Posts Tagged chronic

[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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[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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[ARTICLE] Effect of Exercise on Gait Kinematics and Kinetics in Patients with Chronic Ischaemic Stroke – Full Text

ABSTRACT

Introduction In 2014, American Heart Association and American Stroke Association (AHA/ASA) issued exercise guidelines for stroke patients.
Aim of the Study: To study the effects of an exercise programme based on AHA/ ASA guidelines, on gait kinematics and kinetics in patients with chronic ischemic stroke.
Materials and Methods: Twelve stroke patients, 67.33 ± 9.14 years old, followed an 8-week exercise programme, with 3 hourly sessions per week, consisting of strength, endurance and flexibility training, as well as neuromuscular activities. Patients’ gait kinematics and kinetics were evaluated before and after the intervention using a 3-dimensional gait analysis system.
Results: In most cases, patients in the intervention group showed significant increase or no change in gait kinematics, significant increase in joint moments at the anterior-posterior plane during support phase, and non-signi- ficant change in the frontal and transverse planes kinetics.
Conclusions: Exercise prevented further deterioration and/or led to improved walking pattern.

1. Introduction

It is estimated that one in 5 women and one in 6 men will sustain a stroke up to the age of 75 years [1] . The main purpose of rehabilitation in such patients is to achieve the maximum possible personal performance, physical and psychological, with the ultimate goal of regaining a level of functional independence that will allow them to be re-integrated into social life as much as possible [2] . However, stroke patients often adopt a sedentary lifestyle [3] [4] [5] [6] . This may be attributed to 1) factors associated with patients themselves, such as depression, lack of interest or motivation, decreased perception, decreased confidence, ignorance that exercise is possible and desirability and fear of falls, of a new stroke or other undesirable effects; 2) practical factors, such as lack of support from family or other social actors, inability to access exercise sites, inadequate public transport, health professionals’ ignorance of the availability of physical activity services; 3) financial cost [7] [8] [9] [10] [11] . Conversely, exercise in groups may improve patient motivation [12] .

In 2014, the council of the American Heart Association and the American Stroke association (AHA/ASA) revised the exercise recommendations for stroke patients at all stages of their recovery [13] . Therefore, the aim of this study was to assess the effect of an exercise programme based on these recommendations on gait kinematics and kinetics of ischaemic stroke patients in the chronic phase of recovery.[…]

 

Continue —->  Effect of Exercise on Gait Kinematics and Kinetics in Patients with Chronic Ischaemic Stroke

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[Abstract] Stepping training with external feedback relating to lower limb support ability effectively improved complex motor activity in ambulatory patients with stroke: a randomized controlled trial

 

BACKGROUND: Lower limb support ability is important for steady and efficient mobility, but previous data commonly involved training during double stance positions, with or without external feedback, using a complex and costly machine.
AIM: To compare the effects of stepping training with or without external feedback in relation to the lower limb support ability of the affected limb on the functional ability necessary for independence in individuals with stroke.
DESIGN: A single-blinded, randomised controlled trial.
SETTING: Tertiary rehabilitation centres.
POPULATION: Ambulatory participants with stroke who walked independently over at least 10 meters with or without walking devices.
METHODS: Thirty-six participants were randomly arranged to be involved in a program of stepping training with or without external feedback related to the lower limb support ability of the affected limb (18 participants/group) for 30 minutes, followed by overground walking training for 10 minutes, 5 days/week over 4 weeks. The outcomes, including the lower limb support ability of the affected legs during stepping, functional ability and spatial walking data, were assessed prior to training, immediately after the first training session, and after 2- and 4- week training.
RESULTS: Participants demonstrated significant improvement in the amount of lower limb support ability, immediately after the first training with external feedback. Then, these participants showed further improvement in both the amount and duration of lower limb support ability, as well as the timed up and go data after 2 and 4 weeks of training (p < 0.05). This improvement was not found following control training.
CONCLUSIONS: The external feedback relating to lower limb support ability during stepping training effectively improved the movement stability and complex motor activity of ambulatory individuals with stroke who had long post-stroke time (approximately 3 years).
CLINICAL REHABILITATION IMPACT: Stepping training protocols and feedback can be easily applied in various settings using the amount of body-weight from an upright digital bathroom scale. Thus, the findings offer an alternative rehabilitation strategy for clinical, community and home-based settings for stroke individuals.

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via Stepping training with external feedback relating to lower limb support ability effectively improved complex motor activity in ambulatory patients with stroke: a randomized controlled trial – European Journal of Physical and Rehabilitation Medicine 2019 Oct 15 – Minerva Medica – Journals

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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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[ARTICLE] Effect of social support and health education on depression scale scores of chronic stroke patients – Full Text

Abstract

Post-stroke depression (PSD) constitutes an important complication of stroke, leading to great disability. After stroke, the prevalence rate of depression is about 30%. Depression also affects rehabilitation motivation, delays function recovery, and increases family and social burden. The objective of this study was to explore the effect of social support on depression in chronic stroke patients and the relationship between demographic and disease characteristics. Total samples were randomly divided into an intervention group (n = 31) and a control group (n = 31). Sixteen social support interventions were performed over 8 weeks. Social support programs were implemented 2 times a week. Depressive symptoms were assessed at the second week, 4th week, 8th week, and 4 weeks after the end of the study using the 10-item Center for the Epidemiological Studies of Depression Short Form (CES-D10). There was a significant correlation between depression and the economic status of the patients with chronic stroke, satisfaction in leisure, the presence or absence of caregivers, the duration of stroke, and with or without pain. A significant difference was found between two groups after social support for 8 weeks. Our findings suggest that remission of PSD needs at least 8 weeks of social support.

1 Introduction

Stroke is the third leading cause of death in Taiwan. After an acute stage, stroke patients usually suffer from physical, mental, verbal and social function disorders in varying degrees; in particular, post-stroke depression (PSD) is not only an important sequela, but also an important factor to predict the quality of life. Epidemiological studies have shown that about 30% of stroke patients at early or late stages develop PSD, which affects rehabilitation motivation of the patients, reduce the rehabilitation effect, and increase the load of family care. Although PSD affects the quality of life and functional recovery, it is often overlooked.[1] According to statistical data, the prevalence of depression is about 29% within 10 years after stroke, and the 5-year cumulative incidence is about 39% to 52%.[2] In a study on PSD and post-stroke fatigue of 368 stroke patients hospitalized within 3 months, researchers found that brain damage could result in physiological and psychological impairments. To be able to live independently, patients should learn the skills of adaptation, including the ability to seek social resources.[3] Successful rehabilitation means patients are able to maintain original social relations and actively participate in social activities to return to community life. Community social interaction or participation in activities requires physical and psychological ability.[4] In addition to rehabilitation activities, functional therapists should also meet the psychological needs of stroke patients in order to achieve holistic health care. In this study, we have investigated the effects of routine rehabilitation activities and additional social support and health education by functional therapists on PSD, and proposed suggestions on home and rehabilitation-related activities.[5,6][…]

 

Continue —-> Effect of social support and health education on depression… : Medicine

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[VIDEO] Stem Cell Therapy for Stroke – YouTube

via Stem Cell Therapy for Stroke – YouTube

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[Abstract] A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors

Abstract

BACKGROUND:

Stroke is a leading cause of death and disability in the Western world, and leads to impaired balance and mobility.

OBJECTIVE:

To investigate the feasibility of using a Virtual Reality-based dual task of an upper extremity while treadmill walking, to improve gait and functional balance performance of chronic poststroke survivors.

METHODS:

Twenty-two individuals chronic poststroke participated in the study, and were divided into 2 groups (each group performing an 8-session exercise program): 11 participated in dual-task walking (DTW), and the other 11 participated in single-task treadmill walking (TMW). The study was a randomized controlled trial, with assessors blinded to the participants’ allocated group. Measurements were conducted at pretest, post-test, and follow-up. Outcome measures included: the 10-m walking test (10 mW), Timed Up and Go (TUG), the Functional Reach Test (FRT), the Lateral Reach Test Left/Right (LRT-L/R); the Activities-specific Balance Confidence (ABC) scale, and the Berg Balance Scale(BBS).

RESULTS:

Improvements were observed in balance variables: BBS, FRT, LRT-L/R, (P < .01) favoring the DTW group; in gait variables: 10 mW time, also favoring the DTW group (P < .05); and the ABC scale (P < .01). No changes for interaction were observed in the TUG.

CONCLUSIONS:

The results of this study demonstrate the potential of VR-based DTW to improve walking and balance in people after stroke; thus, it is suggested to combine training sessions that require the performance of multiple tasks at the same time.

 

via A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors. – PubMed – NCBI

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[Abstract] Stroke Survivors’ Perspectives on Post–Acute Rehabilitation Options, Goals, Satisfaction, and Transition to Home

Abstract

Background and Purpose: Patients and caregivers have not typically been involved in the selection of a post–acute care (PAC) provider. In 2015, the Centers for Medicare & Medicaid Services proposed the need to involve patients and their families during discharge planning. Engaging patients in rehabilitation decisions encourages shared decision making among patients and their clinicians. The purpose of this study was to examine stroke survivors’ perspectives on their involvement in selecting a PAC provider and their goal setting and their satisfaction with the rehabilitation stay and their discharge advice for stroke survivors, prior to 2015.

Methods: This qualitative study utilized semistructured interviews. Thematic content analysis was performed on interviews involving 18 stroke survivors (mean age = 68 years) related to their involvement in planning for their inpatient rehabilitation facility or skilled nursing facility stay, goal setting, and discharge needs.

Results: More than half the participants were not involved in the selection of their PAC setting and believed that doctors made these decisions. Around two-fifths of stroke survivors reported that they were not involved in rehabilitation goal setting. Most patients were satisfied with their rehabilitation stay. When asked to recommend discharge topics for other stroke survivors, participants recommended additional information on health care services, interventions, and insurance coverage.

Discussion and Conclusion: Despite recommendations to include stroke patients in PAC selection and goal setting, many former inpatient rehabilitation facility and skilled nursing facility patients report not being involved in either aspect of care.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A273).

via Stroke Survivors’ Perspectives on Post–Acute Rehabilitation… : Journal of Neurologic Physical Therapy

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[WEB PAGE] MEDRhythms Launches Trial of Post-Stroke Walking Device

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MEDRhythms Inc has launched a randomized controlled trial (RCT) at five top rehab hospitals and research centers across the country to examine the impact of a digital therapeutic device on stroke survivors who have post-stroke walking impairments, in support of the company’s eventual FDA submission.

“This clinical trial marks an important milestone toward MEDRhythms’ mission to make this high-quality intervention available to those who need and deserve to have it,” says Brian Harris, Co-Founder and CEO of Portland, Me-based MEDRhythms, in a media release. “As this new industry grows, it is important for digital therapeutics to demonstrate efficacy with the support of rigorous clinical trials, and this RCT is an integral step in MEDRhythms’ evidence generation strategy to do so.”

MEDRhythms’ clinical trial will be conducted at the Shirley Ryan AbilityLab in Chicago, the Kessler Foundation in New Jersey, Mt. Sinai Hospital in New York, Spaulding Rehabilitation Hospital in Boston, and the Boston University Neuromotor Recovery Laboratory in Boston. This trial was launched following completion of a successful feasibility study in the target population, which was conducted at the Boston University Neuromotor Recovery Lab. The results of this feasibility study will be announced at the American Physical Therapy Association’s annual Combined Sections Meeting in February 2020 in Denver, Colorado.

“Right now, the MEDRhythms digital therapeutic technology is a novel treatment for a subset of individuals that have few, if any, effective treatment options,” states David Putrino, the Director of Abilities Research Center (ARC) for the Department of Rehabilitation and Human Performance at the Mount Sinai Health System and the Principal Investigator at MEDRhythms’ Mount Sinai clinical trial site.

“The mission of the ARC is to identify and validate novel technologies that have the potential to significantly enhance the rehabilitation of people who are recovering from brain injuries and neurological conditions, including chronic stroke. The digital therapeutics industry has the potential to transform rehabilitation and disrupt healthcare, and it is imperative for companies in this space to run full-scale, multisite RCTs like MEDRhythms is doing.”

The digital therapeutic for post-stroke walking rehabilitation is one of a full pipeline of products that include therapeutics for indications such as Parkinson’s disease, multiple sclerosis, aging, and fall prevention, for which the company is actively exploring partnerships, per the release.

[Source(s): MEDRhythms, Business Wire]

 

via MEDRhythms Launches Trial of Post-Stroke Walking Device – Rehab Managment

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