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,
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.
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.
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.
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.
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, 2012; Carvalho 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, 2009; Vaughan-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, 2005; Huseyinsinoglu 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
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.
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.
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.
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