Conventional Stroke Rehabilitation Program Research Articles

Restoration of gait and motor recovery by functional electrical stimulation therapy in persons with stroke

Purpose. To evaluate the clinical efficacy of functional electrical stimulation (FES) therapy of the tibialis anterior (TA) muscle on gait restoration and enhancing motor recovery with stroke patients.Method. Thirty hemiparetic participants with spastic foot-drop impairments who were at least 3 months post-stroke were recruited from a rehabilitation institute and were assigned either to a control group or a FES group. Both the groups participated in a conventional stroke rehabilitation program for 60 min per day, 5 days a week, for 12-weeks. The FES group received the electrical stimulation to the TA muscle for correction of foot-drop.Results. Functional electric stimulation (FES) resulted in a 26.3% (p < 0.001) improvement of walking speed measured with 10-m walkway, whereas the improvement in the control group was only 11.5% (p < 0.01). The FES group also showed significantly greater improvements compared to control group in other gait parameters (e.g. cadence, step length), physiological cost index (PCI), ankle range of motion, spasticity of calf muscle, Fugl–Meyer scores, and the maximum value of the root mean square (RMSmax), which reflects the capacity of the muscle output.Conclusions. These findings suggest that, the FES therapy combined with conventional therapy treatment more effectively improves the walking ability and enhances the motor recovery when compared with conventional therapy alone in stroke survivors.

Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial

Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoğlu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Objective To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. Design Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting Rehabilitation education and research hospital. Participants A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke. Interventions Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. Main Outcome Measures The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument). Results The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS. Conclusions In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Effect of Sensory-Amplitude Electric Stimulation on Motor Recovery and Gait Kinematics After Stroke: A Randomized Controlled Study

Yavuzer G, Öken Ö, Atay MB, Stam HJ. Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study. Objective To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke. Design Randomized, controlled, double-blind study. Setting Rehabilitation ward and gait laboratory of a university hospital. Participants A total of 30 consecutive inpatients with stroke (mean age, 63.2y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied. Intervention Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks. Main Outcome Measures Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait. Results Brunnstrom stages improved significantly in both groups ( P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant ( P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant. Conclusions In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.

Mirror Therapy Enhances Lower-Extremity Motor Recovery and Motor Functioning After Stroke: A Randomized Controlled Trial

Sütbeyaz S, Yavuzer G, Sezer N, Koseoglu F. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Objective To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. Design Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting Rehabilitation education and research hospital. Participants A total of 40 inpatients with stroke (mean age, 63.5y), all within 12 months poststroke and without volitional ankle dorsiflexion. Interventions Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. Main Outcome Measures The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories [FAC]), and motor functioning (motor items of the FIM instrument). Results The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2–2.1; vs mean, 0.8; 95% CI, 0.5–1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2–24.7; vs mean, 12.5; 95% CI, 9.6–14.8; P=.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4–1.2; vs mean, 0.3; 95% CI, 0.1–0.7; P=.102) nor FAC (mean, 1.7; 95% CI, 1.2–2.1; vs mean, 1.5; 95% CI, 1.1–1.9; P=.610) showed a significant difference between the groups. Conclusions Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

Neuromuscular Electric Stimulation Effect on Lower-Extremity Motor Recovery and Gait Kinematics of Patients With Stroke: A Randomized Controlled Trial

Yavuzer G, Geler-Külcü D, Sonel-Tur B, Kutlay S, Ergin S, Stam HJ. Neuromuscular electric stimulation effect on lower-extremity motor recovery and gait kinematics of patients with stroke: a randomized controlled trial. Objective To evaluate the effects of neuromuscular electric stimulation (NMES) of the tibialis anterior muscle on motor recovery and gait kinematics of patients with stroke. Design Randomized, controlled, assessor-blinded trial. Setting Rehabilitation ward and gait laboratory of a university hospital. Participants A total of 25 consecutive inpatients with stroke (mean age, 55y), all within 6 months poststroke and without volitional ankle dorsiflexion. Intervention Both the NMES group (n=12) and the control group (n=13) participated in a conventional stroke rehabilitation program, 5 days a week for 4 weeks. The NMES group also received 10 minutes of NMES to the tibialis anterior muscle of the paretic limb. Main Outcome Measures Brunnstrom stages of motor recovery and kinematic characteristics of gait. Results Brunnstrom stages improved significantly in both groups ( P<.05). In total, 58% of the NMES group and 61% of the control group gained voluntary ankle dorsiflexion. Between-group difference of percentage change was not significant ( P>.05). Gait kinematics was improved in both groups, but the difference between groups was not significant. Conclusions NMES of the tibialis anterior muscle combined with a conventional stroke rehabilitation program was not superior to a conventional stroke rehabilitation program alone, in terms of lower-extremity motor recovery and gait kinematics.

A “virtual sensor” tool to simulate accelerometers for upper limb fes triggering

Yavuzer G, Geler-Külcü D, Sonel-Tur B, Kutlay S, Ergin S, Stam HJ. Neuromuscular electric stimulation effect on lower-extremity motor recovery and gait kinematics of patients with stroke: a randomized controlled trial.To evaluate the effects of neuromuscular electric stimulation (NMES) of the tibialis anterior muscle on motor recovery and gait kinematics of patients with stroke.Randomized, controlled, assessor-blinded trial.Rehabilitation ward and gait laboratory of a university hospital.A total of 25 consecutive inpatients with stroke (mean age, 55y), all within 6 months poststroke and without volitional ankle dorsiflexion.Both the NMES group (n=12) and the control group (n=13) participated in a conventional stroke rehabilitation program, 5 days a week for 4 weeks. The NMES group also received 10 minutes of NMES to the tibialis anterior muscle of the paretic limb.Brunnstrom stages of motor recovery and kinematic characteristics of gait.Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the NMES group and 61% of the control group gained voluntary ankle dorsiflexion. Between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the difference between groups was not significant.NMES of the tibialis anterior muscle combined with a conventional stroke rehabilitation program was not superior to a conventional stroke rehabilitation program alone, in terms of lower-extremity motor recovery and gait kinematics.

Stability analysis of Functional Electrical Stimulation (FES)-assisted overground gait in an incomplete spinal cord injured subject

Yavuzer G, Öken Ö, Atay MB, Stam HJ. Effect of sensory-amplitude electric stimulation on motor recovery and gait kinematics after stroke: a randomized controlled study.To evaluate the effects of sensory-amplitude electric stimulation (SES) of the paretic leg on motor recovery and gait kinematics of patients with stroke.Randomized, controlled, double-blind study.Rehabilitation ward and gait laboratory of a university hospital.A total of 30 consecutive inpatients with stroke (mean age, 63.2y), all within 6 months poststroke and without volitional ankle dorsiflexion were studied.Both the SES group (n=15) and the placebo group (n=15) participated in a conventional stroke rehabilitation program 5 days a week for 4 weeks. The SES group also received 30 minutes of SES to the paretic leg without muscle contraction 5 days a week for 4 weeks.Brunnstrom stages of motor recovery and time-distance and kinematic characteristics of gait.Brunnstrom stages improved significantly in both groups (P<.05). In total, 58% of the SES group and 56% of the placebo group gained voluntary ankle dorsiflexion. The between-group difference of percentage change was not significant (P>.05). Gait kinematics was improved in both groups, but the between-group difference was not significant.In our patients with stroke, SES of the paretic leg was not superior to placebo in terms of lower-extremity motor recovery and gait kinematics.

Physical fitness in persons with hemiparetic stroke.

In persons with hemiparetic stroke, assessment and promotion of fitness have so far received limited attention, partly because of the lack of appropriate measures applicable to them. Because these mobility-impaired persons are prone to inactivity, disuse and insulin resistance are likely to occur, and can aggravate the already significant health and economic consequences that stroke entails. It is therefore important to assess objectively their fitness to devize effective and efficient fitness promotion programs. Because of physical limitations, however, many persons with stroke cannot perform traditional stress testing using a treadmill or a cycle ergometer, and maximal oxygen consumption, which is regarded as a gold standard, is not a practical measure. In this article, we reviewed the current status of research on fitness in persons with hemiparetic stroke from the perspectives of evaluation, structure analysis of fitness, and longitudinal changes during a rehabilitation program. As a measure of fitness, indices obtainable with a submaximal exercise are proposed, such as anaerobic threshold and heart rate oxygen coefficient. Protocols applicable to persons with hemiparetic stroke with a variety of functional limitations have been developed (basic bedside activities, bridging activity, or single arm ergometry). The structure of their fitness is demonstrated to be described by a fitness model of healthy persons (cardiopulmonary, muscular and metabolic dimensions) if the paresis/activities of daily living dimension is added. Several studies suggest that fitness improves during a conventional stroke rehabilitation program. Studying the changes of the above four dimensions can help develop more effective fitness training programs.

Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention

Cheng P-T, Wu S-H, Liaw M-Y, Wong AMK, Tang F-T. Symmetrical body-weight distribution training in stroke patients and its effect on fall prevention. Arch Phys Med Rehabil 2001;82:1650-4. Objective: To determine the role of symmetrical body-weight distribution training in preventing falls among patients with hemiplegic stroke. Design: A prospective study using a standing biofeedback trainer. Setting: Hospital-based rehabilitation units. Patients: Fifty-four patients with hemiplegic stroke (30 in the training group, 24 in the control group). Interventions: Conventional stroke rehabilitation program, plus symmetrical standing training and repetitive sit-to-stand training, with a standing biofeedback trainer. Training effect was evaluated by assessing the sit-to-stand performance and comparing the occurrence of falls in the 2 groups at a 6-month follow-up. Main Outcome Measures: Occurrence of falls, sit-to-stand performance, including body-weight distribution, rate of rise in force, and sway in center of pressure (COP). Results: Significant improvement in sit-to-stand performance was found in patients in the training group. Body weight was distributed more symmetrically in both legs, with less mediolateral sway in the COP when rising and sitting down. The mean difference in body-weight distribution between the left and right legs while subjects were rising from a chair significantly decreased, from 49.5% ± 18.9% to 38.6% ± 15.8% of body weight (BW) (p < .005). The rate of rise in force while rising from a chair significantly increased, from 28.3% ± 13.5%BW/s to 53.6% ± 20.5%BW/s (p < .001). At the 6-month follow-up, 10 of 24 patients (41.7%) in the control group had fallen, compared with only 5 of 30 patients (16.7%) in the training group (p < .05). Conclusions: Symmetrical body-weight distribution training may improve sit-to-stand performance and, consequently, decrease the number of falls by stroke patients. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation