Archive for category Paretic Hand

[Abstract] Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial

The aim of this study was to compare the effects of two kinds of wrist-hand orthosis on wrist flexor spasticity in chronic stroke patients.

This is a randomized controlled trial.

The study was conducted in a rehabilitation center.

A total of 40 chronic hemiparetic stroke patients with wrist flexor spasticity were involved in the study.

Patients were randomly assigned to either an experimental group (conventional rehabilitation therapy + 3D-printed orthosis, 20 patients) or a control group (conventional rehabilitation therapy + low-temperature thermoplastic plate orthosis, 20 patients). The time of wearing orthosis was about 4–8 hours per day for six weeks.

Primary outcome measure: Modified Ashworth Scale was assessed three times (at baseline, three weeks, and six weeks). Secondary outcome measures: passive range of motion, Fugl-Meyer Assessment score, visual analogue scale score, and the swelling score were assessed twice (at baseline and six weeks). The subjective feeling score was assessed at six weeks.

No significant difference was found between the two groups in the change of Modified Ashworth Scale scores at three weeks (15% versus 25%, P = 0.496). At six weeks, the Modified Ashworth Scale scores (65% versus 30%, P = 0.02), passive range of wrist extension (P < 0.001), ulnar deviation (P = 0.028), Fugl-Meyer Assessment scores (P < 0.001), and swelling scores (P < 0.001) showed significant changes between the experimental group and the control group. No significant difference was found between the two groups in the change of visual analogue scale scores (P = 0.637) and the subjective feeling scores (P = 0.243).

3D-printed orthosis showed greater changes than low-temperature thermoplastic plate orthosis in reducing spasticity and swelling, improving motor function of the wrist and passive range of wrist extension for stroke patients.

via Effects of a 3D-printed orthosis compared to a low-temperature thermoplastic plate orthosis on wrist flexor spasticity in chronic hemiparetic stroke patients: a randomized controlled trial – Yanan Zheng, Gongliang Liu, Long Yu, Yanmin Wang, Yuan Fang, Yikang Shen, Xiuling Huang, Lei Qiao, Jianzhong Yang, Ying Zhang, Zikai Hua,

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[Abstract] Measurement Properties of the Hand Grip Strength Assessment. A Systematic Review with Meta-analysis

Abstract

Objective

The aim of this study was to critically appraise, compare and summarize the quality of the measurement properties of grip strength (GS) in healthy participants and patients with musculoskeletal, neurological or systemic conditions.

Data Sources

We followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guideline. To identify studies on measurement properties of GS, we searched the Medline, Embase, CINAHL, PEDro and Cochrane Library databases from inception till June 2019. Meta-analyses were carried out using a random effect model and 95% confidence intervals (CI) were calculated.

Study Selection

Studies were included if they reported at least 1 measurement property of hand GS in healthy patient population or with musculoskeletal, neurological and systemic conditions

Data Extraction

The extracted data included the study population, setting, sample size, measurement evaluated and the test interval.

Data Synthesis

Twenty-five studies were included with 1879 participants. The pooled results indicated excellent intra-class correlation coefficients (ICC) 0.92, 95% CI: -0.88 to 0.94 for healthy participants, ICC 0.95, 95% CI: -0.93 to 0.97 for upper extremity conditions and an ICC of 0.96, 95% CI: -0.94 to 0.97 for patients with neurological conditions. Minimum Clinically Important Difference (MCID) scores for hand GS were: 5.0 kg (dominant side) and 6.2 kg (non-dominant side) for post-stroke patients, 6.5 kg for the affected side after distal radius fracture, 10.5lbs and 10 kilopascals for immune-mediated neuropathies, 17kg for patients with lateral epicondylitis and 0.84 kg (affected side) and 1.12 kg (unaffected side) in the carpometacarpal osteoarthritis group, and MCID GS estimates of 2.69 – 2.44 kg in the healthy group

Conclusion

Our synthesized evidence indicated that GS assessment is a reliable and valid procedure among healthy participants as well as across various clinical populations. Furthermore, our MCID summary scores provided useful information for evaluating (clinical importance) new interventions regarding hand GS.

via Measurement Properties of the Hand Grip Strength Assessment. A Systematic Review with Meta-analysis – Archives of Physical Medicine and Rehabilitation

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[Abstract] Impaired force control contributes to car steering dysfunction in chronic stroke

Purpose: Precise control of a car steering wheel requires adequate motor capability. Deficits in grip strength and force control after stroke could influence the ability steer a car. Our study aimed to determine the impact of stroke on car steering and identify the relative contribution of grip strength and grip force control to steering performance.

Methods: Twelve chronic stroke survivors and 12 controls performed three gripping tasks with each hand: maximum voluntary contraction, dynamic force tracking, and steering a car on a winding road in a simulated driving environment. We quantified grip strength, grip force variability, and deviation of the car from the center of the lane.

Results: The paretic hand exhibited reduced grip strength, increased grip force variability, and increased lane deviation compared with the non-dominant hand in controls. Grip force variability, but not grip strength, significantly predicted (R2 = 0.49, p < 0.05) lane deviation with the paretic hand.

Conclusion: Stroke impairs the steering ability of the paretic hand. Although grip strength and force control of the paretic hand are diminished after stroke, only grip force control predicts steering accuracy. Deficits in grip force control after stroke contribute to functional limitations in performing skilled tasks with the paretic hand.

  1. Implications for rehabilitation
  2. Driving is an important goal for independent mobility after stroke that requires motor capability to manipulate hand and foot controls.

  3. Two prominent stroke-related motor impairments that may impact precise car steering are reduced grip strength and grip force control.

  4. In individuals with mild-moderate impairments, deficits in grip force modulation rather than grip strength contribute to compromised steering performance with the paretic hand.

  5. We recommend that driving rehabilitation should consider re-educating grip force modulation for successful driving outcomes post stroke.

via Impaired force control contributes to car steering dysfunction in chronic stroke: Disability and Rehabilitation: Vol 0, No 0

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[ARTICLE] The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits – Full Text

Abstract

Background/Aims

The Bobath concept has long been used to improve postural control and limb function post-stroke, yet its effect in patients with deficits have not been clearly demonstrated. This study aimed to investigate the effect of the latest Bobath therapy programme on upper limb functions, muscle tone and sensation in chronic stroke individuals with moderate to severe deficits.

Methods

A pre–post test design was implemented. The participants were chronic stroke individuals (n=26). Home-based intervention based on the Bobath concept was administered 3 days per week for 6 weeks (20 repetitions × 3 sets per task each session). Outcome measures consisted of the Wolf Motor Function Test, Fugl-Meyer Assessment for the upper extremity, Modified Ashworth Scale, and the Revised Nottingham Sensory Assessment. Data were analysed using the Wilcoxon Signed rank test.

Results

Almost all items of the Wolf Motor Function Test and the Fugl-Meyer Assessment for the upper extremity demonstrated statistically significant differences post-intervention. Finger flexor muscle tone and stereognosis were also significantly improved.

Conclusions

The 6-week Bobath therapy programme could improve upper limb function and impairments in chronic stroke individuals with moderate to severe deficits. Its effects were also demonstrated in improving muscle tone and cortical sensation.

INTRODUCTION

Stroke is a global public health problem that leads to significant disabilities (World Health Organization, 2014). After discharge from a hospital, patients who have experienced stroke return to the community and many do not have access to physical therapy. Around 65% of patients who had experienced a stroke were unable to use their hemiparetic upper limb (Bruce and Dobkin, 2005). Those with moderate to severe arm deficits have difficulty in reaching to grasp, delay in time to maximal grip aperture, prolonged movement time, and a lack of accuracy (Michaelsen et al, 2009). A number of interventions have been proven to be effective in improving upper limb function post-stroke. However, there is little evidence of the effectiveness of these interventions for those with severe deficits.

The therapy programme based on the Bobath concept has been shown to improve upper limb function in individuals who have experienced chronic stroke (Huseyinsinoglu et al, 2012Carvalho et al, 2018). The Bobath concept has been in evolution and the present clinical framework incorporates the integration of postural control and quality of task performance, selective movement, and the role of sensory information to promote normal movement pattern. Therapeutic activities involved movement facilitation together with patient’s active participation in practice to improve motor learning; nevertheless, implementation time varied across studies (Vaughan-Graham et al, 2009Vaughan-Graham and Cott, 2016).

Among the few studies of patients with chronic stroke, none focused on the rehabilitation of patients with different degrees of deficit severity in the community. Moreover, previous studies using the Bobath concept were all conducted in clinical settings (Platz et al, 2005Huseyinsinoglu et al, 2012).[…]

 

Continue —->  The effect of the Bobath therapy programme on upper limb and hand function in chronic stroke individuals with moderate to severe deficits | International Journal of Therapy and Rehabilitation

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[Abstract] Home-based upper extremity stroke therapy using a multi-user virtual reality environment: a randomized trial

Abstract

Objective

To compare participation and subjective experience of participants in both home-based multi-user VR therapy and home-based single-user VR therapy.

Design

Crossover, randomized trial

Setting

Initial training and evaluations occurred in a rehabilitation hospital; the interventions took place in participants’ homes

Participants

Stroke survivors with chronic upper extremity impairment (n=20)

Interventions

4 weeks of in-home treatment using a custom, multi-user virtual reality system (VERGE): two weeks of both multi-user (MU) and single-user (SU) versions of VERGE. The order of presentation of SU and MU versions was randomized such that participants were divided into two groups, first multi-user (FMU) and first single-user (FSU).

Main Outcome Measures

We measured arm displacement during each session (meters) as the primary outcome measure. Secondary outcome measures include: time participants spent using each MU and SU VERGE, and Intrinsic Motivation Inventory (IMI) scores. Fugl-Meyer Upper-Extremity (FMUE) score and compliance with prescribed training were also evaluated. Measures were recorded before, midway, and after the treatment. Activity and movement were measured during each training session.

Results

Arm displacement during a session was significantly affected the mode of therapy (MU: 414.6m, SU: 327.0m, p=0.019). Compliance was very high (99% compliance for MU mode and 89% for SU mode). Within a given session, participants spent significantly more time training in the MU mode than in the SU mode (p=0.04). FMUE score improved significantly across all participants (Δ3.2, p=0.001).

Conclusions

Multi-user VR exercises may provide an effective means of extending clinical therapy into the home.

via Home-based upper extremity stroke therapy using a multi-user virtual reality environment: a randomized trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] BIGHand – A bilateral, integrated, and gamified handgrip stroke rehabilitation system for independent at-home exercise – Demo Video

Effective home rehabilitation is important for recovery of hand grip ability in post-stroke individuals. This paper presents BIGHand, a bilateral, integrated, and gamified handgrip stroke rehabilitation system for independent at-home exercise. BIGHand consists of affordable sensor-integrated hardware (Vernier hand dynamometers, Arduino Uno, interface shield) used to obtain real-time grip force data, and a set of exergames designed as parts of an interactive structural rehabilitation program. This program pairs targeted difficulty progression with user-ability scaled controls to create an adaptive, challenging, and enticing rehabilitation environment. This training prepares users for the many activities of daily living (ADLs) by targeting strength, bilateral coordination, hand-eye coordination, speed, endurance, precision, and dynamic grip force adjustment. Multiple measures are taken to engage, motivate, and guide users through the at-home rehabilitation process, including “smart” post-game feedback and in-game goals.

Demo video 

via BIGHand – A bilateral, integrated, and gamified handgrip stroke rehabilitation system for independent at-home exercise

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[ARTICLE] An Exploratory Study of Predictors of Response to Vagus Nerve Stimulation Paired with Upper-Limb Rehabilitation After Ischemic Stroke – Full Text

Abstract

We have previously shown the safety and feasibility of vagus nerve stimulation (VNS) paired with upper-limb rehabilitation after ischemic stroke. In this exploratory study, we assessed whether clinical and brain MRI variables predict response to treatment. We used data from two completed randomised and blinded clinical trials (N = 35). All participants had moderate to severe upper-limb weakness and were randomised to 6-weeks intensive physiotherapy with or without VNS. Participants had 3 T brain MRI at baseline. The primary outcome was change in Fugl-Meyer Assessment, upper-extremity score (FMA-UE) from baseline to the first day after therapy completion. We used general linear regression to identify clinical and brain MRI predictors of change in FMA-UE. VNS-treated participants had greater improvement in FMA-UE at day-1 post therapy than controls (8.63 ± 5.02 versus 3.79 ± 5.04 points, t = 2.83, Cohen’s d = 0.96, P = 0.008). Higher cerebrospinal fluid volume was associated with less improvement in FMA-UE in the control but not VNS group. This was also true for white matter hyperintensity volume but not after removal of an outlying participant from the control group. Responders in the VNS group had more severe arm impairment at baseline than responders to control. A phase III trial is now underway to formally determine whether VNS improves outcomes and will explore whether these differ in people with more severe baseline upper-limb disability and cerebrovascular disease.

Introduction

Vagus nerve stimulation (VNS) paired with upper-limb rehabilitation is a potential novel treatment for arm weakness after stroke. VNS triggers release of plasticity promoting neuromodulators, such as acetylcholine and norepinephrine, throughout the cortex1. Timing this with motor training drives task-specific plasticity in the motor cortex2 and VNS paired with rehabilitative training has been shown to improve recovery in different preclinical models of stroke, both in comparison to VNS alone and rehabilitation alone3,4. These improvements were associated with synaptic reorganization of cortical motor networks and recruitment of residual motor neurons controlling the impaired forelimb5. Two clinical studies comparing VNS paired with upper-limb rehabilitation with upper-limb rehabilitation alone have shown it to be acceptably safe and feasible and that it may improve arm weakness after ischemic stroke6,7.

Arm weakness is the most common symptom of stroke and approximately half of stroke survivors with arm weakness have prolonged disability, which is associated with reduced quality of life8,9. Restoration of arm function after stroke is a priority for many stroke survivors10. However, recovery of motor function after stroke varies, so identifying factors that help predict response is important to aid patient selection and identify those most likely to respond. This is particularly true where therapies are invasive (involving surgery) and/or time consuming; VNS requires implantation of a nerve stimulator which is costly and associated with risks of anaesthesia, a small risk of infection and small risk of vocal cord palsy. There are several clinical and brain imaging markers that predict cognitive and functional recovery after stroke including age, level of impairment, white matter hyperintensity (WMH) volume, stroke lesion volume, corticospinal tract damage and blood pressure level11,12,13.

In the present study, we combined clinical and brain magnetic resonance imaging (MRI) data from our two previous randomised trials of VNS paired with rehabilitation for the upper-limb after ischemic stroke6,7. We performed exploratory analyses to assess predictors of response to VNS paired with upper-limb rehabilitation. Our goal was to identify predictive factors for further study that may help with patient selection for this promising novel therapy. […]

 

Continue —->  An Exploratory Study of Predictors of Response to Vagus Nerve Stimulation Paired with Upper-Limb Rehabilitation After Ischemic Stroke | Scientific Reports

figure1

Illustration of brain MRI measures obtained. (A) Raw FLAIR image. (B) Segmentation of white matter hyperintensities (WMH; bright red) and ischaemic stroke infarct volumes (royal blue). (C) Estimate of the left (cyan) and right (pink) corticospinal tracts. (D) Interaction between stroke lesion (dull red) and corticospinal tract (light blue) in a 3D rendering. Images A and B come from the same patient, C and D are from separate patients and all are shown in neurological (“left is left”) convention.

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[Abstract] Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study

Abstract

Background and Purpose

Transcranial direct current stimulation (tDCS) is a treatment used in the rehabilitation of stroke patients aiming to improve functionality of the plegic upper extremity. Currently, tDCS is not routinely used in post stroke rehabilitation. The aim of this study was to establish the effects of bihemspheric tDCS combined with physical therapy (PT) and occupational therapy (OT) on upper extremity motor function.

Methods

Thirty-two stroke inpatients were randomised into 2 groups. All patients received 15 sessions of conventional upper extremity PT and OT over 3 weeks. The tDCS group (n = 16) also received 30 minutes of bihemispheric tDCS and the sham group (n = 16) 30 minutes of sham bihemispheric tDCS simultaneously to OT. Patients were evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), functional independence measure (FIM), and Brunnstrom stages of stroke recovery (BSSR) by a physiatrist blind to the treatment group

Results

The improvement in FIM was higher in the tDCS group compared to the sham group (P = .001). There was a significant within group improvement in FMUE, FIM and BSSR in those receiving tDCS (P = .001). There was a significant improvement in FIM in the chronic (> 6months) stroke sufferers who received tDCS when compared to those who received sham tDCS and when compared to subacute stroke (3-6 months) sufferers who received tDCS/sham.

Conclusions

Upper extremity motor function in hemiplegic stroke patients improves when bihemispheric tDCS is used alongside conventional PT and OT. The improvement in functionality is greater in chronic stroke patients.

via Effects of Bihemispheric Transcranial Direct Current Stimulation on Upper Extremity Function in Stroke Patients: A randomized Double-Blind Sham-Controlled Study – ScienceDirect

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[Abstract] Design of Powered Wearable Elbow Brace for Rehabilitation Applications at Clinic and Home – IEEE Conference Publication

Abstract

Spasticity and contractures are secondary to most neurological and orthopaedic pathologies. The most conservative method of management of spasticity and contractures is passive stretching exercises. Robotic rehabilitation aims to provide a solution to this problem. We describe in details the design of a powered wearable orthosis especially designed for managing spasticity and contractures. The device is fully portable, allowing the patient to undergo repeated-passive-dynamic exercises outside the hospital environment. The design of the device is modular to make it adaptable to different anatomies and pathologies. The device is also fitted with electrogoniometers and torque sensors to record kinematics and dynamics of the patient, improving the insight of the clinicians to the rehabilitation of the patient, as well as providing data for further clinical and scientific investigations. The mechanical integrity of the device elements is simulated and verified.

via Design of Powered Wearable Elbow Brace for Rehabilitation Applications at Clinic and Home – IEEE Conference Publication

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