Posts Tagged paretic upper limb

[ARTICLE] The Effects of Constraint Induced Movement Therapy in Improving Functions of Upper Limb in Patients with Stroke – Full Text PDF


Objective: The aim of this was to compare the effects of constraint movement therapy and conventional therapy for improving motor function of upper limb in patients with sub-acute stroke.

Study Design: A randomized controlled trial.

Place and Duration of Study: The study was carried out from January 2016 to December 2016 in Rafsan Neuro Rehabilitation Centre, Peshawar.

Materials and Methods: A total of 60 patients with sub-acute stage of stroke were randomly allocated into constraint induced movement therapy and conventional therapy groups. Patients in conventional therapy group followed conventional physical therapy rehabilitation activities while patients in the constraint induced movement therapy group were guided to perform the same activities while constraining their less effected limb. Patients in both groups were assessed just before and six weeks after the start of these therapies. Mann Whitney U test was used to compare the results of both treatment.

Results: The patients in constraint induced movement therapy group showed better results on upper arm function, hand movement and advanced hand activities of motor assessment scale as compared to the patients in conventional therapy group. The mean rank for upper arm function of constraint induced movement therapy and conventional therapy group were 40 and 20, respectively (p=0.001), hand movement for CIMT and CT were 40 and 20 (p=0.001) and advanced hand activities for CIMT and CT group were 43 and 17 (p=0.001), respectively. The patients in induced movement therapy group showed 20% better result on upper arm function, 21% on hand movements and 26% on advanced hand activities of motor assessment scale. Conclusion: It is concluded that constraint induced movement therapy provides improved upper arm function, hand movement and advanced hand activities as compared to the conventional therapy for the patients with sub-acute stroke.


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[ARTICLE] A new treatment in the rehabilitation of the paretic upper limb after stroke: the ARAMIS prototype and treatment protocol – Full Text PDF


Background. In recent years, as part of the rehabilitation of post stroke patients, the use of robotic technologies to improve recovery of upper limb has become more widespread. The Automatic Recovery Arm Motility Integrated System (ARAMIS) is a concept robot and prototype designed to promote the functional interaction of the arms in the neurorehabilitation of the paretic upper limb. Two computer-controlled, symmetric and interacting exoskeletons compensate for the inadequate strength and accuracy of the paretic arm and the effect of gravity during rehabilitation. Rehabilitation is possible in 3 different modalities; asynchronous, synchronous and active-assisted.

Objectives. To compare the effectiveness of robotic rehabilitation by an exoskeleton prototype system with traditional rehabilitation in motor and functional recovery of the upper limb after stroke.

Methods. Case-control study, 52 patients enrolled in the study, 28 cases (women: 8, age: 65 ± 10 yrs) treated with ARAMIS and 24 controls (women: 11, age: 69 ± 7 yrs) with conventional rehabilitation. Motor impairment assessed before and after treatment with Fugl-Meyer scale and Motricity Index, level of disability assessed with the Functional Independence Measure. A questionnaire was also administered to assess the patient’s tolerance to robotic therapy.

Results. After 28 ± 4 sessions over a 54 ± 3.6-day period, the patients treated by ARAMIS had an improvement on the Fugl-Meyer scale (global score from 43 ± 18 to 73 ± 29; p < 0.00001), Motricity Index scale (p < 0.004) and Functional Independence Measure (p < 0.001). A lesser degree of improvement was achieved using conventional rehabilitation, the Fugl-Meyer global score of the control group improved from 41 ± 13 to 58 ± 16 (p < 0.006) and the motor function item from 9.4 ± 4.1 to 14.9 ± 5.8 (p < 0.023).

Conclusions. Motor improvement was greater at the wrist and hand than at shoulder and elbow level in patients treated by ARAMIS and controls, but it was significantly greater in ARAMIS-treated patients than in controls. The results indicate a greater efficacy of ARAMIS compared to conventional rehabilitation.

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