[ARTICLE] Upper Limb Motor Impairment Post Stroke – Full Text

Synopsis

Understanding upper limb impairment after stroke is essential to planning therapeutic efforts to restore function. However determining which upper limb impairment to treat and how is complex for two reasons: 1) the impairments are not static, i.e. as motor recovery proceeds, the type and nature of the impairments may change; therefore the treatment needs to evolve to target the impairment contributing to dysfunction at a given point in time. 2) multiple impairments may be present simultaneously, i.e., a patient may present with weakness of the arm and hand immediately after a stroke, which may not have resolved when spasticity sets in a few weeks or months later; hence there may be a layering of impairments over time making it difficult to decide what to treat first. The most useful way to understand how impairments contribute to upper limb dysfunction may be to examine them from the perspective of their functional consequences. There are three main functional consequences of impairments on upper limb function are: (1) learned nonuse, (2) learned bad-use, and (3) forgetting as determined by behavioral analysis of tasks. The impairments that contribute to each of these functional limitations are described.

The nature of upper limb motor impairment

According to the International Classification of Functioning, Disability and Health model (ICF) (Geyh, Cieza et al. 2004), impairments may be described as (1) impairments of body function such as a significant deviation or loss in neuromusculoskeletal and movement related function related to joint mobility, muscle power, muscle tone and/or involuntary movements, or (2) impairment of body structures such as a significant deviation in structure of the nervous system or structures related to movement, for example the arm and/or hand. A stroke may lead to both types of impairments. Upper limb impairments after stroke are the cause of functional limitations with regard to use of the affected upper limb after stroke, so a clear understanding of the underlying impairments is necessary to provide appropriate treatment. However understanding upper limb impairments in any given patient is complex for two reasons: 1) the impairments are not static, i.e. as motor recovery proceeds, the type and nature of the impairments may change; therefore the treatment needs to evolve to target the impairment contributing to dysfunction at a given point in time. 2) multiple impairments may be present simultaneously, i.e., a patient may present with weakness of the arm and hand immediately after a stroke, which may not have resolved when spasticity sets in a few weeks or months later; hence there may be a layering of impairments over time making it difficult to decide what to treat first. It is useful to review the progression of motor recovery as described by Twitchell (Twitchell 1951) and Brunnstrom (Brunnstom 1956) to understand how impairments may be layered over time (Figure 1).

Figure 1

Sequential progression of motor recovery as described by Twitchell and Brunstrumm. Note that while recovery is proceeding from one stage to the next, residual impairment from preceding stages may still be present leading to the layering of impairment. Also note the underlying physiological processes that may account for progression from one stage to the next.

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Understanding motor impairment from a functional perspective

The most useful way to understand how impairments contribute to upper limb dysfunction may be to examine them from the perspective of their functional consequences. There are three main functional consequences of stroke on the upper limb: (1) learned nonuse, (2) learned bad-use, and (3) forgetting as determined by behavioral analysis of a task such as reaching for a food pellet and bringing it to the mouth in animal models of stroke (Whishaw, Alaverdashvili et al. 2008). These are equally valid for human behavior. Each of the functional consequences and the underlying impairments are elaborated below.[…]

 

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[WEB SITE] What is “contracture”?

Contracture is a loss of motion over time due to abnormal shortening of the soft tissue structures spanning one or more joints. These include skin, ligaments, tendon, muscles and joint capsules. Loss of motion in any of the structures restricts joint mobility leading to pain, stiffness and eventually contracture.

Disuse and Neglect.

Contractures are a common and debilitating problem for individuals who have suffered from neurological or orthopedic injuries. Following a stroke or brain injury, damage to the cerebral cortex and brain stem results in weakness, decreased motor control, sensation, and spasticity.

These clinical findings lead to limited functional movement and learned nonuse. Through disuse, the affected joint becomes less elastic and stiff and eventually contracted….read more…

If you’ve suffered a stroke or other neurological injury, you may be advised by your therapist to consider using a “resting hand splint” to help prevent or slow the onset of contractures in your hand.

“Resting hand splints” come in a wide variety of designs.  For example, our SaeboStretch design is unique because it employs flexible, energy-storing components to promote comfort and help protect your joints.  To see how the SaeboStretch compares to other splints, watch this brief introductory video:

For more information about the SaeboStretch (or one of our other products) just click this button to submit your request:

Source: What is “contracture”?

[THESIS] Arm function and constraint-induced movement in early post-stroke rehabilitation – Full Txt PDF

Summary

Constraint-induced movement therapy (CIMT) is a treatment for mild-to-moderate upper extremity motor dysfunction in post-stroke patients. The key treatment goal of this therapy is overcoming learned nonuse of the more affected arm. It consists of the following 3 components: (1) repetitive task-oriented training; (2) adherence-enhancing behavioral strategies (transfer package); and (3) constraining use of the less affected arm, usually achieved with a restraining mitt. Behavioral procedures such as behavioral contract, systematic feedback, and encouraging real-world problem solving are used to enhance the transfer of gained motor skills to daily activities. However, as the ideal time to initiate post-stroke treatment remains uncertain, more information is needed regarding the effects of CIMT and arm use in the early stages of stroke recovery. This thesis aimed to:

1. examine the correlations between arm motor impairment and real world arm use and its relationship with dependency in self-care activities in patients in the stroke unit. (Paper I)
2. assess the effects of modified CIMT applied within 28 days after stroke occurrence (Paper II)
3. review existing literature for the effects of CIMT on body function, activity, and participation in post-stroke patients (Paper III)

In Paper I, we found a high correlation between motor impairment and the patient’s actual use of the more affected arm. Further findings revealed that both the Fugl-Meyer motor assessment scores and arm use are related to dependency in self-care activities, but the finding might be confounded by lower extremity motor function. In Paper II, we found that CIMT initiated within 28 days after stroke occurrence was safe and feasible but did not improve long-term motor function. However, there was a significant effect on movement speed immediately after the treatment, and CIMT might promote a faster recovery compared to standard care. There were no differences between the groups with respect to reduced arm motor impairment or increased arm use. In the systematic review and metaanalysis conducted in Paper III, we found that CIMT can improve arm motor function and arm motor activities and may have a lasting effect on arm motor activity. The effects were especially stable in the sub-acute and chronic groups, and CIMT is therefore advocated for selected patients in these post-stroke stages.

Taken together, our study revealed that early CMIT has an immediate effect on timed measures of arm activity but does not improve long-term motor activity. The meta-analysis also showed uncertain effects of CIMT in the early post-stroke phase. This rehabilitative treatment should preferably be offered to patients in sub-acute and chronic stages after stroke. As learned nonuse might not be pronounced in the acute stage of stroke, the treatment should be aimed at preventing its development.

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[ARTICLE] A STUDY ON THE EFFECTIVENESS OF BOBATH APPROACH VERSUS CONSTRAINT INDUCED MOVEMENT THERAPY (CIMT) TO IMPROVE THE ARM MOTOR FUNCTION AND THE HAND DEXTERITY FUNCTION IN POST STROKE PATIENTS – Full Text PDF

Abstract

Objective: To compare the effects of the Bobath Therapy and Constraint-Induced Movement Therapy on arm motor function and hand dexterity function among stroke patients with a high level of function on the affected side.

Materials and Methods: Study has conducted at theOutpatient physiotherapy department of a stroke unit. With a total of 30 patients were conveniently recruited and then randomized to Bobath Concept group and constraintinduced movement therapy group. Intervention included were the Bobath Concept group was treated for 1.5 hours per day during 5 consecutive weekdays for 4 weeks whereas the constraint-induced movement therapy group received training for 2 hours per day during 5 consecutive weekdays for 3 weeks. Outcome measures by the Wolf Motor Function Test, and Jebsen Taylor Hand Function Test.

Results: The two groups were found to be homogeneous based on demographic variables and baseline measurements. There were no significant differencesin Wolf Motor Function Test at post test (p = 0.861) and at follow up (p = 0.395). There is a significantimprovementin JTHFT in both the groupswith sight better improvement in group B (except writing components post test p=0.752and checkers at post test p=0.197 and follow up p=0.167)) as compared to Group A.

Conclusions: Bobath therapy and the Constraint-induced movementtherapy have similar efficienciesin improving arm motor function in the paretic arm among stroke patients with a high level of function. Constraint-induced movement therapy seems to be slightly more efficient than the Bobath Concept in improving hand dexterity function.

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[ARTICLE] Effectiveness of distributed form of constraint induced movement therapy to improve functional outcome in chronic hemiparesis patients

Abstract

Background: Upper limb hemiparesis is among the most common deficits after stroke that leads to disability. Learned nonuse develops due to over-reliance on the less affected limb for the functional activities. However for many stroke patients, participation in a traditional, more intense CIMT may be problematic, given the required practice intensity and the duration of the restraint schedule. So it is necessary to evaluate the effects of distributed form of Constraint Induced Movement Therapy (dCIMT) in improving functional outcome and quality of life in patients with chronic hemiparesis.

Methods: 36 hemiplegic patients following stroke were included. The experimental group was given dCIMT for 5sessions/week for 4 consecutive weeks in addition to conventional therapy while the control group received only conventional therapy. The outcome measures were motor activity log, wolf motor functional test and nine hole peg test.

Results: The results of within group analysis for both the experimental group (Group-A) and control group B showed highly significant improvement on all the 3 outcome measures with P <0.0001.But the difference in the improvement of group-A compared to group-B was highly significant on the MAL and NHPT (P <0.0001) whereas it was not significant for WMFT performance score but highly significant for WMFT duration (U=23).

Conclusion: dCIMT is an effective measure in improving the upper extremity motor function in terms of the quality and amount of use & speed and co- ordination. Thus improves the functional level and the quality of life of the patients with chronic stroke.

via Effectiveness of distributed form of constraint induced movement therapy to improve functional outcome in chronic hemiparesis patients – International Journal of Research in Medical Sciences – ScopeMed.org – Online Journal Management System.