Posts Tagged motor functions

[Abstract] Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial

Abstract

OBJECTIVE:

To determine the effects of inclusion of deep dry needling into a treatment session following the Bobath concept on spasticity, motor function and postural control after a stroke.

METHODS:

26 patients who had suffered a stroke were randomly assigned to one of two treatment groups: Bobath only, or Bobath plus dry needling. Both groups received a session including strengthening, stretching and reconditioning exercises following the principles of the Bobath concept. Patients in the Bobath plus dry needling group also received a single session of ultrasound-guided dry needling of the tibialis posterior. Spasticity (Modified Modified Ashworth Scale), function (Fugl-Meyer Scale) and stability limits (computerised dynamic posturography using the SMART EquiTest System) were collected before and 10 min after treatment by a blinded assessor. The parameters of the stability limits included movement velocity (MVL), maximum excursion (MXE), end-point excursion (EPE) and directional control (DCL).

RESULTS:

A greater number of individuals receiving Bobath plus dry needling exhibited a decrease in spasticity after treatment (P<0.001). Analysis of covariance (ANCOVA) showed that patients receiving Bobath plus dry needling exhibited greater improvements in the balance (0.8, 95% CI 0.2 to 1.4), sensory (1.7, 95% CI 0.7 to 2.7) and range of motion (3.2, 95% CI 2.0 to 4.4) domains of the Fugl-Meyer Scale than those receiving Bobath only. ANCOVA also found that subjects receiving dry needling showed a greater increase in MVL non-affected forward direction, EPE non-affected direction, MXE backward and MXE affected/non-affected, DCL backward and DCL affected backward direction, than those who did not receive it.

CONCLUSIONS:

The inclusion of deep dry needling into a treatment session following the Bobath concept was effective at decreasing spasticity and improving balance, range of motion and the accuracy of maintaining stability in patients who had experienced a stroke.

 

via Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial. – PubMed – NCBI

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[ARTICLE] Cooperative Cooking: A Novel Virtual Environment for Upper Limb Rehabilitation – Full Text PDF

Abstract

Motor rehabilitation technologies commonly include virtual environments that motivate patients to exercise more often or more intensely. In this paper, we present a novel virtual rehabilitation environment in which two people work together to prepare meals. The players’ roles can be fixed or undefined, and optional challenges can be added in the form of flies that must be swatted away. A preliminary evaluation with 12 pairs of unimpaired participants showed that participants prefer cooperating over exercising alone and feel less pressured when cooperating. Furthermore, participants enjoyed the
addition of flies and preferred not to have defined roles. Finally, no significant decrease in exercise intensity was observed as a result of cooperation. These results indicate that cooperation could improve motor rehabilitation by increasing motivation, though the virtual environment needs to be evaluated with participants with motor impairment.

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[Abstract] A brain–computer interface based stroke rehabilitation system, controlling an avatar and functional electrical stimulation, to improve motor functions

Introduction/Background

Brain–computer interfaces (BCI) can detect the neuronal activity of patients’ motor intention to control external devices. With the feedback from the device, the neuronal network in the brain to reorganizes due to neuroplasticity.

Material and method

The BCI controls an avatar and functional electrical stimulation (FES) to provide the feedback. The expected task for the patient is to imagine either left or right wrist dorsiflexion according to the instructions. The training was designed to have 25 sessions (240 trials of either left or right motor imagery) of BCI feedback sessions over 13 weeks. Two days before and two days after we did clinical measures to observe motor improvement. The primary measure was upper extremity Fugl–Meyer assessment (UE-FMA), which evaluates the motor impairment. Four secondary measures were also performed to exam the spasm (modified Ashworth scale, MAS), tremor (Fahn tremor rating scale, FTRS), level of daily activity (Barthel index, BI), and finger dexterity (9-hole peg test, 9HPT).

Results

One male stroke patient (53 years old, 11 months since stroke, and right upper limb paralyzed) participated in the training. He quickly learned to use the BCI and the maximal classification accuracy was over 90% after the 5th session. The UE-FMA increased from 25 to 46 points. The BI increased from 90 to 95 points. MAS and FTRS decreased from 2 to 1 and from 4 to 3 points respectively. Although he could not conduct the 9HPT until 18th training session, he was able to complete the test from 19th session in 10 min 22 s and the time was reduced to 2 min 53 s after 25th session.

Conclusion

The patient could be more independent in his daily activity, he had less spasticity and tremor. Also, the 9HPT was possible to do, which was not before. The system is currently validated with a study of 50 patients.

 

via A brain–computer interface based stroke rehabilitation system, controlling an avatar and functional electrical stimulation, to improve motor functions – ScienceDirect

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[Abstract+References] Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities

More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabNIBSilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on  and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.

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[ARTICLE] Transcranial Direct Current Stimulation: The Effects on Plegic Upper Extremity Motor Function of Patients With Stroke – Full Text HTML

Summary

Objective: The primary aim of this prospective, randomized, sham controlled study was to evaluate the effectiveness of anodal or bihemispheric transcranial direct current stimulation (tDCS) applications on the upper extremity motor functions of patients with stroke. Another aim was to compare the effectiveness of bihemispheric tDCS with anodal tDCS applications.

Methods: Thirty-six patients with stroke were randomly assigned into three groups as anodal tDCS (n:12), bihemispheric tDCS (n:12), or sham tDCS (n:12). All patients participated in a conventional rehabilitation program for 15 days. 31 patient completed study. The plegic upper extremity motor functions were evaluated by Wolf Motor Function Test (WMFT), Jebsen-Taylor Test (JTT) and Kocaeli Functional Evaluation Test (KFET).

Results: The anodal tDCS group showed statistically significant improvements in 10 qualitative-8 quantitative parameters (p<0.05 all parameters), and the bihemispheric tDCS group in 8 qualitative-13 quantitative parameters (p<0.05 all parameters) of WMFT. Significant improvements were also obtained in all sub-parameters of KFET and JTT (p<0.05 all parameters) in both the anodal and bihemispheric tDCS groups. Compared with the sham group after the treatment, significant improvements were seen with respect to 5 qualitative parameters of WMFT (p<0.017 for all) and 1 of JTT (p<0.017) in the anodal tDCS group as well as 5 qualitative and 1 quantitative parameters of WMFT (p<0.017 for all), 3 of JTT (p<0.017), and 1 parameter of KFET (p<0.017) in the bihemispheric tDCS group.

Conclusion: When combined with the conventional rehabilitation programs, tDCS provided additional motor functional gains in the plegic upper extremity of stroke patients in this

Continue —> Journal of Neurological Sciences (Turkish).

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[PRESS RELEASE] Novel robotic walker invented by NUS researchers helps patients regain natural gait and increases productivity of physiotherapists

Survivors of stroke or other neurological conditions such as spinal cord injuries, traumatic brain injuries and Parkinson’s disease often struggle with mobility. To regain their motor functions, these patients are required to undergo physical therapy sessions. A team of researchers from the National University of Singapore’s (NUS) Faculty of Engineering has invented a novel robotic walker that helps patients carry out therapy sessions to regain their leg movements and natural gait. The system also increases productivity of physiotherapists and improves the quality of rehabilitation sessions.

Designed by a team of researchers led by Assistant Professor Yu Haoyong from the NUS Department of Biomedical Engineering, the robotic walker is capable of supporting a patient’s weight while providing the right amount of force at the pelvis of the patient to help the patient walk with a natural gait. In addition, quantitative data can be collected during the therapy sessions so that doctors and physiotherapists can monitor the progress of the patient’s rehabilitation…

more–> Novel robotic walker invented by NUS researchers helps patients regain natural gait and increases productivity of physiotherapists.

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