Conventional Stroke Rehabilitation Program Research Articles

Extracorporeal Shock Wave Therapy with Low-Energy Flux Density Treatment Applied to Hemiplegia Patients on Somatosensory Functions and Spatiotemporal Parameters.

We aimed to investigate the efect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone. This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n=20) or the control group (n=20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes-Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment. In the ESWT and control groups, statistically, significant diferences were obtained in the posttreatment analysis than pre-treatment. Significant diferences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (P < .01). When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance.

Proprioceptive Exercises in Hemiplegia Improve Balance and Spatiotemporal Parameters

Abstract Objective It was planned to investigate the effects of proprioceptive exercises applied to patients with hemiplegia on muscle tone, balance, perception, posture, mobility, and spatiotemporal parameters. Materials and Methods 70 participants with hemiplegia were randomized to an experimental group (conventional stroke rehabilitation program+proprioceptive exercise, 30 sessions) and a control group (conventional stroke rehabilitation program, 30 sessions). Timed Up and Go (TUG) Test, Modified Ashworth Scale (MAS), Posture Assessment Scale for Stroke Patients (PASS), Mini-Mental State Examination (MMSE), Rivermead Mobility Index (RMI), Spatiotemporal parameters (cadence, maximum plantar pressure, total weight transfer, step cycle duration, swing phase, step length and foot angle), and Berg Balance Scale (BERG) were applied on all participants before and after treatment. Results When the intra-group values were compared before and after the treatment, TUG, PASS, MMSE, RMI and BERG values increased significantly. MAS upper extremity and MAS lower extremity values decreased significantly. (p&lt;0.01). In the comparison between the groups, one of the spatiotemporal parameters, cadence, total weight transfer, and maximum plantar pressure values, increased significantly after the treatment. Step cycle duration, swing phase, step length and foot angle values decreased significantly after the treatment. (p&lt;0.01) Conclusion Unlike the literature, proprioceptive exercises that we add to the conventional rehabilitation program can be used to improve muscle tone, balance, perception, postural control, mobility, and spatiotemporal parameters.

Assessment of responsiveness of four hand-related scales in stroke patients.

Self-reporting scales are commonly utilized in determining appropriate treatment strategies and follow-up in hand-related disorders. Responsiveness is described as the ability of a scale to detect clinically significant changes. We aimed to evaluate responsiveness of Michigan Hand Outcomes Questionnaire (MHQ), Duruöz Hand Index (DHI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and ABILHAND questionnaire in stroke patients. Fifty-one stroke patients were assessed in this descriptive study. Participants received conventional stroke rehabilitation program consisting of 30 sessions. Brunnstrom stages of the stroke patients were recorded before and after treatment. MHQ, DHI, DASH, ABILHAND questionnaire and patient satisfaction scores were filled in by participants before and after the conventional rehabilitation program. Significant improvements were found in MHQ, DHI, DASH, ABILHAND, patient satisfaction scores and Brunnstrom motor recovery stages after the rehabilitation program (p < 0.001). Responsiveness values of the scales were calculated as MHQ (effect size (ES) = - 0.74; standardized response mean (SRM) = - 1.25), DHI (ES = 0.64; SRM = 1.22), DASH (ES = 0.71; SRM = 1.01), and ABILHAND (ES = - 0.55; SRM = - 1.22). Our study revealed that MHQ, DHI, DASH and ABILHAND are responsive scales in detecting treatment-related changes in stroke patients. MHQ, DHI, DASH and ABILHAND can be used in the evaluation of treatment responses in stroke patients.

Reflections of mirror therapy on the functional recovery after stroke

Introduction Motor function after stroke is improved after mirror therapy. During mirror therapy, a mirror is placed in the mid-sagittal plane thus reflecting movements of non-paretic side as if it were the affected side. Objectives To evaluate the effectiveness of mirror therapy on upper extremity motor recovery and hand related functioning of patients with sub-acute stroke. Method A total of 60 patients with stroke were randomly selected, all within 6 months post stroke, with 30 patients in each, experimental and control group. Each day, 30 min of mirror therapy was given to patients in experimental group consisting of wrist and finger flexion and extension movements in addition to conventional stroke rehabilitation program, 6 days a week, 1 h a day for 4 weeks, while those in control group didn't receive mirror therapy program. Main Outcome Measures- The Brunnstrom stages of motor recovery & Hand- related functioning (Self-care items of FIM instrument) Results Mean age of the patients was 55 years. The scores of the Brunnstrom stages for hand and upper extremity and FIM self - care score improved more in experimental group than in control group after 4 weeks of treatment (by 0.81, 0.86 and 4.1 respectively; all P Conclusion Hand functioning improved more after mirror therapy compared with control group after 4 weeks of treatment and at 6 month follow up.

Effectiveness of mirror therapy in the motor recovery of upper extremity in the post stroke hemiplegic patients: a randomized controlled trial in a tertiary care hospital in Manipur, Northeast India

Background: Stroke is a leading cause of disability and majority of the stroke survivors experience upper extremity functional limitations. Therefore, the objective of this study was to evaluate the effectiveness of mirror therapy in addition with a conventional upper limb rehabilitation program in a post stroke hemiplegic patient.Methods: A randomized controlled trial was conducted among 72 post stroke patients aged 35-65 years having hemipa¬resis attending the PMR department, RIMS, Manipur from 2013 to 2016. Assessment was done at baseline, 1 and 6 months for FIM self care, Brunnstrom stages of motor recovery and MAS for spasticity. Both the group participated in a stroke rehabilitation program and study group was given mirror therapy in addition. Descriptive statistics such as mean±SD and inferential statistics like Chi-square test, Student’s t test, and ANOVA were used. A p-value &lt; 0.05 was taken as statistically significant.Results: There was an improvement in Brunnstrom stage and FIM self-care score in both groups, but the post-treatment score was significantly higher in the mirror therapy group. Statistically significant difference in FIM self care and motor recovery between the study and control groups was noted [1.1±0.38 (study) versus 0.88±0.32 (control) for motor recovery and 34.1±2.59 (study) versus 29.5±4.58 (control) for FIM self care]. However, no significant difference was seen in spasticity between the groups.Conclusions: Mirror therapy used in addition to conventional stroke rehabilitation program was found to be effective in the recovery of upper extremity motor functions and daily self care activities in post stroke hemiplegic patients.

The Effect of Trunk Stability Exercise on Respiratory Muscles Function in Stroke Patients

Purpose : The purpose of this study is to examine the effects of trunk stability training on improving trunk control, respiratory function, and respiratory muscle activation in stroke patients. Methods : The subjects were assigned to two groups: the intervention group (n=15) and the control group (n=15). Both groups participated in a conventional stroke rehabilitation program, but the intervention group also received trunk stability training for 30 minutes a day, 3 times a week, for 6 weeks. The main trunk stability exercise consisted of the dead bug exercise. Trunk control was assessed using a trunk impairment scale, and respiratory function (pulmonary function and respiratory muscle function) was assessed using spirometry. The data were analyzed using the Pearson correlation, independent t-test, and paired t-test. Results : Trunk control was significantly positively correlated with pulmonary function and respiratory muscle strength. Both groups showed a significant increase in trunk control and respiratory function. Conclusion : This study demonstrated that a conventional stroke rehabilitation program and trunk stability training have positive effects on respiratory function and respiratory muscle activation in stroke patients.

Comparison Between Neuromuscular Electrical Stimulation to Abdominal and Back Muscles on Postural Balance in Post-stroke Hemiplegic Patients.

ObjectiveTo compare the effects of neuromuscular electrical stimulation (NMES) to abdominal muscles and back muscles on postural balance in post-stroke hemiplegic patients.MethodsThirty post-stroke hemiplegic patients were prospectively enrolled and randomly assigned to one of the three groups: core muscle-strengthening exercise (CME) with NMES to abdominal muscles (group A), CME with NMES to back muscles (group B), and CME alone (group C). All subjects underwent their targeted interventions for 30 minutes each day, 5 days per week for 3 weeks under a conventional stroke rehabilitation program. Subjects were evaluated using Korean version of Berg Balance Scale (K-BBS), Trunk Impairment Scale (TIS), Korean version of Modified Barthel Index (K-MBI), Weight Distribution Index (WDI), and Stability Index (SI) just before and 3 weeks after intervention.ResultsChanges in K-BBS (p<0.05) and TIS (p<0.05) were significantly higher in group A (18.5±8.10, 6.6±1.90) and group B (19.9±5.44, 7.0±2.26) than in group C (8.4±4.14, 3.1±0.99). However, K-MBI, WDI, and SI failed to show any significant difference. No significant difference in all outcomes was observed between groups A and B.ConclusionThe effect of NMES to the abdominal muscles was similar to the effect on back muscles in terms of postural balance. This finding indicated that the NMES to the abdominal muscles may be an alternative for post-stroke hemiplegic patients contraindicated for NMES to the back muscles. Additional studies investigating the effects of NMES on abdominal and back muscles are needed.

Efficacy of Bedside Respiratory Muscle Training in Patients With Stroke: A Randomized Controlled Trial.

Inspiratory and expiratory muscles are important for effective respiratory function. This study aimed to investigate the efficacy of bedside respiratory muscle training on pulmonary function and stroke-related disabilities in stroke rehabilitation. Patients with stroke (N = 40) in a rehabilitation unit were randomly assigned to either the intervention group (n1 = 20) or the control group (n2 = 20). Both groups participated in a conventional stroke rehabilitation program. During the study period, the intervention group received bedside respiratory muscle training twice a day for 3 wks. The respiratory muscle training consisted of (1) a breath stacking exercise, (2) inspiratory muscle training, and (3) expiratory muscle training. The primary outcomes were measures of pulmonary function: forced vital capacity, forced expiratory volume in 1 sec, and peak flow. Secondary outcomes were stroke-related disabilities assessed using the National Institutes of Health Stroke Scale, Modified Barthel Index, Berg Balance Scale, Fugl-Meyer Assessment, the Korean Mini-Mental State Examination, and pneumonia incidence. Pulmonary function was significantly improved in the intervention group after 3 wks of respiratory muscle training (P < 0.05). This improvement in pulmonary function was independent of the improvement in stroke-related disabilities. Three weeks of respiratory muscle training had significant effects on pulmonary function in stroke survivors. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Appreciate the respiratory function changes that occur in patients following a stroke; (2) Describe appropriate inspiratory and expiratory muscle training techniques to improve pulmonary function in patients following a stroke; (3) Enhance ability to implement inpatient; and (4) Determine appropriate respiratory training programs for patients following stroke. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Short-term effect of low intensity forced aerob exercise added to conventional physiotherapy on cognitive functions and fitness after stroke: A randomized controlled pilot study

Emerging experimental and clinical findings suggest that aerob forced exercise may potentially have positive benefits on cognitive functions. The purpose of our pilot study was to assess the effect of low intensity aerobic exercise on cognitive functions in individuals with chronic stroke. Thirty-five chronic, ambulatory stroke patients aged between 33 and 76 years old completed the 4-week program, 90 min session/day in every workday. They were randomized into two groups: study group (SG, n = 19, median age 59/40–76/) years and control group (CG, n = 16 median age 62/33–69/) years. Both groups participated in conventional physiotherapy but only SG performed aerob exercise training with bicycles (30 min/day). Exercise intensity progressed from 30 to 40% of heart rate reserve defined by ergospiromety. Functional Independence Measure (FIM-cognitive) and Wechsler Adult Intelligence Scale processing speed (symbol search, coding) and working memory (digit span forward, backward and sequencing) subtests were recorded at baseline and 4 weeks later. Maximum oxygen intake (VO 2max ) was measured at baseline and 4 weeks later. Inside group analysis showed a significant improvement in both groups in cognitive-FIM ( P = 0.008). A significant change was not found in working memory (digit span) subtest ( P = 0.16) in either of the groups. In processing speed subtest (coding) a significant improvement was only measured in SG ( P = 0.003) while in a symbol search test an improvement was found in both groups (SG: P = 0.041, CG: P = 0.006). There were not inter-group differences in any subtest (all P = 0.201) and in VO 2max ( P = 0.8). Any significant improvement in VO 2max was not found in either of the groups ( P = 0.7). The results suggested that low intensity aerobic exercise training integrated into conventional stroke rehabilitation program had effects on the selected measures of cognitive functions, nevertheless the VO 2 max remained unchanged. Further studies are needed to get evidence with sufficient power.

The effect of aerobic exercise on stroke rehabilitation.

To compare the effects of aerobic exercise and conventional exercise that were applied during the rehabilitation process on the aerobic capacity, motor function, activity limitation, quality of life, depression level, and sleep quality in subacute stroke patients. The patients were divided into two groups; aerobic exercise group (n = 22) or conventional exercise group (n = 20). Both groups participated in a conventional stroke rehabilitation program; however, aerobic exercise program was applied only for the patients in group 1. Exercise tolerance test (ETT), respiratory function tests, 6-min walking test (6-MWT), functional independence measure (FIM), Nottingham health profile (NHP), Beck depression scale (BDS), and Pittsburgh sleep quality index (PSQI) were evaluated on admission and discharge. The 6-MWT, FIM, some subgroups of NHP, BDS, and PSQI results demonstrated statistical differences in both groups after rehabilitation programs. Significant differences were recorded in terms of changes between admission and discharge values of ETT and BDS in favor of aerobic exercise group. Incorporation of aerobic exercises into conventional rehabilitation programs of early stroke patients may provide positive contributions, particularly to mood and aerobic capacity.

P295 Effects of functional electric stimulation and task specific training on gait recovery in patients with stroke: Randomized controlled trial

Objectives This work was designed to assess the effects of functional electrical stimulation (FES) combined with task specific training on gait recovery in stroke patients. Methods Thirty hemiparetic stroke patients aged 40–58 years old were randomly assigned into two equal groups; the control group had received conventional physiotherapy program while the study group had received the same program in addition to FES therapy during treadmill training. Two dimensional (2D) gait analysis was used to assess gait parameters before and after completion of the treatment sessions. Results A statistically significant improvement had been reported in all gait parameters in the post-treatment assessment of the study group as compared to the control group including the gait velocity (P = 0.048), cadence (P = 0.030), ten meters walking time (P = 0.043), step length (P = 0.033), stride length (P = 0.015) and the instantaneous angles of knee and ankle of the affected lower limb during gait cycle sub-phases. Discussion These results may be attributed to physiological effect of FES during treadmill training. It induces afferent-efferent stimulation which results in limb movement. It provides task-oriented practice of walking and active repetitive movement training. It activates sensory inputs and central neuronal circuits that allow optimal motor learning. It stimulates neuronal recovery and neuroplasticity. Conclusion FES therapy combined with conventional stroke rehabilitation program improves gait parameters when compared to conventional therapy alone in hemiparetic stroke patients. Significance The beneficial effects of FES on gait encourage the corporation of its use in the rehabilitation programs for patients with hemiparetic stroke.

Combined respiratory muscle training facilitates expiratory muscle activity in stroke patients.

[Purpose] The aim of this study was to investigate the effect of combined respiratory muscle training on expiratory muscle activity in stroke patients. [Subjects and Methods] Twenty-five stroke patients were assigned to either the intervention group (n=12) or the control group (n=13). Both groups participated in a conventional stroke rehabilitation program, while the intervention group also received respiratory muscle training for 20 to 30 minutes a day, 3 times a week, for 8 weeks. Surface electromyographic data were collected from the rectus abdominis, internal oblique, and external oblique on the paretic side. Pulmonary function (forced vital capacity) and cough capacity (peak expiratory flow) also were measured. [Results] Both groups showed a significant increase in muscle activity after the intervention. However, the intervention group also showed significant increases in forced vital capacity and peak expiratory flow. Comparison of the 2 groups revealed that the intervention group had greater improvements in pulmonary function, cough capacity, and muscle activity. [Conclusion] The results of this study suggest that combined respiratory muscle training has positive effects on both respiratory function and expiratory muscle activity in stroke patients.

Inspiratory muscle training in stroke patients with congestive heart failure: A CONSORT-compliant prospective randomized single-blind controlled trial.

BackgroundCardiopulmonary function can be adversely affected after a cerebrovascular accident in patients with congestive heart failure (CHF). The aim of this study was to investigate the efficacy and feasibility of inspiratory muscle training (IMT) for stroke patients with CHF.MethodsA prospective randomized single-blind controlled trial was conducted in a single tertiary medical center in southern Taiwan between May 2011 and July 2015. Forty-one patients were enrolled, of whom 21 completed the study (IMT group n = 11 and control group n = 10). Both groups participated in a conventional stroke rehabilitation program. Patients in the IMT group received an additional IMT program beginning with an intensity of 30% maximal inspiratory pressure (MIP), then increased by 2cmH2O each week for 30 minutes daily for at least 5 days a week for 10 weeks. MIP, maximal expiratory pressure, spirometry, resting oxyhemoglobin saturation, modified Borg Scale, Fatigue Assessment Scale, and Barthel Index were assessed in each patient.ResultsThere were significant differences from baseline in MIP (P = 0.008), percent predicted forced vital capacity (P = 0.033), forced expiratory volume in 1 second (FEV1) (P = 0.008), percent predicted FEV1 (P = 0.008), and Barthel Index (P = 0.012) in the IMT group, and Barthel Index (P = 0.027) in the control group. There were significant differences between groups in MIP (20.91 ± 19.73 vs −9.00 ± 26.01, adjusted P value = 0.023) and Barthel Index (24.55 ± 22.30 vs 7.50 ± 8.25, adjusted P value = 0.044).ConclusionThe 10-week IMT was feasible and effective in improving inspiratory force and activities of daily living for the stroke patients with CHF.

The correlation of respiratory muscle strength and cough capacity in stroke patients.

[Purpose] The purpose of this study was to investigate the correlation between respiratory muscle strength and cough capacity in stroke patients. [Subjects and Methods] Forty-two stroke patients were assigned to 2 different groups (intervention group=21, control group=21). Both groups participated in a conventional stroke rehabilitation program, with the intervention group also receiving respiratory muscle training for 20 to 30 minutes a day, 3 times a week for 8 weeks. Respiratory muscle strength (maximal inspiratory pressure, maximal expiratory pressure), forced vital capacity, and cough capacity were measured. [Results] The intervention group showed significant increases in maximal inspiratory pressure, maximal expiratory pressure, forced vital capacity, and cough capacity. The change in maximal inspiratory pressure, maximal expiratory pressure, and forced vital capacity showed a significant correlation with cough capacity, with maximal expiratory pressure showing the highest correlation. [Conclusion] The present study showed that the increase in maximal expiratory pressure plays an important role in improving the cough capacity of stroke patients.

Effects of Mirror Therapy in Stroke Patients With Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study

ObjectiveTo investigate the effects of mirror therapy on upper limb motor functions, spasticity, and pain intensity in patients with hemiplegia accompanied by complex regional pain syndrome type 1. DesignRandomized controlled trial. SettingTraining and research hospital. ParticipantsAdult patients with first-time stroke and simultaneous complex regional pain syndrome type 1 of the upper extremity at the dystrophic stage (N=30). InterventionsBoth groups received a patient-specific conventional stroke rehabilitation program for 4 weeks, 5d/wk, for 2 to 4h/d. The mirror therapy group received an additional mirror therapy program for 30min/d. Main Outcome MeasuresWe evaluated the scores of the Brunnstrom recovery stages of the arm and hand for motor recovery, wrist and hand subsections of the Fugl-Meyer Assessment (FMA) and motor items of the FIM-motor for functional status, Modified Ashworth Scale (MAS) for spasticity, and visual analog scale (VAS) for pain severity. ResultsAfter 4 weeks of rehabilitation, both groups had significant improvements in the FIM-motor and VAS scores compared with baseline scores. However, the scores improved more in the mirror therapy group than the control group (P<.001 and P=.03, respectively). Besides, the patients in the mirror therapy arm showed significant improvement in the Brunnstrom recovery stages and FMA scores (P<.05). No significant difference was found for MAS scores. ConclusionsIn patients with stroke and simultaneous complex regional pain syndrome type 1, addition of mirror therapy to a conventional stroke rehabilitation program provides more improvement in motor functions of the upper limb and pain perception than conventional therapy without mirror therapy.

EFFECT OF MIRROR THERAPY ON HEMIPARETIC UPPER EXTREMITY IN SUBACUTE STROKE PATIENTS

Background and Objective: Stroke is one of the most common causes for chronic disability. Only 5 to 20% of stroke survivors attain complete functional recovery of their affected upper extremity. The primary objective of this study was to investigate the effect of mirror therapy on hemiparetic upper extremity motor recovery and functions in patients with subacute stroke. Materials and Methods: A total of 30 participants were selected for the study. They were randomly assigned to Mirror Therapy Group (MTG) and Sham Mirror Therapy Group (SMTG) with fifteen participants in each group. All the participants equally took part in conventional stroke rehabilitation program 5 days a week for 4 weeks. In addition to the conventional stroke rehabilitation program, MTG participated in 30 minutes of mirror therapy and SMTG received 30 minutes of sham mirror therapy for the affected hemiparetic upper limb. The participants were measured for upper extremity motor recovery and functions by Fugl-Meyer Assessment (FMA-UE) and Upper Extremity Functional Index (UEFI) scales respectively. Results: Wilcoxon signed ranks test and Mann Whitney U test were used to statistically analyze the data. Spearman correlational technique was used to analyze the relationship between upper limb functions and motor recovery of hand. Based on Wilcoxon signed ranks test, the results were highly significant (p<0.05. On the basis of Mann Whitney U test, Mirror therapy group showed high significance (p<0.05) than sham mirror therapy group. The spearman’s rho value was 0.65 which indicated moderate to maximum positive correlation between the two variables and the alpha level was set at 0.01. Conclusion: This study concludes that incorporating mirror therapy in subacute stroke rehabilitation program improves the hemiparetic upper extremity motor recovery and its functions and also motor recovery of hand can directly influence the upper limb functions.

The Effects of Game-Based Breathing Exercise on Pulmonary Function in Stroke Patients: A Preliminary Study.

BackgroundReduction of respiratory function along with hemiparesis leads to decreased endurance, dyspnea, and increased sedentary behavior, as well as to an increased risk of stroke. The main purpose of this study was to investigate the preliminary effects of game-based breathing exercise (GBE) on pulmonary function in stroke patients.Material/MethodsThirty-eight in-patients with stroke (22 men, 16 women) were recruited for the study. Participants were randomly allocated into 2 groups: patients assigned to the GBE group (n=19), and the control group (n=19). The GBE group participated in a GBE program for 25 minutes a day, 3 days a week, during a 5 week period. For the same period, both groups participated in a conventional stroke rehabilitation program. Forced vital capacity (FVC), forced expiratory volume at 1 second (FEV1), FEV1/FVC, and maximum voluntary ventilation (MVV) were measured by a spirometer in pre- and post-testing.ResultsThe GBE group had significantly improved FVC, FEV1, and MVV values compared with the control group (p<0.05), although there was no significant difference in FEV1/FVC value between groups. Significant short-term effects of the GBE program on pulmonary function in stroke patients were recorded in this study.ConclusionsThese findings gave some indications that it may be feasible to include GBE in rehabilitation interventions with this population.

호흡근 강화 훈련이 뇌졸중 환자의 호흡기능, 호흡근력과 기침능력에 미치는 영향

This study used a nonequivalent control group pre-post test design. We recruited thirty-four stroke patients(16male, 18female), who were assigned to intervention (n=17), or control (n=17) groups. Both groups participated in a conventional stroke rehabilitation program, with the intervention groups also receiving respiratory muscle training 20 minutes a day, three times a week, for 4 weeks. Respiratory function (forced vital capacity) and respiratory muscle strength (maximal inspiratory pressure, maximal †Corresponding Author : hnskim@cup.ac.krThis is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.expiratory pressure) were assessed by spirometry. Cough capacity (peak expiratory flow) was assessed using a peak flow meter. The collected data were analyzed by independent and paired t-tests.

The efficacy of mirror therapy combined with conventional stroke rehabilitation program on motor and functional recovery

OBJECTIVE: A variety of methods is used in the treatment of upper extremity functional impairment after stroke.In recent years, a new therapeutic approach in the treatment of stroke rehabilitation is the mirror therapy.The purpose of this study is to investigate the efficacy of mirror therapy,which is applied through motor imagination training, combined with conventional stroke rehabilitation program on upper extremity motor and functional recovery in patients with subacute stroke. MATERIAL and METHODS: This is a randomized,prospective,controlled single-blind trial.The study included 20 patients who were diagnosed with stroke.Patients were randomly divided into two groups:first group received conventional rehabilitation program and the second group received conventional rehabilitation program plus mirror therapy on nonparetic upper extremity consisting of wrist extension daily 4 times for 15minutes per session. Both groups received the conventional rehabilitation program for 4 weeks, 5 days a week and daily 1-2h. All patients were evaluated at baseline and at the end of the treatment(week 4).The evaluations were performed by using Brunnstrom Staging, Fugl Meyer Motor Function Scale(FM),Barthel Index(BI) and goniometric measurement of wrist extension. ______________________________________________________________________________________________________________________________ Yazisma Adresi: Yrd. Doc. Dr. Merih OZGEN Eskisehir Osmangazi Universitesi Tip Fakultesi Fiziksel Tip ve Rehabilitasyon Anabilim Dali, Eskisehir Tel: 0222-2392979/2455 E-posta: merihsarhus@hotmail.com Gelis Tarihi: 15.08.2012 Kabul Tarihi: 03.09.2012 Received: 15.08.2012 Accepted: 03.09.2012 VI. Ulusal Beyin Damar Hastaliklari Kongresi’nde sozel bildiri olarak sunulmustur. Bu makale su sekilde atif edilmelidir: Kuzgun S, Ozgen M, Armagan O, Tascioglu F, Baydemir C. Inme rehabilitasyon programi ile kombine edilen ayna tedavisinin motor ve fonksiyonel iyilesme uzerine etkinliginin arastirilmasi. Turk Beyin Damar Hastaliklari Dergisi 2012; 18 (3): 77-82.

Effect of functional electrical stimulation on the effort and walking speed, surface electromyography activity, and metabolic responses in stroke subjects

Objective To investigate the effects of functional electrical stimulation (FES) combined with conventional rehabilitation program on the effort and speed of walking, the surface electromyographic (sEMG) activity and metabolic responses in the management of drop foot in stroke subjects. Methods Fifteen patients with a drop foot resulting from stroke at least 3 months prior to the start of the trial took part in this study. All subjects were treated 1 h a day, 5 days a week, for 12 weeks, including conventional stroke rehabilitation program and received 30 min of FES to the tibialis anterior (TA) muscle of the paretic leg in clinical settings. Baseline and post-treatment measurements were made for temporal and spectral EMG parameters of TA muscle, walking speed, the effort of walking as measured by physiological cost index (PCI) and metabolic responses. Results The experimental results showed a significant improvement in mean-absolute-value (21.7%), root-mean-square (66.3%) and median frequency (10.6%) of TA muscle EMG signal, which reflects increased muscle strength. Mean increase in walking speed was 38.7%, and a reduction in PCI of 34.6% between the beginning and at end of the trial. Improvements were also found in cardiorespiratory responses with reduction in oxygen consumption (24.3%), carbon dioxide production (19.9%), heart rate (7.8%) and energy cost (22.5%) while walking with FES device. Conclusions The results indicate that the FES may be a useful therapeutic tool combined with conventional rehabilitation program to improve the muscle strength, walking ability and metabolic responses in the management of drop foot with stroke patients.