Average Fugl-Meyer Assessment Scores Research Articles

The efficacy of median nerve electrical stimulation in rehabilitating post-stroke cognitive impairment and its mechanism

Objective To test the effectiveness of electrical stimulation of the median nerve (MNES) for relieving post-stroke cognitive impairment (PSCI) and explore the possible mechanism. Methods Thirty patients with PSCI were randomly divided into a routine treatment group (the control group) and an MNES group, each of 15. Both groups were given routine rehabilitation treatment, including cognitive rehabilitation training, medications and acupuncture. The MNES group additionally received 30 minutes of MNES on their right hands every day, five times a week for six weeks. One electrode was positioned over the median nerve 2cm up from the rasceta of the right wrist. The other was on the muscles of the thenar eminence. Forty seconds of stimulation were applied with intervals of 20 seconds, for 30 min daily. Before and after 3 and 6 weeks of treatment, both groups were evaluated using the mini-mental state examination (MMSE), the Montreal cognitive assessment (MoCA), the modified Barthel index (MBI) and the Fugl-Meyer assessment (FMA). In another 15 patients oxyhemoglobin levels in the brain before and during the MNES were observed using near-infrared spectroscopy. Results After 3 weeks of treatment, a significant improvement was observed in the average MMSE, FMA and MBI scores of both groups, and the average MoCA score of the observation group. Three weeks later, the average MMSE, FMA, MBI and MoCA scores of both groups had improved significantly compared with before the treatment, with the average MMSE and MoCA improvements in the MNES group significantly greater than the control group′s averages. After 6 weeks of treatment the significant improvements persisted in both groups. Both group′s average FMA scores had also improved significantly, as had the average MBI score of the control group. After 6 weeks of treatment, the observation group′s average time orientation, location orientation, language instant memory, attention, calculation and short-term memory in MMSE had all improved significantly along with visual space capacity, executive capacity, attention, language, orientation and memory in MoCA. The spectroscopic results showed significantly improved oxyhemoglobin concentration in the bilateral frontal lobes after the MNES. Conclusions Electrical stimulation of the median nerve can help to improve cognition after a stroke. It increases oxyhemoglobin concentration in the bilateral frontal lobes. Key words: Median nerves; Electrical stimulation; Stroke; Cognitive impairment; Rehabilitation

High frequency transcranial magnetic stimulation combined with mirror therapy improves upper limb motor function post-stroke

Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) combined with the mirror therapy (MT) on the recovery of upper limb function recovery 3 to 6 months after a stroke. Methods Forty-five male patients were randomly assigned to an MT (A) group, an rTMS+ MT (B) group or an MT+ rTMS group (C ), each of 15. All received conventional medical treatment and stroke rehabilitation. In addition, group A received 60 min of MT daily, 5 days a week for 4 weeks. Group B received 10 min of rTMS over the M1 area of the affected hemisphere followed by 50 min of MT treatment, and group C received 50 min of MT treatment followed by 10 min of rTMS. rTMS was delivered at a frequency of 10 Hz and an intensity of 90% resting motor threshold. The latency of motor evoked potential (MEP) for the affected abductor pollicis brevis muscle and its central motor conduction time (CMCT) were observed before and after the treatment. The upper extremity portion of the Fugl-Meyer assessment (FMA) was performed along with a functional test for the hemiplegic upper extremity (FTHUE). The motricity index (MI) was also quantified. Results Average MEP latency and CMCT had decreased significantly in all three groups after the treatments. The average MEP latency of group B was significantly shorter than that of group A, and CMCT was also significantly shorter than for groups A and C. Moreover, after the intervention, all of the groups had significantly improved their average FMA, MI and FTHUE scores, with the average FMA score of group B significantly better than those of groups A and C. The average FTHUE score of group B was also significantly better than that of group A. Conclusions MT either alone or in combination with rTMS can improve cerebral motor cortex excitability and motor recovery after a stroke. Ten minute rTMS sessions followed by 50 min of MT have the best effect. Key words: Transcranial magnetic stimulation; Mirror therapy; Upper limb motor function; Stroke

Quantitative analysis of the reaching ability of stroke survivors with synchronous surface electromyography

Objective To assess the reaching ability of hemiplegic stroke survivors using a motion capture unit (MCU) combined with surface electromyography (sEMG). Methods Sixteen stroke survivors with hemiplegia formed the experimental group, while healthy counterparts were selected as the control group. Both groups were asked to sit on a chair and reach for a cup on a table in front of their shoulder at arm′s length using their affected arms in the experimental group and their right arms in the control group. MCUs were fixed on their spines and arms to obtain kinematic signals, and the sEMG signals of the trapezius, the anterior deltoids, biceps and triceps of the tested limb were recorded. Each subject repeated the test 3 times, and the best result was retained for further analysis. After signal processing, the range of movement of the shoulders and elbows was extracted along with the time used to reach the cup, peak angular velocity, time to peak velocity of the shoulders and elbows, work of the muscles and work ratios of the trapezius/deltoid and biceps/triceps. The upper limb section of the Fugl-Meyer assessment (FMA) was also administered to evaluate the patients′ upper limb function. Independent sample rank sum tests compared the patients with the controls in terms of kinematics and sEMG parameters. Spearman analysis was used to explore the correlation between the FMA scores and the kinematics and sEMG characteristics. Results Significant differences in the kinematic and myoelectric indicators were found between the patients and the controls. The average FMA score of the patients was correlated with the peak velocity of the shoulder joint. Moreover, the ROM of the shoulder was closely related to the work of the trapezius, while the time for the shoulder joint to reach peak velocity was closely related to the work ratio of the biceps and triceps. Conclusion An MCU integrated with synchronous sEMG can quantitatively assess the kinematics and kinetics of hemiplegic stroke survivors, at least in reaching. This can provide objective guidance to optimize clinical rehabilitation. Key words: Stroke; Hemiplegia; Reaching; Kinematics; Electromyography

Scalp cluster acupuncture combined with constraint-induced movement therapy improves functional recovery after ischemic stroke

Objective To compare the effect of clustered acupuncture of the scalp combined with constraint-induced movement therapy (CIMT) with that of conventional acupuncture of the body points plus conventional rehabilitation intervention after cerebral infarction using blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI). Methods Thirty acute cerebral infarction patients with hemiplegia were equally divided into two groups at random. The test group received the clustered acupuncture of the scalp combined with CIMT, while the control group received the body point acupuncture plus conventional rehabilitation intervention. Before and after two weeks of treatment, blood oxygenation level-dependent functional magnetic resonance imaging at 3.0 T was performed during a passive digital opposition movement. The volume and intensity of the activated areas were compared. Fugl-Meyer assessment (FMA) was carried out as well. Results The most pronounced activation appeared in the contralateral somatosensory motor cortex for both groups. There was no significant difference in average FMA scores between the two groups before the treatment, but after the treatment the averages were significantly different. An increase in activated volume and intensity in the contralateral SMC was observed in both groups after the treatment, but the test group showed a much larger change in both activated volume and intensity. Conclusion The clustered acupuncture of the scalp combined with CIMT can achieve a more significant improvement in functional recovery after acute cerebral infarction than conventional acupuncture of the body points plus conventional rehabilitation intervention. Such combined therapy is worthy of application in clinical practice. Key words: Scalp; Acupuncture; Constraint-induced movement therapy; Functional MRI; Cerebral infarction

Effects of early rehabilitation on the motor function of post-stroke hemiplegic patients after intravenous thrombolysis

Objective To observe the effects of early rehabilitation on the motor function of post-stroke hemiplegic patients treated with intravenous thrombolysis. Methods Thirty-six post-stroke hemiplegic patients after intravenous thrombolysis with rtPA were recruited in this study. They were randomly divided into the early rehabilitation group (with the course less than three days) and the control group (with the course between three and seven days), 18 cases in each group. Both group received a two-week rehabilitation programme. They were assessed using the Fugl-Meyer assessment (FMA) of up extremity, FMA of lower extremity and ADL score (modified Barthel index, MBI) before and after treatment, as well as at the 3rd month after treatment (during the following-up). Results After treatment and at the following-up, FMA scores of up extremity, FMA scores of lower extremity and MBI scores had improved significantly compared with before treatment in both groups. Furthermore, after treatment, in the early rehabilitation group the average FMA score of lower extremity and MBI score reached (23.33±4.37) and (56.11±22.27) respectively, significantly higher than those of the control group [(17.06±4.70) and (40.00±15.81) respectively]. Conclusion Early rehabilitation contributes to short-term recovery of lower extremity motor function and ability in the activities of daily living in post-stroke hemiplegic patients after intravenous thrombolysis. Key words: Stroke; Thrombolysis; Early rehabilitation; Motor function

The effect of a motor relearning programme combined acupuncture on muscle tension and motor function recovery after cerebral infarction

Objective To observe the effects of a motor relearning programme (MRP) combined with different early acupuncture interventions on muscle tension and motor function recovery after cerebral infarction. Methods A total of 90 patients with cerebral infarction who met the inclusion criteria were divided into three groups at random:a YANGMING meridian acupuncture and MRP group ( group A),an anti-spasm acupuncture and MRP group ( group B),and an MRP group ( group C ).All of the patients in all three groups were treated with routine medication.The National Institute of Health stroke scale (NIHSS),the composite spasticity scale (CSS),Fugl-Meyer assessment (FMA),the Fugl-Meyer balance scale (FM-B) and the modified Barthel index (MBI) were used to measure performance before treatment and after 4 weeks of treatment.Another comparison was intra-group between before and after treatment. Results There were significant differences in the assessment results in all of the groups after treatment compared with those before treatment.After treatment,group B was superior to group C only in terms of NIHSS scores.There was no significant NIHSS score difference between groups A and C.The FMA,CSS and MBI results revealed significant differences among all three groups,with the scores of group A consistently the highest.The average FMA score in group B was significantly higher than in group C but there was no statistically significant difference in FM-B scores among the three groups. Conclusion MRP therapy combined with early acupuncture intervention can improve motor function and muscular tension after cerebral infarction.Anti-spasm acupuncture can improve motor function and control muscular tension effectively at the same time,making it beneficial for MRP training. Key words: Motor relearning; Acupuncture; Cerebral infarction; Muscular tension; Motor function; Activities of daily living

Effects of mirror therapy in conjunction with task-oriented training for improving upper extremity function in post-stroke patients

Objective To explore the effect of mirror therapy in conjunction with task-oriented training on the upper extremity function of post-stroke patients and the possible mechanisms. Methods Twenty-one post-stroke patients were randomly assigned to a treatment group (10 patients) or a control group (ll patients).The patients in the treatment group were given conventional rehabilitation therapy and mirror therapy in conjunction with task-oriented training for 4 weeks.The control group was given only the same conventional rehabilitation treatment as the treatment group and upper extremity task-oriented training for 4 weeks.Both groups trained 1 h/d,5 d/week.Upper-extremity motor ability was assessed using the Fugl-Meyer assessment (FMA) and the Hong Kong version of the functional test for the hemiplegic upper extremity (FTHUE-HK).Ability in the activities of daily living (ADL) was assessed using the Barthel Index (BI) pre-treatment and after 2 and 4 weeks of treatment. Results At the 2nd week and 4th week evaluations,the FMA,FTHUE-HK and BI scores in both groups had all significantly increased compared with pretreatment.The average FMA score in the treatment group increased significantly more than in the control group at week 2,but by the 4th week both FMA and FTHUE-HK scores in the treatment group significantly exceeded those in the control group.There was no significant difference between the two groups in the improvement of their average BI scores. Conclusions Implementing mirror therapy in conjunction with task-oriented training is efficacious.It may promote upper-extremity motor ability in patients with hemiparesis soon after stroke,but there is no definite improvement in ADL ability. Key words: Mirror therapy ; Task-oriented training ; Stroke ; Upper-extremity function