Posted by Kostas Pantremenos in REHABILITATION on March 9, 2017
Background. Conventionally, change in motor performance is quantified with discrete measures of behavior taken pre- and postpractice. As a high degree of movement variability exists in motor performance after stroke, pre- and posttesting of motor skill may lack sensitivity to predict potential for motor recovery.
Objective. Evaluate the use of predictive models of motor learning based on individual performance curves and clinical characteristics of motor function in individuals with stroke.
Methods. Ten healthy and fourteen individuals with chronic stroke performed a continuous joystick-based tracking task over 6 days, and at a 24-hour delayed retention test, to assess implicit motor sequence learning.
Results. Individuals with chronic stroke demonstrated significantly slower rates of improvements in implicit sequence-specific motor performance compared with a healthy control (HC) group when root mean squared error performance data were fit to an exponential function. The HC group showed a positive relationship between a faster rate of change in implicit sequence-specific motor performance during practice and superior performance at the delayed retention test. The same relationship was shown for individuals with stroke only after accounting for overall motor function by including Wolf Motor Function Test rate in our model.
Conclusion. Nonlinear information extracted from multiple time points across practice, specifically the rate of motor skill acquisition during practice, relates strongly with changes in motor behavior at the retention test following practice and could be used to predict optimal doses of practice on an individual basis.
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Source: Predicting Motor Sequence Learning in Individuals With Chronic Stroke – Aug 10, 2016
Posted by Kostas Pantremenos in REHABILITATION on January 17, 2017
Improved motor performance is related to the amount of practice completed after a stroke. Australian guidelines recommend that at least one hour of active practice should be completed per day. Yet active practice levels remain low. The aims of this scoping review were to describe how extra practice at the activity level is structured for stroke survivors, and explore the feasibility of participants completing extra practice.
A systematic search was conducted of five electronic databases up to August 2015. Trials were included when the intended dose of the control intervention was less than the experimental intervention. The structure of extra practice was classified by the level of supervision, type of personnel, and whether equipment was used. Feasibility of practice was explored by comparing the intended and actual dose of practice completed.
Thirty-five trials, comprising 40 comparisons were included. Multiple configurations of personnel, supervision and equipment were used to structure extra practice. The structure most often used was full supervision by staff without equipment (30 comparisons), typically involving a therapist (17 comparisons), with equipment being used occasionally (12 comparisons). Sixteen comparisons reported both the intended and the actual dose of extra practice completed. The mean percentage of actual extra practice completed was 80% (SD 18) of the intended dose.
Extra practice during rehabilitation after stroke is most often structured using full supervision by a therapist, and appears feasible for stroke survivors to complete. Less often, extra practice is structured using equipment, non-therapists and/or group classes.
Posted by Kostas Pantremenos in Virtual reality rehabilitation on June 29, 2016
Sometimes in health care, simple activities can be just as effective as the latest technology.
A new study has found that simple, widely available and inexpensive activities such as playing cards or repeatedly throwing a foam ball or wad of paper into a wastepaper basket are just as effective in helping people regain strength and co-ordination following a stroke as playing virtual reality games.
The study, published in the journal Lancet Neurology, is encouraging news for the 15 million people worldwide who suffer a stroke each year and may not live near a stroke rehabilitation centre or in a country with a sophisticated health-care system, or have health-care insurance, said lead author Dr. Gustavo Saposnik, a neurologist at St. Michael’s Hospital in Toronto.
The study was based on a clinical trial conducted at 14 centres in four countries in which patients were randomized into two groups. In addition to conventional rehabilitation therapy, one group received 10, one-hour sessions of virtual reality using the Nintendo Wii system and the other spent the same amount of time doing simple recreational activities such as playing cards or dominoes.
Patients randomized to both groups saw a 30 per cent and 40 per cent improvement in motor performance at the end of two weeks of the intervention and four weeks after the intervention, respectively.
“But there was no significant difference between the two groups in terms of strength, dexterity, gross motor skills, quality of life or activities of daily living,” said Dr. Saposnik, who is also a scientist in St. Michael’s Li Ka Shing Knowledge Institute. “We all like technology and have the tendency to think that new technology is better than old-fashioned strategies, but sometimes that’s not the case. In this study, we found that simple recreational activities that can be implemented anywhere may be as effective as technology.”
Dr. Saposnik said he was surprised by the results, because many previous studies, including his own, had a different conclusion, and because virtual reality has become an emerging strategy to enhance motor skills in stroke rehabilitation. Previous studies and review, including Dr. Saposnik’s pilot study published in 2010, suggested up to 20 to 30 per cent improvements in the motor skills of patients who had virtual reality therapy.
Dr. Saposnik said the new findings could be the result of the fact this clinical trial was the largest of its kind and used a more accurate comparison of the total time of therapy each group had. Both groups of randomized patients received the same amount of conventional therapy and then the same amount of time of either recreational activities or virtual reality. In previous studies, groups who received conventional and virtual reality therapy were compared to those who received only conventional therapy, with no add-ons.
This study received funding from the Heart and Stroke Foundation of Canada, the Ontario Stroke Strategy and the Ontario Ministry of Health and Long-Term Care.
Article: Efficacy and safety of non-immersive virtual reality exercising in stroke rehabilitation (EVREST): a randomised, multicentre, single-blind, controlled trial, Dr Gustavo Saposnik, MDcorrespondenceemail, Leonardo G Cohen, MD, Muhammad Mamdani, PharmD, Sepideth Pooyania, MD, Michelle Ploughman, PhD, Donna Cheung, OT, Jennifer Shaw, RhT, Judith Hall, MSc, Peter Nord, MD, Sean Dukelow, MD, Yongchai Nilanont, MD, Felipe De los Rios, MD, Lisandro Olmos, MD, Mindy Levin, PhD, Robert Teasell, MD, Ashley Cohen, MSc, Prof Kevin Thorpe, MMath, Prof Andreas Laupacis, MD, Mark Bayley, MD for Stroke Outcomes Research, Lancet Neurology, doi: 10.1016/S1474-4422(16)30121-1, published online 27 June 2016.
Posted by Kostas Pantremenos in Paretic Hand, REHABILITATION on March 25, 2016
Stroke Recovery: More Rehab Isn’t Better, Study Says
BY JAMIE TALAN
A new study testing the benefits of a task-oriented rehabilitation program to strengthen hand and arm weakness post-stroke suggests that more hours of an intensive program are not necessarily better than usual occupational therapy. Patients who received intensive upper-body training–30 one-hour sessions over a 10-week period–fared no better than those who received a more standard type of rehabilitation, or the usual therapy with significantly fewer hours.
Study Parameters
Researchers at the University of Southern California (USC) randomly assigned 361 stroke patients from seven hospitals around the country to receive either one-hour intensive, structured upper-extremity training three times a week; 30 hours of usual occupational therapy; or occupational therapy that was monitored but with no prescribed amount of hours. The rehabilitation services were delivered in an outpatient setting and the patients’ upper extremity motor function and recovery were measured over the course of a year
Results
As reported in the Journal of the American Medical Association, there were no differences between the groups in upper extremity motor performance. The group undergoing intensive, task-oriented rehabilitation did not have better arm or hand strength than the groups who had usual occupational therapy or monitored-only standard rehabilitation practice. In other words, a more intensive treatment protocol wasn’t better at restoring motor performance. “These findings do not support superiority of this task-oriented rehabilitation program for patients with motor stroke and moderate upper extremity impairment,” the study authors wrote.
Unexpected Findings
The study counters recent research that suggested that more hours of task-oriented upper-extremity training are better for stroke patients than standard occupational and physical therapy. The USC researchers acknowledged that changing practices among physical and occupational therapists could have accounted for the similar motor outcome identified in the study. Also, the variability in the hours of rehabilitation patients received in the control arm of the study could have skewed the results, they said.
Less May Be More
Still, the researchers concluded: “The findings from this study provide important new guidance to clinicians who must choose the best treatment for stroke patients. The results suggest that usual community-based therapy, provided during the typical outpatient rehabilitation time window by licensed therapists, improves upper extremity motor function and that more than doubling the dose of therapy does not lead to meaningful differences in motor outcomes.”
Read the full story from which this post was adapted in Neurology Today at bit.ly/NT-StrokeRehab.
Source: Neurology Now
Posted by Kostas Pantremenos in Functional Electrical Stimulation (FES), Gait Rehabilitation - Foot Drop on March 6, 2016
Abstract
Background: Drop foot is a distal deficiency common in patients with central nervous system diseases that makes clearance difficult during swing phase, contributes to inefficient gait compensations, contributes to increase incidence of falls and energy expenditure. Aim of this study is to evaluate the effectiveness of a single application of functional electrical stimulation compared with ankle-foot orthoses in patients with drop foot.
Methods: Patients enrolled were unable to walk and to perform test without ankle-foot orthoses. They were evaluated by 10-meters walk test, obstacles test, up-and-down stair test, six-minute walk test and gait analysis with inertial sensors. All tests were performed with ankle-foot orthoses and with no ankle-foot orthoses and application of single functional electrical stimulation.
Results: Thirteen patients (8 males and 5 females) were recruited for this study out of 41 potential subjects. Data collected were processed by Student’s t test and by Wilcoxon test for paired observations and by Student’s t test and Mann-Whitney test for independent samples. P ≤ 0.05 were considered significant. For each test suitable effect sizes (Cohen’s d, and Pearson’s r) were calculated. Analysis of results with ankle-foot orthoses and with no anklefoot orthoses and application of single functional electrical stimulation showed no statistically significant difference in all test.
Conclusions: The use of single functional electrical stimulation showed same effects of ankle-foot orthoses on walking capacity and motor performance in chronic neurological diseases. More studies would be required to assess the long term effectiveness of functional electrical stimulation and to evaluate if its application in acute-phase may be used in association with traditional treatment.
Posted by Kostas Pantremenos in Mirror therapy, Paretic Hand, Spasticity on February 10, 2015
Abstract
OBJECTIVE: To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke.
DESIGN: Randomized, controlled, assessor-blinded study.
SETTING: Inpatient stroke rehabilitation center of a tertiary care teaching hospital.
PARTICIPANTS: Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study.
INTERVENTION: The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation.
MAIN OUTCOME MEASURES: The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity.
RESULTS: After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647).
CONCLUSIONS: MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.
via Mirror therapy enhances motor performance in the paretic upper limb… – PubMed – NCBI.
TBI Rehabilitation 