Posts Tagged paretic hand
[ARTICLE] Effects of observation of hand movements reflected in a mirror on cortical activation in patients with stroke – Full Text PDF
[Purpose] The purpose of this study was to examine what changes occur in brain waves when patients with stroke receive mirror therapy intervention.
[Subjects and Methods] The subjects of this study were 14 patients with stroke (6 females and 8 males). The subjects were assessed by measuring the alpha and beta waves of the EEG (QEEG-32 system CANS 3000). The mirror therapy intervention was delivered over the course of four weeks (a total of 20 sessions).
[Results] Relative alpha power showed statistically significant differences in the F3, F4, O1, and O2 channels in the situation comparison and higher for hand observation than for mirror observation. Relative beta power showed statistically significant differences in the F3, F4, C3, and C4 channels.
[Conclusion] This study analyzed activity of the brain in each area when patients with stroke observed movements reflected in a mirror, and future research on diverse tasks and stimuli to heighten activity of the brain should be carried out.
Dysfunction from upper extremity hemiparesis impairs performance of many activities of daily living (ADL)1) . Individuals affected by stroke will learn or relearn competencies necessary to perform ADL. Traditionally, the practice of skills provided in neurologic rehabilitation has focused on reducing motor impairment and minimizing physical disability2, 3) . Since 2000, various studies of upper extremity function recovery using interventions such as constraint-induced movement therapy, functional electric stimulation, robotic-assisted rehabilitation, and bilateral arm training have been carried out4) . Such interventions were effective in increasing upper extremity functions in patients with stroke and are continually utilized in the clinical field5–7) .
However, most of the treatment protocols for the paretic upper extremity are labor intensive and require one on one manual interaction with therapists for several weeks, which makes the provision of intensive treatment for all patients difficult8) . Hence, alternative strategies and therapies are needed to reduce the long-term disability and functional impairment from upper extremity hemiparesis9) .
Mirror therapy may be a suitable alternative because it is simple; inexpensive; and, most importantly, patient-directed treatment that may improve upper extremity function8, 10) . Emerging methods in mirror therapy aim to restore motor control through a change in brain function, i.e. motor relearning11, 12) . Voluntary movements of the paretic upper extremity and hand by referring to a mirror activate the bilateral cortex and cause reorganization for other areas around the damaged brain to replace its function, thereby affecting recovery in motor function13) .
Although such methods are promising, they have failed to restore functional motor control for many patients who have experienced stroke. It is important to explore new methods that may facilitate the recovery of brain function and the restoration of more normal motor control14) . Many studies have addressed the neurophysiological effects of mirror therapy. The EEG study gave diverse stimulations to the thumb with or without a mirror to examine which area of the cortex was activated. They observed common activation areas in the primary motor cortex (M1), cingulate, and prefrontal cortex15) . And the study with healthy adults used mirror therapy with functional MRI (fMRI) and showed no difference between the dominant and non-dominant hand. Excitability of M1 ipsilateral to a unilateral hand movement was facilitated by viewing a mirror reflection of the moving hand16) . This finding provides neurophysiological evidence supporting the application of mirror therapy in stroke rehabilitation. Even though, previous studies concerned healthy subjects and had no interventions, a diversity of studies have shown upper extremity functional improvement through mirror therapy8) .
Thus, the purpose of this study was to examine what changes occur in brain waves when patients with stroke receive mirror therapy intervention.
The hand is an organ of grasping as well as sensation, communication, and fine dexterity. Since the 80’s, many researchers have been attempting to develop robotic devices aiming at replicating the functions of the human hand in the fields of industrial robotics, tele-manipulation, humanoid robotics, and upper limb prosthetics.
A special kind of robotic hand is the hand exoskeleton, that is directly attached to the human hand with the aim of providing assistance in motion/power generation. Hand exoskeletons are increasingly widespread in robot-based rehabilitation of patients suffering from different pathologies (in particular neurological diseases).
This paper reviews the state-of-the-art of hand exoskeletons developed for rehabilitation purposes and proposes a new systematic classification according to three key points related to the kinematic architecture: (i) mobility of a single finger exoskeleton, (ii) number of physical connections between the exoskeleton and the human finger phalanges, and (iii) way of integration of the exoskeleton mechanism with the human parts.
The discussion based upon the classification can be helpful to understand the reasons of adopting certain solutions for specific applications and the advantages and drawbacks of different designs, based on the work already done by other researchers.
The final purpose of the proposed classification is then to provide guidelines useful for the design of new hand exoskeletons on the basis of a systematic analysis. As an example, the solution designed, manufactured and clinically tested by the authors is reported.
[ARTICLE] Perceived ability to perform daily hand activities after stroke and associated factors: a cross-sectional study – Full Text
Despite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance.
Seventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models.
The activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model.
Persons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.
This video aims to give you an idea of what’s required in the Upper Limb Neurological Examination OSCE.
Always adhere to your medical schools / local hospital trusts guidelines when performing examinations or clinical procedures. Do NOT perform any examination or procedure on patients based purely upon the content of these videos. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon information provided in this video.
THURSDAY, Sept. 8, 2016
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Tricks for Stretching a Tight Hemiplegic Hand
Trick # 2) Avoid touching the palm because it elicits the palmar grasp reflex that closes the hand.
Trick # 3) To open the hand start by bending the wrist slightly 1st. Bending the wrist stretches tendons that cross over the wrist and go to the ends of your fingers. Caution: Aim for a few degrees of wrist motion to protect these tendons (see angle in photo). As the tendons stretch, the fingers will move away from the palm so you don’t have to dig fingers out of a tight fist.
Trick # 4) A fist will relax more if you straighten the thumb first. The thumb has half the muscles in the hand so it is a bully. Here is a good video for people who have a caregiver. The trick is to wrap several fingers around the base of the thumb rather than grab the thumb close to the fingernail with the bony ends of your fingers.
No one wants to walk with a walker, but age has a way of making people compromise on their quality of life. The team behind Superflex, which spun out of SRI International in May, thinks there could be another way.
The company is building wearable robotic suits, plus other types of clothing, that can make it easier for soldiers to carry heavy loads or for elderly or disabled people to perform basic tasks. A current prototype is a soft suit that fits over most of the body. It delivers a jolt of supporting power to the legs, arms, or torso exactly when needed to reduce the burden of a load or correct for the body’s shortcomings.
A walker is a “very cost-effective” solution for people with limited mobility, but “it completely disempowers, removes dignity, removes freedom, and causes a whole host of other psychological problems,” SRI Ventures president Manish Kothari says. “Superflex’s goal is to remove all of those areas that cause psychological-type encumbrances and, ultimately, redignify the individual.”
A senior with shaky hands could use the technology to achieve a steadier grip. Or a soldier could wear the suit to conserve energy while carrying a heavy pack.
Superflex’s suit uses a suite of sensors to learn wearers’ individual movement styles and safely kicks in power at the exact moment it is needed. As a result, the suit’s batteries last much longer than they would if they were fully powering each step or motion (though the company would not state how long the batteries do last). This is important because even as computing has advanced rapidly, batteries and motors have remained bulky and limited in their power.
“For an elderly or general population with reduced mobility due to injury or disease, [the suit] could restore mobility and independence and therefore increase the quality of life,” says Volker Bartenbach, an exoskeleton researcher at ETH Zurich, who is not involved with Superflex. For example, he says, it could enable people to climb stairs again. A suit like this could also increase productivity and reduce the risk of injury in the workplace, Bartenbach says.
Other powered exoskeletons are also under development for medical and industrial applications. The $40,000 Phoenix suit is designed to help someone totally paralyzed from the waist down walk again. Superflex, which doesn’t aim to provide full mobility, is joined in its category by a wide variety of suits from institutions like Hyundai and Harvard’s Wyss Institute. It stands apart for its compact size and unique way of learning each wearer’s stride in order to provide extra power at the right moment.
Kothari couldn’t say how much the suit will cost or what exactly it will look like, because the company is currently looking at options for its commercialization. While it currently takes five minutes or less to put on with some practice, he believes the commercial product will take just two minutes to get into. He emphasizes that affordability has been a goal at every step of the design process. SRI International is also working on several other projects that involve powered clothing to make people’s lives easier.
[Abstract] Effect of Dual Therapy with Botulinum Toxin A Injection and Electromyography-controlled Functional Electrical Stimulation on Active Function in the Spastic Paretic Hand
Background: Many previous studies have demonstrated that botulinum toxin A (BTX-A) injections satisfactorily reduce spasticity. Nevertheless, BTX-A, with or without an adjuvant therapy, effectively improves the direct functional movement in few patients with spastic upper extremity paralysis. Therefore the present study aimed to determine the effectiveness of task-orientated therapy on spasticity and functional movement by using electromyography-triggered functional electrical stimulation (EMG-FES) after BTX-A injections.
Design: Open-label, prospective clinical trial
Method: The subjects were 15 patients with spastic paresis (12 male, 3 female; age range, 17-74 years; 14 due to stroke, 1 due to spinal cord injury) who received BTX-A injections. Before the study was started, all subjects had undergone task-orientated therapy sessions with EMG-FES for 4 months. Despite all patients showing a various extent of improved upper extremity function, upper extremity function reached a plateau because of upper extremity spasticity. After BTX-A injection, all patients underwent task-orientated therapy sessions with EMG-FES for 4 months. The outcomes were assessed with the modified Ashworth scale, the simple test for evaluating hand function, box and block test, grip and release test, finger individual movement test, and grip strength. Assessments were performed at baseline and 10 days and 4 months after BTX-A injection.
Results: The median modified Ashworth scale score decreased from 2 at baseline to 1 at 10 days and 4 months after BTX-A injection. The finger individual movement test score increased slightly at 10 days (p=0.29) and further increased at 4 months (p<0.05). The simple test for evaluating hand function, grip and release test, box and block test, and grip strength decreased after 10 days (p<0.05, p=0.26, p<0.01, andp<0.01, respectively) but increased after 4 months (p<0.01, p<0.05, p<0.01, and p=0.18, respectively).
Conclusion: Task-orientated therapy with EMG-FES after BTX-A injection effectively reduced spasticity and improved upper limb motor function. Our results also suggest that spasticity occurs as a compensation for the force of the affected muscles and leads to misuse movements and ostensible dexterity in many patients. In addition, we hypothesize that BTX-A injection initializes the abnormal adapted movement pattern and that more active hand movements with facilitation of the paretic muscles when using EMG-FES induce an efficient muscle reeducation of the inherent physiological movement pattern that ultimately could prove useful in the activities of daily living.
At a sophisticated lab in Barcelona, researchers are convinced that computer models based on virtual reality can help people who have suffered strokes, by providing them with better rehabilitation techniques. The claim is not just science fiction.
Right after giving birth to her second child, Gloria was fighting for her life. A stroke almost completely paralysed her; she could barely speak.
For months, she engaged in a rehabilitation programme that included playing with a brand new virtual reality game.
An experimental rehabilitation approach for stroke patients is being tested at the Vall d´Hebron Hospital in Barcelona.
“The rehabilitation programme was really motivating, because I learnt new things. I was able to greatly improve the movement of my arms, in a very subconscious, natural way,” explained Gloria Bou Ferreiro a stroke patient at the hospital.
The virtual reality game was developed as a tool to complement classic rehabilitation techniques for stroke sufferers.
The goal is to teach the brain to control the body movements again, specially the upper extremities.
“We think this technology can be really useful for patients who have already finished their classic hospital rehabilitation and are back home. These patients often think that rehabilitation is over; their brains don’t use the sides that have been affected by the stroke any more. This tool has proven really effective in forcing the brain to really use the side that was damaged during the stroke.” Susana Rodríguez González, the physician specialising in Physical Medicine and Rehabilitation at the Vall d´Hebron Hospital pointed out.
The game was developed at the Pompeu Fabra University, not far from the hospital.
A team of computer scientists, psychologists and bioscientists from a European research project created the system from a basic starting point: plasticity of the brain remains throughout life. So it can be used to achieve a functional reorganization of the brain areas affected by strokes.
“Our theory tells us that the brain is an active learning machine. It continuously builds models of the world. So we thought that maybe we had to provide the brain with new forms of stimulation, new forms of goal-orientated training to make the brain believe it can perform certain tasks. And that is exactly what we do via virtual reality,” explained Paul Verschure, psychologist at project coordinator at Pompeu Fabra University.
The system optimizes the user’s training by analyzing the patient’s performances. And these virtual reality models can have further applications, far beyond rehabilitation.
“We can virtually assess how the brain activity in those affected regions of the brain are going to change. We can sort of visualize how the patient’s motor and cognitive functions will be affected. And this can greatly help us to provide better diagnostics,” explained Anna Mura who is a neuroscientist at Pompeu Fabra University.
Virtual reality can indeed help stroke patients in recovering the control of their upper extremities, researchers say.
Now they aim at using the same tools to improve other brain functions that are often also affected by strokes.
“Alterations in language, swallowing problems, equilibrium disorders, neuro- psychological problems, attentional disorders… We could also address those issues with tools like this. Strokes not only affect the patient’s physical strength and psychomotor activity. We could also address those issues with virtual reality tools like the one that we have developed,” said Susana Rodríguez González.
After successful validation tests, first units of the virtual reality tool are about to be installed in clinics all over Europe.