Archive for June, 2015

[ARTICLE] The effect of a wrist-hand stretching device for spasticity in chronic hemiparetic stroke patients.


BACKGROUND: The majority of these stretching devices have focused on spasticity of the leg and only a few devices have been developed for spasticity of the wrist and hand. In addition, most of these devices were large and complicated, with less easy applicability for personal use.

AIM: To investigate the effect of a stretching device for spasticity of the wrist and hand in chronic hemiparetic stroke patients.

DESIGN: Prospective single blind randomized controlled clinical trial.

SETTING: Outpatients.

METHODS: Patients were randomly assigned to either the intervention group(11 patients) or the control group(10 patients). The stretching device consisted of a circular shaped plastic plate and five holders to immobilize the fingers. In position 1, finger tips were facing forward, position 2 was 90° external rotation from position 1, and position 3 was 90° external rotation from position 2. Each position was maintained for 4 minutes and a rest period of 1 minute was given, therefore, one session was performed for 14 minutes. The stretching program was conducted 3 sessions/day, 6 days/week for 4 weeks. Spasticity(modified Ashworth scale [MAS]) and motor function(Fugl-Meyer motor assessment [FMA], Active Range of Motion [AROM]) of affected wrist and hand were assessed three times(first assessment; Pre, second assessment; Post-2 weeks, third assessment; Post-4 weeks).

RESULTS: In the intervention group, significant differences in the wrist and hand MAS and FMA were observed between three assessment times(p0.05). In the control group, no differences in MAS, FMA, and AROM were observed between three assessment times(p>0.05).

CONCLUSION: Findings showed that this stretching device was effective in terms of relieving spasticity and functional recovery.

CLINICAL REHABILITATION IMPACT: This stretching device is effective in spasticity reducing and motor function improvement. Moreover, it is useful to patient because it is easy to use and portable.

via The effect of a wrist-hand stretching device for spasticity in chronic hemiparetic stroke patients. – Abstract – Europe PubMed Central.

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A patient with right anterior pons and superior cerebellar stroke was seen for
physical therapy treatment for 16 sessions from 6/11/14 to 6/23/14 at an inpatient
physical therapy clinic. Treatment was provided by a student physical therapist under the
supervision of a licensed physical therapist.
The patient was evaluated at the initial encounter with Timed Up and Go, 10 Meter
Walk Test, Dynamic Gait Index, Berg Balance Scale, and Functional Independence
Measure, and a plan of care was established. Main goals for the patient were to improve
strength, range of motion, motor control and sequencing during functional activities, gait
speed, static and dynamic standing balance, and functional independence. Main
interventions used were over-ground gait training, restorative training, task-specific
training, and functional training.

The patient improved strength, motor control and sequencing, gait speed, balance, and
functional independence. The patient was discharged to home with a home exercise
program and with follow up with outpatient physical therapy.

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[ARTICLE] Assessment of Real-World Upper Limb Activity in Adults with Chronic Stoke


Hemiparesis is a common motor impairment following stroke that leads to disability. The goal of stroke-related physical rehabilitation is to reduce the severity of motor-related disability in hopes that improved motor capacity (i.e. what one can do) will generalize to improved motor performance (i.e. what one actually does) in everyday activities. Recent studies have demonstrated that motor capacity and motor performance are distinct domains of motor function, but few have objectively measured motor performance. Furthermore, even though many studies have demonstrated that motor capacity is only moderately associated with motor performance, few studies have examined other factors that might influence motor performance. The purpose of this dissertation was to characterize motor performance, and potential modifying factors of motor performance, in nondisabled adults and adults with chronic stroke, and to develop and validate a novel, accelerometry-derived assessment methodology to quantify motor performance.

Using wrist-worn accelerometry, we characterized duration of upper limb (UL) activity that occurred in everyday environments (i.e. real-world activity) as an index of motor performance. We also characterized several potential modifying factors of UL activity [i.e. self-reported time spent in sedentary activity, cognitive impairment, depressive symptomatology, number of comorbidities, living arrangement, age, motor capacity, pre-stroke hand dominance, and Activities of Daily Living (ADLs) status]. Increased self-reported time spent in sedentary activity was associated with decreased UL activity in nondisabled adults. Decreased motor capacity and dependence in ADLs were associated with decreased UL activity in adults with chronic stroke. These results identify potential factors that could be targeted during rehabilitation in patient populations. Additionally, duration of UL activity obtained from nondisabled adults could be used as a referent value for setting outcome goals for patients with UL impairment.

We also developed and validated a novel, accelerometry-based methodology to quantify real-world bilateral UL activity. This methodology was first validated in a laboratory setting in nondisabled adults. We derived two accelerometry-based metrics to quantify intensity of bilateral UL activity and contribution of each UL to activity. The accelerometry-derived metrics distinguished between high- and low-intensity UL activity, and between UL activities that were completed using both ULs versus one UL. The accelerometry-derived metrics were also strongly correlated with secondary measures (i.e. convergent validity was established).

Having established the validity of the accelerometry-based methodology, we characterized real-world bilateral UL activity during a “typical” day in nondisabled adults and adults with chronic stroke. We demonstrated that duration and intensity of UL activity were lower in adults with stroke than in nondisabled adults, and that UL activity was more lateralized (i.e. unaffected UL activity exceeded affected UL activity) in adults with stroke. We also demonstrated that motor capacity and motor performance were not associated in a subset of adults with stroke.

Taken together, our results suggest that motor capacity and motor performance are distinct domains of motor function that should be assessed separately. Furthermore, factors other than motor capacity should be identified and targeted during rehabilitation to improve motor performance above that which can be obtained by improvement in motor capacity alone.

via “Assessment of Real-World Upper Limb Activity in Adults with Chronic St” by Ryan Bailey.

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[BLOG POST] Changing a Common Belief About Brain Injury – from Huffington Post

Broken Brain - Brilliant Mind

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As a scientist, I am impassioned to share research findings that upend conventionally-held wisdom about the brain – modifying viewpoints that are obsolete, wrong, and disabling.

The journal Neuropsychological Rehabilitation has just published the results of a study conducted by our interdisciplinary team of experts at the Center for BrainHealth at The University of Texas at Dallas. The study found that strategy-based cognitive training significantly improves the cognitive performance, psychological and neural health of those who have experienced a traumatic brain injury (TBI), long after the initial injury.

These findings should permanently put to rest the view, once commonly held among scientists and the medical community, that the brain can only recover lost functions for a period of one year following injury. Unfortunately, insurance companies still base their coverage policies on this outdated assumption. What’s worse, many of those afflicted with TBI may be…

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[WEB SITE] Can virtual reality help stroke patients recover arm movement?

In the US, stroke is the number five cause of death and a leading cause of disability. Many people who have had a stroke experience hemiparesis – reduced muscle strength on one side of the body – and often compensate by relying more heavily on their healthy limb. Prolonged periods of not using the affected limb can lead to further impairment, but now, researchers say virtual reality could help some stroke patients regain the use of their arm.

Virtual reality arm

The researchers – led by Belén Rubio, of the Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems at Universitat Pompeu Fabra in Spain – publish their clinical pilot study in the Journal of NeuroEngineering and Rehabilitation.

They note that “learned non-use” of a limb is common in stroke patients and is linked to reduced quality of life.

“There is a need for designing new rehabilitation strategies that promote the use of the affected limb in performing daily activities,” says Rubio. “Often we neglect the remarkable contribution of the patient’s emotional and psychological states to recover, and this included their confidence.”

To increase patient confidence in using their paralyzed arm, Rubio and colleagues conducted a small pilot study with 20 hemiparetic stroke patients.

Continue —>  Can virtual reality help stroke patients recover arm movement? – Medical News Today.

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[Systematic review] What is the effect of additional physiotherapy on sitting balance following stroke compared to standard physiotherapy treatment



Sitting balance dysfunction is commonly experienced following stroke. Physiotherapists utilize interventions to address this problem but it is unclear whether treatment type, target or practice intensity may affect outcomes.


To compare the effects of standard physiotherapy to standard physiotherapy plus an additional physiotherapy treatment after stroke.

Data Sources:

The databases of Cochrane Library, CINAHL, Embase, Ovid Medline, AMED, and the Physiotherapy Evidence Database (PEDro) up to December 2014 were searched.

Study Selection:

Randomized controlled trials in English reported in peer-reviewed journals regarding the effect of additional physiotherapy on sitting balance were retrieved.

Data Extraction:

The PEDro scale was used to assess study quality.


Eleven studies met inclusion criteria. Nine targeted the ICF (International Classification of Function, Disability and Health) domain of Activity. The Trunk control test (TCT) was used as a primary outcome measure in five studies, and the Trunk Impairment Scale (TIS) was used in four. There was a significant effect (mean difference = 1.67, 95% CI = 0.54–2.80) favoring intervention, as measured by the TIS. There was no evidence to support the effect of additional treatment on sitting balance as measured by the TCT (mean difference = − 1.53, 95% CI = − 9.37 to 6.32).


The current evidence supports strategies that target deficits at the activity level and increase total treatment time. The TIS is most responsive as a measure of treatment efficacy. Further research is required using recommended outcome measures to facilitate generation of a minimum data set and data pooling.

via Maney Online – Maney Publishing.

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[ARTICLE] Effects of Neuromuscular Electrical Stimulation (NMES) on Hand Function in Stroke Patients



Motor dysfunction after stroke is a major reason which disables a person in performing activities of daily living (ADL). During the process of natural recovery affected upper limb and lower limb recovers but recovery of the hand function often remains incomplete and can lead to a major disability for a person. A lot of treatment options are available to solve this problem and NMES appears to be a promising and easily available among them.


To assess the effectiveness of NMES along with Conventional Physiotherapy on Hand Function rehabilitation in Stroke Patients.


30 (thirty) patients were divided in a consecutive manner into two groups for the study; one group received conventional treatment (Control Group) and other for conventional treatment as well as NMES to wrist and finger extensors (Experimental group). An assessment was done prior to starting of treatment and after 4 weeks of treatment.


At the end of 4 weeks experimental group showed significant improvement in Block to Box Test (p<0.05), Fugl Meyer Assessment Tool for Wrist and Hand (p<0.05) and Grip Strength (p0.05).


Conventional exercise therapy and NMES to wrist and finger extensors is more effective than Conventional exercise therapy alone in improving hand function in stroke patients.

via Indian Journals.

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[Abstract] Task-Based Mirror Therapy Augmenting Motor Recovery in Poststroke Hemiparesis: A Randomized Controlled Trial


To establish the effect of the task-based mirror therapy (TBMT) on the upper limb recovery in stroke.


A pilot, randomized, controlled, assessor-blinded trial was conducted in a rehabilitation institute. A convenience sample of 33 poststroke (mean duration, 12.5 months) hemiparetic subjects was randomized into 2 groups (experimental, 17; control, 16). The subjects were allocated to receive either TBMT or standard motor rehabilitation—40 sessions (5/week) for a period of 8 weeks. The TBMT group received movements using various goal-directed tasks and a mirror box. The movements were performed by the less-affected side superimposed on the affected side. The main outcome measures were Brunnstrom recovery stage (BRS) and Fugl-Meyer assessment (FMA)—FMA of upper extremity (FMA-UE), including upper arm (FMA-UA) and wrist–hand (FMA-WH).


The TBMT group exhibited highly significant improvement on mean scores of FMA-WH (P < .001) and FMA-UE (P < .001) at postassessment in comparison to the control group. Furthermore, there was a 12% increase in the number of subjects at BRS stage 5 (out of synergy movement) in the experimental group as compared to a 0% rise at the same stage in the control group.


This pilot trial confirmed the role of TBMT in improving the wrist–hand motor recovery in poststroke hemiparesis. MT using tasks may be used as an adjunct in stroke rehabilitation.

via Task-Based Mirror Therapy Augmenting Motor Recovery in Poststroke Hemiparesis: A Randomized Controlled Trial.

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[ARTICLE] A cohort study investigating a simple, early assessment to predict upper extremity function after stroke – a part of the SALGOT study – Full Text HTML


Background: For early prediction of upper extremity function, there is a need for short clinical measurements suitable for acute settings. Previous studies demonstrate correct prediction of function, but have ether included a complex assessment procedure or have an outcome that does not automatically correspond to motor function required to be useful in daily activity. The purpose of this study was to investigate whether a sub-set of items from the Action Research Arm Test (ARAT) at 3 days and 1 month post-stroke could predict the level of upper extremity motor function required for a drinking task at three later stages during the first year post-stroke.

Methods: The level of motor function required for a drinking task was identified with the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A structured process was used to select ARAT items not requiring special equipment and to find a cut-off level of the items’ sum score. The early prognostic values of the selected items, aimed to determine the level of motor function required for a drinking task at 10 days and 1 and 12 months, were investigated in a cohort of 112 patients. The patients had a first time stroke and impaired upper extremity function at day 3 after stroke onset, were ≥18 years and received care in a stroke unit.

Results: Two items, “Pour water from glass to glass” and “Place hand on top of head”, called ARAT-2, met the requirements to predict upper extremity motor function. ARAT-2 is a sum score (0-6) with a cut-off at 2 points, where >2 is considered an improvement. At the different time points, the sensitivity varied between 98 % and 100 %, specificity between 73 % and 94 %. Correctly classified patients varied between 81 % and 96 %.

Conclusions: Using ARAT-2, 3 days post-stroke could predict the level of motor function (assessed with FMA-UE) required for a drinking task during the first year after a stroke. ARAT-2 demonstrates high predictive values, is easily performed and has the potential to be clinically feasible.

Full Text HTML —>  BMC Neurology | Full text | A cohort study investigating a simple, early assessment to predict upper extremity function after stroke – a part of the SALGOT study.

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[ARTICLE] Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination


Background. The velocity of reaching movements is often reduced in patients with stroke-related hemiparesis; however, they are able to voluntarily increase paretic hand velocity. Previous studies have proposed that faster speed improves movement quality.

Objective. To investigate the combined effects of reaching distance and speed instruction on trunk and paretic upper-limb coordination. The hypothesis was that increased speed would reduce elbow extension and increase compensatory trunk movement.

Methods. A single session study in which reaching kinematics were recorded in a group of 14 patients with spastic hemiparesis. A 3-dimensional motion analysis system was used to track the trajectories of 5 reflective markers fixed on the finger, wrist, elbow, acromion, and sternum. The reaching movements were performed to 2 targets at 60% and 90% arm length, respectively, at preferred and maximum velocity. The experiment was repeated with the trunk restrained by a strap.

Results. All the patients were able to voluntarily increase reaching velocity. In the trunk free, faster speed condition, elbow extension velocity increased but elbow extension amplitude decreased and trunk movement increased. In the trunk restraint condition, elbow extension amplitude did not decrease with faster speed. Seven patients scaled elbow extension and elbow extension velocity as a function of reach distance, the other 7 mainly increased trunk compensation with increased task constraints. There were no clear clinical characteristics that could explain this difference.

Conclusions. Faster speed may encourage some patients to use compensation. Individual indications for therapy could be based on a quantitative analysis of reaching coordination.

via Faster Reaching in Chronic Spastic Stroke Patients Comes at the Expense of Arm-Trunk Coordination.

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