Posts Tagged upper limb function

[Abstract] The effect of transcranial direct current stimulation on motor sequence learning and upper limb function after stroke

Introduction

Transcranial direct current stimulation (tDCS) is a safe and non-invasive brain stimulation technique with the potential to improve upper limb function after stroke. Ipsilesional primary motor cortex (M1) excitability can be increased with anodal tDCS, contralesional M1 excitability can be decreased with cathodal tDCS or both anodal and cathodal tDCS can be used simultaneously on both cortices (bihemispheric). The impact of these different electrode arrangements on the efficacy of tDCS, and whether any of the changes are due to callosal connections between cortices, is unclear.

Objectives

This study aimed to investigate the effect of tDCS electrode arrangement on motor sequence learning and upper limb function in chronic stroke survivors.

Patients and methods

21 stroke survivors (range 3–124 months post-stroke, 34–81 years of age) with upper limb impairment received 20 min of 1 mA tDCS (0.04 mA·cm−2) during performance of a motor sequence learning task which involved movement of a computer mouse with the paretic arm to circular targets on a monitor in a repeating pattern. Four tDCS conditions were studied in a repeated-measures design; (i) anodal to the ipsilesional M1, (ii) cathodal to the contralesional M1, (iii) bihemispheric and (iv) sham. Upper limb function was assessed before and after tDCS, using the Jebsen–Taylor hand function test (JTT). Changes in transcallosal inhibition (TCI) were assessed using transcranial magnetic stimulation (ipsilateral silent period duration).

Results

There was no effect of tDCS condition on performance of the motor sequence learning task. Performance on the JTT improved significantly after unilateral tDCS (anodal or cathodal) compared to sham (p < 0.05), but not after bihemispheric (Fig. 1). There was no effect on TCI (p > 0.5), and no relationship between changes in TCI and upper limb function.

Conclusions

Unilateral, but not bihemispheric, tDCS improves upper limb function. The response to tDCS does not appear to be driven by changes in TCI. These results have implications for the use of tDCS for upper limb rehabilitation.

Source: P244 The effect of transcranial direct current stimulation on motor sequence learning and upper limb function after stroke – Clinical Neurophysiology

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[Abstract] Determining the benefits of transcranial direct current stimulation on functional upper limb movement in chronic stroke. – International Journal of Rehabilitation Research

Abstract

Transcranial direct current stimulation (tDCS) has been proposed as a tool to enhance stroke rehabilitation; however, evidence to support its use is lacking. The aim of this study was to investigate the effects of anodal and cathodal tDCS on upper limb function in chronic stroke patients. Twenty five participants were allocated to receive 20 min of 1 mA of anodal, cathodal or sham cortical stimulation in a random, counterbalanced order. Patients and assessors were blinded to the intervention at each time point. The primary outcome was upper limb performance as measured by the Jebsen Taylor Test of Hand Function (total score, fine motor subtest score and gross motor subtest score) as well as grip strength. Each outcome was assessed at baseline and at the conclusion of each intervention in both upper limbs. Neither anodal nor cathodal stimulation resulted in statistically significantly improved upper limb performance on any of the measured tasks compared with sham stimulation (P>0.05). When the data were analysed according to disability, participants with moderate/severe disability showed significantly improved gross motor function following cathodal stimulation compared with sham (P=0.014). However, this was accompanied by decreased key grip strength in the unaffected hand (P=0.003). We are unable to endorse the use of anodal and cathodal tDCS in the management of upper limb dysfunction in chronic stroke patients. Although there appears to be more potential for the use of cathodal stimulation in patients with severe disability, the effects were small and must be considered with caution as they were accompanied by unanticipated effects in the unaffected upper limb.

Source: Determining the benefits of transcranial direct current stim… : International Journal of Rehabilitation Research

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[ARTICLE] The effects of bilateral movement training on upper limb function in chronic stroke patients – Full Text

Abstract

[Purpose] This study compared the functional and kinematic changes associated with two rehabilitation protocols: bilateral and unilateral movement training.

[Subjects and Methods] Twenty-five patients with chronic stroke were randomly assigned to two training protocols for four weeks of training. Each training session consisted of three tasks. The tasks were performed with either the impaired and unimpaired arms moving synchronously (bilateral training) or with the impaired arm alone (unilateral training). To compare the changes associated with each rehabilitation protocol, functional and kinematic assessments were performed before and after the interventions. The functional state of each patient was measured by the Box and Block Test, and the kinematic variables were assessed by three-dimensional motion analysis. The Box and Block Test was used to assess the functional abilities of the affected upper limb. Kinematic measurements of upper limb movement were measured with a 3-dimensional motion analysis system.

[Results] Results showed that the bilateral movement group had significantly improved motion of the shoulder compared to the unilateral movement group.

[Conclusion] Bilateral movement training should be used to improve upper limb function in patients with chronic stroke.

Continue —> The effects of bilateral movement training on upper limb function in chronic stroke patients

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[Abstract] Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

Abstract

Functional electrical stimulation (FES) has shown to improve motor function of the affected side in stroke patients; however, the effects of FES on proprioception, the functional recovery of the paretic upper limb, and the patient quality of life (QoL) are not clear. The aim of the current case report was to determine whether FES can improve joint position sense and the scores on measurements of upper limb function and a QoL survey. The participant was assessed before and after 10 consecutive intervention sessions; in addition, the patient performed the training tasks in the workstation assisted by the FES device. Improvements in angles and time only in the affected wrist and enhancement in the Action Research Arm Test scores for both upper limbs were found after FES intervention. In addition, the patient’s health-related QoL measurements improved. FES could ameliorate the proprioceptive deficit and the activity limitations of a stroke survivor.

Source: Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

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[Abstract] Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

Functional electrical stimulation (FES) has shown to improve motor function of theaffected side in stroke patients; however, the effects of FES on proprioception, thefunctional recovery of the paretic upper limb, and the patient quality of life (QoL)are not clear. The aim of the current case report was to determine whether FES canimprove joint position sense and the scores on measurements of upper limb functionand a QoL survey. The participant was assessed before and after 10 consecutive interventionsessions; in addition, the patient performed the training tasks in the workstationassisted by the FES device.

References

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Source: Effect of functional electrical stimulation on the proprioception, motor function of the paretic upper limb, and patient quality of life: A case report – Journal of Hand Therapy

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[ARTICLE] The effects of bilateral movement training on upper limb function in chronic stroke patients – Full Text PDF

Abstract.

[Purpose] This study compared the functional and kinematic changes associated with two rehabilitation protocols: bilateral and unilateral movement training.

[Subjects and Methods] Twenty-five patients with chronic stroke were randomly assigned to two training protocols for four weeks of training. Each training session consisted of three tasks. The tasks were performed with either the impaired and unimpaired arms moving synchronously (bilateral training) or with the impaired arm alone (unilateral training). To compare the changes associated with each rehabilitation protocol, functional and kinematic assessments were performed before and after the interventions. The functional state of each patient was measured by the Box and Block Test, and the kinematic variables were assessed by three-dimensional motion analysis. The Box and Block Test was used to assess the functional abilities of the affected upper limb. Kinematic measurements of upper limb movement were measured with a 3-dimensional motion analysis system.

[Results] Results showed that the bilateral movement group had significantly improved motion of the shoulder compared to the unilateral movement group.

[Conclusion] Bilateral movement training should be used to improve upper limb function in patients with chronic stroke.
INTRODUCTION
For motor recovery in patients with stroke, repetitive and intensive practice of voluntary motor control is essential. Utilizing this concept, diverse treatment methods, such as constraint-induced movement therapy1), electromyographic biofeedback2), virtual reality3), and task-oriented training4) have been attempted for recovery of upper-limb control in patients with stroke. However, such treatment methods have focused on unilateral movement of the paretic upper extremity.

Bilateral exercise is a training method that utilizes the non-paretic limb in order to promote functional recovery of the damaged limb through the interlimb coupling effect. To achieve this effect, both hands are drawn into coordinated positions by the muscle groups of identical structures, and combined into one coordinated unit. In order to obtain the interlimb coupling effect in the upper limbs, both the paretic side and the non-paretic side should be repetitively and intensively trained in a simultaneous manner. In this way, the paretic arm will couple with the movement pattern of the non-paretic arm and, accordingly, the function of the paretic arm will improve5). When movement occurs in only one of the upper limbs, inhibition of activation in the same-sided hemisphere takes place; however, while performing symmetric bilateral movement tasks, both the left and the right cerebral hemispheres are activated, reducing inhibition between the hemispheres and thereby promoting recovery of the paretic limb6).

Extensive research has been done to clarify the effects of bilateral exercise, but the results have been controversial. Some research has asserted that the interlimb coupling effect does not improve the performance of the paretic arm in patients with hemiplegia resulting from stroke7). However, other studies have shown that bilateral movement increases the function of the paretic arm in patients with chronic stroke, suggesting the potential role of bilateral movement in recovering upper limb function after stroke8).

Therefore, in order to help clarify the effect of bilateral movement through diverse tasks, the subjects of this study were asked to perform tasks that did not force mirror-symmetric movement but required coordination between both hands. The results derived from this study will provide information that is useful for clarifying the effects of bilateral movement and for systemizing efficient rehabilitation treatment methods.

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[ARTICLE] Asymmetric Training Using Virtual Reality Reflection Equipment and the Enhancement of Upper Limb Function in Stroke Patients: A Randomized Controlled Trial

Background

Asymmetric movements with both hands contributed to the improvement of spatially coupled motion. Thus, the aim of this study was to investigate the effects of an asymmetric training program using virtual reality reflection equipment on upper limb function in stroke patients.

Methods

Twenty-four stroke patients were randomly allocated to an experimental group (n = 12) or a control group (n = 12). Both groups participated in conventional physical therapy for 2×30 min/d, 5 d/wk, for 4 weeks. The experimental group also participated in an asymmetric training program using virtual reality reflection equipment, and the control group participated in a symmetric training program. Both asymmetric and symmetric programs were conducted for 30 min/d, 5 d/wk, for 4 weeks. To compare upper limb function before and after intervention, the Fugl–Meyer Assessment (FMA), the Box and Block Test (BBT), grip strength, range of motion (ROM), and spasticity were assessed.

Results

Both groups showed significant increases in upper limb function, excepting spasticity, after intervention (P < .05, 1-way repeated-measures analysis of variance [ANOVA]). A significant group–time interaction was demonstrated only for shoulder/elbow/wrist items of FMA, BBT, grip strength, and ROM of wrist flexion, extension, and ulnar deviation (P < .05, 2-way repeated-measures ANOVA).

Conclusions

This study confirms that the asymmetric training program using virtual reality reflection equipment is an effective intervention method for improving upper limb function in stroke patients. We consider that an additional study based on a program using virtual reflection, which is more functional than performing simple tasks, and consisting of tasks relevant to the activities of daily living be conducted.

via Asymmetric Training Using Virtual Reality Reflection Equipment and the Enhancement of Upper Limb Function in Stroke Patients: A Randomized Controlled Trial.

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[ARTICLE] Telerehabilitation services for stroke.

Abstract

BACKGROUND:Telerehabilitation is an alternative way of delivering rehabilitation services. Information and communication technologies are used to facilitate communication between the healthcare professional and the patient in a remote location. The use of telerehabilitation is becoming more viable as the speed and sophistication of communication technologies improve. However, it is currently unclear how effective this model of delivery is relative to rehabilitation delivered face-to-face.

OBJECTIVES:To determine whether the use of telerehabilitation leads to improved ability to perform activities of daily living amongst stroke survivors when compared with (1) in-person rehabilitation (when the clinician and the patient are at the same physical location and rehabilitation is provided face-to-face); or (2) no rehabilitation. Secondary objectives were to determine whether use of telerehabilitation leads to greater independence in self care and domestic life and improved mobility, health-related quality of life, upper limb function, cognitive function or functional communication when compared with in-person rehabilitation and no rehabilitation. Additionally, we aimed to report on the presence of adverse events, cost-effectiveness, feasibility and levels of user satisfaction associated with telerehabilitation interventions.

SEARCH METHODS:We searched the Cochrane Stroke Group Trials Register (November 2012), the Cochrane Effective Practice and Organization of Care Group Trials Register (November 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 11, 2012), MEDLINE (1950 to November 2012), EMBASE (1980 to November 2012) and eight additional databases. We searched trial registries, conference proceedings and reference lists.

SELECTION CRITERIA:Randomised controlled trials (RCTs) of telerehabilitation in stroke. We included studies that compared telerehabilitation with in-person rehabilitation or no rehabilitation. In addition, we synthesised and described the results of RCTs that compared two different methods of delivering telerehabilitation services without an alternative group. We included rehabilitation programmes that used a combination of telerehabilitation and in-person rehabilitation provided that the greater proportion of intervention was provided via telerehabilitation.

DATA COLLECTION AND ANALYSIS:Two review authors independently identified trials on the basis of prespecified inclusion criteria, extracted data and assessed risk of bias. A third review author moderated any disagreements. The review authors contacted investigators to ask for missing information.

MAIN RESULTS:We included in the review 10 trials involving a total of 933 participants. The studies were generally small, and reporting quality was often inadequate, particularly in relation to blinding of outcome assessors and concealment of allocation. Selective outcome reporting was apparent in several studies. Study interventions and comparisons varied, meaning that in most cases, it was inappropriate to pool studies. Intervention approaches included upper limb training, lower limb and mobility retraining, case management and caregiver support. Most studies were conducted with people in the chronic phase following stroke.

PRIMARY OUTCOME:no statistically significant results for independence in activities of daily living (based on two studies with 661 participants) were noted when a case management intervention was evaluated.

SECONDARY OUTCOMES:no statistically significant results for upper limb function (based on two studies with 46 participants) were observed when a computer programme was used to remotely retrain upper limb function. Evidence was insufficient to draw conclusions on the effects of the intervention on mobility, health-related quality of life or participant satisfaction with the intervention. No studies evaluated the cost-effectiveness of telerehabilitation. No studies reported on the occurrence of adverse events within the studies.

AUTHORS’ CONCLUSIONS:We found insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke. Moreover, we were unable to find any randomised trials that included an evaluation of cost-effectiveness. Which intervention approaches are most appropriately adapted to a telerehabilitation approach remain unclear, as does the best way to utilise this approach.

via Telerehabilitation services for stroke. – PubMed – NCBI.

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