limb suspension and RotaRod tests, Golgi-Cox staining, transmission electron microscopy, immunofluorescence staining, western blotting, and quantitative polymerase chain reaction experiments were used to analyze the motor function, dendrite/axon area, myelin ultrastructure, and levels of expression of oligodendrocytes and Sox2/Fyn/RhoA/ROCK2 in the motor cortex. RESULTS: The rats in the HCP + LS + CIMT group had better values for motor function, dendrite/axon area, myelin ultrastructure, oligodendrocytes, and Sox2/Fyn/RhoA/ROCK2 expression in the motor cortex than rats in the HCP and HCP + NS groups. The improvement of motor function and myelin remodeling, the expression of oligodendrocytes, and the expression of Sox2/Fyn/RhoA/ROCK2 in the HCP + LS group were similar to those in the HCP + CIMT group. CONCLUSION: CIMT might overcome RhoA/ROCK2 signaling by upregulating the transcription of Sox2 to Fyn in the brain to induce the maturation and differentiation of oligodendrocytes, thereby promoting myelin remodeling and improving motor function in rats with HCP. IMPACT: The pathway mediated by Sox2/Fyn could be a promising therapeutic target for HCP.

Effect of core stabilization versus rebound therapy on balance in children with cerebral palsy.

OBJECTIVE: This study aimed to compare the effect of core stabilization exercises and rebound therapy on balance in children with hemiplegic cerebral palsy (CP). METHODS: Fifty- two children of spastic hemiplegic CP aged 5 up to 8 years from both genders were assigned randomly into two groups: core stability and rebound therapy groups. Both groups received 3 sessions/week, 1.5-h training per session, for 12 successive weeks. The measurement was performed at baseline and post-treatment. Balance as a primary outcome for this study was measured by a Biodex Balance System (BBS), and knee extensor strength and functional capacity as secondary outcomes were assessed using a hand-held dynamometer, and a six-minute walk test (6MWT), respectively. RESULTS: All variables showed a significant improvement after intervention in each group (p < 0.0001), with significant improvement in all stability indices (overall, anteroposterior, and mediolateral) in core stability group when compared to rebound therapy group. CONCLUSION: Core stability exercises and rebound therapy are recommended in the rehabilitation of children with hemiplegic CP. Core stability exercises were more effective than rebound therapy for balance improvement. TRIAL REGISTRATION NUMBER: NCT05739396.

Immediate effects of standing unstable board intervention on the non-paralyzed leg on sitting balance in severe hemiplegia: a randomized controlled trial.

BACKGROUND: Unstable board intervention for patients with stroke improves sitting balance and trunk function. However, because patients with severe stroke are at high risk of falling, it is mostly adapted in mild cases. OBJECTIVE: We aimed to examine the effect of standing unstable board intervention for the non-paralyzed lower limbs on sitting balance in patients with hemiplegia. METHODS: The participants were 42 patients with stroke who were randomly assigned to a control or intervention group. In the intervention group, the non-paralyzed leg was placed on an unstable board, and the patient wore a knee-ankle-foot orthosis on the paralyzed side and practiced standing and weight-bearing exercises on the unstable board for 3 days. The outcomes were the angle of righting reaction of the neck, trunk, and both lower legs and the movement distance of the center of pressure of the righting reaction from lateral tilted sitting. RESULTS: In the intervention group, the righting reaction angle of the trunk to the paralyzed and non-paralyzed sides and the movement distance of the center of pressure were increased significantly after the unstable board intervention. CONCLUSION: The standing unstable board intervention for the non-paralyzed lower limb increased sensory input to the non-paralyzed side of the trunk weight-bearing on the lower limb of the paralyzed side. The increase in the righting reaction angle and the movement distance of the center of pressure contributed to improved sitting balance.

Relationship between motor dysfunction, the respiratory muscles and pulmonary function in stroke patients with hemiplegia: a retrospective study.

BACKGROUND: The interaction between motor dysfunction and respiratory functions in stroke patients with hemiplegia are not fully understood, particularly with regard to the relationship between changes in trunk control, balance, and daily activities, and changes in respiratory muscle strength and pulmonary volume. Investigating this relationship will facilitate the optimization of stroke rehabilitation strategies. METHODS: Clinical history data were collected from 134 patients to analyze the relationship between motor function scales scores and spirometric data. The data from 60 patients' data were used to evaluate the relationship between motor function scales scores and spirometric data at baseline and after 3-weeks rehabilitation. RESULTS: (1) Patients with lower scores on Trunk impairment Scale (TIS), Berg Balance Scale (BBS) and Barthel Index (BI) had weaker respiratory muscle strength and pulmonary function. (2) Stroke patients' BBS and BI scores showed differences between normal and unnormal maximal inspiratory pressure (MIP), but not in TIS. (3) Improvements in motor function led to promotion of enhanced respiratory function. Patient exhibited less MIP improvement at the severe level of TIS and BBS. CONCLUSIONS: Patients with hemiplegia exhibited diminished respiratory muscle strength and pulmonary function at a more severe motor dysfunction level. Impaired inspiratory muscle strength was associated with reduced balance ability and limitations in activities required for daily living. Enhanced motor function improved respiration and rehabilitation programs should prioritize the activation of diaphragm function to improve overall outcomes.

Modified-constraint movement induced therapy versus neuro-developmental therapy on reaching capacity in children with hemiplegic cerebral palsy.

BACKGROUND AND OBJECTIVE: Upper extremity impairment is one of the complications in hemiplegic children. The purpose of modified constraint-induced movement therapy (mCIMT) is to improve the function of impaired arms and hands in these children. This study compared the efficacy of mCIMT and the approach of neurodevelopmental therapy (NDT) on reaching capacity in children with spastic hemiplegia. METHODS: Fifty-two spastic hemiplegic children ranging in age from four to 6 years were selected for this study from an outpatient clinic and biomechanical lab (Prince Sattam bin Abdulaziz University, KSA). They were randomly divided into two experimental groups: group I received NDT and group II received mCIMT for the involved upper limb and restriction of the uninvolved arm movements for 12 weeks (three times per week). Both groups received a conventional exercise program in addition to experimental one. Active elbow extension range of motion and three-dimensional motion analysis of the reaching task were measured before and after 3 months of treatment. RESULTS: Significant enhancement in all pre-treatment and post-treatment outcomes was observed in both groups by a two-way mixed MANOVA; furthermore, Group II (mCIMT) showed the most significant improvement (elbow extension, percentage of reach to peak velocity, movement time and movement units) when comparing the post-treatment outcomes between the two groups (p < 0.001). IMPLICATION FOR PHYSIOTHERAPY PRACTICE: Addition of mCIMT to a conventional exercise was superior to adding NDT exercise therapy in promoting the performance of reaching pattern in hemiplegic children.

Usefulness of one-arm motorized gait device for chronic hemiplegic stroke survivors.

BACKGROUND: After stroke, gait training is a key component of rehabilitation, and most individuals use a variety of walking aids depending on their physical condition and environment. OBJECTIVE: This study aimed to investigate the potential effect of a one-arm motorized gait device for gait assist of chronic hemiplegic stroke survivors through comparison with traditional gait devices (parallel bar and hemi-walker). METHODS: This study was conducted on 14 chronic hemiplegic stroke survivors. The participants were asked to walk under three conditions using different gait devices, and their gait parameters during walking were collected and analyzed. The first condition involved walking on parallel bars; second condition, walking using hemi-walkers; and third condition, walking using one-arm motorized gait devices. With the use of a gait analysis system, the spatio-temporal gait parameters in each condition were collected, such as gait velocity, cadence, step length, stride length, single support time, and double support time. RESULTS: In the results by repeated-measures ANOVA or the Friedman test, a significant difference was found in the gait parameters among all three conditions (p< 0.05). The post-hoc test showed a significant change in the spatio-temporal gait parameters (especially, velocity, cadence and affected side single and double support time) when one-arm motorized gait device were used compared with parallel bars and hemi-walkers (p< 0.05). CONCLUSION: The results of this study suggest that one-arm motorized gait devices developed for hemiplegic stroke survivors may be more effective potentially than parallel bars and hemi-walkers in gait assistance of chronic hemiplegic stroke survivors.

Evaluation of finger strength and spasticity in hemiplegic patients using hand-finger robotic device: A validity and reliability study.

We aimed to investigate the validity, reliability, and clinical relevance of Amadeo hand-finger robotic rehabilitation system measurements for evaluating spasticity and strength in hemiplegic patients. In total, 161 participants (107 hemiplegic patients and 54 sex- and age-matched healthy controls) were included in this study. Spasticity was evaluated using the Modified Ashworth Scale, hand motor functions were evaluated using the Fugl-Meyer Assessment Hand Subscale, and hand grip and pinch strength were evaluated using the Jamar hand grip and pinch dynamometer. The Amadeo (Tyromotion) hand-finger robotic rehabilitation system was used to evaluate finger spasticity and strength of the participants. A statistically significant difference was found between the median values of the Modified Ashworth Scale (both clinical and robotic evaluation results) and the mean values of hand flexor and extensor strength measured with the robotic device in patients compared to healthy subjects (P < .01). Statistically, excellent agreement was obtained between the clinical and robotic test-retest results of the scale (P < .01) (intra-class correlation coefficient, ICC = .98-.99; ICC = .98-.99, respectively). There was a statistically significant positive correlation between the clinical and robotic device results of the Modified Ashworth Scale (r = .72; P < .01). There was a statistically significant positive correlation between the hand strength values measured with the robotic device, Jamar grip, pinch, and Fugl-Meyer Assessment Hand Subscale scores (P < .01) in the patient group. Hand finger spasticity and strength measurements of the Amadeo hand-finger robotic rehabilitation system were valid, reliable, and clinically correlated in stroke patients.

Research on an ankle rehabilitation robot for hemiplegic patients after stroke.

This paper proposes an ankle rehabilitation robot to assist hemiplegic patients with movement training. The robot consists of two symmetric mechanisms, allowing stroke survivors to execute ankle rehabilitation training based on physiological differences. LPMS-B sensors measure the range of movement (ROM) of the human ankle joint, and the results are used for control parameters of the robot. Control strategies for constant speed training mode, constant torque training mode, and combination training mode are put forth based on the hardware system of the robot. Experiments verify the feasibility of the robot for ankle rehabilitation training. Results show a maximum mean error of 0.3364° between the trajectory of the intact side and the affected side, a maximum mean error of 0.0335°/s between target speed and experimental speed, and a maximum mean error of 0.0775 N m between target torque and experimental torque. The ankle joint rehabilitation robot proposed in this paper can help patients complete the training well under the three control modes.

Combined Effects of Transcranial Magnetic Stimulation and Argatroban on Balance Function and Daily Living Activities in Hemiplegic Patients Following Cerebral Infarction.

Objective: This study aimed to investigate the impact of combining transcranial magnetic stimulation (TMS) with argatroban on balance function and activities of daily living in patients with hemiplegia following cerebral infarction (CI). Methods: A retrospective analysis was conducted on the clinical data of 104 patients with hemiplegia after CI who were admitted to our hospital from July 2020 to July 2021. The patients were randomly assigned to either the experimental group (EG) or the control group (CG), with 52 patients in each group. The EG received TMS in combination with argatroban, while the CG received argatroban alone. The Berg Balance Scale (BBS) and modified Barthel index (BI) were used to assess the balance function and activities of daily living in both groups after treatment. Results: After treatment, the EG demonstrated significantly higher BBS and BI scores compared to the CG (P < .001). Additionally, the EG showed significantly improved upper limb and lower limb Functional Ambulation Profile (FAM) scores compared to the CG (P < .05). Conclusions: The combination of TMS and argatroban proves to be an effective approach for enhancing balance function and activities of daily living in hemiplegic patients with CI. Therefore, it is recommended as a valuable rehabilitation treatment for such patients.

Quantitative measurement of finger usage in stroke hemiplegia using ring-shaped wearable devices.

BACKGROUND: In post-stroke rehabilitation, positive use of affected limbs in daily life is important to improve affected upper-limb function. Several studies have quantitatively evaluated the amount of upper-limb activity, but few have measured finger usage. In this study, we used a ring-shaped wearable device to measure upper-limb and finger usage simultaneously in hospitalized patients with hemiplegic stroke and investigated the association between finger usage and general clinical evaluation. METHODS: Twenty patients with hemiplegic stroke in an inpatient hospital participated in this study. All patients wore a ring-shaped wearable device on both hands for 9 h on the day of the intervention, and their finger and upper-limb usage were recorded. For the rehabilitation outcome assessments, the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), Simple Test for Evaluating Hand Function (STEF), Action Research Arm Test (ARAT), Motor Activity Log-14 (MAL), and Functional Independence Measure Motor (FIM-m) were performed and evaluated on the same day as the intervention. RESULTS: Finger usage of the affected hand was moderately correlated with STEF ([Formula: see text], [Formula: see text]) and STEF ratio ([Formula: see text], [Formula: see text]). The finger-usage ratio was moderately correlated with FMA-UE ([Formula: see text], [Formula: see text]) and ARAT ([Formula: see text], [Formula: see text]), and strongly correlated with STEF ([Formula: see text], [Formula: see text]) and STEF ratio ([Formula: see text], [Formula: see text]). The upper-limb usage of the affected side was moderately correlated with FMA-UE ([Formula: see text], [Formula: see text]), STEF ([Formula: see text], [Formula: see text]) and STEF ratio ([Formula: see text], [Formula: see text]), and strongly correlated with ARAT ([Formula: see text], [Formula: see text]). The upper-limb usage ratio was moderately correlated with ARAT ([Formula: see text], [Formula: see text]) and STEF ([Formula: see text], [Formula: see text]), and strongly correlated with the STEF ratio ([Formula: see text], [Formula: see text]). By contrast, there was no correlation between MAL and any of the measurements. CONCLUSIONS: This measurement technique provided useful information that was not biased by the subjectivity of the patients and therapists.

Use of Botulinum Toxin as a Treatment of Hemiplegic Shoulder Pain Syndrome: A Randomized Trial.

OBJECTIVE: The primary objective of this paper is to assess whether the use of 200 units of abobotulinum in the pectoralis major and subscapularis muscles modifies the pain complaint assessed using the visual analog scale in subjects with shoulder pain after the onset of spastic hemiplegia due to cerebrovascular disease when compared to the application of a placebo to the same muscles. DESIGN: A prospective, double-blind, randomized, and placebo-controlled clinical trial study in two different rehabilitation centers. SETTING: Two distinct outpatient neurological rehabilitation services. PARTICIPANTS: Patients older than 18 years who were included presented upper limb spasticity resulting from ischemic or hemorrhagic stroke and a diagnosis of Painful Hemiplegic Shoulder Syndrome (PHSS) that was independent of motor dominance. INTERVENTIONS: Patients were divided into two groups, one of them underwent the application of botulinum toxin (TXB-A) in the pectoralis major and subscapularis muscles, at a total dose of 400 U. MAIN OUTCOME MEASURE: Patients were assessed for a change in pain using the Visual Analog Scale (VAS) for at least 13 mm. RESULTS: An improvement in pain and spasticity levels in both groups, more intense in the toxin group, but without statistical significance. The comparison between the groups showed a reduction in pain by VAS (p = 0.52). CONCLUSIONS: The use of botulinum toxin in the subscapularis and pectoralis major muscles resulted in a reduction in shoulder pain in spastic hemiplegic patients without statistical significance.

Managing painful shoulder after neurological injury.

Shoulder pain is common after neurological injury and can be disabling, lead to poor functional outcomes and increase care costs. Its cause is multifactoral and several pathologies contribute to the presentation. Astute diagnostic skills and a multidisciplinary approach are required to recognise what is clinically relevant and to implement appropriate stepwise management. In the absence of large clinical trial data, we aim to provide a comprehensive, practical and pragmatic overview of shoulder pain in patients with neurological conditions. We use available evidence to produce a management guideline, taking into account specialty opinions from neurology, rehabilitation medicine, orthopaedics and physiotherapy.

Acute effects of Kinesio Taping on lower-limb coordination of gait in hemiplegic patients.

BACKGROUND: Kinesio taping can effectively strengthen weakened muscles, increase walking speed, and improve dynamic balance in hemiplegic patients, but its effect on lower-limb coordination is not clear. Improving lower-limb coordination in hemiplegic patients can decrease risk of fall during walking. RESEARCH QUESTION: This study utilized continuous relative phase to depict the pattern and variability of lower-limb coordination in hemiplegic patients and healthy subjects during walking, and investigate whether it has the acute effect of Kinesio Taping on lower-limb coordination in hemiplegic patients during walking. METHODS: Gait was measured by a three-dimensional motion capture system for 29 hemiplegic patients (KT group) and 15 healthy subjects (control group). Mean continuous relative phase (MCRP) and mean continuous relative phase variability (MCRPV) were calculated to describe and evaluate lower-limb coordination. RESULTS: KT intervention only changed the coordination between the bilateral ankle joints in hemiplegic patients. Before the intervention, the MCRP of the two ankles (AA-MCRP) in the stance period of the control group was greater than the KT group (P < 0.001), the MCRPV of the two ankles (AA-MCRPV) in the swing period was lower than that in KT group (P < 0.001). After the intervention, the AA-MCRP in the stance period of the KT group increased (P < 0.001), the AA-MRPV in the swing period of KT group significantly decreased (P = 0.001). SIGNIFICANCE: Immediate ankle KT intervention can result in the in-phase or anti-phase coordination between the two ankles developing to out-of-phase coordination during the stance period of the affected limb during walking, and increase the stability of the out-of-phase coordination between the two ankles during the swing period of the affected limb. KT can be used in rehabilitation treatment for hemiplegic patients to improve acute coordination between the patients' ankles.