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1.
Medicine (Baltimore) ; 100(3): e24351, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546067

RESUMO

PURPOSE: Although several types of occupational therapy for motor recovery of the upper limb in patients with chronic stroke have been investigated, most treatments are performed in a hospital or clinic setting. We investigated the effect of graded motor imagery (GMI) training, as a home exercise program, on upper limb motor recovery and activities of daily living (ADL) in patients with stroke. METHODS: This prospective randomized controlled trial recruited 42 subjects with chronic stroke. The intervention group received instruction regarding the GMI program and performed it at home over 8 weeks (30 minutes a day). The primary outcome measure was the change in motor function between baseline and 8 weeks, assessed the Manual Function Test (MFT) and Fugl-Meyer Assessment (FMA). The secondary outcome measure was the change in ADL, assessed with the Modified Barthel Index (MBI). RESULTS: Of the 42 subjects, 37 completed the 8-week program (17 in the GMI group and 20 controls). All subjects showed significant improvements in the MFT, FMA, and MBI over time (P < .05). However, the improvements in the total scores for the MFT, FMA, and MBI did not differ between the GMI and control groups. The MFT arm motion score for the GMI group was significantly better than that of the controls (P < .05). CONCLUSIONS: The GMI program may be useful for improving upper extremity function as an adjunct to conventional rehabilitation for patients with chronic stroke.


Assuntos
Terapia por Exercício/normas , Imagens, Psicoterapia/normas , Acidente Vascular Cerebral/complicações , Extremidade Superior/inervação , Adulto , Idoso , Distribuição de Qui-Quadrado , Terapia por Exercício/instrumentação , Terapia por Exercício/métodos , Feminino , Humanos , Imagens, Psicoterapia/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Estatísticas não Paramétricas , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia
2.
Sports Health ; 13(1): 57-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32649842

RESUMO

CONTEXT: Evidence concerning a systematic, comprehensive injury risk assessment in the elite swimming population is scarce. OBJECTIVE: To evaluate the quality of current literature regarding clinical assessment techniques used to evaluate the presence and/or development of pain/injury in elite swimmers and to categorize objective clinical assessment tools into relevant predictors (constructs) that should consistently be evaluated in injury risk screens of elite swimmers. DATA SOURCES: PubMed, Embase, Scopus, CINAHL, SPORTDiscus, PEDro, and the Cochrane Library Reviews were searched through September 2018. STUDY SELECTION: Studies were included for review if they assessed a correlation between clinic-based objective measures and the presence and/or development of acute or chronic pain/injury in elite swimmers. All body regions were included. Elite swimmers were defined as National Collegiate Athletic Association, collegiate, and junior-, senior-, or national-level swimmers. Only cohort and cross-sectional studies were included (both prospective and retrospective); randomized controlled trials, expert opinion, and case reports were excluded, along with studies that focused on interventions, performance, or specific swim-stroke equipment or technology. STUDY DESIGN: Systematic review and qualitative analysis. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were utilized at each phase of review by 2 reviewers; a third reviewer was utilized for tie breaking purposes. Qualitative analysis was performed using the Methodological Items for Non-Randomized Studies (MINORS) assessment tool. RESULTS: A total of 21 studies assessed the presence and/or development of injury/pain in 3 different body regions: upper extremity, lower extremity, and spine. Calculated average MINORS scores for comparative (n = 17) and noncomparative (n = 4) studies were 18.1 of 24 and 10.5 of 16, respectively. Modifiable, objectively measurable injury risk factors in elite swimmers were categorized into 4 constructs: (1) strength/endurance, (2) mobility, (3) static/dynamic posture, and (4) patient-report regardless of body region. CONCLUSION: Limited evidence exists to draw specific correlations between identified clinical objective measures and the development of pain and/or injury in elite swimmers.


Assuntos
Medição de Risco/métodos , Natação/lesões , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/fisiopatologia , Força Muscular , Exame Físico , Postura , Fatores de Risco , Autorrelato , Traumatismos da Coluna Vertebral/etiologia , Traumatismos da Coluna Vertebral/fisiopatologia , Extremidade Superior/lesões , Extremidade Superior/fisiopatologia
3.
Artigo em Inglês | MEDLINE | ID: mdl-33339299

RESUMO

BACKGROUND: Aquatic physiotherapy has been shown to be effective in developing balance, strength, and functional reach over time. When dealing with immediate effects, the literature has concentrated more on the body's physiological response to the physical and mechanical properties of water during passive immersion. The purpose of this study was to evaluate the effects of a single 45-min active aquatic physiotherapy session on standing balance and strength, and its relationship with functional reach in persons 55 years and older with upper limb dysfunction. METHODS: The intervention group (n = 12) was assessed before and after a single aquatic physiotherapy session, while the control group (n = 10) was evaluated before and after 45 min of sitting rest. Functional assessment was made using the visual analogue pain scale (points), step test (repetitions), functional reach test (cm), and global balance-standing test on a force platform (% time). A two-way repeated-measures ANOVA was applied (p < 0.05). RESULTS: The intervention group showed non-significant improvements between measurement before and after the intervention: Pain: 6.2 ± 1.9 vs. 5.2 ± 2.3 cm, steps: 7.0 ± 2.0 vs. 7.4 ± 1.8 repetitions, reach: 9.1 ± 2.8 vs. 10.4 ± 3.8 cm, and balance: 61.7 ± 5.9 vs. 71.3 ± 18.2% time in balance on the platform. The control group showed fewer changes but had better baseline values. A comparison between groups with time showed no significant differences in these changes. CONCLUSIONS: No significant immediate effects were found for one session of aquatic physiotherapy applied to patients older than 55 years with upper limb dysfunction.


Assuntos
Modalidades de Fisioterapia , Equilíbrio Postural , Extremidade Superior , Idoso , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Extremidade Superior/fisiopatologia
4.
PLoS One ; 15(9): e0239064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986757

RESUMO

The Performance of the Upper Limb (PUL) module is an externally-assessed clinical scale, initially designed for the Duchenne muscular dystrophy population. It provides an upper extremity functional score suitable for both weaker ambulatory and non-ambulatory phases up to the severely impaired patients. It is capable of characterizing overall progression and severity of disease and of tracking the stereotypical proximal-to-distal progressive loss of upper limb function in muscular dystrophy. Since the PUL module has been validated only with Duchenne patients, its use also for Becker and Limb-Girdle muscular dystrophy patients has been here evaluated, to verify its reliability and extend its use. In particular, two different assessors performed this scale on 32 dystrophic subjects in two consecutive days. The results showed that the PUL module has high reliability, both absolute and relative, based on the calculation of Pearson's r (0.9942), Intraclass Correlation Coefficient (0.9943), Standard Error of Measurement (1.36), Minimum Detectable Change (3.77), and Coefficient of Variation (3%). The Minimum Detectable Change, in particular, can be used in clinical trials to perform a comprehensive longitudinal evaluation of the effects of interventions with the lapse of time. According to this analysis, an intervention is effective if the difference in the PUL score between subsequent evaluation points is equal or higher than 4 points; otherwise, the observed effect is not relevant. Inter-rater reliability with ten different assessors was evaluated, and it has been demonstrated that deviation from the mean is lower than calculated Minimum Detectable Change. The present work provides evidence that the PUL module is a reliable and valid instrument for measuring upper limb ability in people with different forms of muscular dystrophy. Therefore, the PUL module might be extended to other pathologies and reliably used in multicenter settings.


Assuntos
Distrofia Muscular de Duchenne/fisiopatologia , Extremidade Superior/fisiopatologia , Adolescente , Adulto , Técnicas e Procedimentos Diagnósticos , Progressão da Doença , Humanos , Distrofia Muscular de Duchenne/diagnóstico , Reprodutibilidade dos Testes , Adulto Jovem
5.
J Rehabil Med ; 52(10): jrm00118, 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-32915239

RESUMO

OBJECTIVE: To investigate the effectiveness of self-administered, home-based, upper limb practice in improving upper limb activity after stroke. To compare structured home-based practice vs non-structured home-based practice. METHODS: Databases were searched for randomized or quasi-randomized controlled trials using a pre-defined search strategy. Data were extracted from 15 studies involving 788 participants. The quality of included studies was assessed using the PEDro scale. The studies included an experimental group that received self-administered, home-based practice for upper limb activity limitations of any level of severity and any time after stroke, and a control group that received no intervention, or received non-structured home-based practice. Only measures of upper limb activity were investigated. RESULTS: Self-administered, home-based practice did not improve activity compared with no intervention (standardized mean difference 0.00, 95% confidence interval; -0.47 to 0.48). There was no difference between structured and non-structured home-based practice in terms of upper limb activity (SMD -0.05, 95% CI -0.22 to 0.13). CONCLUSION: Existing self-administered, home-based practice is not more effective than no intervention in improving upper limb activity in chronic, severely disabled stroke survivors. Structured home-based practice is no more effective than non-structured home-based practice.


Assuntos
Autocuidado/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Feminino , Serviços de Assistência Domiciliar , Humanos , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento , Extremidade Superior/fisiopatologia
7.
Medicine (Baltimore) ; 99(34): e21846, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846833

RESUMO

INTRODUCTION: Stroke often causes residual hemiparesis, and upper extremity motor impairment is usually more disabling than lower extremity in those who are suffering from post-stroke hemiparesis. Cell therapy is one of the promising therapies to reduce post-stroke disability. PATIENT CONCERNS: Three male participants were included in the study to investigate the feasibility and tolerability of autologous adipose tissue derived stromal vascular fraction. DIAGNOSIS: All participants had hemiparesis after 1st-ever stroke longer than 6 months previously. INTERVENTIONS: Under general anesthesia, liposuction of abdominal subcutaneous fat was performed. Stromal vascular fraction freshly isolated from the adipose tissue extract was injected into the muscles of paretic upper extremity. All participants received inpatient stroke rehabilitation consisted of physical and occupational therapy more than 3 hours a day for 2 months or more. OUTCOMES: The whole procedure did not produce any significant adverse event in all participants. Adipose tissue extracts yielded sufficient stromal cells. One participant showed clinically important change in upper extremity Fugl-Meyer assessment after the injection and it lasted up to 6 months. Functional magnetic resonance imaging showed concomitant increase in ipsilesional cortical activity. The other 2 participants did not show remarkable changes. LESSONS: Intramuscular injection of autologous adipose tissue derived stromal vascular fraction seems to be a safe and tolerable procedure in subjects with chronic stroke, and its utility in rehabilitation needs further investigation.


Assuntos
Tecido Adiposo/irrigação sanguínea , Tecido Adiposo/transplante , Transplante de Células-Tronco Mesenquimais/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Células Estromais/transplante , Tecido Adiposo/citologia , Adulto , Hemorragia Cerebral/complicações , Humanos , Injeções Intramusculares , Lipectomia/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Células-Tronco Mesenquimais , Terapia Ocupacional/métodos , Paresia/fisiopatologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Células Estromais/citologia , Extremidade Superior/fisiopatologia
8.
PLoS One ; 15(7): e0235314, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645051

RESUMO

OBJECTIVES: 1) Determine the effects of old age on sensorimotor responses to a fatiguing work-like task. 2) Explore how old age influences the relationships between task fatigability, everyday perceptions of fatigability, and sensorimotor function. METHODS: Healthy young (N = 17, 9W) and older (N = 13, 10W) adults completed the Pittsburgh Fatigability Scale to assess everyday perceptions of physical (PF) and mental fatigability and performed a repetitive tapping task to fatigue. Before and after the task, grip strength was assessed using a hand-grip dynamometer and touch-pressure sensitivity was measured (shoulder, hand) using Semmes-Weinstein monofilaments. RESULTS: Older, but not young adults, had increased touch-pressure sensitivity at the shoulder after fatigue (interaction, p = 0.007). No changes in grip strength were observed (p>0.05). Task fatigability was not different between young and old adults (p>0.05). Having less task fatigability was associated with lower PF, higher grip strength, and higher touch-pressure sensitivity at the hand (ρ = 0.37-0.58, p<0.05), with the hand sensation association also observed in the old adult subgroup (ρ = 0.56, p = 0.046). CONCLUSIONS: With old age, there were fatigue-related alterations to sensory but not physical function. While task fatigability was associated with perceptual, physical, and sensory features, sensory features appear to have a more important role with old age.


Assuntos
Envelhecimento/fisiologia , Fadiga/fisiopatologia , Atividade Motora/fisiologia , Extremidade Superior/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Fadiga Mental/fisiopatologia , Pessoa de Meia-Idade , Percepção , Pressão , Estatísticas não Paramétricas , Análise e Desempenho de Tarefas , Tato/fisiologia , Adulto Jovem
9.
Zhongguo Zhen Jiu ; 40(7): 697-701, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32648390

RESUMO

OBJECTIVE: To compare the therapeutic effect of yin-yang balance penetrating acupuncture combined with rehabilitation training and single rehabilitation training on upper limb spasticity in patients with stroke hemiplegia. METHODS: A total of 60 patients with upper limb spasticity of stroke hemiplegia were randomized into an observation group and a control group, 30 cases in each one. On the basis of conventional western medication, rehabilitation training was adopted in the control group. On the basis of treatment in the control group, yin-yang balance penetrating acupuncture was applied from Jianyu (LI 15) to Binao (LI 14), Quchi (LI 11) to Shaohai (HT 3), Yanglingquan (GB 34) to Yinlingquan (SP 9), Xuanzhong (GB 39) to Sanyinjiao (SP 6), etc. of the affected side in the observation group. The treatment was given once a day, 5 days were as one course, with a 2-day interval between two courses, 4 courses were required in both groups. The classification of modified Ashworth spasticity scale (MAS), surface integrated electromyogram (iEMG) of affected upper limb and the scores of National Institute of Health stroke scale (NIHSS), Fugl-Meyer assessment (FMA) of upper limb and modified Barthel index (MBI) before and after treatment were observed, the therapeutic effect was evaluated in both groups. RESULTS: ①After treatment, the MAS classification reduced in both groups (P<0.05), the cases of grade 0 to Ⅰ+ in the observation group were more than those in the control group (P<0.05); iEMG values of the maximum isometric voluntary contraction of affected usculus biceps brachii, musculus triceps brachii, musculus flexor carpi, musculus extensor carpi, extensor digitorum, aductor pollicis brevis were increased in both groups (P<0.05), and the variations of iEMG of above muscles on the affected side in the observation group were larger than those in the control group (P<0.05). ②After treatment, the scores of NIHSS were decreased (P<0.05), the scores of FMA, MBI were increased in both groups (P<0.05), and the variations of NIHSS, FMA and MBI scores were larger than those in the control group (P<0.05). ③The total effective rate was 93.3% (28/30) in the observation group, which was superior to 70.0% (21/30) in the control group (P<0.05). CONCLUSION: Yin-yang balance penetrating acupuncture combined with rehabilitation training can improve upper limb spasticity, heighten the motor function of upper limb and daily self care in patients with stroke hemiplegia, its therapeutic effect is superior to single rehabilitation training.


Assuntos
Terapia por Acupuntura , Hemiplegia/terapia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Yin-Yang , Hemiplegia/etiologia , Humanos , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Extremidade Superior/fisiopatologia
10.
Medicine (Baltimore) ; 99(29): e21040, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702844

RESUMO

BACKGROUND: Functional disability is the most common disorder that occurs after stroke and seriously affects the quality of life of stroke survivors. Tai Chi Yunshou (TCY), a fundamental form of Tai Chi, is a simple, convenient, and economical exercise therapy from ancient China. Some clinical trials have reported that it improves upper limb function and balance during stroke rehabilitation. Thus, we plan to conduct a systematic review to investigate the effects of TCY in stroke survivors. METHODS: This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. We will search English and Chinese databases for randomized controlled trials on TCY for stroke survivors from the dates when the databases were established to 1 July 2020. The English databases will include MEDLINE (PubMed), EMBASE (embase.com), and the Cochrane Central Register of Controlled Trials (Cochrane Library). In addition, the Chinese databases will include the Chinese National Knowledge Infrastructure, the Chinese Biomedical Literature Database, the Chinese Science and Technology Periodical Database, the Wanfang database, and the Chinese Dissertation Database. The primary outcomes will include upper limb function and balance function, as measured by the Fugl-Meyer assessment and Berg balance scale, respectively. Two reviewers will independently screen the studies on the basis of the inclusion criteria and extract data. Review Manager (v5.3) will be used for data synthesis, and Cochrane Collaboration's tool will be used to assess the risk of bias. A fixed effects model or a random effects model will be selected based on the level of heterogeneity. The grading of recommendations assessment, development, and evaluation system will be used to evaluate the quality of the outcomes. RESULTS: This systematic review results will be carried out after the completion of the protocol. CONCLUSIONS: This protocol aims to guide a systematic review and meta-analysis investigating the effects of JCY on upper limb function and body balance in stroke survivors, which will provide evidence for post-stroke rehabilitation training. PROSPERO REGISTRATION NUMBER: CRD42020169549.


Assuntos
Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Tai Ji , Extremidade Superior/fisiopatologia , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
11.
Health Qual Life Outcomes ; 18(1): 247, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703292

RESUMO

BACKGROUND: The English version of the Chedoke Arm and Hand Activity Inventory is a validated, upper-limb measure with the purpose of assessing functional recovery of the arm and hand after a stroke. A German translation and cross-cultural adaptation was recently produced and demonstrated high validity, inter-rater reliability and internal consistency. As a follow-up, the present study evaluated the intra-rater reliability and responsiveness of the CAHAI-G for the long and all shortened versions. METHODS: The CAHAI-G and the Action Research Arm Test were assessed on three different measurement events: upon entry (ME1), two to 3 days after entry (ME2), and after three to 4 weeks (ME3). For the intra-rater reliability analysis, the ME1 CAHAI assessments were recorded on video and rated by three therapists to obtain the intraclass coefficients (ICC). The data of all three MEs were analysed in a group of stroke inpatients for the evaluation of responsiveness. To test for responsiveness, the CAHAI-G change data were compared to concurrent instruments: The Global Rating of Change-questionnaire and the Global Rating of Concept-questionnaire. Both served as external criteria. For all CAHAI-G versions (7, 8, 9 or 13 items), the same analysis procedures for the evaluation of the responsiveness parameter were performed. RESULTS: In total, 27 patients (9 females, age 63 ± 13.7) were enrolled in the study. The ICCs for the intra-rater reliability were calculated to be between 0.988 and 0.998 for all CAHAI versions. Responsiveness parameters were as follows from CAHAI-G 7 to 13: Minimal Detectable Change (MDC90) 5.3, 6.0, 6.1, 8.2; Pearson's correlation coefficients CAHAI-Gs with ARAT 0.365, 0.409*, 0.500**, 0.597**. The Area und Under the Curve and the Minimal Clinical Important Difference values for all CAHAI-G versions and the three external criteria ranged between 0.483 to 0.603 and 2.5 to 9.0, respectively. CONCLUSION: In addition to the high validity, inter-rater reliability and internal consistency, the CAHAI-G revealed high intra-rater reliability. The data also suggest an adequate responsiveness of the CAHAI-G versions 9 and 13.


Assuntos
Reabilitação do Acidente Vascular Cerebral/psicologia , Inquéritos e Questionários/normas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Suíça , Traduções , Extremidade Superior/fisiopatologia
12.
NeuroRehabilitation ; 46(4): 551-559, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508335

RESUMO

BACKGROUND: Spastic hypertonia of the upper limb after stroke or traumatic brain injuries (TBI) is a prevalent clinical sign causing abnormal postures and movement patterns due to hyperexcitability of the upper motor neurons and rheological alterations in the affected muscles. These alterations limit the use of the upper limb, restricting its functional activities and affecting the individual's quality of life and social participation. OBJECTIVE: To determine the association between spastic patterns of the upper limb, wrist, fingers and thumb, and independence in everyday activities after a stroke or TBI. METHODS: The design is a cross-sectional descriptive and correlational study. The sample consisted of 206 individuals who complied with the eligibility criteria and signed an informed consent. Clinical evaluation was carried out, including determination of the postural pattern of the upper extremity according to Hefter's taxonomy and postural pattern classification of the wrist, fingers and thumb. Functional independence was evaluated using the Functional Independence Measure (FIM) and the Barthel Index (BI). RESULTS: Univariate between-subject ANOVAs were used to examine associations of the four pattern classifications with the two independence measures, FIM and BI. Results indicate that Pattern I of Hefter's upper limb taxonomy is associated with lesser functional independence according to FIM and BI mean scores. CONCLUSIONS: The postural pattern of the upper limb after TBI or stroke is related to the patient's functional independence. Specifically, Pattern I tends to co-occur with low independence.


Assuntos
Atividades Cotidianas , Lesões Encefálicas Traumáticas/fisiopatologia , Equilíbrio Postural , Acidente Vascular Cerebral/fisiopatologia , Extremidade Superior/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral
13.
NeuroRehabilitation ; 46(4): 561-567, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508338

RESUMO

BACKGROUND: Hemiplegic shoulder pain (HSP) after stroke has negative effects on functional use of hemiplegic arm. OBJECTIVE: This study aimed to investigate the effects of HSP on upper extremity motor function and proprioception. METHODS: Hundred and twenty-two patients with hemiplegia were included in this study. The patients' shoulder pain was evaluated by Visual Analog Scale. According to pain scores, patients were divided into two groups as group with HSP (Group 1, n = 76) and group without HSP (Group 2, n = 46). Upper extremity motor function level and proprioception were assessed by using Fugl Meyer Motor Function Scale and the Laser-pointer Assisted Angle Reproduction Test for the 45°, 60° and 90° of shoulder flexion. RESULTS: Upper extremity motor function and shoulder's proprioceptive sense at each angles of group 1 were found significantly worse than group 2's (p≤0.005). Correlation analysis revealed a significant positive correlation between HSP severity, and upper extremity motor dysfunction and proprioceptive impairment (p < 0.005). CONCLUSIONS: Presence of HSP is one of the main determinators of upper extremity motor function level and proprioceptive ability at different angles. Management of HSP can make a significant contribution to sensorimotor integration by leading to recovery in the motor function and proprioceptive acuity.


Assuntos
Hemiplegia/fisiopatologia , Propriocepção , Amplitude de Movimento Articular , Dor de Ombro/fisiopatologia , Adulto , Idoso , Feminino , Hemiplegia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Dor de Ombro/etiologia , Extremidade Superior/fisiopatologia
14.
NeuroRehabilitation ; 46(4): 569-575, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508342

RESUMO

BACKGROUND: It is very difficult for patients with severe upper extremity (UE) paresis after stroke to achieve full recovery because of the lack of a definitive approach for improving severe UE paresis immediately after onset. OBJECTIVE: to investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on severe UE paresis during early acute phase of stroke. METHODS: Nineteen participants with severe UE disability met the criteria. 10 subjects received 15-20 minutes of rPMS prior to standard care per session, while 9 age- and severity-matched subjects received two times 20 minutes of standard care. Outcome measures included UE motor section of the Fugl-Meyer Motor Assessment Scale (FMA-UE), Wolf motor function test (WMFT), and box and block test (BBT). RESULTS: The rPMS group received treatment (average sessions: 7.8) after a median 9.2 days from stroke (16.5 sessions after 5 days for control). To adjust the different treatment durations, we defined "progress rate" as the gains of UE function scores divided by treatment duration. The progress rate was significantly different in FMA-UE and WMFT, but not in BBT. CONCLUSIONS: The present study suggested beneficial effects of rPMS on severe UE paresis during early acute phase of stroke.


Assuntos
Terapia de Campo Magnético/métodos , Paresia/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Acidente Vascular Cerebral/complicações , Extremidade Superior/fisiopatologia
15.
JMIR Mhealth Uhealth ; 8(7): e17216, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32480361

RESUMO

BACKGROUND: Recent advancements in wearable sensor technology have shown the feasibility of remote physical therapy at home. In particular, the current COVID-19 pandemic has revealed the need and opportunity of internet-based wearable technology in future health care systems. Previous research has shown the feasibility of human activity recognition technologies for monitoring rehabilitation activities in home environments; however, few comprehensive studies ranging from development to clinical evaluation exist. OBJECTIVE: This study aimed to (1) develop a home-based rehabilitation (HBR) system that can recognize and record the type and frequency of rehabilitation exercises conducted by the user using a smartwatch and smartphone app equipped with a machine learning (ML) algorithm and (2) evaluate the efficacy of the home-based rehabilitation system through a prospective comparative study with chronic stroke survivors. METHODS: The HBR system involves an off-the-shelf smartwatch, a smartphone, and custom-developed apps. A convolutional neural network was used to train the ML algorithm for detecting home exercises. To determine the most accurate way for detecting the type of home exercise, we compared accuracy results with the data sets of personal or total data and accelerometer, gyroscope, or accelerometer combined with gyroscope data. From March 2018 to February 2019, we conducted a clinical study with two groups of stroke survivors. In total, 17 and 6 participants were enrolled for statistical analysis in the HBR group and control group, respectively. To measure clinical outcomes, we performed the Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment of Upper Extremity, grip power test, Beck Depression Inventory, and range of motion (ROM) assessment of the shoulder joint at 0, 6, and 12 months, and at a follow-up assessment 6 weeks after retrieving the HBR system. RESULTS: The ML model created with personal data involving accelerometer combined with gyroscope data (5590/5601, 99.80%) was the most accurate compared with accelerometer (5496/5601, 98.13%) or gyroscope data (5381/5601, 96.07%). In the comparative study, the drop-out rates in the control and HBR groups were 40% (4/10) and 22% (5/22) at 12 weeks and 100% (10/10) and 45% (10/22) at 18 weeks, respectively. The HBR group (n=17) showed a significant improvement in the mean WMFT score (P=.02) and ROM of flexion (P=.004) and internal rotation (P=.001). The control group (n=6) showed a significant change only in shoulder internal rotation (P=.03). CONCLUSIONS: This study found that a home care system using a commercial smartwatch and ML model can facilitate participation in home training and improve the functional score of the WMFT and shoulder ROM of flexion and internal rotation in the treatment of patients with chronic stroke. This strategy can possibly be a cost-effective tool for the home care treatment of stroke survivors in the future. TRIAL REGISTRATION: Clinical Research Information Service KCT0004818; https://tinyurl.com/y92w978t.


Assuntos
Serviços de Assistência Domiciliar , Internet , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/fisiopatologia , Telerreabilitação , Extremidade Superior/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Idoso , Doença Crônica , Terapia por Exercício/estatística & dados numéricos , Humanos , Aprendizado de Máquina , Pessoa de Meia-Idade , Aplicativos Móveis , Modelos Teóricos , Estudos Prospectivos , Sobreviventes , Resultado do Tratamento
16.
Occup Ther Int ; 2020: 2387378, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32565757

RESUMO

Objectives: Spontaneous arm use in patients with poststroke hemiparesis is crucial to the recovery of functional interaction. Patients with stroke and subsequent right hemiparesis have more difficulty adapting to a right-handed environment. The aim of this study was to use wearable devices to assess the asymmetry and difference in the amount of activity of the nondominant and dominant affected hands among patients with stroke and right hemiparesis. The real activity of both hands was measured to assess the correlation with various aspects of the International Classification of Functioning, Disability and Health (ICF). Subjects and Methods. Patients with stroke and right hemiparesis were recruited. They were divided into two groups according to the affected hand. Groups A and B comprised patients with affected nondominant and dominant hands, respectively. The Fugl-Meyer assessment-Upper Extremity (FM-UE) scores, Motor Activity Log (MAL), and hand function domain scores on the Stroke Impact Scale (SIS) were used for assessment. Patients were asked to wear smart wearable devices on both hands 24 hours a day for a month. The amount of activity in both hands was recorded and analyzed. Results: A total of 29 patients with stroke were divided into group A (n = 14) and group B (n = 15). FM-UE scores were significantly and strongly correlated with the amount of use (AOU) in the MAL. The recorded differential real activity of both hands in group B was significantly lower than that in group A. The asymmetry index of hand use was significantly less favorable in group B. However, no significant differences in AOU in the MAL, FM-UE, and hand function domain in the SIS were identified between the nondominant and dominant affected hands. Conclusions: The asymmetry and differential activity of both hands were worse in the patients with poststroke right hemiparesis, whose dominant hand was affected. However, no differences of three aspects of the ICF were found between dominant and nondominant affected hands.


Assuntos
Avaliação da Deficiência , Dominância Cerebral , Mãos/fisiopatologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional , Paresia/etiologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral , Extremidade Superior/fisiopatologia , Dispositivos Eletrônicos Vestíveis
17.
BMC Neurol ; 20(1): 254, 2020 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-32593293

RESUMO

BACKGROUND: Stroke is a leading cause of long-term disability. Cost-effective post-stroke rehabilitation programs for upper limb are critically needed. Brain-Computer Interfaces (BCIs) which enable the modulation of Electroencephalography (EEG) sensorimotor rhythms are promising tools to promote post-stroke recovery of upper limb motor function. The "Promotoer" study intends to boost the application of the EEG-based BCIs in clinical practice providing evidence for a short/long-term efficacy in enhancing post-stroke hand functional motor recovery and quantifiable indices of the participants response to a BCI-based intervention. To these aims, a longitudinal study will be performed in which subacute stroke participants will undergo a hand motor imagery (MI) training assisted by the Promotoer system, an EEG-based BCI system fully compliant with rehabilitation requirements. METHODS: This longitudinal 2-arm randomized controlled superiority trial will include 48 first ever, unilateral, subacute stroke participants, randomly assigned to 2 intervention groups: the BCI-assisted hand MI training and a hand MI training not supported by BCI. Both interventions are delivered (3 weekly session; 6 weeks) as add-on regimen to standard intensive rehabilitation. A multidimensional assessment will be performed at: randomization/pre-intervention, 48 h post-intervention, and at 1, 3 and 6 month/s after end of intervention. Primary outcome measure is the Fugl-Meyer Assessment (FMA, upper extremity) at 48 h post-intervention. Secondary outcome measures include: the upper extremity FMA at follow-up, the Modified Ashworth Scale, the Numeric Rating Scale for pain, the Action Research Arm Test, the National Institute of Health Stroke Scale, the Manual Muscle Test, all collected at the different timepoints as well as neurophysiological and neuroimaging measures. DISCUSSION: We expect the BCI-based rewarding of hand MI practice to promote long-lasting retention of the early induced improvement in hand motor outcome and also, this clinical improvement to be sustained by a long-lasting neuroplasticity changes harnessed by the BCI-based intervention. Furthermore, the longitudinal multidimensional assessment will address the selection of those stroke participants who best benefit of a BCI-assisted therapy, consistently advancing the transfer of BCIs to a best clinical practice. TRIAL REGISTRATION: Name of registry: BCI-assisted MI Intervention in Subacute Stroke (Promotoer). TRIAL REGISTRATION NUMBER: NCT04353297 ; registration date on the ClinicalTrial.gov platform: April, 15/2020.


Assuntos
Interfaces Cérebro-Computador , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto , Eletroencefalografia/métodos , Feminino , Humanos , Imaginação/fisiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral/instrumentação , Extremidade Superior/fisiopatologia
18.
BMC Neurol ; 20(1): 243, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532249

RESUMO

BACKGROUND: Cerebral palsy (CP), which is the leading cause of motor disability during childhood, can produce sensory and cognitive impairments at different degrees. Most recent therapeutic interventions for these patients have solely focused on upper extremities (UE), although more than 60% of these patients present lower extremities (LE) deficits. Recently, a new therapeutic concept, Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), has been proposed, involving the constant stimulation of UE and LE. Based on motor skill learning principles, HABIT-ILE is delivered in a day-camp setting, promoting voluntary movements for several hours per day during 10 consecutive week days. Interestingly, the effects of this intervention in a large scale of youngsters are yet to be observed. This is of interest due to the lack of knowledge on functional, neuroplastic and biomechanical changes in infants with bilateral CP. The aim of this randomized controlled study is to assess the effects of HABIT-ILE adapted for pre-school children with bilateral CP regarding functional, neuroplastic and biomechanical factors. METHODS: This international, multicentric study will include 50 pre-school children with CP from 12 to 60 months of age, comparing the effect of 50 h (2 weeks) of HABIT-ILE versus regular motor activity and/or customary rehabilitation. HABIT-ILE presents structured activities and functional tasks with continuous increase in difficulty while the child evolves. Assessments will be performed at 3 period times: baseline, two weeks later and 3 months later. The primary outcome will be the Gross Motor Function Measure 66. Secondary outcomes will include Both Hands Assessment, Melbourne Assessment-2, Semmes-Weinstein Monofilament Test, algometry assessments, executive function tests, ACTIVLIM-CP questionnaire, Pediatric Evaluation of Disability Inventory (computer adaptative test), Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, neuroimaging and kinematics. DISCUSSION: The results of this study should highlight the impact of a motor, intensive, goal-directed therapy (HABIT-ILE) in pre-school children at a functional, neuroplastic and biomechanical level. In addition, this changes could demonstrated the impact of this intervention in the developmental curve of each child, improving functional ability, activity and participation in short-, mid- and long-term. NAME OF THE REGISTRY: Evaluation of Functional, Neuroplastic and Biomechanical Changes Induced by an Intensive, Playful Early-morning Treatment Including Lower Limbs (EARLY-HABIT-ILE) in Preschool Children With Uni and Bilateral Cerebral Palsy (HABIT-ILE). TRIAL REGISTRATION: NCT04017871 REGISTRATION DATE: July 12, 2019.


Assuntos
Paralisia Cerebral/reabilitação , Modalidades de Fisioterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Canadá , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Extremidade Inferior/fisiopatologia , Masculino , Destreza Motora/fisiologia , Estudos Multicêntricos como Assunto , Extremidade Superior/fisiopatologia
19.
J Neuroeng Rehabil ; 17(1): 76, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539738

RESUMO

BACKGROUND: Reduction of compensation and improved movement quality indicate recovery after stroke. Since clinical measures alone are often inadequate to distinguish between behavioral recovery and compensation, kinematic analysis of functional tasks has been recommended. OBJECTIVE: To quantify longitudinal changes and residual deficits in movement performance and quality during the first year after stroke using kinematic analysis of drinking task. METHODS: A total of 56 participants with first ever stroke causing upper extremity impairment were extracted from a non-selected stroke unit cohort (Stroke Arm Longitudinal Study at the University of Gothenburg-SALGOT). Participants needed to able to perform the drinking task with the more-affected arm at least on 2 occasions out of 6 (3 days, 10 days, 4 weeks, and 3, 6, and 12 months) during the first year to be included. A cohort of 60 healthy individuals was used as reference. Longitudinal changes were analyzed using linear mixed models. RESULTS: Movement time, number of movement units, peak angular velocity of the elbow, peak hand velocity, and trunk displacement improved significantly over the first 3 months with a peak at 6 months. Movement time and peak hand velocity reached levels comparable to healthy at 3 months, but number of movement units, peak elbow angular velocity, trunk displacement, and arm abduction remained different from healthy over the first year after stroke. CONCLUSIONS: Even when the recovery patterns of kinematics follow the known nonlinear pattern, not all kinematic measures reach the levels in par with healthy controls at one year post stroke. Since the number of movement units, peak angular velocity, trunk displacement, and arm abduction remained impaired over the first year, they might be the most suited measures to distinguish behavioral recovery from compensation strategies. TRIAL REGISTRATION: ClinicalTrials: NCT01115348. 4 May 2010. Retrospectively registered.


Assuntos
Movimento/fisiologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/fisiopatologia , Adulto , Idoso , Fenômenos Biomecânicos , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Extremidade Superior/fisiopatologia
20.
J Neuroeng Rehabil ; 17(1): 73, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32539812

RESUMO

BACKGROUND: Non-invasive brain stimulation techniques have been shown in several studies to improve the motor recovery of the affected upper-limbs in stroke patients. This study aims to investigate whether or not cathodal transcranial direct current stimulation (c-tDCS), combined with virtual reality (VR), is superior to VR alone in reducing motor impairment and improving upper limb function and quality of life in stroke patients. METHODS: Forty patients who suffered ischemic stroke between 2 weeks to 12 months were recruited for this single-blind randomized control trial. The patients were randomly assigned either to an experimental group who receiving c-tDCS and VR, or a control group receiving sham stimulation and VR. The cathodal electrode was positioned over the primary motor cortex (M1) of the unaffected hemisphere. The treatment session consisted of 20 min of daily therapy, for 10 sessions over a 2-week period. The outcome measures were the Fugl-Meyer Upper Extremity (FM-UE), the Action Research Arm Test (ARAT) and the Barthel Index (BI). RESULTS: The two groups were comparable in demographic characteristic and motor impairment. After 2 weeks of intervention, both groups demonstrated significant improvement in FM-UE, ARAT and BI scores (P<0.05).The experiment group demonstrated more improvement in FM-UE than the control group (10.1 vs. 6.4, p = 0.003) and, ARAT (7.0 vs 3.6, p = 0.026) and BI (12.8 vs 8.5, p = 0.043). CONCLUSIONS: The findings from our study support that c-tDCS, along with VR, can facilitate a stronger beneficial effect on upper limb motor impairment, function and quality of life than VR alone in patients with ischemic stroke. TRIAL REGISTRATION: The study was registered in the Chinese Clinical Trial Registry (ChiCTR1800019386) in November 8, 2018-Retrospectively registered.


Assuntos
Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral , Estimulação Transcraniana por Corrente Contínua/métodos , Terapia de Exposição à Realidade Virtual/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Método Simples-Cego , Acidente Vascular Cerebral/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/efeitos adversos , Extremidade Superior/fisiopatologia
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