Block Test Scores Research Articles

Effectiveness of mixed reality-based rehabilitation on hands and fingers by individual finger-movement tracking in patients with stroke

BackgroundMixed reality (MR) is helpful in hand training for patients with stroke, allowing them to fully submerge in a virtual space while interacting with real objects. The recognition of individual finger movements is required for MR rehabilitation. This study aimed to assess the effectiveness of updated MR-board 2, adding finger training for patients with stroke.MethodsTwenty-one participants with hemiplegic stroke (10 with left hemiplegia and 11 with right hemiplegia; nine female patients; 56.7 ± 14.2 years of age; and onset of stroke 32.7 ± 34.8 months) participated in this study. MR-board 2 comprised a board plate, a depth camera, plastic-shaped objects, a monitor, a palm-worn camera, and seven gamified training programs. All participants performed 20 self-training sessions involving 30-min training using MR-board 2. The outcome measurements for upper extremity function were the Fugl–Meyer assessment (FMA) upper extremity score, repeated number of finger flexion and extension (Repeat-FE), the thumb opposition test (TOT), Box and Block Test score (BBT), Wolf Motor Function Test score (WMFT), and Stroke Impact Scale (SIS). One-way repeated measures analysis of variance and the post hoc test were applied for the measurements. MR-board 2 recorded the fingers’ active range of motion (AROM) and Dunnett’s test was used for pairwise comparisons.ResultsExcept for the FMA-proximal score (p = 0.617) and TOT (p = 0.005), other FMA scores, BBT score, Repeat-FE, WMFT score, and SIS stroke recovery improved significantly (p < 0.001) during MR-board 2 training and were maintained until follow-up. All AROM values of the finger joints changed significantly during training (p < 0.001).ConclusionsMR-board 2 self-training, which includes natural interactions between humans and computers using a tangible user interface and real-time tracking of the fingers, improved upper limb function across impairment, activity, and participation. MR-board 2 could be used as a self-training tool for patients with stroke, improving their quality of life.Trial registration number: This study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

Immediate effects of kinesio taping and vibration therapy on manual dexterity in children with unilateral spastic cerebral palsy: a randomised controlled trial

Background/Aims In children with unilateral spastic cerebral palsy, the upper extremity is usually more affected than the lower extremity. Somatosensory, functional and developmental disorders cause difficulties in hand function. The aim of this study was to assess the immediate effects of kinesio tape and vibration therapy in addition to conventional physiotherapy on gross and fine manual dexterity in children with unilateral spastic cerebral palsy. Methods A total of 45 children aged 4–18 years with mild to moderate spasticity (at levels 0, 1, 1+, 2 according to the Modified Ashworth Scale) who could grip and release an object, and those who had hand function at levels 1, 2 and 3 according to the Manual Ability Classification System and were diagnosed with unilateral spastic cerebral palsy, were included in the study. The children were randomised into three groups: vibration therapy, kinesio taping and control, with 15 children in each group. While conventional physiotherapy was regularly continued in all three groups, the kinesio taping group had kinesio tape applied to the wrist extensors, with 50% tension on the wrist and thumb and 25% tension on the fingers at the beginning of the session. The vibration therapy group received vibration to the forearm extensor muscle group at the end of the session. Vibration was applied to the widest part of the forearm extensor muscles with a 7 cm tip at a frequency of 80 Hz, amplitude of 1 mm, vibration for 10 seconds and rest for 5 seconds, for a total of 10 minutes. Gross and fine dexterity were assessed by Box and Block Test and Nine-Hole Peg Test before and after treatment. Results When the groups were compared before and after the intervention, a significant improvement was found in the Nine-Hole Peg Test scores of the kinesio taping (105.11± 66.99 vs 86.22 ± 51.88, P&lt;0.05) and vibration therapy (61.70 ± 35.54 vs 57.29 ± 38.05, P&lt;0.05) groups and in the Box and Block Test scores of all three groups: kinesio taping group (25.13 ± 14.33 vs 28.40 ± 14.23, P&lt;0.05), vibration therapy group (35.00 ± 11.69 vs 39.07 ± 12.43, P&lt;0.05), control group (34.60 ± 11.74 vs 37.80 ± 11.22, P&lt;0.05). There was no significant difference in the Nine-Hole Peg Test scores between the groups, while a significant improvement was found in the Box-Block Test scores of the kinesio taping group compared to the vibration therapy and control groups (P&lt;0.05). Conclusions Kinesio taping and vibration have positive immediate effects on gross and fine manual dexterity in children with unilateral spastic cerebral palsy and can be used by physiotherapists to support conventional physiotherapy and rehabilitation programmes.

A Tailorable Robotic Hand Orthosis to Support Children with Neurological Hand Impairments: a Case Study in a Child's Home.

Neurological disorders such as traumatic brain injuries (TBI) can lead to hand impairments in children, negatively impacting their quality of life. Fully wearable robotic hand orthoses (RHO) have been proposed to actively support children and promote the use of the impaired limb in daily life. Here we report a case study on the feasibility of using the pediatric RHO PEXO for assistance at home in a 13- year-old child with hand impairment after TBI. The size and functionalities of the RHO were first fully tailored to the child's needs. We trained the child and their parent on independently using the RHO before taking it home for a period of two weeks. The use of the RHO improved hand ability. Additionally, the tailoring and training benefited the unimanual capacity (Box and Block Test score +2 after tailoring) and bimanual performance (Assisting Hand Assessment score +4) of the child with PEXO. Further, it increased device acceptance by the child and the parent. The child used PEXO at home for 76 minutes distributed over three days during eating and drinking tasks. Personal and environmental factors caused the moderate use. No adverse events or safety-related issues occurred. This study highlights the value of tailoring an assistive RHO and, for the first time, demonstrates the feasibility of home use of a pediatric RHO by children with neurological hand impairments.

Trajectories of arm recovery early after stroke: an exploratory study using latent class growth analysis

Aim To investigate trajectories of recovery of motor arm function after stroke during inpatient rehabilitation. Materials and methods Data were available from 74 consecutively-admitted stroke survivors receiving inpatient rehabilitation from an inception cohort study. Heterogeneity of arm recovery in the first 4-weeks was investigated using latent class analysis and weekly Box and Block Test (BBT) scores. Optimal number of clusters were determined; characterised and cluster associated factors explored. Results A 4-cluster model was identified, including 19 participants with low baseline arm function and minimal recovery (‘LOWstart/LOWprogress’, 26%), 15 with moderate function and low recovery (‘MODstart/LOWprogress’, 20%), 15 with low function and high recovery (‘LOWstart/HIGHprogress’, 20%), and 25 with moderate function and recovery (‘MODstart/MODprogress’, 34%). Compared to LOWstart/LOWprogress: LOWstart/HIGHprogress presented earlier post-stroke (β, 95%CI) (−4.81 days, −8.94 to −0.69); MODstart/MODprogress had lower modified Rankin Scale scores (−0.74, −1.15 to −0.32); and MODstart/LOWprogress, LOWstart/HIGHprogress and MODstart/MODprogress had higher admission BBT (23.58, 18.82 to 28.34; 4.85, 0.85 to 9.61; 28.02, 23.82 to 32.21), Upper Limb-Motor Assessment Scale (9.60, 7.24 to 11.97; 3.34, 0.97 to 5.70; 10.86, 8.77 to 12.94), Action Research Arm Test (31.09, 22.86 to 39.33; 12.69, 4.46 to 20.93; 38.01, 30.76 to 45.27), and Manual Muscle Test scores (10.64, 7.07 to 14.21; 6.24, 2.67 to 9.81; 11.87, 8.72 to 15.01). Conclusions We found unique patterns of arm recovery with distinct characteristics for each cluster. Better understanding of patterns of arm recovery can guide future models and intervention development. KEY MESSAGES Arm recovery early after stroke follows four distinct trajectories that relate to time post stroke, initial stroke severity and baseline level of motor arm function. Identification of recovery patterns gives insight into the uniqueness of individual’s recovery. This study offers a novel approach on which to build and develop future models of arm recovery.

The feasibility of mixed reality-based upper extremity self-training for patients with stroke-A pilot study.

Mixed reality (MR), which combines virtual reality and tangible objects, can be used for repetitive training by patients with stroke, allowing them to be immersed in a virtual environment while maintaining their perception of the real world. We developed an MR-based rehabilitation board (MR-board) for the upper limb, particularly for hand rehabilitation, and aimed to demonstrate the feasibility of the MR-board as a self-training rehabilitation tool for the upper extremity in stroke patients. The MR-board contains five gamified programs that train upper-extremity movements by using the affected hand and six differently shaped objects. We conducted five 30-min training sessions in stroke patients using the MR-board. The sensor measured hand movement and reflected the objects to the monitor so that the patients could check the process and results during the intervention. The primary outcomes were changes in the Box and Block Test (BBT) score, and the secondary outcomes were changes in the Fugl–Meyer assessment and Wolf Motor Function Test (WMFT) scores. Evaluations were conducted before and after the intervention. In addition, a usability test was performed to assess the patient satisfaction with the device. Ten patients with hemiplegic stroke were included in the analysis. The BBT scores and shoulder strength in the WMFT were significantly improved (p < 0.05), and other outcomes were also improved after the intervention. In addition, the usability test showed high satisfaction (4.58 out of 5 points), and patients were willing to undergo further treatment sessions. No safety issues were observed. The MR-board is a feasible intervention device for improving upper limb function. Moreover, this instrument could be an effective self-training tool that provides training routines for stroke patients without the assistance of a healthcare practitioner.Trial registrationThis study was registered with the Clinical Research Information Service (CRIS: KCT0004167).

Functional Implications of Motor Evoked Potential Operant Conditioning of Wrist Extensors in an Individual Poststroke

Abstract Date Presented 04/02/2022 This poster presents a case study of 56 year-old woman with weak wrist extension 2.5 years after subcortical ischemic stroke who participated in an extensor carpi radialis (ECR) motor evoked potential (MEP) operant conditioning training study. The participant increased maximum voluntary contraction in the ECR and improved Box and Block Test and Fugl-Meyer upper extremity (UE) scores. This could indicate that MEP operant conditioning is a viable means of improving UE function in individuals poststroke. Primary Author and Speaker: Blair H. S. Dellenbach Contributing Authors: Bridgette Pouliot, Jinsook Roh, Aiko K. Thompson

Effect of somatosensory stimulation on hand functions in post stroke hemiparetic patients

Somatosensory cues provide with the first chance to create a precise movement pattern and execute proper motor control. Somatosensory impairment can exacerbate hemiparesis, either directly because of a stroke or indirectly through the loss of the ability to interact with the environment. This study aims to investigate the effect of somatosensory stimulation on hand functions, dexterity, and handgrip strength in post stroke hemi paretic patients. This study is a randomized control trial research using two group's pre-posttest design. Thirty stroke hemi paretic patients (15 patients’ study (group A) received a selected physical therapy program in addition to somatosensory training., and 15 patients’ control (group B) received a selected physical therapy program only) participated in this study. Their age ranged from 50 to 67years. All patients undergone evaluation of handgrip strength(HGS) using handheld dynamometer, hand dexterity using box block test (BBT) and hand functional activities using Jepsen–Taylor hand function test (JTHFT). Unpaired t-test was conducted for comparison of the mean age between groups and comparison of handgrip strength, box and block test score and JTHFT between groups. Chi-squared test was conducted for comparison of sex distribution between groups.

Differential volume reductions in the subcortical, limbic, and brainstem structures associated with behavior in Prader\u2013Willi syndrome

Individuals with Prader–Willi syndrome (PWS) exhibit complex behavioral characteristics, including hyperphagia, autistic features, and subsequent age-related maladaptive behaviors. While this suggests functional involvements of subcortical, limbic, and brainstem areas, developmental abnormalities in such structures remain to be investigated systematically. Twenty-one Japanese individuals with PWS and 32 healthy controls with typical development were included. T1-weighted three-dimensional structural magnetic resonance images were analyzed for subcortical, limbic, and brainstem structural volumes, with age as a covariate, using a model-based automatic segmentation tool. Correlations were determined between each volume measurement and behavioral characteristics as indexed by questionnaires and block test scores for hyperphagia (HQ), autistic and obsessional traits, non-verbal intelligence (IQ), and maladaptive behavior (VABS_mal). Compared with the control group, the PWS group showed significantly reduced relative volume ratios per total intracranial volume (TIV) in thalamus, amygdala, and brainstem structures, along with TIV and native volumes in all substructures. While the brainstem volume ratio was significantly lower in all age ranges, amygdala volume ratios were significantly lower during early adulthood and negatively correlated to HQ and VABS_mal but positively correlated to Kohs IQ. Thus, limbic and brainstem volume alterations and differential volume trajectories may contribute to the developmental and behavioral pathophysiology of PWS.

Low-Frequency rTMS over Contralesional M1 Increases Ipsilesional Cortical Excitability and Motor Function with Decreased Interhemispheric Asymmetry in Subacute Stroke: A Randomized Controlled Study

Objective To determine the long-term effects of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) over the contralesional M1 preceding motor task practice on the interhemispheric asymmetry of the cortical excitability and the functional recovery in subacute stroke patients with mild to moderate arm paresis. Methods Twenty-four subacute stroke patients were randomly allocated to either the experimental or control group. The experimental group underwent rTMS over the contralesional M1 (1 Hz), immediately followed by 30 minutes of motor task practice (10 sessions within 2 weeks). The controls received sham rTMS and the same task practice. Following the 2-week intervention period, the task practice was continued twice weekly for another 10 weeks in both groups. Outcomes were evaluated at baseline (T0), at the end of the 2-week stimulation period (T1), and at 12-week follow-up (T2). Results The MEP (paretic hand) and interhemispheric asymmetry, Fugl-Meyer motor assessment, Action Research Arm Test, and box and block test scores improved more in the experimental group than controls at T1 (p < 0.05). The beneficial effects were largely maintained at T2. Conclusion LF-rTMS over the contralesional M1 preceding motor task practice was effective in enhancing the ipsilesional cortical excitability and upper limb function with reducing interhemispheric asymmetry in subacute stroke patients with mild to moderate arm paresis. Significance. Adding LF-rTMS prior to motor task practice may reduce interhemispheric asymmetry of cortical excitabilities and promote upper limb function recovery in subacute stroke with mild to moderate arm paresis.

MODEL PEMBELAJARAN SKEMA PADA PELAJARAN BAHASA INDONESIA DAPAT MENINGKATKAN KETERAMPILAN MEMBACA PEMAHAMAN TEKS ULASAN SISWA KELAS VIII MADRASAH TSANAWIYAH NEGERI BINJAI

This study aims to find out that the implementation of the schema learning model in Indonesian lessons can improve reading comprehension skills for grade VIII Madrasah Tsanawiyah Negeri Binjai students in the Odd Semesters of the 2019/2020 Academic Year. The results showed that the schema learning model in Indonesian lessons could improve reading comprehension skills of the VIII grade students of Madrasah Tsanawiyah Negeri Binjai in the Odd Semesters of the 2019/2020 Academic Year. This can be seen from the results of the calculation in the first cycle between the value of the first daily test and the score of the second daily test, the Product Moment value is 0.823 with a t-test of 8.198. And the second cycle between the second block test scores and the third daily test scores obtained a Product Moment value of 0.903 with a t-test value of 11.902, while the results of the calculation showed that it was greater than the results in the table, of 0.478 and 2.725. Likewise, the average score for the first daily exam was 86.35, and the second daily exam was 87.53 in the first cycle, as well as the average score for the third daily exam was 88.53 and the fourth daily exam was 90.71 in the second cycle. there is an increase. while the minimum completeness criteria value (KKM is 84). Keywords: Schematic Learning Model, Reading Comprehension Skills Review Text

MODEL PEMBELAJARAN DAS PADA MATERI BERPIDATO DENGAN MENGGUNAKAN BAHASA INGGRIS SISWA DI KELAS IX MADRASAH TSANAWIYAH NEGERI BINJAI

This study aims to find out the DAS learning model (Listen, Observe, Convey) on speaking material using English can improve students' English learning outcomes in class IX of MTsN Binjai odd semester of the 2019/2020 school year. This research consists of two cycles. The results showed that the DAS (Listen, Observe, Convey) learning model on speaking materials using English could improve English learning outcomes and student activities in class IX of MTsN Binjai in the odd semester of the 2019/2020 school year. This can be seen from the results of the calculation in the first cycle between the test scores of the first block and the test scores of the second block, the correlation of the moment r arithmetic products is 0.846, and the t-test value is 8.983, and in the second cycle between the third block test scores and the fourth block test scores. The product correlation of moment r count is 0.925, and the t test value is 13,808, while all the calculated r values are greater than the r table of 0.478, also the t count is greater than the t table test of 2.725, and can also be seen from the results of student attendance in the first cycle the attendance was around 90%, and in the second cycle the attendance was around 95%, and increased to 100%. Keywords: Learning Model, Watershed, Speech

Effect of mCIMT with and without interval on hand in patient suffering from stroke

Introduction. Paresis of hand has severe impact on the life of the stroke patients. Modified constrained induced movement therapy (mCIMT) can be used to treat the involved limb of the patient. It involves constraining of functional hand and increasing the activity of paretic hand which overcomes the “learned disuse” that develops following stroke but the constraining also creates difficulties for the patient and reduces his/her compliance to the treatment. Hence this trial aims to study the effect of mCIMT with and without interval to see if providing relaxation in between the treatment would be able to produce similar effect as mCIMT without interval protocol. Matgerial and methods. 44 patients were recruited in the study and were divided in to three groups: mCIMT without interval (n = 18), mCIMT with interval (n = 16) and control group (n = 10). Participants in three groups were examined for pain and functionality of hand through Patient rated wrist hand evaluation score and Box and Block test at pre and post intervention. The intervention was given for 6 days/week for two weeks. Therapy time was 2 hours and constrain was for 6 hours a day. Clinical trial registration number -CTRI/2019/12/022547. Results. No baseline differences were found in between the three groups. There was significant increase in box and block test score and significant decrease in PRWHE score in pre and post treatment readings for with and without interval mCIMT but non-significant changes in PRWHE score and box and block test were seen in control group. Conclusion. Both interval and without interval mCIMT was effective. Interval mCIMT was seen to be more comfortable than without interval mCIMT for the patient.

A connectome-based approach to assess motor outcome after neonatal arterial ischemic stroke.

ObjectiveStudies of motor outcome after Neonatal Arterial Ischemic Stroke (NAIS) often rely on lesion mapping using MRI. However, clinical measurements indicate that motor deficit can be different than what would solely be anticipated by the lesion extent and location. Because this may be explained by the cortical disconnections between motor areas due to necrosis following the stroke, the investigation of the motor network can help in the understanding of visual inspection and outcome discrepancy. In this study, we propose to examine the structural connectivity between motor areas in NAIS patients compared to healthy controls in order to define the cortical and subcortical connections that can reflect the motor outcome.MethodsThirty healthy controls and 32 NAIS patients with and without Cerebral Palsy (CP) underwent MRI acquisition and manual assessment. The connectome of all participants was obtained from T1‐weighted and diffusion‐weighted imaging.ResultsSignificant disconnections in the lesioned and contra‐lesioned hemispheres of patients were found. Furthermore, significant correlations were detected between the structural connectivity metric of specific motor areas and manuality assessed by the Box and Block Test (BBT) scores in patients.InterpretationUsing the connectivity measures of these links, the BBT score can be estimated using a multiple linear regression model. In addition, the presence or not of CP can also be predicted using the KNN classification algorithm. According to our results, the structural connectome can be an asset in the estimation of gross manual dexterity and can help uncover structural changes between brain regions related to NAIS.

Video Game-Based Rehabilitation Approach for Individuals Who Have Undergone Upper Limb Amputation: Case-Control Study.

BackgroundBrain plasticity is an important factor in prosthesis usage. This plasticity helps with brain adaptation to learn new movement and coordination patterns needed to control a prosthetic hand. It can be achieved through repetitive muscle training that is usually very exhausting and often results in considerable reduction in patient motivation. Previous studies have shown that a playful concept in rehabilitation can increase patient engagement and perseverance.ObjectiveThis study investigated whether the inclusion of video games in the upper limb amputee rehabilitation protocol could have a beneficial impact for muscle preparation, coordination, and patient motivation among individuals who have undergone transradial upper limb amputation.MethodsTen participants, including five amputee participants and five able-bodied participants, were enrolled in 10 1-hour sessions within a 4-week rehabilitation program. In order to investigate the effects of the rehabilitation protocol used in this study, virtual reality box and block tests and electromyography (EMG) assessments were performed. Maximum voluntary contraction was measured before, immediately after, and 2 days after interacting with four different EMG-controlled video games. Participant motivation was assessed with the Intrinsic Motivation Inventory (IMI) questionnaire and user evaluation survey.ResultsSurvey analysis showed that muscle strength and coordination increased at the end of training for all the participants. The results of Pearson correlation analysis indicated that there was a significant positive association between the training period and the box and block test score (r8=0.95, P<.001). The maximum voluntary contraction increment was high before training (6.8%) and in the follow-up session (7.1%), but was very small (2.1%) shortly after the training was conducted. The IMI assessment showed high scores for the subscales of interest, perceived competence, choice, and usefulness, but low scores for pressure and tension.ConclusionsThis study demonstrated that video games enhance motivation and adherence in an upper limb amputee rehabilitation program. The use of video games could be seen as a complementary approach for physical training in upper limb amputee rehabilitation.

Low-Frequency Repetitive Transcranial Magnetic Stimulation Over Contralesional Motor Cortex for Motor Recovery in Subacute Ischemic Stroke: A Randomized Sham-Controlled Trial

Background Low-frequency repetitive transcranial magnetic stimulation (rTMS) over the contralesional motor cortex (M1) has demonstrated beneficial effects on motor recovery, but evidence among patients with subacute stroke is lacking. We aimed to investigate whether 1-Hz rTMS over the contralesional M1 versus sham rTMS could improve arm function in patients with subacute ischemic stroke when combined with rehabilitative motor training. Methods In total, 77 patients who were within 90 days after their first-ever ischemic stroke were enrolled and randomly allocated to either real (n = 40) or sham rTMS (n = 37). We delivered 1-Hz 30-minute active or sham rTMS before each daily 30-minute occupational therapy sessions over a 2-week period. The primary endpoint was changes in the Box and Block Test (BBT) score immediately after the end of treatment (EOT). Secondary analyses assessed changes in Fugl-Meyer assessment, Finger Tapping Test (FTT), Brunnstrom stage, and grip strength. Clinical Trial Registration ClinialTrials.gov (NCT02082015). Results Changes in BBT immediately after the end of treatment did not differ significantly between the 2 groups (P = .267). Subgroup analysis according to cortical involvement revealed that real rTMS resulted in improvements in BBT at 1 month after EOT (17.4 ± 9.8 real vs 10.9 ± 10.3 sham; P = .023) and Brunnstrom stage of the hand immediately after EOT (0.6 ± 0.5 real vs 0.2 ± 0.5 sham; P = .023), only in the group without cortical involvement. Conclusion The effects of real and sham rTMS did not differ significantly among patients within 3 months poststroke. The location of stroke lesions should be considered for future clinical trials.

Measuring Functional Outcomes After Bilateral Vascularized Composite Hand Allotransplantation: A Report of 3 Cases

Currently, numerous assessment tools are available to measure functional outcomes after bilateral hand transplantation. The purpose of this article is to present our experience utilizing quantitative assessment tools for functional evaluation and to describe our results after bilateral hand transplantation. A single surgeon's experience with bilateral hand transplantation from 2011 to 2016 was retrospectively reviewed. Three bilateral hand transplantations were performed in 2 adults and 1 child. Aminimum 2-year follow-up evaluation was available. For the adult patients, postoperative outcome measures included patient-reported pain and disability scores, return of sensation, muscle strength, range of motion, and return to work/activities of daily living, the Hand Transplant Scoring System (HTSS), theSollerman hand function test, and complications. For our pediatric patient, postoperative outcome measures included the Functional Independence Measure for children (WeeFIM) scale, a functional independence measure for children, the 9-Hole Peg Test, the Box and Block test, and complications. Our 2 adult patients were age 28 and our pediatric patient was age 8 at transplantation. Follow-up ranged from 2 to 7 years. The functional assessments were performed over a period from 11 to 48 months after transplantation. Both adult patients achieved functional independence and the HTSS, Short Form-36 Health Score (SF-36), DASH, and Sollerman tests demonstrated sequential improvement compared with pretransplantation scores assessed with the use of prostheses. Our pediatric patient demonstrated improvement in his Box and Block test score for each hand at sequential visits after transplantation. His 9-Hole Peg Test demonstrated improvement, and his WeeFIM assessment at 20 months indicated a greater level of independence. Patient-reported outcomes and the Sollerman test when used in addition to the HTSS appear to reflect functional improvement in adult patients after bilateral hand transplantation. Although children pose a unique challenge with functional assessment, we found the WeeFIM assessment, 9-Hole Peg Test, and the Box and Block test helpful in evaluating functional outcomes in our pediatric patient. Therapeutic V.

The effects of vest type dynamic elastomeric fabric orthosis on sitting balance and gross manual dexterity in children with cerebral palsy: a single-blinded randomised controlled study*

Purpose: To evaluate the effects of vest type dynamic elastomeric fabric orthosis on posture and balance during sitting and gross manual dexterity and to compare the efficacy of daily wearing time of 2 h versus 6 h.Method: Twenty-four children with cerebral palsy (CP) aged 3–9 years with GMFCS levels III and IV were randomised to either of three groups: (i) a control group who received only conventional exercise therapy, (ii) dynamic elastomeric fabric orthosis 2 h group who wore the orthosis for 2 h during therapy and dynamic elastomeric fabric orthosis 6 h group who wore the orthosis for 4 h in addition to the 2 h of wear along with therapy during hospital inpatient stay for 2 weeks. Children continued to use dynamic elastomeric fabric orthosis during the post-discharge period. The primary outcome measure was the Sitting Assessment Scale. The secondary outcome measurements were the sitting dimension of Gross Motor Function Measure, Box and Block Test and Parent Satisfaction Survey. Assessments were made before treatment, at post-treatment, at 1-month post-treatment, and at 3-months post-treatment. Sitting Assessment Scale and Box and Block Test were also assessed when immediately after wearing the orthosis. This trial is registered with Clinicaltrials.gov, under number NCT03191552.Results: All groups showed similar improvements except the control group which showed less improvement in Sitting Assessment Scale scores compared to the dynamic elastomeric fabric orthosis groups. Dynamic elastomeric fabric orthosis groups showed greater improvements compared to the control group in the Sitting Assessment Scale but not in the sitting dimension of Gross Motor Function Measure and Box and Block Test at post-treatment, at 1-month post-treatment and at 3-months post-treatment. When the dynamic elastomeric fabric orthosis groups (2 h versus 6 h) were compared, there were no significant differences in any of the assessments. The Sitting Assessment Scale and Box and Block Test scores also improved immediately after the patients put on the orthosis. At 1-month post-treatment, parents of children in the control group reported less satisfaction than parents of the children in dynamic elastomeric fabric orthosis groups.Conclusions: Dynamic elastomeric fabric orthosis vest has an immediate effect on the sitting balance and gross manual dexterity. It also provides improvements in posture and balance during sitting. Wearing dynamic elastomeric fabric orthosis vest for 2 h during therapy is as much effective as wearing it for 6 h in children with CP in addition to therapy to improve sitting balance.Implications for rehabilitationDynamic elastomeric fabric orthosis vest provides improvements in sitting balance when used in addition to conventional therapy in children with cerebral palsy.Wearing dynamic elastomeric fabric orthosis for 2 h and wearing dynamic elastomeric fabric orthosis vest for 6 h resulted in similar clinical outcomes.Dynamic elastomeric fabric orthosis vest has an immediate effect on sitting balance and gross manual dexterity in children with cerebral palsy.

Effects of live and video form action observation training on upper limb function in children with hemiparetic cerebral palsy.

The purpose of this study was to investigate the effects of live and video form action observation training (AOT) on upper limb (UL) movement acceleration and function in children with cerebral palsy (CP). In total, 12 children (7 boys, 5 girls) with CP participated in this study. The children were allocated randomly to live (experimental) and video (control) AOT groups. All children completed 20 treatment sessions, each 30 minutes in duration, 5 days per week for a month. Mediolateral (ML) and vertical (VT) acceleration data, Jebsen-Taylor Hand Function (JTHF) scores, and Box and Block Test (BBT) scores were obtained at baseline and at 4 weeks after the intervention. ML and VT movement acceleration and JTHF scores were significantly lower in the live group (p< 0.05). The BBT score was significantly higher in the live than in the video group (p< 0.05). Our findings suggest that live AOT is more effective than video AOT for improving UL movement acceleration and function. Clinically, our findings offer important insights for clinicians when planning AOT interventions to reduce UL movement acceleration and improve UL function.

Change in Hand Function and Dexterity with Age after Index Pollicization for Congenital Thumb Hypoplasia.

Little is known about how performance on strength, range of motion, and dexterity measures changes as children with index finger pollicization mature. The authors reviewed performance in range of motion, strength, and dexterity over a 7-year period and report outcomes over time. Data from children treated with index finger pollicization for congenital thumb hypoplasia from 2007 to 2014 were reviewed retrospectively. Children were followed for an average of 3.9 years (range, 1 to 7 years) during the study period. Standardized assessments included range of motion, grip, key pinch and tripod pinch strength, the Box and Block Test, the Nine Hole Peg Test, and the Functional Dexterity Test. Average score by age and average yearly change were calculated for each assessment, and scores were plotted against published age-matched scores of normal children when available. Twenty-three patients with 29 affected thumbs were included. Distal grasp span increased 0.17 inch and Kapandji opposition improved 0.26 point with each year of age; however, proximal web-space size did not increase over time. Grip strength improved an average of 2.69 kg/year, and tripod and key pinch improved 0.58 kg and 0.67 kg with each year of age. Box and Block Test scores improved an average of 4.11 blocks/year. Scores on the Nine Hole Peg Test improved 3.83 seconds/year, and scores on the Functional Dexterity Test improved 0.026 peg/second each year. Children with pollicized thumbs improve in dexterity and strength with growth. Web-space size did not change with age; therefore, the thumb should be carefully positioned at the time of surgery. Therapeutic, IV.

Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke

ObjectiveTo investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke. DesignDouble-blinded, randomized, placebo-controlled study. SettingUniversity hospital rehabilitation unit. ParticipantsInpatients with stroke (N=41; mean age, 65y; range, 28–85y; mean weeks poststroke, 5; range, 2–10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3–48). InterventionsSubjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy. Main Outcome MeasuresBrain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time. ResultsNeither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke. ConclusionsThe inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions.