Hyperbaric oxygen and focused rehabilitation program: a feasibility study in improving upper limb motor function after stroke.

Objectives: Stroke is one of the main causes of disability and mortality worldwide. Most survivors experience impairments in their upper limb motor function. Methods: This experimental study was performed as a clinical trial on 30 chronic stroke patients who experienced stroke from 6 to 96 months ago. Patients were non-randomly divided into the intervention (Virtual Reality besides conventional occupational therapy) and control (conventional occupational therapy) groups. Each treatment session lasted for one hour which was divided into conducting conventional occupational therapy techniques and Virtual Reality (VR) for the intervention group, and routine techniques for the control group. The intervention effectiveness was evaluated by the Fugl-Meyer Upper Extremity Scale, Stroke Impact Scale, Chedoke Arm and Hand Activity Inventory, Motricity Index, Modified Ashworth Scale and goniometer. Results were analyzed by SPSS and one-sample Kolmogorov-Smirnov, Shapiro- Wilk test, Independent Samples t-test and Mann Whitney U test were applied to assess the normality of data and to detect significant differences between study variables. Results: The results suggested that investigated parameters such as upper limb motor function, muscle tone and the range of motion were significantly different in the intervention group, compared to control group; however, there was no significant changes in none of the group's daily living activities. Discussion: VR-based computer games in combination with routine occupational therapy interventions could improve upper extremities functional impairments in chronic stroke patients. However, it seems the mechanisms behind the effectiveness of video games and their impact on brain cortex as well as upper limbs function need to be further investigated. © 2019, Iranian Rehabilitation Journal.

Upper limb motor function and activities of daily living (ADL) are related in chronic stroke patients. This study investigated this relationship after removal of the influence of motor function of the affected lower limb, which until now has remained unclear. This retrospective cross-sectional study included 53 patients with chronic stroke. Upper and lower limb motor function and ADL were assessed using the Fugl-Meyer assessment of the upper (FMA-UL) and lower limbs (FMA-LL) and functional independence measure motor score (FIM-M). To clarify the relationship between FMA-UL and total FIM-M before and after removal of the influence of FMA-LL, Spearman's rank correlation coefficient and partial correlation analysis were used. The relationship between FMA-UL and each item of FIM-M after removal of the influence of FMA-LL was assessed using partial correlation analysis. Before the influence of FMA-LL was removed, FMA-UL was moderately to well correlated with total FIM-M. This became weak after the influence was removed. Regarding each item of FIM-M, FMA-UL was correlated with dressing (upper body), toileting, and walking or wheelchair after removal of the influence. The relationship between upper limb motor function and ADL is strongly influenced by lower limb motor function.

Background/Aims Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients. Methods In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy. Results A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105). Conclusions Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.

The Effects of Unilateral Versus Bilateral Motor Training on Upper Limb Function in Adults with Chronic Stroke: A Systematic Review

Physical exercise can improve patient outcomes and reduce hospitalization and mortality rates among subjects with chronic obstructive pulmonary disease. This study aimed to compare the effects of upper limb and breathing exercises on six-minute walking distance among these patients. This three-group randomized controlled clinical trial was conducted in 2017-2018 in Velayat hospital, Qazvin, Iran. Seventy-five patients were purposively selected from the outpatient lung clinic of the hospital and randomly allocated to either the 25-patient groups of upper limb exercise, breathing exercise, or control. The patients in the first group were performing upper limb exercises thrice weekly for one month in the study setting. Their counterparts in the second group were doing pursed-lip and diaphragmatic breathing exercises four times daily for one month at their homes. However, the patients in the control group received no exercise intervention. Six-minute walk test was performed by each participant both before and after the study intervention. The SPSS for Windows program (v. 23.0) was used to analyze the data via the Chi-square test, the paired-sample t test, and the one-way analysis of variance. Before the intervention, the groups did not significantly differ from each other respecting six-minute walking distance. During the study, walking distance in the control group did not change significantly, while it remarkably increased in both the upper limb exercise and the breathing exercise groups (p < 0.05). After the intervention, walking distance in the upper limb exercise group was significantly greater than the breathing exercise group (p < 0.05) and the control group (p < 0.05); however, the difference between the breathing exercise and the control groups was not statistically significant (p > 0.05). Upper limb exercise is more effective than breathing exercise in increasing walking distance among patients with chronic obstructive pulmonary disease. Therefore, upper limb exercise can be used as a safe, simple, and inexpensive rehabilitation technique for these patients.

Purpose Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. Methods Twenty-four patients (35–65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. Results The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). Conclusions Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1 IMPLICATION FOR REHABILITATION Upper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily living Applying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions

Background Comparative studies of different robotic types are warranted to tailor robot-assisted upper limb training to patient’s functional level. Objectives This study aimed to directly compare the effects of high inertia robot arm (whole arm manipulator, WAM) and low inertia robot arm (Proficio) on upper limb motor function in chronic stroke patients. Methods In this randomized controlled trial, 40 chronic stroke survivors were randomized into robot-assisted arm training with WAM (RAT-WAM) and robot-assisted arm training with Proficio (RAT-P) groups. The RAT-WAM and RAT-P groups participated in the robot-assisted arm training with WAM and robot-assisted arm training with Proficio, respectively, for 40 min daily, three times weekly over a four week. Upper limb motor function was measured before and after the intervention using the Fugl–Meyer assessment (FMA), action research arm test, and box and block test (BBT). Curvilinearity ratio (the length ratio of a straight line from the start to the target) was also measured as an index for upper limb kinematic performance. Results The RAT-WAM and RAT-P groups showed significant improvements in FMA-total and -proximal (shoulder/elbow units), BBT, and ARAT after the intervention (P < .05). Also, the RAT-P group showed significantly more improvement than the RAT-WAM group in FMA-distal (hand/wrist units) (P < .05). Conclusions Improvements of upper limb motor function occurred during robot-assisted arm training with robotic systems. Low inertia robot arm was more effective in improving the motor function of the hand and wrist. The results may be useful for robot-assisted training for upper limb impairment.

After stroke, the function of primary motor cortex (M1) between the hemispheres may become unbalanced. Techniques that promote a re-balancing of M1 excitability may prime the brain to be more responsive to rehabilitation therapies and lead to improved functional outcomes. The present study examined the effects of Active-Passive Bilateral Therapy (APBT), a putative movement-based priming strategy designed to reduce intracortical inhibition and increase excitability within the ipsilesional M1. Thirty-two patients with upper limb weakness at least 6 months after stroke were randomized to a 1-month intervention of self-directed motor practice with their affected upper limb (control group) or to APBT for 10-15 min prior to the same motor practice (APBT group). A blinded clinical rater assessed upper limb function at baseline, and immediately and 1 month after the intervention. Transcranial magnetic stimulation was used to assess M1 excitability. Immediately after the intervention, motor function of the affected upper limb improved in both groups (P < 0.005). One month after the intervention, the APBT group had better upper limb motor function than control patients (P < 0.05). The APBT group had increased ipsilesional M1 excitability (P < 0.025), increased transcallosal inhibition from ipsilesional to contralesional M1 (P < 0.01) and increased intracortical inhibition within contralesional M1 (P < 0.005). None of these changes were found in the control group. APBT produced sustained improvements in upper limb motor function in chronic stroke patients and induced specific and sustained changes in motor cortex inhibitory function. We speculate that APBT may have facilitated plastic reorganization in the brain in response to motor therapy. The utility of APBT as an adjuvant to physical therapy warrants further consideration.

ABSTRACTBackground:Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. Objective:To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. Method:Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). Results:Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. Conclusion:Grip strength assessed with the MST could be used to report paretic UL global strength.

Clinical Prediction Rule for Identifying the Stroke Patients who will Obtain Clinically Important Improvement of Upper Limb Motor Function by Robot-Assisted Upper Limb

Constraint-induced movement therapy after injection of Botulinum toxin improves spasticity and motor function in chronic stroke patients

The inflammatory response to upper and lower limb exercise and the effects of exercise training in patients with claudication

22. Early vs (<24 hrs) late (=24 hrs) surgical decompression for central cord syndrome: a propensity score matched analysis of prospective, multicenter data

Exaggerated pressor responses, but unaltered blood flow regulation and functional sympatholysis during lower limb exercise in young, non-Hispanic black males.

The rate of cerebrovascular accident is keep on increasing in Pakistan which cause major disability in affected person. In developed countries it has been reported that an action observation treatment for rehabilitation, promotes motor function of upper limb in stroke population.Objective: To find out effects of action observation treatment on upper limb motor functions of chronic stroke patients.Study Design: A randomized control trial with registered number NCT05084820.Place and Duration of study:Fourteen chronic stroke patients were taken from Umer hospital and Riphah rehab center Lahore. Total duration of study was 6 months.Materials and method:A randomized control trial was done containing total 14 chronic stroke patients. Patients in experimental group were given action observationtreatment three days per week for one month along with conventional physiotherapy treatment. Patients in conventional group, received strengthening exercises, reach and grasp of hand, stretch of hand muscles. Modified Barthel Index was used to measure function of upper limb and Fugl-Meyer Assessment for upper extremity (FMA-UE) for assessment of motor function. Statistical analysis was done by using SPSS 21.Results: There were significant difference in MBI and FMA-UE score, P value was &lt;0.05, but sensation and joint pain from FMA-UE tool P value was &gt;0.05 which was non-significant.Conclusion:Action observation treatment together with conventional treatment was an effective treatment approach on improving motor function of upper limb in chronic stroke patients.