Posts Tagged Hand

[Abstract] Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial.

Abstract

OBJECTIVE:

The objective of this study was the evaluation of the clinical and neurophysiological effects of intensive robot-assisted hand therapy compared to intensive occupational therapy in the chronic recovery phase after stroke.

METHODS:

50 patients with a first-ever stroke occurred at least six months before, were enrolled and randomised into two groups. The experimental group was provided with the Amadeo™ hand training (AHT), whereas the control group underwent occupational therapist-guided conventional hand training (CHT). Both of the groups received 40 hand training sessions (robotic and conventional, respectively) of 45 min each, 5 times a week, for 8 consecutive weeks. All of the participants underwent a clinical and electrophysiological assessment (task-related coherence, TRCoh, and short-latency afferent inhibition, SAI) at baseline and after the completion of the training.

RESULTS:

The AHT group presented improvements in both of the primary outcomes (Fugl-Meyer Assessment for of Upper Extremity and the Nine-Hole Peg Test) greater than CHT (both p < 0.001). These results were paralleled by a larger increase in the frontoparietal TRCoh in the AHT than in the CHT group (p < 0.001) and a greater rebalance between the SAI of both the hemispheres (p < 0.001).

CONCLUSIONS:

These data suggest a wider remodelling of sensorimotor plasticity and interhemispheric inhibition between sensorimotor cortices in the AHT compared to the CHT group.

SIGNIFICANCE:

These results provide neurophysiological support for the therapeutic impact of intensive robot-assisted treatment on hand function recovery in individuals with chronic stroke.

 

via Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a … – PubMed – NCBI

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[NEWS] NEOFECT Wins Design Week VirtualTech Award for Second Year In a Row

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SmartBoardforHome

NEOFECT was once again honored at the San Francisco Design Week (SFDW) Awards, winning the VirtualTech award for its new Smart Board for Home NextGen, a gamified rehabilitation device for stroke survivors to use at home.

This marks the second consecutive year that the company has received the VirtualTech award, according to a company announcement.

“The Smart Board for Home NextGen is the epitome of the 2019 SFDW Awards theme, and we’re humbled to have won this year after receiving Honorable Mention in the VirtualTech category last year for our Smart Glove for Home,” says Scott Kim, co-founder and CEO of NEOFECT USA, in the release.

“We took every aspect of the patient experience into account when redesigning the Smart Board for Home NextGen,” Kim adds.

“For example, stroke patients’ grip is often weak, so we re-engineered the handle to be more secure. We developed more interactive virtual reality games, like tennis, so patients can have more variety, and also created a dual-player option.”

SFDW is an international design competition that honors projects encouraging thought leadership in design, focusing on “Where Innovation Meets Social Responsibility.”

The awards celebrate and recognize exemplary work in all fields of design, including architecture, interior design, industrial design, communication design, and user experience design.

Twenty-four winning projects and 11 honorable mentions were selected by a jury comprised of professionals—including executives from Lyft, Google, Microsoft, and Fitbit—who reviewed submissions from a pool of applicants from the USA and Europe. Each winning project was judged based on impact, singularity, inclusiveness, social responsibility, ease of use, visual appeal, and feasibility.

Award winners from leading design firms, in-house teams, and creative individuals were honored recently during a ceremony that took place at Pier 27 in San Francisco, the release explains.

“We are extremely excited the San Francisco Design Week Awards returned this year,” states SFDW Executive Director Dawn Zidonis.

“As with last year, the quality of the many entries exceeded our expectations. Congratulations to this year’s outstanding and diverse winners, including NEOFECT.”

[Source(s): NEOFECT, Business Wire]

 

via NEOFECT Wins Design Week VirtualTech Award for Second Year In a Row – Rehab Managment

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[ARTICLE] Mechanical Design of Exoskeleton for Hand Therapeutic Rehabilitation – Full Text PDF

ABSTRACT 

In this study an exoskeleton is designed for hand in therapeutic rehabilitation. The mechanical design is manufactured in consideration of anthropometrical measurements of the hand studied from literature. Kinematic model of the hand exoskeleton was obtained by results of position, velocity and torque-moment analysis.
The exoskeleton has a single degree of freedom (DOF) for the PIP and MCP joints. Basic four-bar linkage mechanisms are used in the exoskeleton. With this design, while movements (flexion and extension) occurs in both joints at the same time, angular displacement come out as in healthy hands. Linkage lengths aroptimized to achieve the targeted angular dynamics. The manipulation of the exoskeleton is actuated by a linear
servo motor.

Continue —>  Mechanical Design of Exoskeleton for Hand Therapeutic Rehabilitation

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Fig 2 Hand Rehabilitation System

 

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[Abstract] Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study

BACKGROUND: Post-stroke spasticity is a common complication in patients with stroke and a key contributor to impaired hand function after stroke.
AIM: The purpose of this study was to investigate the effects of Kinesiotaping on managing spasticity of upper extremity and motor performance in patients with subacute stroke.
DESIGN: A Randomized Controlled Pilot Study.
SETTING: One hospital center.
POPULATION: Participants with stroke within six months.
METHODS: Thirty-one participants were enrolled. Patients were randomly allocated into Kinesiotaping (KT) group or control group. In KT group, Kinesio tape was applied as an add- on treatment over the dorsal side of the affected hand during the intervention. Both groups received regular rehabilitation 5 days a week for 3 weeks. The primary outcome was muscle spasticity measured by modified Ashworth Scale (MAS). Secondary outcomes were functional performances of affected limb measured by using Fugl-Meyer assessment for upper extremity (FMA-UE), Brunnstrom stage, and the Simple Test for Evaluating Hand Function (STEF). Measures were taken before intervention, right after intervention (the third week) and two weeks later (the fifth week).
RESULTS: Within-group comparisons yielded significant differences in FMA-UE and Brunnstrom stages at the third and fifth week in the control group (p=0.003-0.019). In the KT group, significant differences were noted in FMA-UE, Brunnstrom stage, and MAS at the third and fifth week (p=0.001-0.035), and in the proximal part of FMA-UE between the third and fifth week (p=0.005). Between-group comparisons showed a significant difference in the distal part of FMA-UE at the fifth week (p=0.037).
CONCLUSIONS: Kinesiotaping could provide some benefits in reducing spasticity and in improving motor performance on the affected hand in patients with subacute stroke.
CLINICAL REHABILITATION IMPACT: Kinesiotaping could be a choice for clinical practitioners to use for effectively managing post-stroke spasticity.

via Effects of kinesiotaping on hemiplegic hand in patients with upper limb post-stroke spasticity: a randomized controlled pilot study – European Journal of Physical and Rehabilitation Medicine 2019 Jun 13 – Minerva Medica – Journals

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[Abstract] Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials

Background. After stroke, recovery of movement in proximal and distal upper extremity (UE) muscles appears to follow different time courses, suggesting differences in their neural substrates.

Objective. We sought to determine if presence or absence of motor evoked potentials (MEPs) differentially influences recovery of volitional contraction and strength in an arm muscle versus an intrinsic hand muscle. We also related MEP status to recovery of proximal and distal interjoint coordination and movement fractionation, as measured by the Fugl-Meyer Assessment (FMA).

Methods. In 45 subjects in the year following ischemic stroke, we tracked the relationship between corticospinal tract (CST) integrity and behavioral recovery in the biceps (BIC) and first dorsal interosseous (FDI) muscle. We used transcranial magnetic stimulation to probe CST integrity, indicated by MEPs, in BIC and FDI. We used electromyography, dynamometry, and UE FMA subscores to assess muscle-specific contraction, strength, and inter-joint coordination, respectively.

Results. Presence of MEPs resulted in higher likelihood of muscle contraction, greater strength, and higher FMA scores. Without MEPs, BICs could more often volitionally contract, were less weak, and had steeper strength recovery curves than FDIs; in contrast, FMA recovery curves plateaued below normal levels for both the arm and hand.

Conclusions. There are shared and separate substrates for paretic UE recovery. CST integrity is necessary for interjoint coordination in both segments and for overall recovery. In its absence, alternative pathways may assist recovery of volitional contraction and strength, particularly in BIC. These findings suggest that more targeted approaches might be needed to optimize UE recovery.

 

via Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials – Heidi M. Schambra, Jing Xu, Meret Branscheidt, Martin Lindquist, Jasim Uddin, Levke Steiner, Benjamin Hertler, Nathan Kim, Jessica Berard, Michelle D. Harran, Juan C. Cortes, Tomoko Kitago, Andreas Luft, John W. Krakauer, Pablo A. Celnik, 2019

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[Abstract + References] Robotic hand system design for mirror therapy rehabilitation after stroke

Abstract

This paper developed a robotics-assisted device for the stroke patients to perform the hand rehabilitation. Not only the system can perform passive range of motion exercises for impaired hand, but also can perform mirror therapy for pinching and hand grasping motions under the guidance of the posture sensing glove worn on patient’s functional hand. Moreover, the framework and operation flow of the developed system has been and delineated in this paper. Practical results with human subjects are shown in this paper to examine the usability of proposed system, trial experiment of advance mirror therapy that use the proposed system to interact with realities is also presented in this paper.

References

  1. Bruder N (2010) Faculty of 1000 evaluation for Robot assisted therapy for long-term upper-limb impairment after stroke. F1000—post-publication peer review of the biomedical literatureGoogle Scholar
  2. Bullock IM et al (2012) Assessing assumptions in kinematic hand models: a review. In: 4th IEEE RAS/EMBS international conference on biomedical robotics and biomechatronicsGoogle Scholar
  3. Burgar CG et al (2011) Robot-assisted upper-limb therapy in acute rehabilitation setting following stroke: Department of Veterans Affairs multisite clinical trial. J Rehabil Res Dev 48:445–458CrossRefGoogle Scholar
  4. Dohle C et al (2009) Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair 23(3):209–217CrossRefGoogle Scholar
  5. Emerson et al (2016) Control Implementation for an Integrated robotic and virtual mirror therapy system for stroke rehabilitation. In 2016 IEEE 14th international workshop on advanced motion control (AMC)Google Scholar
  6. Hesse S et al (2006) Machines to support motor rehabilitation after stroke 10 years of experience in Berlin. J Rehabil Res Dev 53(5):671–678CrossRefGoogle Scholar
  7. Huang VS, Krakauer JW (2009) Robotic neurorehabilitation: a computational motor learning perspective. J NeuroEng Rehabil 5(6):5CrossRefGoogle Scholar
  8. Johansson BB (2000) Brain plasticity and stroke rehabilitation the Willis lecture. Stroke 31(1):223–230CrossRefGoogle Scholar
  9. Krebs HI et al (2008) A paradigm shift for rehabilitation robotics. IEEE Eng Med Biol Magn 27(4):61–70CrossRefGoogle Scholar
  10. Lo AC et al (2010) Robot-assisted therapy for long-term upper-limb impairment after stroke. New Engl J Med 362(19):1772–1783CrossRefGoogle Scholar
  11. Lum P, Burgar CG et al (2005) The mime robotic system for upper-limb neuro-rehabilitation: results from a clinical trial in subacute stroke. In: 9th International conference on rehabilitation robotics, pp 511–514Google Scholar
  12. Mendis S (2013) Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int J Stroke 8(1):3–4CrossRefGoogle Scholar
  13. Morris C et al (2017) Low-cost assistive robot for mirror therapy rehabilitation. In: Proceedings of the 2017 IEEE international conference on robotics and biomimetics, pp 2057–2062Google Scholar
  14. Mukherjee D, Patil CG (2011) Epidemiology and the global burden of stroke. World Neurosurg 76(6):S85–S90CrossRefGoogle Scholar
  15. Narang G et al (2013) Use of unobtrusive human-machine interface for rehabilitation of stroke victims through robot assisted mirror therapy. In: Technologies for practical robot applications (TePRA), 2013 IEEE international conference on, pp 1–6Google Scholar
  16. Pérez-Cruzado D et al (2016) Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors. Aust Occup Ther J 64(2):91–112CrossRefGoogle Scholar
  17. Pu S-W et al (2016) Anthropometry-based structural design of a hand exoskeleton for rehabilitation. In: 23rd International conference on mechatronics and machine vision in practice (M2VIP)Google Scholar
  18. Shahbazi M et al (2014) A framework for supervised robotics-assisted mirror rehabilitation therapy. In: 2014 IEEE/RSJ international conference on intelligent robots and systems (IROS 2014)Google Scholar
  19. Summers JJ et al (2007) Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study. J Neurol Sci 252(1):76–82CrossRefGoogle Scholar
  20. Sydney Hand Surgery Pty Ltd (2017) Sydney hand surgery clinic. Available: http://www.sydneyhandsurgeryclinic.com.au/anatomy.asp. Accessed 2017
  21. Takeuchi N, Izumi S-I (2013) Rehabilitation with poststroke motor recovery: a review with a focus on neural plasticity. Stroke Res Treat 2013:1–13CrossRefGoogle Scholar

via Robotic hand system design for mirror therapy rehabilitation after stroke | SpringerLink

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[NEWS] NEOFECT Redesigns Smart Board for Home

Published on May 8, 2019

SmartBoardforHome

NEOFECT has redesigned its Smart Board for Home in reply to feedback from patients recovering from stroke and other musculoskeletal conditions and neurological disorders.

The new Smart Board for Home NextGen includes a smaller surface to help patients use it at home more easily, a redesigned handle to better stabilize the user’s hand and arm, and updated gamified software.

The board size has been reduced from 42 inches to 32 inches so it can fit on most tables. To accommodate the weakened grip of many stroke patients, the redesigned handle includes more straps to better stabilize the user’s arm, ensure appropriate measurement for the post-game metrics, and provide a more secure, comfortable experience, according to the company in a media release.

“We took patient feedback and completely revamped the Smart Board for Home NextGen,” says Scott Kim, co-founder and CEO of San Francisco-based NEOFECT USA.

“This new model still has all the fun, measurable qualities patients can use at home, but now we’ve reduced even more barriers so that people of all abilities can gain back function in their hands and upper arms.”

Patients play games on the Smart Board for Home NextGen by placing their forearm in a cradle and moving their arm across the board. All movements are virtually mimicked on a Bluetooth-connected screen in real time. The gamified software also features an updated AI-powered algorithm to curate a more customized experience for each patient.

The Smart Board for Home NextGen games mimic real-world motions to rehabilitate users’ upper arms and shoulders, including new games like “Air Hawk” and “Tennis.”

Additionally, NEOFECT is developing a dual-player game for patients to use at home, which will be available in summer 2019.

[Source(s): NEOFECT, Business Wire]

Source:
http://www.rehabpub.com/2019/05/neofect-redesigns-smart-board-home/

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[Abstract] Stroke, hand rehabilitation, motor synergy pattern correction, deep relaxation, multisensory stimulation, motor synergy rehabilitation.

Abstract

Background: This study aims to determine motor synergy rehabilitation for upper limb functional recovery in stroke patients.

Methodology: A 48year old male, apparently normal till June, 2016, had an acute onset of right sided hemiparesis and slurred speech. 2 years later he reported with inability to use the upper limb and difficulty in walking independently. He was a diagnosed case of left capsule-ganglionic bleed with accelerated hypertension. His participation limitations were inability to finger feed, drink his coffee, dress and groom selfand discontinuation of his job as an automobile salesman. He received motor synergy rehabilitation for 6 weeks.

Result: At 6 weeks patient was able to perform scapular elevation and shoulder scaption up to 100° with isolated elbow and forearm movements. He re-learnt to release objects with wrist in neutral position with verbal cues. His ability to feel rough textures improved by 50% and silky texture by 40% (self-reported) throughout the limb except hand. He retrained to eat hard cut fruit, sip water from a glass with straw and comb hair with 20–25% assistance and rejoined his job once a week.

Conclusion: Muscle synergy rehabilitation can help to improve the functional use of upper limb in stroke.

Indian Journals

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[BLOG POST] Stroke rehabilitation: maximizing arm and hand function after stroke – Evidently Cochrane

Potters hands

Stroke is the leading cause of disability in developed countries. The effects of stroke on the upper extremities are a major cause of functional impairment. This impairment of the upper extremity often leads to loss of independence with activities of daily living and of important occupations. There has been much research along different schools of thought that are intended to help people regain function and range of motion in their hand and arm after stroke. A quick search through the Cochrane Library would lead you to over a dozen Systematic Reviews of different interventions for the upper limb for people with stroke: these include: Constraint-induced movement therapyMental practiceMirror therapyVirtual realityRepetitive task practiceElectrical stimulation, and Occupational therapy for stroke … the list goes on.

So while it’s great that we are accumulating more and more evidence all the time, the challenge for therapists is that we just don’t have the time to spend scouring through the research, trying to find which one of these interventions is most effective for regaining upper limb function. Thankfully, Pollock and colleagues did the work for us and published a Cochrane Corner Overview paper titled “Interventions for Improving Upper Limb Function after Stroke.”

What was different about this study?

First, this study was called an “Overview” because it is basically a systematic review of systematic reviews of stroke on the upper extremity. In total, it included 40 systematic reviews (19 Cochrane Reviews and 21 non-Cochrane reviews with 18,078 participants) looking at improving arm function after stroke. That is a lot of research by any means. Their intent was to summarize the best evidence and, whenever possible, provide a side by-side comparison of interventions to give healthcare providers a succinct overview of the typical interventions for stroke to rehabilitate the upper limb.

So what did they find?

Good news and bad news. The bad news is they found that:

  • “There is no high quality evidence for any interventions that are currently routine practice, and evidence is insufficient to enable comparison of the relative effectiveness of interventions.” In other words, the evidence is insufficient to show which of the interventions are the most effective for improving upper limb function.

The good news is that they did find:

  • “Moderate quality evidence suggests that each of the following interventions may be effective: Constraint-Induced Movement Therapy (CIMT), Mental Practice, Mirror Therapy, interventions for sensory impairment, Virtual Reality and a relatively high dose of Repetitive Task Practice.”
  • Moderate quality evidence also indicates that unilateral arm training (exercise for the affected arm) may be more effective than bilateral arm training (doing the same exercise with both arms at the same time).
  • Some evidence shows that a greater dose of an intervention is better than a lesser dose.
  • “Effective collaboration is urgently needed to support definitive randomized controlled trials of interventions used routinely within clinical practice. Evidence related to dose is particularly needed because this has widespread clinical and research implications.”

What do we know about how intense therapy should be?

Team of health professionals

Until recently, the Scottish Intercollegiate Guidelines Network 2010 (SIGN) guideline on stroke management and rehabilitation recommended considering Constraint Induced Movement. However, Repetitive Task Training was not routinely recommended for improving upper limb function, and increased intensity of therapy for improving upper limb function in stroke patients was also not recommended.

The NICE Guidelines Stroke Rehabilitation in Adults 2013 in the UK recommended that therapists consider Constraint Induced Movement Therapy, and offer initially at least 45 minutes of each relevant stroke rehabilitation therapy for a minimum of 5 days per week to people who have the ability to participate.

A recent article in Advances in Clinical Neuroscience and Rehabilitation, called The Future of Stroke Rehabilitation: Upper Limb Recovery, points out that there is real concern that the dose and intensity of upper limb rehabilitation after stroke is just too low. The article brings some research results that at least two to three hours of arm training a day, for six weeks, reduced impairment and improved function by clinically meaningful amounts when started one to two months after stroke. However, anything less than this does not appear to provide much benefit overall.

The newly released AHA/ASA Guidelines for Stroke 2016 pulls all the updated evidence together, and states that when it comes to upper limb therapy following stroke, the research suggests that a higher dose is better. These new guidelines state that the patients who perform more than three hours of therapy daily made significantly more functional gains than those receiving less than three hours. The AHA/ASA Guidelines states that there is preliminary evidence suggesting the ideal setting appears to be the inpatient rehabilitation setting. Additionally, rehabilitation is best performed by an interprofessional team that can include a physician with expertise in rehabilitation, nurses, physical therapists, occupational therapists, speech/language therapists, psychologists, and orthotists.

What are the implications for therapists?

In order to truly have evidence based practice, we first need to identify the highest quality evidence. One of the main goals of the Cochrane Overview was to direct therapists to the highest quality evidence when making day-to-day clinical decisions. As we know, each person and each stroke is different. So for therapists, this overview suggests that that we can and should look closely into the evidence for and consider using Constraint-Induced Movement Therapy (CIMT), Mental Practice, Mirror Therapy, Interventions for Sensory Impairment, Virtual Reality and Repetitive Task Training in our practice. Preliminary evidence also suggests that we need to provide at least three hours of therapy a day in the post-acute setting.

While updated guidelines and reviews of the best available evidence are very helpful, we must always use our clinical reasoning and judgement to decide which intervention is most appropriate in our particular practice setting. The guidelines suggest that it benefits the patients when we work synergistically to facilitate an increased intensity of therapy by combining our efforts within the interprofessional team. Finally, to be truly effective we should strive to translate the evidence into functional interventions to ultimately make meaningful improvements in everyday lives of our patients.

Stroke rehabilitation: maximizing arm and hand function after stroke by Danny Minkow is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Based on a work at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010820.pub2/full. Images have been purchased for Evidently Cochrane from istock.comand may not be reproduced.

Links:

Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Cochrane Overview: interventions for improving upper limb function after stroke. Stroke 2015;46:e57-8. doi:10.1161/STROKEAHA.114.008295. Available from: http://stroke.ahajournals.org/content/46/3/e57.full.pdf+html

Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, van Wijck F. Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD010820. DOI: 10.1002/14651858.CD010820.pub2.

Scottish Intercollegiate Guidelines Network (SIGN). Management of patients with stroke: rehabilitation, prevention and management of complications, and discharge planning. Edinburgh: SIGN; 2010. (SIGN publication no. 118). [cited June 2010]. Available from: http://www.sign.ac.uk/pdf/sign118.pdf

The Stroke Association. “Web Upper Limb Video. UK Stroke Forum: Cochrane overview of interventions to improve upper limb function after stroke”. YouTube videocast, 24:28. YouTube, 18 December, 2015. Web. 9 May 2016. https://www.youtube.com/watch?v=7XuSLrB319Q.

National Clinical Guideline Centre; National Institute for Health and Care Excellence (commissioner). Stroke rehabilitation: long term rehabilitation after stroke. London: National Clinical Guideline Centre, Royal College of Physicians; 2013 (NICE CG162). [Issued June 2013]. Available from: https://www.nice.org.uk/guidance/cg162

Ward NS, Kelly K, Brander F. The future of stroke rehabilitation: upper limb recovery. Advances in Clinical Neuroscience & Rehabilitation2015; 15(4): 6-8. Available from: http://www.acnr.co.uk/2015/09/the-future-of-stroke-rehabilitation-upper-limb-recovery/.

Clarke D, Forster A, Drummond A, Tyson S, Rodgers H, Jones F, Harris R. Delivering optimum intensity of rehabilitation in hospital and at home: what do we know? [PowerPoint slides]. Oral presentation at Key Advances in Stroke Rehabilitation conference, London, 12thJune 2013. Available from: http://www.medineo.org

Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016;47(6):e98-e169. doi: 10.1161/STR.0000000000000098. Available from: http://stroke.ahajournals.org/content/47/6/e98.full.pdf+html

via Stroke rehabilitation: maximizing arm and hand function after stroke – Evidently Cochrane

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[ARTICLE] Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study – Full Text

Abstract

Introduction

Improvement of arm-hand function and arm-hand skill performance in stroke patients is reported by many authors. However, therapy content often is poorly described, data on actual arm-hand use are scarce, and, as follow-up time often is very short, little information on patients’ mid- and long-term progression is available. Also, outcome data mainly stem from either a general patient group, unstratified for the severity of arm-hand impairment, or a very specific patient group.

Objectives

To investigate to what extent the rate of improvement or deterioration of actual arm-hand use differs between stroke patients with either a severely, moderately or mildly affected arm-hand, during and after rehabilitation involving a well-defined rehabilitation program.

Methods

Design: single–armed prospective cohort study. Outcome measure: affected arm-hand use during daily tasks (accelerometry), expressed as ‘Intensity-of arm-hand-use’ and ‘Duration-of-arm-hand-use’ during waking hours. Measurement dates: at admission, clinical discharge and 3, 6, 9, and 12 months post-discharge. Statistics: Two-way repeated measures ANOVAs.

Results

Seventy-six patients (63 males); mean age: 57.6 years (sd:10.6); post-stroke time: 29.8 days (sd:20.1) participated. Between baseline and 1-year follow-up, Intensity-of-arm-hand-use on the affected side increased by 51%, 114% and 14% (p < .000) in the mildly, moderately and severely affected patients, respectively. Similarly, Duration-of-arm-hand-use increased by 26%, 220% and 161% (p < .000). Regarding bimanual arm-hand use: Intensity-of-arm-hand-use increased by 44%, 74% and 30% (p < .000), whereas Duration-of-arm-hand-use increased by 10%, 22% and 16% (p < .000).

Conclusion

Stroke survivors with a severely, moderately or mildly affected arm-hand showed different, though (clinically) important, improvements in actual arm-hand use during the rehabilitation phase. Intensity-of-arm-hand-use and Duration-of-arm-hand-use significantly improved in both unimanual and bimanual tasks/skills. These improvements were maintained until at least 1 year post-discharge.

 

Introduction

After stroke, the majority of stroke survivors experiences significant arm-hand impairments [12] and a decreased use of the paretic arm and hand in daily life [3]. The actual use of the affected hand in daily life performance depends on the severity of the arm-hand impairment [46] and is associated with perceived limitations in participation [78]. Severity of arm-hand impairment is also associated with a decrease of health-related quality of life [9], restricted social participation [10], and subjective well-being [1112].

Numerous interventions and arm-hand rehabilitation programs have been developed in order to resolve arm-hand impairments in stroke patients [613]. In the Netherlands, a number of stroke units in rehabilitation centres implemented a well-described ‘therapy-as-usual’ arm-hand rehabilitation program, called CARAS (acronym for: Concise Arm and hand Rehabilitation Approach in Stroke)[14], serving a broad spectrum of stroke patients across the full stroke severity range of arm-hand impairments. The arm-hand rehabilitation program has been developed to guide clinicians in systematically designing arm-hand rehabilitation, tailored towards the individual patient’s characteristics while keeping control over the overall heterogeneity of this population typically seen in stroke rehabilitation centres. A vast majority of stroke patients who participated in CARAS improved on arm-hand function (AHF), on arm-hand skilled performance (AHSP) capacity and on (self-) perceived performance, both during and after clinical rehabilitation [15]. The term ‘arm-hand function’ (AHF) refers to the International Classification of Functioning (ICF) [16] ‘body function and structures level’. The term ‘arm-hand skilled performance’ (AHSP) refers to the ICF ‘activity level’, covering capacity as well as both perceived performance and actual arm-hand use [17].

Improved AHF and/or AHSP capacity do not automatically lead to an increase in actual arm-hand use and do not guarantee an increase of performing functional activities in daily life [1820]. Improvements at function level, i.e. regaining selectivity, (grip) strength and/or grip performance, do not automatically lead to improvements experienced in real life task performance of persons in the post-stroke phase who live at home [1821]. Next to outcome measures regarding AHF, AHSP capacity and (self-) perceived AHSP, which are typically measured in controlled conditions, objective assessment of functional activity and actual arm-hand use outside the testing situation is warranted [2223].

Accelerometry can be used to reliably and objectively assess actual arm-hand use during daily task performance [2432]and has been used in several studies to detect arm-hand movements and evaluate arm-hand use in the post-stroke phase [203335]. Previous studies have demonstrated that, in stroke patients, movement counts, as measured with accelerometers, are associated with the use of the affected arm-hand (Motor Activity Log score) [3637] and, at function level, with the Fugl-Meyer Assessment [38]. Next to quantifying paretic arm-hand use, accelerometers have also been used to provide feedback to further enhance the use of the affected hand in home-based situations [39]. Most studies consist of relatively small [27304044] and highly selected study populations [45] with short time intervals between baseline and follow-up measurements. As to our knowledge, only a few studies monitored arm-hand use in stroke patients for a longer period, i.e. between time of discharge to a home situation or till 6 to 12 months after stroke [194446]. However, they used a relatively small study sample and their intervention aimed at arm-hand rehabilitation was undefined. Both studies of Connell et al. and Uswatte et al. describe a well-defined arm hand intervention where accelerometry data were used as an outcome measure [2747]. However, the study population described by Connell et al. consisted of a relative small and a relative mildly impaired group of chronic stroke survivors. The study population described by Uswatte et al. consisted of a large group of sub-acute stroke patients within strict inclusion criteria ranges [37], who, due to significant spontaneous neurologic recovery within this sub-acute phase, had a mildly impaired arm and hand [4849]. This means that the group lacked persons with a moderately to severely affected arm-hand, who are commonly treated in the daily rehabilitation setting.

The course of AHF and AHSP of a broad range of sub-acute stroke patients during and after rehabilitation involving a well-defined arm-hand rehabilitation program (i.e. CARAS) [14] has been reported by Franck et al. [15]. The present paper provides data concerning actual arm-hand use in the same study population, and focuses on two objectives. The first aim is to investigate changes in actual arm-hand use across time, i.e. during and after clinical rehabilitation, within a stroke patient group typically seen in daily medical rehabilitation practice, i.e. covering a broad spectrum of arm-hand problem severity levels, who followed a well-described arm-hand treatment regime. The second aim is to investigate to what extent improvement (or deterioration) regarding the use of the affected arm-hand in daily life situations differs between patient categories, i.e. patients with either a severely, moderately or mildly impaired arm-hand, during and after their rehabilitation, involving a well-defined arm-hand rehabilitation program.[…]

Continue —->  Changes in actual arm-hand use in stroke patients during and after clinical rehabilitation involving a well-defined arm-hand rehabilitation program: A prospective cohort study

Fig 3. Mean values for Intensity-of-arm-hand-use during uptime for subgroups 1, 2 and 3.
T = time; bl = baseline; cd = clinical discharge; m = month; Solid line = subgroup 1; Dotted line = subgroup 2; Dashed line = subgroup 3.
https://doi.org/10.1371/journal.pone.0214651.g003

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