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1.
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
2.
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
3.
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
4.
Medicine (Baltimore) ; 99(10): e19517, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150113

RESUMO

INTRODUCTION: Radiotherapy is a valid treatment option for nasopharyngeal carcinoma. However, complications can occur following irradiation of the closest anatomical structures, including brainstem radionecrosis (BRN). The rehabilitation is poorly described in patients with BRN, despite its usefulness in improving functional independence in patients with brain tumors. We aimed at testing the usefulness of intensive, robot-assisted neurorehabilitation program to improve functional independence in a 57-year-old male with BRN. PATIENT CONCERNS: A 57-year-old male diagnosed with a nasopharyngeal carcinoma, received a radiation total dose of 72 Gy. Owing to the appearance of a severe symptomatology characterized by dysphagia, hearing loss, and left sided hemiparesis, the patient was hospitalized to be provided with intensive pharmacological and neurorehabilitation treatment. DIAGNOSIS: Follow-up brain magnetic resonance imaging disclosed no residual cancer, but some brainstem lesions compatible with BRN areas were appreciable. INTERVENTION: The patient underwent a 2-month conventional, respiratory, and speech therapy. Given that the patient only mildly improved, he was provided with intensive robot-aided upper limb and gait training and virtual reality-based cognitive rehabilitation for other 2 months. OUTCOMES: The patient reported a significant improvement in functional independence, spasticity, cognitive impairment degree, and balance. CONCLUSION: Our case suggests the usefulness of neurorobotic intensive rehabilitation in BRN to reduce functional disability. Future studies should investigate whether an earlier, even multidisciplinary rehabilitative treatment could lead to better functional outcome in patients with BRN.


Assuntos
Tronco Encefálico/lesões , Terapia por Exercício , Neoplasias Nasofaríngeas/radioterapia , Lesões por Radiação/reabilitação , Robótica , Tronco Encefálico/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Paresia/reabilitação , Lesões por Radiação/diagnóstico por imagem
5.
Medicine (Baltimore) ; 99(11): e19512, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176098

RESUMO

To investigate the relationships between grip strengths and self-care activities in stroke patients using a non-linear support vector machine (SVM).Overall, 177 inpatients with poststroke hemiparesis were enrolled. Their grip strengths were measured using the Jamar dynamometer on the first day of rehabilitation training. Self-care activities were assessed by therapists using Functional Independence Measure (FIM), including items for eating, grooming, dressing the upper body, dressing the lower body, and bathing at the time of discharge. When each FIM item score was ≥6 points, the subject was considered independent. One thousand bootstrap grip strength datasets for each independence and dependence in self-care activities were generated from the actual grip strength. Thereafter, we randomly assigned the total bootstrap datasets to 90% training and 10% testing datasets and inputted the bootstrap training data into a non-linear SVM. After training, we used the SVM algorithm to predict a testing dataset for cross-validation. This validation procedure was repeated 10 times.The SVM with grip strengths more accurately predicted independence or dependence in self-care activities than the chance level (mean ±â€Šstandard deviation of accuracy rate: eating, 0.71 ±â€Š0.04, P < .0001; grooming, 0.77 ±â€Š0.03, P < .0001; upper-body dressing, 0.75 ±â€Š0.03, P < .0001; lower-body dressing, 0.72 ±â€Š0.05, P < .0001; bathing, 0.68 ±â€Š0.03, P < .0001).Non-linear SVM based on grip strengths can prospectively predict self-care activities.


Assuntos
Avaliação da Deficiência , Força da Mão , Paresia/reabilitação , Autocuidado , Reabilitação do Acidente Vascular Cerebral , Idoso , Feminino , Humanos , Aprendizado de Máquina , Masculino , Paresia/fisiopatologia , Alta do Paciente , Valor Preditivo dos Testes
6.
Fisioterapia (Madr., Ed. impr.) ; 42(1): 5-16, ene.-feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-187810

RESUMO

Objetivo: Establecer el efecto de un programa de intervención basado en el reaprendizaje motor sobre el control postural en adultos con hemiparesia. Material y método: Se realizó un ensayo clínico no aleatorizado, prospectivo, con grupo control y enmascaramiento simple. Se realizó un muestreo intencional de adultos de ambos sexos con hemiparesia de entre 18 y 60 años. Se analizaron 34 personas en el grupo control (intervención convencional) y 35 en el experimental (reaprendizaje motor orientado a la tarea). Ambos grupos recibieron programas de fisioterapia 3 veces a la semana durante 6 semanas. Se aplicaron las siguientes pruebas: escala de Tinetti, test de organización sensorial, Timed Get Up and Go, test del alcance funcional y evaluación de la calidad de patrones de movimiento básicos y selectivos. Se realizaron análisis de diferencias intramuestrales e intermuestrales. Resultados: Se encontró una diferencia promedio de 3cm en la prueba del alcance funcional (p=0,035) y de 2,43 puntos en la calidad de patrones de movimiento de miembros inferiores (p=0,011) a favor del grupo experimental. En las demás pruebas no hubo diferencias significativas (p>0,05). Conclusiones: El programa evaluado es más efectivo para mejorar el control postural antigravitatorio y la calidad de patrones selectivos de miembros inferiores, comparado con un programa fisioterapéutico convencional. Sin embargo, en el análisis intramuestral se evidenció que aquel produce cambios significativos en la estabilidad durante la marcha, el control postural antigravitatorio, el equilibrio, la organización sensorial y en la calidad de los patrones de movimiento de mano, miembro inferior, movilidad en sedente-arrodillado, bípedo, marcha, desplazamientos en bípedo y global


Objective: To establish the impact of an intervention programme based on motor relearning on postural control in adults with hemiparesis. Material and method: A prospective non-randomised single-masked clinical trial with control group was conducted. The sample was collected intentionally, and consisted of adults of both sexes with hemiparesis between 18 to 60 years old. Thirty-four individuals from the control group (conventional intervention) and 35 individuals from the experimental group (task-oriented motor re-learning) were analysed. Both groups were involved in physiotherapy programmes 3 times a week for 6 weeks. Tinetti Balance Scale, Sensory Organization Test, Timed Get Up and Go test, Functional Movement Assessment and quality of basic and selective movement patterns assessment were applied. Analysis of intra-sample and inter-sample differences was performed. Results: An average difference of 3cm was found in Functional Movement Assessment (P=.035) and 2.43 points in the quality of lower limb movement patterns (P=.011), in favour of the experimental group. The other tests did not show significant differences (P>.05). Conclusions: This programme is more effective at improving postural anti-gravitational control and the quality of selective lower limb patterns compared to a conventional physiotherapeutic programme. However, in the intra-sample analysis, it was evidenced that it produces significant changes in stability during gait, anti-gravitational postural control, balance, sensory organisation and in the quality of hand movement patterns, lower limb, seated mobility-kneeling, biped, walking, biped and global movements


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Paresia/terapia , Equilíbrio Postural , Modalidades de Fisioterapia/instrumentação , Lesões Encefálicas/reabilitação , Reabilitação Neurológica/métodos , Paresia/reabilitação , Estudos Prospectivos , Postura/fisiologia , Análise da Marcha/métodos
7.
Am J Phys Med Rehabil ; 99(1): 86-90, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31469683

RESUMO

The role and function that proprioception plays in movement and motor learning have been debated since the 19th century but can be difficult to isolate and study. Lesions at various points along the proprioceptive pathway result in afferent paresis that can be significantly disabling. Compensatory mechanisms can help with successful rehabilitation and provide an opportunity to study the role of these mechanisms in sensory feedback. Here, we present two cases of adult patients with complete hemisensory loss after a stroke: one patient with a cortical stroke and the other one with a thalamic stroke. First, we see that that motor learning can occur without proprioception, with the help of visual feedback. Second, proprioception plays an important role in movement: in the upper limb, it can facilitate individual finger movements, and in the lower limb, it maintains sufficient knee flexion to prevent the knee from going into recurvatum (backward bending) during ambulation.


Assuntos
Paresia/reabilitação , Propriocepção , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Idoso , Retroalimentação Sensorial , Feminino , Humanos , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Movimento , Paresia/etiologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/complicações , Resultado do Tratamento , Extremidade Superior/fisiopatologia
8.
J Stroke Cerebrovasc Dis ; 29(1): 104463, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31740027

RESUMO

BACKGROUND: Stroke often results in motor impairment and limited functional capacity. This study aimed to verify the relationship between widely used clinical scales and instrumented measurements to evaluate poststroke individuals with mild, moderate, and severe motor impairment. METHODS: This cross-sectional study included 34 participants with chronic hemiparesis after stroke. Fugl-Meyer Assessment and Modified Ashworth Scale were used to quantify upper and lower limb motor impairment and the resistance to passive movement (i.e., spasticity), respectively. Upper limb Motor performance (movement time and velocities) and movement quality (range of motion, smoothness and trunk displacement) were analyzed during a reaching forward task using an optoelectronic system (instrumented measurement). Lower limb motor performance (gait and functional mobility parameters) was assessed by using an inertial measurement unit system. FINDINGS: Fugl-Meyer Assessment correlated with motor performance (upper and lower limbs) and with movement quality (upper limb). Modified Ashworth scale correlated with movement quality (upper limb). Cutoff values of 9.0 cm in trunk anterior displacement and .57 m/s in gait velocity were estimated to differentiate participants with mild/moderate and severe compromise according to the Fugl-Meyer Assessment. CONCLUSIONS: These results suggest that the Fugl-Meyer Assessment can be used to infer about motor performance and movement quality in chronic poststroke individuals with different levels of impairment.


Assuntos
Avaliação da Deficiência , Atividade Motora , Paresia/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Atividades Cotidianas , Idoso , Fenômenos Biomecânicos , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Paresia/reabilitação , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral , Resultado do Tratamento
9.
Biomed Res Int ; 2019: 9471921, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31828151

RESUMO

Aim: This study evaluated whether specific actual performance could accurately predict body function levels and upper limb use in the real-life functioning of poststroke hemiparesis patients to aid in choosing the most appropriate rehabilitation exercises. Methods: We measured the time taken for poststroke patients to move small objects with the paralyzed hand and investigated how the measurement could estimate upper extremity motor impairment and hand usage during activities of daily living (ADL). We examined 86 stroke patients (age 66 ± 16 years) whose upper extremity motor paralysis was measured using the Fugl-Meyer assessment (FMA) and Southampton Hand Assessment Procedure (SHAP), and patient-reported ADL was investigated using the Jikei Assessment Scale for Motor Impairment in Daily Living (JASMID). To identify the time required to perform each SHAP item, we employed a linear regression analysis. The prediction formula was used in the linear regression analysis, and the coefficient of determination (R 2) was applied to compare each component item score that was obtained with the predicted values derived from the linear regression analysis. Results: The most easily accomplished task was Heavy Power in the SHAP. The R 2 between the SHAP Heavy Power item score and the FMA scores was moderate (R 2 = 0.344, P < 0.0001), whereas the R 2 with the JASMID score was low (R 2 = 0.126, P < 0.001). Conclusions: By measuring the time it takes for poststroke hemiparesis patients to hold and move an object, we developed a prediction formula for upper extremity motor function and hand dexterity.


Assuntos
Atividades Cotidianas , Transtornos Motores , Paresia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Extremidade Superior/fisiopatologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Motores/etiologia , Transtornos Motores/fisiopatologia , Transtornos Motores/reabilitação , Paresia/etiologia , Paresia/fisiopatologia , Paresia/reabilitação , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia
10.
NeuroRehabilitation ; 45(3): 323-329, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31796693

RESUMO

BACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) and Repetitive facilitative exercise (RFE) improves motor impairment after stroke. OBJECTIVE: To investigate whether neuromuscular electrical stimulation (NMES) can facilitate the effects of rTMS and RFE on the function of the hemiparetic hand in stroke patients. METHODS: This randomized double-blinded crossover study divided 20 patients with hemiparesis into two groups and provided treatment for 4 weeks at 5 days/week. NMES-before-sham group and NMES-following-sham group performed NMES sessions and sham NMES sessions for each 2 weeks. Patients received NMES or sham NMES for the affected extensor muscle concurrently with 1 Hz rTMS for the unaffected motor cortex for 10 min and performed RFE for 60 min. The Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box and Block Test (BBT) and Modified Ashworth Scale (MAS) were used for evaluation. RESULTS: FMA and ARAT improved significantly during both sessions. The gains in the BBT during an NMES session were significantly greater than those during a sham NMES session. MAS for the wrist and finger significantly decreased only during an NMES session. CONCLUSIONS: NMES combined with rTMS might facilitate, at least in part, the beneficial effects of RFE on motor function and spasticity of the affected upper limb.


Assuntos
Terapia por Exercício/métodos , Mãos , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Estimulação Transcraniana por Corrente Contínua/métodos , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Terapia Combinada/métodos , Terapia Combinada/tendências , Estudos Cross-Over , Método Duplo-Cego , Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/tendências , Terapia por Exercício/tendências , Feminino , Mãos/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/fisiopatologia , Distribuição Aleatória , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/tendências , Estimulação Transcraniana por Corrente Contínua/tendências , Estimulação Magnética Transcraniana/tendências , Resultado do Tratamento
11.
Restor Neurol Neurosci ; 37(5): 437-443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31594264

RESUMO

1 out of 6 people worldwide will have suffered a stroke in their lifetime, 1/3rd of whom will die. Of the 2/3rd who survive, half will be permanently disabled (World Stroke Organization). Given these alarming statistics, it's not surprising that tremendous of amounts of time, resources and funding have been devoted towards research into stroke rehab. In view of this, simple, easy-to-implement procedures are highly sought after. One such procedure is the use of visual feedback conveyed by a mirror, which seems to reactivate some dormant pathways in patients who have suffered a recent stroke (Altschuler et al., 1999; Ramachandran & Altschuler, 2009). This procedure has been validated in several dozen clinical trials, of which a substantial number were conducted rigorously. Morkisch et al. (2019) now present a systematic review and meta-analysis of this dense literature pertaining to this topic. They conclude that "there is a high level evidence for mirror therapy's effectiveness in treating post-stroke hemiparesis". A novel conclusion that emerged from this meta-analysis was that the larger the mirror the more effective the treatment is. Additionally, if an object is manipulated by the normal hand and its reflection viewed in the mirror, the procedure is not as effective, possibly because the discrepancy of signals between the visual feedback (reflection of the object) and the lack of confirmatory somatosensory input from the affected limb leads to inhibition rather than synergy. Lastly, for reasons yet unclear, sending movement commands to the unaffected hand alone (unilateral) is more effective than sending bilateral commands, contrary to the original protocol.Taken collectively, research in this field has two implications - First, the immediate practical utility in the clinic by optimizing mirror therapy's efficacy for hemiparesis after stroke. Second, it leads to a rejection of the model of the brain as made up of isolated, autonomous modules, towards a more dynamic picture, in which the brain is composed of a fluctuating mosaic of neural activity as it adapts to changing sensory inputs. Therefore, dysfunction results not from 'punch out a module - lose a function', but by shifts in equilibria, which can be corrected, perhaps, by hitting a reset button. Even if this turns out to be true for a minority of syndromes, it will be well worth the effort.


Assuntos
Retroalimentação Sensorial/fisiologia , Metanálise como Assunto , Paresia/reabilitação , Recuperação de Função Fisiológica/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Encéfalo/patologia , Encéfalo/fisiologia , Humanos , Plasticidade Neuronal/fisiologia , Paresia/etiologia , Acidente Vascular Cerebral/complicações
12.
Stroke ; 50(12): 3643-3646, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31662119

RESUMO

Background and Purpose- A reliable measure of movement repetitions is required to assist in determining the optimal dose for maximizing upper limb recovery after stroke. This study investigated the ability of a new wearable device to capture reach-to-grasp repetitions in individuals with stroke. Methods- Eight individuals with stroke wore an instrumented wrist bracelet while completing 12 upper limb activities. Participants completed 5 and 10 repetitions of each activity on 2 separate sessions (time 1 and time 2) and completed clinical assessments (Fugl-Meyer Upper Extremity Assessment and Action Research Arm Test). Mean reach-to-grasp counts (ie, hand counts) were compared across activities. Scaling properties were assessed by the ratio of 10 repetitions to 5 repetitions for the activities (ie, expected value of 2). Bland-Altman diagrams were used to examine agreement between time 1 and time 2 counts. Results- The wrist bracelet averaged 0 to 0.6 hand counts per repetition for the arm-only and hand-only activities and averaged 1 to 2 counts per repetition of the reach-to-grasp activities. The mean ratio of 10 repetition to 5 repetition counts was ≈2 for all of the reach-to-grasp activities. Mean differences from time 1 to time 2 were <0.3 counts/repetition for all activities except one. Conclusions- These preliminary results provide evidence that the wrist bracelet is able to capture hand counts over a variety of tasks in a consistent manner. This wrist bracelet could be further developed as a tool to record dose of upper limb practice for research or clinical practice, as well as providing motivation and accountability to patients participating in treatments requiring upper limb movement repetitions. Currently, there are limitations in interpreting the impact of impairment and common compensatory movements on hand counts, and it would be valuable for future studies to explore these effects.


Assuntos
Força da Mão , Mãos , Atividade Motora/fisiologia , Paresia/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Dispositivos Eletrônicos Vestíveis , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miografia/instrumentação , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Análise e Desempenho de Tarefas
13.
Stroke ; 50(12): 3545-3552, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31623545

RESUMO

Background and Purpose- The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods- Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter. Results- Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention (P<0.05). The net cardiopulmonary metabolic energy cost (mL·kg-1·min-1) was also reduced by 14.71% in the experimental group after the intervention (P<0.01). Significant group×time interactions were observed for all parameters (P<0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group (P<0.01). Conclusions- Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration- URL: https://clinicaltrials.gov. Unique identifier: NCT02843828.


Assuntos
Exoesqueleto Energizado , Transtornos Neurológicos da Marcha/reabilitação , Paresia/reabilitação , Robótica , Reabilitação do Acidente Vascular Cerebral/instrumentação , Idoso , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Locomoção , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Projetos Piloto , Acidente Vascular Cerebral/complicações , Reabilitação do Acidente Vascular Cerebral/métodos
14.
J Stroke Cerebrovasc Dis ; 28(11): 104337, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522886

RESUMO

AIM: This study aimed to determine the effects of repeated use of the 6-minute walk test (6MWT) with immediate knowledge of results (KR) on the walking capacity by comparing fast and slow walkers in patients with chronic hemiparesis. METHODS: Twenty-five subjects were allocated to 2 groups depending on their walking speed1: Group 1 (fast walkers, n1 = 11): greater than equal to .8 m/s and2 Group 2 (slow walkers, n2 = 14): less than .8 m/s. All subjects underwent the 6MWT once a day, 5 days a week, for 4 weeks (a total of 20 sessions). The 6MWT was performed on a 30-m path with immediate KR; subjects informed the time taken to walk each 30-m path. Outcome measures included the 6MWT and 10-meter walk test (10MWT). Measurements were taken before and after 4 weeks. Results of within-group comparisons showed significant improvements in the 10MWT and 6MWT for both groups pre- and post-test (P < .05). Furthermore, in between-group comparison, results of Group 1 differences were greater between pre- and post-test in the 10MWT and 6MWT values as compared to Group 2 (P < .05). These findings indicate that repeated use of the 6MWT with immediate KR may be beneficial to enhance walking capacity in patients with chronic stroke, with more favorable changes in better poststroke walking speed.


Assuntos
Retroalimentação Psicológica , Paresia/diagnóstico , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Teste de Caminhada , Velocidade de Caminhada , Doença Crônica , Avaliação da Deficiência , Tolerância ao Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/etiologia , Paresia/fisiopatologia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/psicologia , Análise e Desempenho de Tarefas , Fatores de Tempo , Resultado do Tratamento
15.
Phys Ther ; 99(12): 1667-1678, 2019 12 16.
Artigo em Inglês | MEDLINE | ID: mdl-31504952

RESUMO

BACKGROUND: Constraint-induced movement therapy (CI therapy) produces, on average, large and clinically meaningful improvements in the daily use of a more affected upper extremity in individuals with hemiparesis. However, individual responses vary widely. OBJECTIVE: The study objective was to investigate the extent to which individual characteristics before treatment predict improved use of the more affected arm following CI therapy. DESIGN: This study was a retrospective analysis of 47 people who had chronic (> 6 months) mild to moderate upper extremity hemiparesis and were consecutively enrolled in 2 CI therapy randomized controlled trials. METHODS: An enhanced probabilistic neural network model predicted whether individuals showed a low, medium, or high response to CI therapy, as measured with the Motor Activity Log, on the basis of the following baseline assessments: Wolf Motor Function Test, Semmes-Weinstein Monofilament Test of touch threshold, Motor Activity Log, and Montreal Cognitive Assessment. Then, a neural dynamic classification algorithm was applied to improve prognostic accuracy using the most accurate combination obtained in the previous step. RESULTS: Motor ability and tactile sense predicted improvement in arm use for daily activities following intensive upper extremity rehabilitation with an accuracy of nearly 100%. Complex patterns of interaction among these predictors were observed. LIMITATIONS: The fact that this study was a retrospective analysis with a moderate sample size was a limitation. CONCLUSIONS: Advanced machine learning/classification algorithms produce more accurate personalized predictions of rehabilitation outcomes than commonly used general linear models.


Assuntos
Braço/fisiopatologia , Terapia por Exercício/métodos , Movimento , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral , Atividades Cotidianas , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Redes Neurais de Computação , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Acidente Vascular Cerebral/complicações , Fatores de Tempo , Tato
16.
Stroke ; 50(9): 2492-2499, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31434543

RESUMO

Background and Purpose- The amount of task-specific stepping practice provided during rehabilitation poststroke can influence locomotor recovery and reflects one aspect of exercise dose that can affect the efficacy of specific interventions. Emerging data suggest that markedly increasing the intensity and variability of stepping practice may also be critical, although such strategies are discouraged during traditional rehabilitation. The goal of this study was to determine the individual and combined contributions of intensity and variability of stepping practice to improving walking speed and distance in individuals poststroke. Methods- This phase 2, randomized, blinded assessor clinical trial was performed between May 2015 and November 2018. Individuals between 18 and 85 years old with hemiparesis poststroke of >6 months duration were recruited. Of the 152 individuals screened, 97 were randomly assigned to 1 of 3 training groups, with 90 completing >10 sessions. Interventions consisted of either high-intensity stepping (70%-80% heart rate reserve) of variable, difficult stepping tasks (high variable), high-intensity stepping performing only forward walking (high forward), and low-intensity stepping in variable contexts at 30% to 40% heart rate reserve (low variable). Participants received up to 30 sessions over 2 months, with testing at baseline, post-training, and a 3-month follow-up. Primary outcomes included walking speeds and timed distance, with secondary measures of dynamic balance, transfers, spatiotemporal kinematics, and metabolic measures. Results- All walking gains were significantly greater following either high-intensity group versus low-variable training (all P<0.001) with significant correlations with stepping amount and rate (r=0.48-60; P<0.01). Additional gains in spatiotemporal symmetry were observed with high-intensity training, and balance confidence increased only following high-variable training in individuals with severe impairments. Conclusions- High-intensity stepping training resulted in greater improvements in walking ability and gait symmetry than low-intensity training in individuals with chronic stroke, with potential greater improvements in balance confidence. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT02507466.


Assuntos
Terapia por Exercício , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/fisiopatologia , Caminhada/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Exercício Físico/fisiologia , Teste de Esforço , Terapia por Exercício/métodos , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/reabilitação , Amplitude de Movimento Articular/fisiologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Adulto Jovem
17.
Clin Rehabil ; 33(12): 1919-1930, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31423822

RESUMO

OBJECTIVE: To establish feasibility of initiating electrical stimulation treatment of wrist extensors and flexors in patients early after stroke to prevent muscle contractures and pain. DESIGN: Feasibility randomized controlled trial with economic evaluation. SETTING: A specialist stroke unit in Nottinghamshire. SUBJECTS: A total of 40 patients recruited within 72 hours post-stroke with arm hemiparesis. INTERVENTIONS: Participants were randomized to receive usual care or usual care and electrical stimulation to wrist flexors and extensors for 30 minutes, twice a day, five days a week for three months. Initial treatment was delivered by an occupational therapist or physiotherapist who trained participants to self-manage subsequent treatments. MEASURES: Measures of feasibility included recruitment and attrition rates, completion of treatment, and successful data collection. Outcome data on wrist range of motion, pain, arm function, independence, quality of life, and resource use were measured at 3-, 6-, and 12-months post-randomization. RESULTS: A total of 40 participants (of 215 potentially eligible) were recruited in 15 months (20 men; mean age: 72 (SD: 13.0)). Half the participants lacked mental capacity and were recruited by consultee consent. Attrition at three-month follow-up was 12.5% (death (n = 2), end-of-life care (n = 2), and unable to contact (n = 1)). Compliance varied (mean: 65 (SD: 53)) and ranged from 10 to 166 treatments per patient (target dosage was 120). Data for a valid economic analysis can be adequately collected. CONCLUSION: Early initiation of electrical stimulation was acceptable and feasible. Data collection methods used were feasible and acceptable to participants. A large definitive study is needed to determine if electrical stimulation is efficacious and cost effective.


Assuntos
Contratura/prevenção & controle , Terapia por Estimulação Elétrica , Dor/prevenção & controle , Paresia/reabilitação , Acidente Vascular Cerebral/complicações , Punho , Adulto , Idoso , Idoso de 80 Anos ou mais , Contratura/etiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Paresia/etiologia , Qualidade de Vida , Amplitude de Movimento Articular , Reabilitação do Acidente Vascular Cerebral
18.
Restor Neurol Neurosci ; 37(5): 421-435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424422

RESUMO

BACKGROUND: A recently updated Cochrane review for mirror therapy (MT) showed a high level of evidence in the treatment of hemiparesis after stroke. However, the therapeutic protocols used in the individual studies showed significant variability. OBJECTIVE: A secondary meta-analysis was performed to detect which parameters of these protocols may influence the effect of MT for upper limb paresis after stroke. METHODS: Trials included in the Cochrane review, which published data for motor function / impairment of the upper limb, were subjected to this analysis. Trials or trial arms that used MT as group therapy or combined it with electrical or magnetic stimulation were excluded. The analysis focused on the parameters mirror size, uni- or bilateral movement execution, and type of exercise. Data were pooled by calculating the total weighted standardized mean difference and the 95% confidence interval. RESULTS: Overall, 32 trials were included. The use of a large mirror compared to a small mirror showed a higher effect on motor function. Movements executed unilaterally showed a higher effect on motor function than a bilateral execution. MT exercises including manipulation of objects showed a minor effect on motor function compared to movements excluding the manipulation of objects. None of the subgroup differences reached statistical significance. CONCLUSIONS: The results of this analysis suggest that the effects on both motor function and impairment of the affected upper limb depend on the therapy protocol. They furthermore indicate that a large mirror, unilateral movement execution and exercises without objects may be parameters that enhance the effects of MT for improving motor function after stroke.


Assuntos
Técnicas de Exercício e de Movimento/métodos , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Humanos , Paresia/etiologia , Paresia/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Recuperação de Função Fisiológica/fisiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento , Extremidade Superior/fisiologia
19.
Int J Rehabil Res ; 42(4): 309-315, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31425349

RESUMO

Among the new rehabilitation strategies aimed at improving independent walking after stroke, the body weight-support training allows an early and controlled ambulatory training. To date, most available studies are based on treadmill body weight-support (BWS) training and involve patients with chronic stroke sequelae. In contrast, the effects of a BWS training performed on the ground in patients with subacute hemiparesis (stroke within 4 weeks), with significant gait deficiencies, is unknown. The primary aim of this study was to evaluate the efficacy of a rehabilitative program that combines conventional approach with an early overground body weight-support training, in terms of recovery of independent walking focussing on patients with subacute stroke. The secondary aim was to evaluate the impact of body weight-support also on functional mobility, overall disability, and gait endurance. A total of 37 participants were enrolled and randomized to experimental group or control group for the baseline evaluations. In the experimental group, body weight-supported overground walking was added to conventional physiotherapy for 4 weeks. The outcome measurements used were: Functional Ambulation Classification (FAC), Rivermead Mobility Index, Barthel Index, and the 6-minute Walk Test. At the evaluation 1 week after the end of the intervention period, experimental group reached a statistically significant increase of independent walking as detected by FAC (experimental group: 3 vs. control group: 2, P < 0.01). No differences were observed by the other evaluation outcome measures. We conclude that BWS training may be more effective than conventional therapy alone in improving walking autonomy in persons with subacute stroke.


Assuntos
Modalidades de Fisioterapia , Reabilitação do Acidente Vascular Cerebral/métodos , Caminhada , Idoso , Peso Corporal/fisiologia , Feminino , Marcha/fisiologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Paresia/fisiopatologia , Paresia/reabilitação , Projetos Piloto , Amplitude de Movimento Articular/fisiologia , Projetos de Pesquisa , Equipamentos de Autoajuda , Acidente Vascular Cerebral/fisiopatologia , Cuidados Semi-Intensivos , Resultado do Tratamento , Teste de Caminhada
20.
BMC Neurol ; 19(1): 196, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416436

RESUMO

BACKGROUND: Recovery of upper limb function in individuals after a stroke remains challenging. Modified constraint-induced movement therapy (m-CIMT) has strong evidence for increasing the use and recovery of sensorimotor function of the paretic upper limb. Recent studies have shown that priming with aerobic exercise prior to task-specific training potentiates upper limb recovery in individuals with stroke. This protocol describes a randomized clinical trial designed to determine whether priming with moderate-high intensity aerobic exercise prior to m-CIMT will improve the manual dexterity of the paretic upper limb in individuals with chronic hemiparesis. METHODS: Sixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + m-CIMT or Stretching + m-CIMT. m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence. Aerobic exercise will be conducted on a stationary bicycle at intervals of moderate to high intensity. Participants will be evaluated at baseline, 3, 30, and 90 days postintervention by the following instruments: Motor Activity Log, Nottingham Sensory Assessment, Wolf Motor Function Test, Box and Block Test, Nine-Hole Peg Test, Stroke Specific Quality of Life Scale and three-dimensional kinematics. The data will be tested for normality and homogeneity. Parametric data will be analyzed by two-way ANOVA with repeated measures and Bonferroni's adjustment. For nonparametric data, the Friedman test followed by the Wilcoxon test with Bonferroni's adjustment will be used to compare the ratings for each group. To compare the groups in each assessment, the Mann-Whitney test will be used. DISCUSSION: This study will provide valuable information about the effect of motor priming for fine upper limb skill improvement in people with chronic poststroke hemiparesis, bringing new evidence about the association of two therapies commonly used in clinical practice. TRIAL REGISTRATION: This trial was retrospectively registered (registration number RBR-83pwm3 ) on 07 May 2018.


Assuntos
Terapia por Exercício/métodos , Exercício Físico , Paresia/reabilitação , Projetos de Pesquisa , Reabilitação do Acidente Vascular Cerebral/métodos , Atividades Cotidianas , Adulto , Feminino , Humanos , Masculino , Paresia/etiologia , Qualidade de Vida , Acidente Vascular Cerebral/complicações , Extremidade Superior/fisiopatologia
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