Posts Tagged Motor activity log

[ARTICLE] Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program

Abstract — Individuals with chronic stroke have limited options for hand rehabilitation at home. Here, we sought to determine the feasibility and efficacy of home-based MusicGlove therapy. Seventeen participants with moderate hand impairment in the chronic phase of stroke were randomized to 3 wk of home-based exercise with either the MusicGlove or conventional tabletop exercises. The primary outcome measure was the change in the Box and Blocks test score from baseline to 1 mo post treatment. Both groups significantly improved their Box and Blocks test score, but no significant difference was found between groups. The MusicGlove group did exhibit significantly greater improvements than the conventional exercise group in Motor Activity Log Quality of Movement and Amount of Use scores 1 mo posttherapy (p = 0.007 and p = 0.04, respectively). Participants significantly increased their use of MusicGlove over time, completing 466 gripping movements per day on average at study end. MusicGlove therapy was not superior to conventional tabletop exercises for the primary end point but was nevertheless feasible and led to a significantly greater increase in self-reported functional use and quality of movement of the impaired hand than conventional home exercises.

 

INTRODUCTION

Hand impairment after stroke contributes substantially to disability in the United States and around the world [1]. Intensive movement practice can reduce hand impairment [2–6], but issues such as cost and access may limit the dose of rehabilitation exercise delivered one-on-one with a therapist. Because of these and other factors, most individuals do not perform the large number of exercise repetitions required during therapy to maximize recovery [7–8]. Home-based rehabilitation programs may be prescribed after stroke with the intent to increase the amount of rehabilitation exercise individuals perform. However, the most common approach to home-based hand therapy is following a printed handout of exercises. This approach is often not motivating and thus is associated with low compliance and high dropout rates [9–13].

To address this problem, other types of home-based rehabilitation programs for the hand have been proposed. For example, one pilot study explored a modified form of constraint-induced movement therapy performed under the supervision of a nonprofessional coach in the home and found similar benefits to the same program performed with a trained therapist in a clinic [14]; a larger study using this protocol found that home-based constraint-induced movement therapy led to significantly greater self-reported use of the impaired limb than conventional therapy [15]. Another common approach is telerehabilitation, which allows a therapist to guide therapy remotely [16]. While this approach is gaining popularity, a recent Cochrane systematic review of 10 trials with 933 total participants found limited evidence to support its use and no studies that examined its cost-effectiveness [17]. Other approaches to home-based hand rehabilitation include functional electrical stimulation [18], computer gaming with custom devices [19–21], and music-based therapy [22]. However, despite the variety of options, few home-based programs have been tested in controlled studies [23]. Further, it is still unclear which methods are the most effective and efficient means of providing an increased dose of rehabilitation, though the use of computer games and music has been found to be highly motivating [20,24–26].

We developed the MusicGlove, an instrumented glove with sensors on each of the fingertips and the lateral aspect of the index finger. The MusicGlove requires the user to practice functional gripping movements by touching the sensor on the tip of the thumb to one of the other five sensors in time with music through a video game that displays scrolling notes on a screen (Figure 1). In previous pilot studies performed in a clinical setting, we found that the MusicGlove motivated individuals with chronic stroke to perform hundreds of functional gripping movements during a 30 min training session and that exercise with the device led to a significantly greater improvement in hand grasping ability, measured with the Box and Blocks test, than a time-matched dose of conventional tabletop therapy performed with a rehabilitation therapist [27–28]. The individuals who used the MusicGlove also reported that the exercise was more motivating than conventional therapy and expressed interest in using the device to exercise at home. An important question, therefore, was whether self-guided exercise with the MusicGlove performed at home is feasible and improves hand function compared with conventional home therapy.

Figure 1. MusicGlove device used in study. Users are visually cued by scrolling notes on screen (top) to make specific grips in time with popular songs, similar to the video game Guitar Hero. Grips include (a) key pinch grip; (b) pincer grip; and (c) finger-thumb opposition with second, third, and fourth fingers. During gameplay, the user must complete the cued grip when a colored note passes over the starred strip shown at bottom of the game screen (time window of about 800 ms). If the user is successful, the colored note disappears, providing visual feedback. If the user is unsuccessful, a beep is played, providing auditory feedback.

Figure 1. MusicGlove device used in study. Users are visually cued by scrolling notes on screen (top) to make specific grips in time with popular songs, similar to the video game Guitar Hero. Grips include (a) key pinch grip; (b) pincer grip; and (c) finger-thumb opposition with second, third, and fourth fingers. During gameplay, the user must complete the cued grip when a colored note passes over the starred strip shown at bottom of the game screen (time window of about 800 ms). If the user is successful, the colored note disappears, providing visual feedback. If the user is unsuccessful, a beep is played, providing auditory feedback.

Continue —> Home-based hand rehabilitation after chronic stroke: Randomized, controlled single-blind trial comparing the MusicGlove with a conventional exercise program

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[ARTICLE] Constraint-Induced Movement Therapy in Compared to Traditional Therapy in Chronic Post-stroke patients – Full Text PDF

Abstract

Introduction: Constraint-induced movement therapy (CIMT) forces the use of the affected side by restraining the unaffected side. The purpose of this article is to explore the changes of motor and functional performance after modified CIMT (mCIMT) in comparison with traditional rehabilitation (TR) in chronic post-stroke patients.

Material and Methods: A total of 12 patients randomly assigned into two treatment groups. Six patients in the mCIMT group received intensive training in a more affected limb for 2 hours daily, 5 days/week using shaping method over a period of 21 days. Participants less affected limb were restrained in arm – hand splint with a target of wearing it for 5 hours daily. The patients in TR group received bimanual and unilateral activities, stretching, strengthening and coordination exercises of the impaired side, tone modification and coordination exercises of the affected side. The focus was to increase independence in activities of daily living activities using affected side. The motor activity log (MAL), wolf motor function test (WMFT), and modified ashworth scale were measured at pre-test (1 day before training), posttest (1 day after training) and follow-up in 3 weeks after training.

Results: The Friedman test found significant differences between pre-test, post-test, and follow-up in MAL and WMFT in mCIMT group. Furthermore, mCIMT group showed significant decreased spasticity (P = 0.030) that measured by ash worth scale. The effect sizes between post-test and pre-test in the above-mentioned outcome measures were moderate to large in mCIMT, ranging from 0.3 to 0.76, but in TR group the effect size were small, ranging from 0 to 0.2.

Conclusion: Therefore, it seems that the mCIMT treatment was more effective than TR in improving some parameters.

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[ARTICLE] Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review – Full Text

Abstract

Background

Establishing which upper limb outcome measures are most commonly used in stroke studies may help in improving consensus among scientists and clinicians.

Objective

In this study we aimed to identify the most commonly used upper limb outcome measures in intervention studies after stroke and to describe domains covered according to ICF, how measures are combined, and how their use varies geographically and over time.

Methods

Pubmed, CinHAL, and PeDRO databases were searched for upper limb intervention studies in stroke according to PRISMA guidelines and477 studies were included.

Results

In studies 48different outcome measures were found. Only 15 of these outcome measures were used in more than 5% of the studies. The Fugl-Meyer Test (FMT)was the most commonly used measure (in 36% of studies). Commonly used measures covered ICF domains of body function and activity to varying extents. Most studies (72%) combined multiple outcome measures: the FMT was often combined with the Motor Activity Log (MAL), the Wolf Motor Function Test and the Action Research Arm Test, but infrequently combined with the Motor Assessment Scale or the Nine Hole Peg Test. Key components of manual dexterity such as selective finger movements were rarely measured. Frequency of use increased over a twelve-year period for the FMT and for assessments of kinematics, whereas other measures, such as the MAL and the Jebsen Taylor Hand Test showed decreased use over time. Use varied largely between countries showing low international consensus.

Conclusions

The results showed a large diversity of outcome measures used across studies. However, a growing number of studies used the FMT, a neurological test with good psychometric properties. For thorough assessment the FMT needs to be combined with functional measures. These findings illustrate the need for strategies to build international consensus on appropriate outcome measures for upper limb function after stroke.

Continue —> PLOS ONE: Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review

Fig 2. Frequency of use of different upper limb outcome measures (in % of studies). Frequency of use varies widely, between 36% and 1%. Only 15 measures were used in more than 5% of studies (dotted line). The 48 outcome measures are in alphabetic order: AMAT = Arm Motor Ability Test, ARAT = Action Research Arm Test, Ashworth = Ashworth scale, BBT = Box and Blocks Test, CAHAI = Chedoke Arm Hand Inventory, CMSA = Chedoke McMaster Stroke Assessment, COPM = Canadian Occupational Performance Measure, DAS = Disability Assessment Scale, DTI = Diffusion Tensor Imaging, EMG = Electromyography, FAT = Frenchay Arm Test, FC = Force Control, fMRI = Functional Magnetic Resonance Imaging, FMT = Fugl-Meyer Test, FTHUE = Functional Test for the Hemiplegic Upper Extremity, FTT = Finger Tapping Test, GOT = Grating Orientation Task, GRT = Grasp Release Test, HFS = Hand Function Survey, HFT = Hand Function Test, JTHT = Jebsen Taylor Hand Test, KIN = Kinematics, MAL = Motor Activity Log, MAM36 = Manual Ability Measurement 36, MAS = Motor Assessment Scale, MHS = Mini Hand Score, MI = Motricity Index, MMDT = Minnesota Manual Dexterity Test, NHPT = Nine Hole Peg Test, NSA = Nottingham Sensory Assessment, PT = Pegboard Test, RELHFT = Rehabilitation Engineering Laboratory Hand Function Test, RMA = Rivermead Motor Assessment, ROM = Range of Movement, SHFT = Shollerman Hand Function Test, SHPT = Sixteen Hole Peg Test, SIAS = Stroke Impairment Assessment Set, SMES = Sodring Motor Evaluation Scale, SSDI = Standardized Somatosensory Deficit Index, STEF = Simple Test for Hand Function, TDT = Tactile Discrimination Test, TMS = Transcranial Magnetic Stimulation, TS = Tardieu Scale, UEFT = Upper Extremity Function Test, ULIS = Upper Limb Impairment Scale, VAS = Visual Analogue Scale, VFHT = Von-Frey Hair Test, WMFT = Wolf Motor Function Test. http://dx.doi.org/10.1371/journal.pone.0154792.g002

 

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[ARTICLE] Bilateral Versus Unilateral Upper Extremity Training on Upper Limb Motor Activity in Hemiplegia – Full Text PDF

Abstract

Background: Upper extremity paresis post stroke is an important contributor to disability and task oriented rehabilitation aims at compensating loss of function in the affected upper extremity. Bilateral arm training focuses on coupling both the extremities during treatment to gain symmetrical and synchronous movement in both the limbs.

Objective: To analyze the efficacy of bilateral arm training over unilateral training in improving upper limb functional tasks of subjects with hemiplegia.

Methods: 30 hemiplegic subjects were randomly assigned into experimental and control groups where the former performed three sets of exercises using both the upper extremities while those in the latter group performed same exercises using only the affected extremity. Motor Activity Log (MAL) was used to quantify the treatment outcome. Results: Pre-post comparison within groups showed significant improvement in AOU (amount of usage) and QOM (quality of movement ) components of MAL(p< 0.001) in both experimental and control groups, whereas only AOU showed significant difference between the groups (p <0.05 ). Conclusion: Bilateral arm training improved functional tasks better than unilateral arm training in subjects with hemiplegia.

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