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1.
Plast Reconstr Surg ; 146(2): 343-354, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740587

RESUMO

Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.


Assuntos
Implementação de Plano de Saúde , Doenças Musculoesqueléticas/terapia , Sistemas On-Line , Ortopedia/organização & administração , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Estudos de Coortes , Coleta de Dados/métodos , Mãos/fisiopatologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Países Baixos , Ortopedia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Medição da Dor , Melhoria de Qualidade , Punho/fisiopatologia
2.
J Neurol Phys Ther ; 44(4): 256-260, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32815891

RESUMO

BACKGROUND AND PURPOSE: Telephone-based assessment may be a valuable and cost-effective approach to improve monitoring and follow-up assessments in patients and research participants. Telephone-based assessment may be of particular value during times when it is important to reduce in-person contract, such as during the Covid-19 pandemic. The purpose of this study was to investigate concurrent validity of the telephone-based administration of the ABILHAND for the assessment of manual ability in individuals with stroke. METHODS: Using a cross-sectional study design, participants with stroke were invited to answer the ABILHAND questionnaire on 2 randomized occasions, face to face and by telephone, 5 to 7 days apart. The mean difference (MD) between the interviews was calculated (95% confidence interval [95% CI]) to investigate the concurrent validity. Intraclass correlation (ICC) and weighted κ coefficients were used to investigate the agreement between face-to-face and telephone-based administration. RESULTS: One hundred two participants (50 men; mean age = 65 years, SD = 13 years) were included. No significant differences were observed between the mean scores obtained with face-to-face and telephone-based administration of the ABILHAND (MD = -0.06; 95% CI, -0.72 to 0.60). Very high agreement was found between face-to-face and telephone-based administration (ICC = 0.90; 95% CI, 0.85 to 0.93) on the ABILHAND total scores. Most of the individual items had moderate or substantial κ agreement. DISCUSSION AND CONCLUSIONS: Telephone-based administration of the ABILHAND is valid for the assessment of manual ability after stroke. Clinicians and researchers may use the ABILHAND for monitoring manual ability in persons with stroke and/or screening potential research participants.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A318).


Assuntos
Técnicas de Diagnóstico Neurológico/normas , Mãos/fisiopatologia , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Telemedicina , Telefone , Idoso , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Reprodutibilidade dos Testes
3.
J Vis Exp ; (159)2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32510515

RESUMO

A robot-assisted hand is used for the rehabilitation of patients with impaired upper limb function, particularly for stroke patients with a loss of motor control. However, it is unclear how conventional occupational training strategies can be applied to the use of rehabilitation robots. Novel robotic technologies and occupational therapy concepts are used to develop a protocol that allows patients with impaired upper limb function to grasp objects using their affected hand through a variety of pinching and grasping functions. To conduct this appropriately, we used five types of objects: a peg, a rectangular cube, a cube, a ball, and a cylindrical bar. We also equipped the patients with a robotic hand, the Mirror Hand, an exoskeleton hand that is fitted to the subject's affected hand and follows the movement of the sensor glove fitted to their unaffected hand (bimanual movement training (BMT)). This study had two stages. Three healthy subjects were first recruited to test the feasibility and acceptability of the training program. Three patients with hand dysfunction caused by stroke were then recruited to confirm the feasibility and acceptability of the training program, which was conducted on 3 consecutive days. On each day, the patient was monitored during 5 min of movement in a passive range of motion, 5 min of robot-assisted bimanual movement, and task-oriented training using the five objects. The results showed that both healthy subjects and subjects who had suffered a stroke in conjunction with the robotic hand could successfully grasp the objects. Both healthy subjects and those who had suffered a stroke performed well with the robot-assisted task-oriented training program in terms of feasibility and acceptability.


Assuntos
Exoesqueleto Energizado , Mãos , Robótica , Reabilitação do Acidente Vascular Cerebral/instrumentação , Adulto , Feminino , Mãos/fisiopatologia , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Movimento
4.
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
5.
Sci Rep ; 10(1): 10179, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32576918

RESUMO

Adductor-type spasmodic dysphonia (ADSD) manifests in effortful speech temporarily relievable by botulinum neurotoxin type A (BoNT-A). Previously, abnormal structure, phonation-related and resting-state sensorimotor abnormalities as well as peripheral tactile thresholds in ADSD were described. This study aimed at assessing abnormal central tactile processing patterns, their spatial relation with dysfunctional resting-state connectivity, and their BoNT-A responsiveness. Functional MRI in 14/12 ADSD patients before/under BoNT-A effect and 15 controls was performed (i) during automatized tactile stimulus application to face/hand, and (ii) at rest. Between-group differential stimulation-induced activation and resting-state connectivity (regional homogeneity, connectivity strength within selected sensory(motor) networks), as well as within-patient BoNT-A effects on these differences were investigated. Contralateral-to-stimulation overactivity in ADSD before BoNT-A involved primary and secondary somatosensory representations, along with abnormalities in higher-order parietal, insular, temporal or premotor cortices. Dysphonic impairment in ADSD positively associated with left-hemispheric temporal activity. Connectivity was increased within right premotor (sensorimotor network), left primary auditory cortex (auditory network), and regionally reduced at the temporoparietal junction. Activation/connectivity before/after BoNT-A within-patients did not significantly differ. Abnormal ADSD central somatosensory processing supports its significance as common pathophysiologic focal dystonia trait. Abnormal temporal cortex tactile processing and resting-state connectivity might hint at abnormal cross-modal sensory interactions.


Assuntos
Disfonia/fisiopatologia , Distúrbios Distônicos/fisiopatologia , Células Receptoras Sensoriais/fisiologia , Toxinas Botulínicas Tipo A/uso terapêutico , Mapeamento Encefálico/métodos , Disfonia/tratamento farmacológico , Distúrbios Distônicos/tratamento farmacológico , Feminino , Mãos/fisiopatologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Córtex Motor/efeitos dos fármacos , Córtex Motor/fisiopatologia , Fonação/efeitos dos fármacos , Fonação/fisiologia , Células Receptoras Sensoriais/efeitos dos fármacos , Fala/efeitos dos fármacos , Fala/fisiologia
8.
Muscle Nerve ; 62(2): 233-238, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32415859

RESUMO

INTRODUCTION: In contrast to needle electromyography (EMG), surface EMG recordings are painless. It is of interest to develop methods to analyze surface EMG for diagnostic purposes. METHODS: Surface EMG interference pattern (SIP) recordings from the abductor pollicis brevis muscle of healthy subjects and subjects with amyotrophic lateral sclerosis (ALS) were analyzed by measuring root-mean-square (RMS) voltage, mean rectified voltage, form factor (FF), and the clustering index (CI). The FF vs SIP area plot was used for analysis. RESULTS: The SIP FF was increased and abnormal in ALS subjects, especially when SIP area was less than 200 mVms. Power regression showed a faster FF decline with SIP area in ALS patients than in healthy subjects. The CI and FF showed a strong correlation. DISCUSSION: FF is easy to calculate and demonstrates abnormalities in ALS patients.


Assuntos
Potenciais de Ação/fisiologia , Esclerose Amiotrófica Lateral/fisiopatologia , Eletromiografia/métodos , Contração Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Eletrodiagnóstico/métodos , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Am J Occup Ther ; 74(3): 7403205080p1-7403205080p10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32365314

RESUMO

IMPORTANCE: Hand osteoarthritis is a musculoskeletal problem that is associated with hand pain, stiffness, functional limitation, decreased grip strength, and reduced quality of life. OBJECTIVE: To evaluate the effectiveness of nighttime orthoses on the second or third finger of the dominant hand in controlling pain in women with symptomatic osteoarthritis (OA) in the interphalangeal joint. DESIGN: Randomized controlled trial. SETTING: Outpatient clinic. PARTICIPANTS: Fifty-two women with symptomatic OA and presence of Heberden's and Bouchard's nodes, allocated randomly to the intervention group or the control group. INTERVENTION: The intervention group used a nighttime orthosis on the second or third finger of the dominant hand. Both groups participated in an educational session. OUTCOMES AND MEASURES: The following parameters were measured: pain (numerical rating scale, Australian/Canadian Osteoarthritis Hand Index), grip and pinch strength, function (Cochin Hand Functional Scale), and manual performance (Moberg Pick Up Test). RESULTS: The intervention group showed a statistically significant improvement in pain (p < .001) and hand function. The improvement in pain correlated with Cochin Hand Functional Scale scores and the absence of Bouchard's nodes in the third finger, which are predictors of the best prognosis for treatment with a nighttime orthosis. CONCLUSIONS AND RELEVANCE: This study demonstrates that nighttime orthoses are effective in reducing pain and lead to improvement in hand function in women with hand OA. They are therefore specifically recommended for nonpharmacological treatment of hand OA. WHAT THIS ARTICLE ADDS: Orthoses can be considered, together with manual exercises and joint protection, as an intervention to reduce symptoms and improve hand function in people with hand OA. This study is an important step in empowering occupational therapists to determine appropriate and effective intervention for clients with OA.


Assuntos
Mãos/fisiopatologia , Aparelhos Ortopédicos , Osteoartrite/terapia , Manejo da Dor/instrumentação , Austrália , Canadá , Feminino , Força da Mão , Humanos , Dor , Qualidade de Vida
10.
PLoS One ; 15(5): e0233175, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433665

RESUMO

This study investigated the generalized effects of positive feedback (PF) versus negative feedback (NF) during training on performance and sense of agency for a reach-to-touch task with a virtual hand. Virtual reality (VR) is increasingly employed for rehabilitation after neuromuscular traumas such as stroke and spinal cord injury. However, VR methods still need to be optimized for greater effectiveness and engagement to increase rates of clinical retention. In this study, we observed that training with disproportionate PF subsequently produced greater reaching performance (minimizing path length) and greater agency (perception of control) than with disproportionate NF. During PF training, there was also progressive increase in agency, but conversely a decrease in performance. Thus, the increase in performance after training may not be due to positively bolstered learning, but rather priming higher confidence reflected in greater agency. Agency was positively measured as compression in perceived time-intervals between the action of touch to a sound consequence, as standard with intentional binding paradigms. Positive feedback desirably increased agency (~180 msec) and reduced path length (1.8 cm) compared to negative feedback, which itself showed insignificant, or neutral, effects. Future investigations into optimizing virtual reality paradigms for neuromotor rehabilitation should consider agency as a driving factor for performance. These studies may serve to optimize how feedback is better presented with performance results for complex motor learning. Investigators should also ponder how personal characteristics, both cognitive and physical, may further affect sensitivity to feedback and the rate of neuromotor rehabilitation.


Assuntos
Mãos/fisiopatologia , Movimento , Realidade Virtual , Adulto , Feminino , Humanos , Masculino , Estudos Prospectivos , Tato
11.
J Neuroeng Rehabil ; 17(1): 66, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429963

RESUMO

BACKGROUND: We hypothesized that a selective neural electrical stimulation of radial and median nerves enables the activation of functional movements in the paralyzed hand of individuals with tetraplegia. Compared to previous approaches for which up to 12 muscles were targeted through individual muscular stimulations, we focused on minimizing the number of implanted electrodes however providing almost all the needed and useful hand movements for subjects with complete tetraplegia. METHODS: We performed acute experiments during scheduled surgeries of the upper limb with eligible subjects. We scanned a set of multicontact neural stimulation cuff electrode configurations, pre-computed through modeling simulations. We reported the obtained isolated and functional movements that were considered useful for the subject (different grasping movements). RESULTS: In eight subjects, we demonstrated that selective stimulation based on multicontact cuff electrodes and optimized current spreading over the active contacts provided isolated, compound, functional and strong movements; most importantly 3 out of 4 had isolated fingers or thumb flexion, one patient performed a Key Grip, another one the Power and Hook Grips, and the 2 last all the 3 Grips. Several configurations were needed to target different areas within the nerve to obtain all the envisioned movements. We further confirmed that the upper limb nerves have muscle specific fascicles, which makes it possible to activate isolated movements. CONCLUSIONS: The future goal is to provide patients with functional restoration of object grasping and releasing with a minimally invasive solution: only two cuff electrodes above the elbow. Ethics Committee / ANSM clearance prior to the beginning of the study (inclusion period 2016-2018): CPP Sud Méditerranée, #ID-RCB:2014-A01752-45, first acceptance 10th of February 2015, amended 12th of January 2016. TRIAL REGISTRATION: (www.clinicaltrials.gov): #NCT03721861, Retrospectively registered on 26th of October 2018.


Assuntos
Terapia por Estimulação Elétrica/métodos , Nervo Mediano/cirurgia , Quadriplegia/terapia , Nervo Radial/cirurgia , Traumatismos da Medula Espinal/terapia , Adulto , Eletrodos Implantados , Antebraço/fisiopatologia , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento/fisiologia , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicações , Adulto Jovem
12.
BMC Neurol ; 20(1): 181, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397973

RESUMO

BACKGROUND: Recovery patterns of motor function and activity capacity of the upper extremity after stroke have been described, but less is known about longitudinal changes of perceived manual activity performance. The aim of this study was to investigate longitudinal changes of self-perceived manual ability at several timepoints from onset until 12 months post-stroke in a cohort of consecutively recruited individuals with mild, moderate and severe stroke. METHODS: The study included 106 participants from a non-selected cohort with first-ever mild, moderate or severe stroke and impaired upper extremity function (Stroke Arm Longitudinal Study at the University of Gothenburg, SALGOT). Self-perceived manual ability was assessed with the ABILHAND Questionnaire at 3 and 10 days, 4 weeks, 3, 6 and 12 months after stroke. Longitudinal change was assessed by linear mixed models (fixed and random effects) and adjusted models were built by adding effects of cofactors age, gender, stroke severity, living condition and affected hand. RESULTS: Self-perceived manual ability increased over time the first year after stroke for the total group and the subgroups. The final adjusted model for the total group included fix-effects of time (expected mean change 0.24 logits per month) adjusted by age (- 0.06 per year) and stroke severity (- 0.19 per NIHSS-score). In addition to significant effect of time, the adjusted models for moderate stroke subgroup included fixed effect of age, and for mild and severe subgroups there was an interaction effect between time and age. Further analyses between time-points showed that no significant change of self-perceived manual ability was detected beyond 3 months post-stroke. CONCLUSIONS: Self-perceived manual ability increased over time the first year after stroke, and this change was to some degree modulated by age and stroke severity at onset. Most of the improvements occurred early, predominantly within the first three months after stroke.


Assuntos
Atividade Motora , Recuperação de Função Fisiológica , Autorrelato , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mãos/fisiopatologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários , Extremidade Superior/fisiopatologia
13.
Brain Stimul ; 13(3): 614-624, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32289686

RESUMO

BACKGROUND: Studies examining the contribution of contralesional brain regions to motor recovery after stroke have revealed conflicting results comprising both supporting and disturbing influences. Especially the relevance of contralesional brain regions beyond primary motor cortex (M1) has rarely been studied, particularly concerning the temporal dynamics post-stroke. METHODS: We, therefore, used online transcranial magnetic stimulation (TMS) interference to longitudinally assess the role of contralesional (right) frontoparietal areas for recovery of hand motor function after left hemispheric stroke: contralesional M1, contralesional dorsal premotor cortex (dPMC), and contralesional anterior intraparietal sulcus (IPS). Fourteen stroke patients and sixteen age-matched healthy subjects performed motor tasks of varying complexity with their (paretic) right hand. Motor performance was quantified using three-dimensional kinematic data. All patients were assessed twice, (i) in the first week, and (ii) after more than three months post-stroke. RESULTS: While we did not observe a significant effect of TMS interference on movement kinematics following the stimulation of contralesional M1 and dPMC in the first week post-stroke, we found improvements of motor performance upon interference with contralesional IPS across motor tasks early after stroke, an effect that persisted into the later phase. By contrast, for dPMC, TMS-induced deterioration of motor performance was only evident three months post-stroke, suggesting that a supportive role of contralesional premotor cortex might evolve with reorganization. CONCLUSION: We here highlight time-sensitive and region-specific effects of contralesional frontoparietal areas after left hemisphere stroke, which may influence on neuromodulation regimes aiming at supporting recovery of motor function post-stroke.


Assuntos
Córtex Motor/fisiopatologia , Movimento , Acidente Vascular Cerebral/fisiopatologia , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Parietal/fisiopatologia , Acidente Vascular Cerebral/terapia
14.
BMC Neurol ; 20(1): 133, 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32290815

RESUMO

BACKGROUND: Cerebral palsy (CP) causes motor, cognitive and sensory impairment at different extents. Many recent rehabilitation developments (therapies) have focused solely on the upper extremities (UE), although the lower extremities (LE) are commonly affected. Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the UE and LE. It involves constant stimulation of the UE and LE, for several hours each day over a 2-week period. The effects of HABIT-ILE have never been evaluated in a large sample of young children. Furthermore, understanding of functional, neuroplastic and biomechanical changes in infants with CP is lacking. The aim of this study is to carry out a multi-center randomized controlled trial (RCT) to evaluate the effects of HABIT-ILE in pre-school children with unilateral CP on functional, neuroplastic and biomechanical parameters. METHODS: This multi-center, 3-country study will include 50 pre-school children with CP aged 1-4 years. The RCT will compare the effect of 50 h (two weeks) of HABIT-ILE versus usual motor activity, including regular rehabilitation. HABIT-ILE will be delivered in a day-camp setting, with structured activities and functional tasks that will be continuously progressed in terms of difficulty. Assessments will be performed at 3 intervals: baseline (T0), two weeks later and 3 months later. Primary outcomes will be the Assisting Hand Assessment; secondary outcomes include the Melbourne Assessment-2, executive function assessments, questionnaires ACTIVLIM-CP, Pediatric Evaluation of Disability Inventory, Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, as well as neuroimaging and kinematics measures. DISCUSSION: We expect that HABIT-ILE will induce functional, neuroplastic and biomechanical changes as a result of the intense, activity-based rehabilitation process and these changes will impact the whole developmental curve of each child, improving functional ability, activity and participation in the short-, mid- and long-term. Name of the registry: Changes Induced by Early HABIT-ILE in Pre-school Children With Uni- and Bilateral Cerebral Palsy (EarlyHABIT-ILE). TRIAL REGISTRATION: Trial registration number: NCT04020354-Registration date on the International Clinical Trials Registry Platform (ICTRP): November 20th, 2018; Registration date on NIH Clinical Trials Registry: July 16th, 2019.


Assuntos
Paralisia Cerebral/terapia , Modalidades de Fisioterapia , Paralisia Cerebral/fisiopatologia , Pré-Escolar , Avaliação da Deficiência , Mãos/fisiopatologia , Humanos , Lactente , Extremidade Inferior/fisiopatologia , Destreza Motora/fisiologia , Plasticidade Neuronal , Prevenção Secundária , Inquéritos e Questionários , Extremidade Superior/fisiopatologia
15.
Percept Mot Skills ; 127(4): 684-697, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32321360

RESUMO

Manual dexterity has strongly predicted functional independence for daily life activities among children with cerebral palsy (CP). The Jebsen-Taylor Hand Function Test (JTHFT) is the most widely used assessment tool for exploring manual dexterity in the CP population, though no research has yet examined its psychometric properties for this use. This cross-sectional study explored the validity and internal consistency of the JTHFT in an Italian sample of inpatient and outpatient children with CP aged between 6-18 years (35 girls and 49 boys). We calculated internal consistency with Cronbach's alpha and tested validity against the Manual Ability Classification System (MACS) using Pearson's correlation coefficient. To better understand how the JTHFT compares with different levels of the MACS, we performed dominant hand timing variability for each test item. Results showed excellent internal consistency with a Cronbach's alpha of .944 and .911, respectively, for nondominant and dominant hands. There was also a statistically significant positive linear Pearson's correlation coefficient between the JTHFT and the MACS (p < .01). We observed high variability in writing performance (Item 1 of the JTHFT) within this sample for each level of the MACS. This study confirms that the JTHFT is a valid assessment tool when used in children with CP aged 6-18 years.


Assuntos
Paralisia Cerebral/fisiopatologia , Mãos/fisiopatologia , Adolescente , Criança , Estudos Transversais , Avaliação da Deficiência , Feminino , Humanos , Itália , Masculino , Psicometria , Reprodutibilidade dos Testes
16.
J Electromyogr Kinesiol ; 51: 102410, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32193087

RESUMO

To define the skin temperature at which diseased nerves are better differentiated from the healthy. Motor and sensory conduction of median and ulnar nerve were evaluated in 52 patients with carpal tunnel syndrome (CTS) and 52 matched healthy controls at environmental skin temperature (mean 32-33 °C), after warming by an average of 2 °C and cooling to approximately 6 °C below baseline. In the hot condition, group comparisons for the median nerve showed a similar rate of distal motor latency (DML) reduction and sensory conduction velocity (SCV) increase in CTS and controls. With cold, the rate of change was smaller for the patients: DML mean increase was 5% /°C (7% for controls) and SCV mean decrease was 2.5%/°C (3.2% for controls). Individual patients' analysis revealed fewer abnormal median DML and SCV values at hot or at cold, compared to environmental temperature. It is concluded that conduction adjustments for low hand temperatures based on healthy measurements resulted in overcorrection and therefore underdiagnosis of CTS. Alternatively, at excessive hand warming the convergence of patient and healthy measurements also lead to underdiagnosis. Maintenance of skin temperature at 32-33 °C, corresponding to normal body temperature, is the optimum approach and should always be employed in clinical practice.


Assuntos
Síndrome do Túnel Carpal/fisiopatologia , Mãos/fisiopatologia , Condução Nervosa , Temperatura , Adulto , Feminino , Mãos/inervação , Humanos , Masculino , Nervo Mediano/fisiopatologia , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Nervo Ulnar/fisiopatologia
17.
Am J Phys Med Rehabil ; 99(9): 795-800, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32167956

RESUMO

OBJECTIVE: The aim of the study was to determine the association of Nine Hole Peg Test, Box and Block Test, Jebsen-Taylor Hand Function Test, and kinematic measures of a simple reaching task with ataxia severity in adults with degenerative cerebellar disease. DESIGN: Fourteen adults with cerebellar degeneration were recruited, and ataxia severity was determined using the Scale for the Assessment and Rating of Ataxia. The median Scale for the Assessment and Rating of Ataxia score was used to divide participants into less and more severe ataxia groups. The two groups' average scores on the hand function tests were compared, and correlation of each test with ataxia severity was determined. RESULTS: The Nine Hole Peg Test, Box and Block Test, and Jebsen-Taylor Hand Function Test all differentiated between less and more severe ataxia groups, and the Nine Hole Peg Test performed with the participant's dominant hand had the highest correlation with ataxia severity (rs = 0.92, P < 0.01). Although accuracy, precision, and number of submovements were statistically different between healthy individuals and the more ataxic participant group, most kinematic measures were not significantly different between the less and more severe ataxic groups. CONCLUSION: Overall, our results indicate that all three clinical tests correlate with ataxia severity. Larger future studies should examine the reliability and validity of these hand function measures in adults with degenerative cerebellar disease.


Assuntos
Ataxia/fisiopatologia , Doenças Cerebelares/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Índice de Gravidade de Doença , Adulto , Idoso , Ataxia/etiologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Doenças Cerebelares/complicações , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/complicações , Projetos Piloto , Reprodutibilidade dos Testes , Análise e Desempenho de Tarefas , Adulto Jovem
18.
Am J Phys Med Rehabil ; 99(6): 514-521, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32167957

RESUMO

OBJECTIVE: Different methods of neuromuscular electrical stimulation may be used for poststroke upper limb rehabilitation. This study evaluated the effects of contralaterally controlled functional electrical stimulation of the triceps and finger extensors. DESIGN: This is a randomized controlled trial of 67 participants who were less than 2 yrs poststroke and assigned to the following: (a) arm + hand contralaterally controlled functional electrical stimulation, (b) hand contralaterally controlled functional electrical stimulation, or (c) arm + hand cyclic neuromuscular electrical stimulation. Participants were prescribed 10 sessions/week of assigned electrical stimulation at home plus 24 sessions of functional task practice in the laboratory for 12 wks. The primary outcome measure was the Box and Blocks Test. Secondary measures included reachable workspace, Upper Extremity Fugl-Meyer, Stroke Upper Limb Capacity Scale, Arm Motor Abilities Test, and Motor Activity Log. RESULTS: There were no significant between-group differences on the Box and Blocks Test. At 6 mos after treatment, arm + hand contralaterally controlled functional electrical stimulation improved reachable workspace more than hand contralaterally controlled functional electrical stimulation, between-group difference of 264 (95% confidence interval = 28-500) cm and more than arm + hand cyclic neuromuscular electrical stimulation, between-group difference of 281 (95% confidence interval = 22-540) cm. Arm + hand contralaterally controlled functional electrical stimulation improved Upper Extremity Fugl-Meyer score more than hand contralaterally controlled functional electrical stimulation, between-group difference of 6.7 (95% confidence interval = 0.6-12.7). The between-group differences on the Stroke Upper Limb Capacity Scale and Arm Motor Abilities Test were not significant. CONCLUSIONS: Adding contralaterally controlled elbow extension to hand contralaterally controlled functional electrical stimulation does not improve on gains in hand dexterity, but it further reduces upper limb impairment and improves reachable workspace measured in the laboratory. However, these additional benefits may not be large enough to be perceived by stroke survivors when they are performing activities of daily living at home.


Assuntos
Braço/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Mãos/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/métodos , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
19.
J Neuroeng Rehabil ; 17(1): 40, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32138780

RESUMO

BACKGROUND: Loss of hand function following high level spinal cord injury (SCI) is perceived as a high priority area for rehabilitation. Following discharge, it is often impractical for the specialist care centre to provide ongoing therapy for people living with chronic SCI at home, which can lead to further deterioration of hand function and a direct impact on an individual's capability to perform essential activities of daily living (ADL). OBJECTIVE: This pilot study investigated the therapeutic effect of a self-administered home-based hand rehabilitation programme for people with cervical SCI using the soft extra muscle (SEM) Glove by Bioservo Technologies AB. METHODS: Fifteen participants with chronic cervical motor incomplete (AIS C and D) SCI were recruited and provided with the glove device to use at home to complete a set task and perform their usual ADL for a minimum of 4 h a day for 12 weeks. Assessment was made at Week 0 (Initial), 6, 12 and 18 (6-week follow-up). The primary outcome measure was the Toronto Rehabilitation Institute hand function test (TRI-HFT), with secondary outcome measures including pinch dynamometry and the modified Ashworth scale. RESULTS: The TRI-HFT demonstrated improvement in hand function at Week 6 of the therapy including improvement in object manipulation (58.3 ±3.2 to 66.9 ±1.8, p ≈ 0.01), and palmar grasp assessed as the length of the wooden bar that can be held using a pronated palmar grip (29.1 ±6.0 cm to 45.8 ±6.8 cm, p <0.01). A significant improvement in pinch strength, with reduced thumb muscle hypertonia was also detected. Improvements in function were present during the Week 12 assessment and also during the follow-up. CONCLUSIONS: Self-administered rehabilitation using the SEM Glove is effective for improving and retaining gross and fine hand motor function for people living with chronic spinal cord injury at home. Retention of improved hand function suggests that an intensive activity-based rehabilitation programme in specific individuals is sufficient to improve long-term neuromuscular activity. Future studies should characterise the neuromuscular mechanism of action and the minimal rehabilitation programme necessary with the assistive device to improve ADL tasks following chronic cervical SCI. TRIAL REGISTRATION NUMBER: Trial registration: ISRCTN, ISRCTN98677526, Registered 01/June/2017 - Retrospectively registered, http://www.isrctn.com/ISRCTN98677526.


Assuntos
Exoesqueleto Energizado , Traumatismos da Medula Espinal/reabilitação , Atividades Cotidianas , Adulto , Feminino , Mãos/fisiopatologia , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Desempenho Psicomotor , Equipamentos de Autoajuda
20.
Neuropsychology ; 34(4): 479-492, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32134282

RESUMO

OBJECTIVE: It was suggested that the bimanual coupling effect might be linked to motor intentionality and planning, which are the top-down components of motor execution. However, previous results in pathological and healthy individuals have also underlined the pivotal role of bottom-up sensorimotor information. METHOD: In this single-case study, the Circles-Lines Coupling Task was administered to a left-parietal-brain-damaged individual. The cerebral lesion caused a central proprioceptive loss, relative to the impaired right hand, when out of the visual control. For the 1st time in literature, we sought to investigate whether the movement of the unaffected hand induced an efficient coupling effect on the movement of the affected one. The bimanual task was performed in the presence and absence of visual input. The patient's performance was compared with that of healthy controls. RESULTS: We observed the traditional bimanual coupling effect in healthy controls. Moreover, we also replicated the effect when they performed the task blindfolded. In the case of the patient, both hands showed the typical ovalization of the line trajectory when the task was performed in visual modality. It is interesting that when the patient performed the task blindfolded, the trajectories of the impaired right hand seemed to be not influenced by the concomitant circular movement of the spared left hand. CONCLUSIONS: The movement of the unaffected hand induced a bimanual coupling effect on the movement of the affected one only when the visual input was available. In absence of a visual feedback, the aberrant proprioceptive information might preclude the emerging of bimanual coupling, even in the case of a preserved motor intentionality and planning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/psicologia , Propriocepção , Adulto , Dano Encefálico Crônico/diagnóstico por imagem , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/psicologia , Retroalimentação Sensorial , Feminino , Lateralidade Funcional , Mãos/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Meningioma/complicações , Meningioma/psicologia , Pessoa de Meia-Idade , Lobo Parietal/diagnóstico por imagem , Desempenho Psicomotor
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