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1.
J Stroke Cerebrovasc Dis ; 30(6): 105774, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33848906

RESUMO

This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided into two groups: Control (CG) and CIMT (CIMTG); evaluated before and after 12 and 24 intervention sessions. The scales used were: adapted Fugl-Meyer Motor Assessment (FMA), Modified Ashworth, Stroke Specific Quality Of Life (SS-QOL) and the Functional Reach Test (FRT). The scores for all FMA variables in the CIMTG increased until the 24th session, differing from the pre-treatment. In the CG, the scores increased for pain, coordination/ speed and sensitivity. In the FRT there was an increase in the scores in both groups; after the 12th and 24th sessions, the result of the CIMTG was superior to the CG. For the SS-QOL in the CIMTG, the general score and most of the variables increased, as well as in the CG. Muscle tone in CIMTG was lower compared to CG after 24 sessions. Both protocols used in the study were effective, the CIMT protocol showed benefits in recovering the functionality of the paretic upper limb, in the functional range and in reducing muscle tone, with a consequent improvement in quality of life.


Assuntos
Terapia por Exercício , Atividade Motora , Paresia/reabilitação , Qualidade de Vida , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/terapia , Extremidade Superior/inervação , Idoso , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Cooperação do Paciente , Estudos Prospectivos , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(16): e25212, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879656

RESUMO

ABSTRACT: Gait rehabilitations have been abundantly performed for post-stroke patients, because gait is the most important factor for the return of post-stroke patients to daily life. However, conventional uniform gait rehabilitations tend to be tedious and reduce motivation. The aim of this study was to contribute to the development of personalized rehabilitation of gait by identifying differences in gait recovery pattern according to the paralyzed side of post-stroke patients.The gait analysis was performed on stroke patients who are right-handed and can walk independently. We retrospectively analyzed the results of pelvic movements and displacement of center of pressure (COP) during gait using corresponding equipments. To show the difference of gait recovery pattern according to the paralyzed side, we divided subjects into two groups, right (n = 19) and left (n = 20) hemiparesis group. The measured variables were as follows: tilt, obliquity, and rotation symmetries of pelvis; area, velocity, and lateral symmetry of COP.First, in the left hemiparesis group, obliquity (P < .01) and rotation (P < .01) symmetries of the movement of the pelvis were significantly improved in the follow-up compared to the initial gait analysis. In the right hemiparesis group, tilt (P < .001), obliquity (P < .001), and rotation (P < .05) symmetries were significantly improved in the follow-up compared to the initial gait analysis. Second, COP area and COP velocity values in the follow-up were significantly smaller than those in the initial gait analysis in the left (P < .001, P < .05) and right (P < .001, P < .01) hemiparesis groups. The positive value of lateral symmetry increased, although not a significant difference statistically, as walking ability improved in both groups. In the correlation analysis among variables obtained using Treadmill, there were significant positive linear relationships between the lateral symmetry and the COP area (P < .05), and between the COP velocity and the lateral symmetry (P < .001) of the follow-up gait analysis in the right hemiparesis group.It was confirmed that the gait recovery pattern differs according to the paralyzed side of post-stroke patients and the role of the intact side, such as moving the COP to the intact side, is important for the improvement of gait function in both groups.This study was registered with the Clinical Research Information Service (CRIS) of the Korea National Institute of Health (NIH), Republic of Korea (KCT0002984) and was approved by the Institutional Review Board (IRB) of the WKUGH (WKIRB [2018-25], November 28, 2018).


Assuntos
Transtornos Neurológicos da Marcha/reabilitação , Paresia/reabilitação , Recuperação de Função Fisiológica , Reabilitação do Acidente Vascular Cerebral/estatística & dados numéricos , Acidente Vascular Cerebral/fisiopatologia , Idoso , Teste de Esforço , Feminino , Lateralidade Funcional , Marcha/fisiologia , Análise da Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Movimento , Paresia/etiologia , Pelve/fisiopatologia , República da Coreia , Estudos Retrospectivos , Resultado do Tratamento
3.
Neurology ; 95(17): e2318-e2330, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-32999058

RESUMO

OBJECTIVE: To determine the effects of a 12-week home-based motor training telerehabilitation program in patients with subcortical stroke by combining motor function assessments and multimodality MRI analysis methods. METHODS: Fifty-two patients with stroke and hemiplegia were randomly assigned to either a home-based motor training telerehabilitation (TR) group or a conventional rehabilitation (CR) group for 12 weeks. The Fugl-Meyer assessment (FMA) for upper and lower extremities and the modified Barthel Index were used as primary outcomes. The secondary outcomes included resting-state functional connectivity (rsFC) between the bilateral M1 areas, gray matter volumes of the primary motor cortex (M1) areas, and white matter integrity of the corticospinal tract. Analysis of covariance was applied to examine the effects of the home-based motor training TR program on neural function recovery and brain plasticity. RESULTS: Compared with the CR group, the TR group showed significant improvement in the FMA (p = 0.011) and significantly increased M1-M1 rsFC (p = 0.031) at the end of the rehabilitation. The M1-M1 rsFC change was significantly positively correlated with the FMA change in the TR group (p = 0.018). CONCLUSION: This study showed a beneficial effect of the home-based motor training telerehabilitation program on motor function in patients with stroke, which was accompanied by enhanced interhemispheric functional connectivity of the M1 areas. We inferred that it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home. The combined use of imaging biomarkers should be encouraged in motor training clinical studies in patients with stroke. CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for patients with stroke with hemiplegia, home-based telerehabilitation compared to conventional rehabilitation significantly improves some motor function tests.


Assuntos
Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/diagnóstico por imagem , Telerreabilitação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Imagem de Tensor de Difusão , Avaliação da Deficiência , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/fisiopatologia , Serviços de Assistência Domiciliar , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiopatologia , Vias Neurais , Plasticidade Neuronal , Paresia/etiologia , Paresia/reabilitação , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/fisiopatologia , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/instrumentação , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(43): e22423, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120737

RESUMO

Severe stroke patients are known to be associated with larger rehabilitation length of stay (LOS) but other factors besides severity may be contributing. We aim to identify LOS predictors within a population of mostly severe patients and analyze the impact of socioeconomic situation in functionality at admission.A retrospective observational cohort study was conducted including 172 inpatients admitted to a rehabilitation center between 2007 and 2019. Associations with LOS were examined among 30 potential predictor variables using bivariate correlations. Significantly correlated (P < .002, Bonferroni adjustment) variables were entered into 9 different multiple linear regression models.No mild participants were included, 63.37% severe and 36.63% moderate. Most significant LOS determinants were: 1) total functional independence measure (FIM) (P < .001) and hemiparesis (P = .0108) (adjusted R = 0.24), 2) cognitive FIM (P = .002) and severity (P = .001) (adjusted R = 0.22), and 3) home accessibility (P = .043) and hemiparesis (P = 0.032) (adjusted R = 0.19).Known LOS predictors (e.g., depression, ataxia) within the full stroke severities were not found significant in our dataset.Socioeconomic situation was found moderately correlated with total FIM (r = -0.32, P < .0001).When stratifying the patients' socioeconomic situation into mild, important, and severe social risk, their respective median total FIM at admission were 61.5, 50, and 41, with significant differences between the mild and important group (P < .001); also significant differences were found between mild and severe groups (P < .001).A few of the variables identified in the literature as significant predictors of LOS within the full stroke population were also significant for our dataset (National Institutes of Health Stroke Scale, FIM, home accessibility) explaining less than 25% of the LOS variance. Most of the 30 analyzed known predictors were not significant (e.g., depression, age, recurrent stroke, ataxia, orientation, verbal communication, etc) suggesting that factors outside functional, socioeconomic, medical, and demographics not included in this study (e.g., rehabilitation sessions intensity) have important influences on LOS for severe patients.Patients at mild social risk obtained significantly higher total FIM at admission than patients at important and severe social risk. The importance of socioeconomic situation has been scarcely studied in the literature in relation to functionality at admission; our results suggest that it requires to be considered.


Assuntos
Avaliação da Deficiência , Tempo de Internação/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Paresia/reabilitação , Centros de Reabilitação , Estudos Retrospectivos , Fatores Socioeconômicos
5.
J Stroke Cerebrovasc Dis ; 29(10): 105174, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912567

RESUMO

Stroke survivors often face difficulty in community ambulation though they attain steady-state walking in clinical setups. Compliance and unpredictability of the environment may alter the muscle activity and challenge the individual's gait. Successful reintegration into the community requires gait assessment and training in a real-life challenging environment. Little is known about the assessment and training of gait in the community environment under challenging mobility dimensions. Hence, we aimed to study the changes that real-life environmental dimensions have on the activity of selected muscles in hemiparetic lower limb and gait velocity in stroke survivors. METHODS: An observational cross-sectional study was conducted on 16 ambulatory stroke survivors to assess the hemiparetic lower limb muscle activity during walking in real-life environmental dimensions. Participants were made to walk in the community on a walkway consisting of even surface, ramp, stairs, uneven terrain and obstacles. They were also made to manoeuvre through traffic and pick a load while walking for a distance in the walkway. Muscle activity of Rectus Femoris, Biceps Femoris, Gastrocnemius Medialis and Tibialis Anterior of the paretic lower limb were continuously recorded while walking using wireless surface electromyography. Gait velocity for the entire walkway and level of perceived difficulty while walking in different dimensions were also measured. Paired t-test was used to compare the percentage Maximum Voluntary Contraction (%MVC) of lower limb muscles between even surface and real-life environment dimensions while walking. One sample t-test was used to compare the gait velocity in real-life dimensions versus gait velocity in even surface measured in an earlier study. RESULTS: There was a significant reduction (p < 0.01) in the activity of all four hemiparetic lower limb muscles while walking under the influence of real-life environmental dimensions compared to even surface. Gait velocity (0.33 ± 0.17 m/s) was significantly lower than that is essential to be a community ambulator. The level of perceived difficulty across all dimensions was reported qualitatively with the highest difficulty reported during stair and obstacle clearance. CONCLUSION: Real-life environmental dimensions lead to the reduction of paretic lower limb muscle activities and gait velocity during walking in community-dwelling stroke survivors. Stroke survivors perceived more difficulty while walking in real-life environment dimensions particularly while negotiating stairs and obstacles. SIGNIFICANCE: Knowledge about the influence of real-life environmental dimensions will help the clinicians to target rehabilitation methods to improve walking adaptability.


Assuntos
Meio Ambiente , Contração Muscular , Músculo Esquelético/inervação , Paresia/fisiopatologia , Acidente Vascular Cerebral/complicações , Velocidade de Caminhada , Atividades Cotidianas , Adulto , Idoso , Estudos Transversais , Eletromiografia , Análise da Marcha , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paresia/diagnóstico , Paresia/etiologia , Paresia/reabilitação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral
6.
J Stroke Cerebrovasc Dis ; 29(9): 105035, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807447

RESUMO

BACKGROUND AND PURPOSE: Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS: Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS: In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS: Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.


Assuntos
Acidentes por Quedas/prevenção & controle , Ciclismo , Terapia por Exercício , Transtornos Neurológicos da Marcha/reabilitação , Marcha , Articulação do Joelho/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/etiologia , Paresia/fisiopatologia , Projetos Piloto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
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 , Imageamento 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.
J Rehabil Med ; 52(7): jrm00078, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32556348

RESUMO

OBJECTIVE: To assess the changes in gait parameters in adults with hemiparesis using a rolling cane (quadripod cane with small wheels; Wheeleo®) compared with a classical quadripod cane. DESIGN: A prospective, multicentric, cross-over randomized trial. PARTICIPANTS: Thirty-two ambulatory adults with hemiparesis. METHODS: Participants were assessed using a quadripod cane and a rolling cane. Outcome measures were changes in: walking speed during a 10-m walk test and a 6-min walk test; frequency of 2-step gait; physiological cost index; number of therapist interventions to control the balance; perceived exertion; and participant satisfaction. RESULTS: The following outcomes were improved with the use of a rolling cane: walking speed during a 10-m walk test at comfortable (+22%: p<0.001) and maximal (+30: p<0.001) speeds; walking speed (+50%: p<0.001) and distance (+49%: p

Assuntos
Bengala/provisão & distribuição , Marcha/fisiologia , Paresia/complicações , Paresia/reabilitação , Idoso , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
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
10.
J Neuroeng Rehabil ; 17(1): 80, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32552775

RESUMO

BACKGROUND: Atypical walking in the months and years after stroke constrain community reintegration and reduce mobility, health, and quality of life. The ReWalk ReStore™ is a soft robotic exosuit designed to assist the propulsion and ground clearance subtasks of post-stroke walking by actively assisting paretic ankle plantarflexion and dorsiflexion. Previous proof-of-concept evaluations of the technology demonstrated improved gait mechanics and energetics and faster and farther walking in users with post-stroke hemiparesis. We sought to determine the safety, reliability, and feasibility of using the ReStore™ during post-stroke rehabilitation. METHODS: A multi-site clinical trial (NCT03499210) was conducted in preparation for an application to the United States Food and Drug Administration (FDA). The study included 44 users with post-stroke hemiparesis who completed up to 5 days of training with the ReStore™ on the treadmill and over ground. In addition to primary and secondary endpoints of safety and device reliability across all training activities, an exploratory evaluation of the effect of multiple exposures to using the device on users' maximum walking speeds with and without the device was conducted prior to and following the five training visits. RESULTS: All 44 study participants completed safety and reliability evaluations. Thirty-six study participants completed all five training days. No device-related falls or serious adverse events were reported. A low rate of device malfunctions was reported by clinician-operators. Regardless of their reliance on ancillary assistive devices, after only 5 days of walking practice with the device, study participants increased both their device-assisted (Δ: 0.10 ± 0.03 m/s) and unassisted (Δ: 0.07 ± 0.03 m/s) maximum walking speeds (P's < 0.05). CONCLUSIONS: When used under the direction of a licensed physical therapist, the ReStore™ soft exosuit is safe and reliable for use during post-stroke gait rehabilitation to provide targeted assistance of both paretic ankle plantarflexion and dorsiflexion during treadmill and overground walking. TRIAL REGISTRATION: NCT03499210. Prospectively registered on March 28, 2018.


Assuntos
Exoesqueleto Energizado , Transtornos Neurológicos da Marcha/reabilitação , Robótica/instrumentação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Adulto , Exoesqueleto Energizado/efeitos adversos , Estudos de Viabilidade , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/reabilitação , Modalidades de Fisioterapia , Qualidade de Vida , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/efeitos adversos
11.
Medicine (Baltimore) ; 99(24): e20752, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541528

RESUMO

INTRODUCTION: Repetitive peripheral magnetic stimulation (rPMS) therapy is an innovative and minimally invasive neurorehabilitative technique and has been shown to facilitate neural plasticity. However, there is at present no research that clarifies the dose-response of rPMS therapy on the recovery of upper limb hemiparesis after stroke. This trial aims to clarify the dose-response of rPMS therapy combined with intensive occupational therapy (OT) for chronic stroke patients with moderate to severe upper limb hemiparesis. METHODS AND ANALYSIS: This multicenter, prospective, assessor-blinded, randomized controlled study with 3 parallel groups will be conducted from January 20, 2020 to September 30, 2022. Fifty patients will be randomly assigned in a ratio of 1:2:2 to the control group, the group receiving daily 2400 pulses of rPMS, or the group receiving daily 4800 pulses of rPMS, respectively. From the day after admission (Day 1), rPMS therapy and intensive OT will be initiated. The primary outcome is the change in the motor function of the affected upper extremity (Fugl-Meyer Assessment) between the time of admission (Day 0) and the day after 2 weeks of treatment (Day 14). Secondary outcomes will include the changes in spasticity, active range of motion, motor evoked potential, and activity of daily living. ETHICS AND DISSEMINATION: The study was approved by the Jikei University Certified Review Board for all institutions (reference number: JKI19-020). Results of the primary and secondary outcomes will be published in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients. TRIAL REGISTRATION NUMBER: jRCTs032190191.


Assuntos
Terapia de Campo Magnético/métodos , Terapia Ocupacional , Paresia/reabilitação , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Extremidade Superior , Terapia Combinada , Humanos , Estudos Multicêntricos como Assunto , Paresia/etiologia , Estudos Prospectivos , Método Simples-Cego , Acidente Vascular Cerebral/complicações
12.
J Neuroeng Rehabil ; 17(1): 69, 2020 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493440

RESUMO

BACKGROUND: Promising studies have shown that the gait symmetry of individuals with hemiparesis due to brain lesions, such as stroke, can improve through motor adaptation protocols forcing patients to use their affected limb more. However, little is known about how to facilitate this process. Here we asked if increasing propulsion demands during split-belt walking (i.e., legs moving at different speeds) leads to more motor adaptation and more symmetric gait in survivors of a stroke, as we previously observed in subjects without neurological disorders. METHODS: We investigated the effect of propulsion forces on locomotor adaptation during and after split-belt walking in the asymmetric motor system post-stroke. To test this, 12 subjects in the chronic phase post-stroke experienced a split-belt protocol in a flat and incline session so as to contrast the effects of two different propulsion demands. Step length asymmetry and propulsion forces were used to compare the motor behavior between the two sessions because these are clinically relevant measures that are altered by split-belt walking. RESULTS: The incline session resulted in more symmetric step lengths during late split-belt walking and larger after-effects following split-belt walking. In both testing sessions, subjects who have had a stroke adapted to regain speed and slope-specific leg orientations similarly to young, intact adults. Importantly, leg orientations, which were set by kinetic demands, during baseline walking were predictive of those achieved during split-belt walking, which in turn predicted each individual's post-adaptation behavior. These results are relevant because they provide evidence that survivors of a stroke can generate the leg-specific forces to walk more symmetrically, but also because we provide insight into factors underlying the therapeutic effect of split-belt walking. CONCLUSIONS: Individuals post-stroke at a chronic stage can adapt more during split-belt walking and have greater after-effects when propulsion demands are augmented by inclining the treadmill surface. Our results are promising since they suggest that increasing propulsion demands during paradigms that force patients to use their paretic side more could correct gait asymmetries post-stroke more effectively.


Assuntos
Adaptação Fisiológica/fisiologia , Teste de Esforço/métodos , Transtornos Neurológicos da Marcha/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Locomoção/fisiologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/reabilitação
13.
Medicine (Baltimore) ; 99(19): e20144, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384499

RESUMO

RATIONALE: Limb-kinetic apraxia (LKA), a kind of apraxia, means the inability to perform precise and voluntary movements of extremities resulting from injury of the premotor cortex (PMC) or the corticofugal tract (CFT) from the PMC. Diagnosis of LKA is made by observation of movements without specific assessment tools. PATIENT CONCERNS: A 44-year-old male underwent conservative management for traumatic intracerebral hemorrhage in the left basal ganglia and subarachnoid hemorrhage due to a pedestrian-car crash. When he was admitted to the rehabilitation department of a university hospital after 41 months after onset, he presented with right hemiparesis (Medical Research Council (MRC): shoulder abductor; 3, elbow flexor; 3, finger extensor; 0, hip flexor; 2- [range: 30°], knee extensor; 1 and ankle dorsiflexor; 3-). In addition, he exhibited slow, clumsy, and mutilated movements when performing movements of his right ankle. DIAGNOSES: The patient was diagnosed as traumatic brain injury (TBI). INTERVENTIONS: Clinical assessments and DTI were performed at 41 and 44 months after onset. During three months, rehabilitative therapy was performed including dopaminergic drugs (pramipexole 2.5 mg, ropinirole 2.5 mg, and amantadine 300 mg, and carbidopa/levodopa 75 mg/750 mg). OUTCOMES: The right leg weakness slowly recovered during 3 months, until 44 months after the initial injury (MRC: shoulder abductor, 3; elbow flexor, 3; finger extensor, 0; hip flexor, 3; knee extensor, 3; and ankle dorsiflexor, 3+). The fiber number of the right corticospinal tract (CST) was decreased on 44-month diffusion tensor tractography (DTT) (1319) compared with 41-month DTT (1470) and the left CST was not reconstructed on both DTTs. The fiber number of both CRTs were decreased on 44-month DTT (right: 1547, left: 698) than 41-month DTT (right: 3161, left: 1222). LESSONS: A chronic patient with TBI showed motor recovery of the hemiparetic leg by improvement of LKA after rehabilitation. This results have important implications for neurorehabilitation.


Assuntos
Apraxia Ideomotora/tratamento farmacológico , Apraxia Ideomotora/etiologia , Hemorragia Encefálica Traumática/complicações , Agonistas de Dopamina/uso terapêutico , Paresia/tratamento farmacológico , Paresia/etiologia , Adulto , Apraxia Ideomotora/reabilitação , Lesões Encefálicas Traumáticas/complicações , Hemorragia Cerebral/complicações , Doença Crônica , Agonistas de Dopamina/administração & dosagem , Humanos , Masculino , Córtex Motor/lesões , Paresia/reabilitação , Recuperação de Função Fisiológica , Hemorragia Subaracnóidea/complicações
14.
Cochrane Database Syst Rev ; 5: CD005950, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32449959

RESUMO

BACKGROUND: Stroke is caused by the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels within the brain (hemorrhagic stroke) and may lead to changes in perception, cognition, mood, speech, health-related quality of life, and function, such as difficulty walking and using the arm. Activity limitations (decreased function) of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities. OBJECTIVES: To determine whether MP improves outcomes of upper extremity rehabilitation for individuals living with the effects of stroke. In particular, we sought to (1) determine the effects of MP on upper extremity activity, upper extremity impairment, activities of daily living, health-related quality of life, economic costs, and adverse effects; and (2) explore whether effects differed according to (a) the time post stroke at which MP was delivered, (b) the dose of MP provided, or (c) the type of comparison performed. SEARCH METHODS: We last searched the Cochrane Stroke Group Trials Register on September 17, 2019. On September 3, 2019, we searched the Cochrane Central Register of Controlled Trials (the Cochrane Library), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science, the Physiotherapy Evidence Database (PEDro), and REHABDATA. On October 2, 2019, we searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We reviewed the reference lists of included studies. SELECTION CRITERIA: We included randomized controlled trials (RCTs) of adult participants with stroke who had deficits in upper extremity function (called upper extremity activity). DATA COLLECTION AND ANALYSIS: Two review authors screened titles and abstracts of the citations produced by the literature search and excluded obviously irrelevant studies. We obtained the full text of all remaining studies, and both review authors then independently selected trials for inclusion. We combined studies when the review produced a minimum of two trials employing a particular intervention strategy and a common outcome. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks, called upper extremity activity. Secondary outcomes included upper extremity impairment (such as quality of movement, range of motion, tone, presence of synergistic movement), activities of daily living (ADLs), health-related quality of life (HRQL), economic costs, and adverse events. We assessed risk of bias in the included studies and applied GRADE to assess the certainty of the evidence. We completed subgroup analyses for time since stroke, dosage of MP, type of comparison, and type of arm activity outcome measure. MAIN RESULTS: We included 25 studies involving 676 participants from nine countries. For the comparison of MP in addition to other treatment versus the other treatment, MP in combination with other treatment appears more effective in improving upper extremity activity than the other treatment without MP (standardized mean difference [SMD] 0.66, 95% confidence interval [CI] 0.39 to 0.94; I² = 39%; 15 studies; 397 participants); the GRADE certainty of evidence score was moderate based on risk of bias for the upper extremity activity outcome. For upper extremity impairment, results were as follows: SMD 0.59, 95% CI 0.30 to 0.87; I² = 43%; 15 studies; 397 participants, with a GRADE score of moderate, based on risk of bias. For ADLs, results were as follows: SMD 0.08, 95% CI -0.24 to 0.39; I² = 0%; 4 studies; 157 participants; the GRADE score was low due to risk of bias and small sample size. For the comparison of MP versus conventional treatment, the only outcome with available data to combine (3 studies; 50 participants) was upper extremity impairment (SMD 0.34, 95% CI -0.33 to 1.00; I² = 21%); GRADE for the impairment outcome in this comparison was low due to risk of bias and small sample size. Subgroup analyses of time post stroke, dosage of MP, or comparison type for the MP in combination with other rehabilitation treatment versus the other treatment comparison showed no differences. The secondary outcome of health-related quality of life was reported in only one study, and no study noted the outcomes of economic costs and adverse events. AUTHORS' CONCLUSIONS: Moderate-certainty evidence shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity activity. Moderate-certainty evidence also shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity impairment after stroke. Low-certainty evidence suggests that ADLs may not be improved with MP in addition to other treatment versus the other treatment. Low-certainty evidence also suggests that MP versus conventional treatment may not improve upper extremity impairment. Further study is required to evaluate effects of MP on time post stroke, the volume of MP required to affect outcomes, and whether improvement is maintained over the long term.


Assuntos
Braço , Imaginação/fisiologia , Paresia/reabilitação , Prática Psicológica , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Paresia/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica
15.
J Neuroeng Rehabil ; 17(1): 64, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410626

RESUMO

PURPOSE: The purpose of this study was to investigate transient bimanual effects on the force control capabilities of the paretic and non-paretic arms in individuals post stroke across submaximal and maximal force control tasks. METHODS: Fourteen chronic stroke patients (mean age = 63.8 ± 15.9; stroke duration = 38.7 ± 45.2 months) completed two isometric force control tasks: (a) submaximal control and (b) maximal sustained force production. Participants executed both tasks with their wrist and fingers extending across unimanual (paretic and non-paretic arms) and bimanual conditions. Mean force, force variability using coefficient of variation, force regularity using sample entropy were calculated for each condition. RESULTS: During the submaximal force control tasks (i.e., 5, 25, and 50% of maximum voluntary contraction), the asymmetrical mean force between the paretic and non-paretic arms decreased from unimanual to bimanual conditions. The asymmetry of force variability and regularity between the two arms while executing unimanual force control tended to decrease in the bimanual condition because of greater increases in the force variability and regularity for the non-paretic arm than those for the paretic arm. During the maximal sustained force production tasks (i.e., 100% of maximum voluntary contraction), the paretic arm increased maximal forces and decreased force variability in the bimanual condition, whereas the non-paretic arm reduced maximal forces and elevated force variability from unimanual to bimanual conditions. CONCLUSIONS: The current findings support a proposition that repetitive bimanual isometric training with higher execution intensity may facilitate progress toward stroke motor recovery.


Assuntos
Paresia/reabilitação , Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/complicações , Idoso , Feminino , Lateralidade Funcional/fisiologia , Humanos , Contração Isométrica/fisiologia , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Extremidade Superior/fisiopatologia
16.
J Clin Neurosci ; 78: 301-306, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32389546

RESUMO

Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient's foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/reabilitação , Marcha/fisiologia , Paresia/reabilitação , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço/métodos , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Projetos Piloto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
17.
Ann Phys Rehabil Med ; 63(4): 376-378, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32315800
18.
Medicine (Baltimore) ; 99(14): e19495, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243365

RESUMO

INTRODUCTION: Upper extremity motor impairment is one of the major sequelae of stroke, resulting in limitations of activities of daily living. Recently, contralesional cortical activation has been reported to be important for motor recovery in stroke patients with severe upper extremity hemiparesis due to the extensive corticospinal tract involvement. We therefore designed this study to investigate the effects of contralesional anodal transcranial direct current stimulation (tDCS), which induces cortical activation, in stroke patients with severe upper extremity motor impairment. METHODS AND ANALYSIS: We will recruit patients with subacute stroke (<3 months after onset) with unilateral upper extremity weakness who meet the following criteria: Shoulder Abduction and Finger Extension (SAFE) score below 8, Fugl-Meyer Assessment for upper extremity (FMA-UE) score ≤25, and absent motor evoked potential (MEP) response on the affected extensor carpi radialis muscle. Subjects will be randomly allocated to either the intervention (n = 18) or the control group (n = 18). The intervention group will undergo 10 sessions of robotic arm rehabilitation with simultaneous anodal tDCS over the contralesional premotor area, whereas the control group will receive sham tDCS during the same sessions. One daily session consists of 25 minutes.The primary outcome measure of this study is the Fugl-Meyer Assessment score of the upper extremity; the secondary outcome measures are the Korean version of the Modified Barthel Index, the Brunnstrom stage of the affected arm and hand, the Box and Block Test, the Modified Ashworth Scale, the Manual Muscle Power Test, and the patient's encephalographic laterality index. DISCUSSION: Findings of this study will help to establish an individualized tDCS protocol according to the stroke severity and to find out the EEG parameters to predict the better recovery in subacute stroke patients with severe upper extremity hemiparesis. ETHICS AND DISSEMINATION: The study was approved by the Seoul National University Bundang Hospital Institutional Review Board (IRB No. B-1806-475-006) and will be carried out in accordance with the approved guidelines. The results of the trial will be submitted for publication in a peer-reviewed journal.


Assuntos
Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Extremidade Superior , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Potencial Evocado Motor , Feminino , Lateralidade Funcional , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiopatologia , Recuperação de Função Fisiológica , Adulto Jovem
19.
Arch Phys Med Rehabil ; 101(7): 1131-1137, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32283048

RESUMO

OBJECTIVE: To investigate the STRoke Interactive Virtual thErapy (STRIVE) intervention on upper-extremity clinical outcomes in community-dwelling stroke survivors. DESIGN: Assessor-blinded randomized controlled trial. SETTING: Study screening and testing was conducted in a university clinic. Participants completed the virtual therapy (VT) intervention in a community-based stroke support group setting. PARTICIPANTS: Of 124 stroke survivors initially assessed, 60 participants were recruited (time poststroke, 13.4±8.9 y). Participants were allocated to either VT or control group using a block randomization design and were stratified by sex. INTERVENTIONS: Participants were randomized to receive 8 weeks of VT or usual care. The intervention consisted of approximately 45 minutes of twice weekly VT training on the Jintronix Rehabilitation System. MAIN OUTCOME MEASURES: Between-group differences in the Fugl-Meyer Upper Extremity scale and Action Research Arm Test score were joint primary outcomes in this study. RESULTS: Significant between-group differences for the Fugl-Meyer Upper Extremity scale were seen at the end of the intervention (F1, 1=5.37, P=.02, d=0.41). No significant differences were observed with the Action Research Arm Test. No adverse events were reported. CONCLUSIONS: We demonstrated clinically meaningful improvements in gross upper extremity motor function and use of the affected arm after a VT intervention delivered via a community-based stroke support group setting. This data adds to the contexts in which VT can be used to improve upper limb function. Use of VT in community-based rehabilitation in chronic stroke recovery is supported.


Assuntos
Terapia por Exercício/métodos , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Terapia de Exposição à Realidade Virtual/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Vida Independente/estatística & dados numéricos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/métodos , Paresia/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Método Simples-Cego , Estatísticas não Paramétricas , Acidente Vascular Cerebral/diagnóstico , Sobreviventes/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Extremidade Superior/fisiopatologia
20.
NeuroRehabilitation ; 46(3): 287-297, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32250331

RESUMO

BACKGROUND: Neurological injuries cause persistent upper extremity motor deficits. Device-assisted therapy is an emerging trend in neuro-rehabilitation as it offers high intensity, repetitive practice in a standardized setting. OBJECTIVE: To investigate the effects of therapy duration and staff-participant configuration on device-assisted upper limb therapy outcomes in individuals with chronic paresis. METHODS: Forty-seven participants with chronic upper extremity weakness due to neurological injury were assigned to a therapy duration (30 or 60 min) and a staff-participant configuration (1-to-1 or 1-to-2). Therapy consisted of 3 sessions a week for 6 weeks using the Armeo®Spring device. Clinical assessments were performed at three timepoints (Pre, Post, and 3 month Follow up). RESULTS: Improvements in upper limb impairment, measured by change in Fugl-Meyer score (FM), were observed following therapy in all groups. FM improvement was comparable between 30 and 60 min sessions, but participants in the 1-to-2 group had significantly greater improvement in FM from Pre-to-Post and from Pre-to-Follow up than the 1-to-1 group. CONCLUSIONS: Device-assisted therapy can reduce upper limb impairment to a similar degree whether participants received 30 or 60 min per session. Our results suggest that delivering therapy in a 1-to-2 configuration is a feasible and more effective approach than traditional 1-to-1 staffing.


Assuntos
Paresia/reabilitação , Reabilitação , Extremidade Superior/fisiopatologia , Humanos , Reabilitação/instrumentação , Reabilitação/métodos , Reabilitação/organização & administração , Resultado do Tratamento
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