Upper-extremity Function Research Articles

The effects of trunk repositioning errors on trunk and extremity functions in stroke

ABSTRACT Aim The aim of this study was to analyze the TRE in three directions including forward flexion, lateral flexion to the hemiparetic side, and rotation to the hemiparetic side in patients with stroke and to compare the errors with age- and sex-matched healthy subjects. In addition, it was investigated which functional outcomes were explanatory for TRE in patients with stroke. Methods Forty-one patients with subacute/chronic stroke (age 59 ± 14.5 years) and 41 healthy subjects (age 57 ± 12.8 years) were included in the study. Demographic and clinical data were collected. TREs were measured using an inclinometer. The Trunk Impairment Scale (TIS), Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), Timed Up and Go Test, and 10-m walk test (10MWT) were also used to assess trunk control, motor impairment, upper extremity function, and lower extremity function, respectively, in patients with stroke. Results TRE scores in three directions were higher in patients with stroke than in healthy subjects (p < 0.001). TREs in three directions were significantly strongly correlated with all functional outcomes (ρ > 0.60, r < 0.001). Multiple regression analysis determined 10MWT, WMFT-Performance, TIS, and FMA-Upper Extremity as explanatory factors for TRE. Conclusion The model presented in this study could help clinicians and researchers to predict the TRE in patients with stroke. Gait speed, upper extremity motor ability, upper extremity motor impairment, and trunk control should be considered for TRE after a stroke.

Factors Associated With Episode of Care Adverse Events After Humerus Nonunion Repair.

Humeral nonunions have devastating negative effects on patients' upper extremity function and health-related quality of life. The objective of this study was to identify factors independently associated with 30-day complication, hospital readmission, and reoperation after surgical treatment of humeral nonunions. A retrospective case-control study was performed using the American College of Surgeons National Surgical Quality Improvement Program database by querying the Current Procedural Terminology codes for patients who underwent humeral nonunion repair from 2011 to 2020. The study outcomes were 30-day complication, hospital readmission, and reoperation. Of the 1306 patients in our cohort, 135 patients (10%) developed a complication, 66 patients (5%) were readmitted to the hospital, and 44 patients (3%) underwent reoperation during the 30-day postoperative period. Multivariable logistic regression analysis showed that older age, longer operative time, partially dependent functional status, congestive heart failure, bleeding disorder, and contaminated wound classification were associated with 30-day complication after humeral nonunion repair. Older age and disseminated cancer were associated with 30-day reoperation after humeral nonunion repair. Disseminated cancer was associated with 30-day readmission after humeral nonunion repair. Using a large database over a recent 10-year period, we identified demographic and comorbid factors independently associated with episode of care adverse events after humeral nonunion repair. Patients 50 years or older had approximately three times the incidence of complications, readmissions, and reoperations in the first month after humeral nonunion repair compared with patients younger than 50 years. Our findings are relevant for preoperative risk stratification and counseling. [Orthopedics. 2024;47(4):e181-e187.].

Effects of Repetitive Transcranial Magnetic Stimulation with Different Brain Stimulation Sites on Cognition and Upper Extremity Function in Stroke Patients

Effects of Repetitive Transcranial Magnetic Stimulation with Different Brain Stimulation Sites on Cognition and Upper Extremity Function in Stroke Patients

Effects of hippotherapy on upper extremity functions in children with cerebral palsy

Purpose: The purpose of our study was to investigate the effects of hippotherapy on upper extremity functions in children with cerebral palsy (CP). &#x0D; Materials and Methods: The study was carried out with a quasi-hippotherapy design by evaluating the hippotherapy and control groups with pretests and posttests. Sixteen children with CP who were treated with 30 minutes of additional hippotherapy three times a week for five weeks were included in the hippotherapy group. Eleven children with CP who had conventional physiotherapy were recruited for the control group. Upper extremity functions were evaluated before and after the intervention using the Box and Block Test (BBT) and the Jebsen Taylor Hand Function Test (JTHFT). &#x0D; Results: There were no significant differences between the hippotherapy and control groups in terms of their baseline BBT and JTHFT scores. After 5-weeks, no statistically significant difference was found between the BBT scores of the hippotherapy and control groups. Significant increases were detected in all parameters of JTHFT in the posttest in the hippotherapy group, compared to the pretest. Moreover, in the posttest, a statistically significant difference was found between the hippotherapy and control groups in the parameters of turning over cards and picking up small objects, which subscales of JTHFT.&#x0D; Conclusion: In children with CP, hippotherapy provided in addition to conventional treatment was an effective practice, especially in improving fine motor skills in the hands.

뇌졸중 환자를 대상으로 인지기반 작업수행(Cognitive Orientation to Daily Occupational Performance) 중재 조건, 형태 및 효과: 체계적 고찰

Objective: This paper systematically reviewed the conditions, forms, and efficacy of CO-OP interventions in patients with stroke. Methods: Relevant research papers published between 2014 and 2023 were obtained via searches in PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, and Korea Citation Index. Among the 164 articles initially found, nine research papers that implemented Cognitive Orientation to daily Occupational Performance (CO-OP) interventions for stroke patients were included in our analyses. Results: Six of the nine papers described randomized controlled trials of relatively high quality. Most participants were enrolled 1~6 months post-stroke. Cognition and communication were confirmed to be important selection criteria. Most of the selected intervention activity areas were Basic Activities of Daily Living and Instrumental Activities of Daily Living. Most periods were 4 or 7 weeks, with 10 sessions performed at a pace of fewer than three sessions per week. All studies focused on occupational performance, but recorded potential effects in other areas, including upper extremity function. Assessment tools focused primarily on occupational performance. Among these, Canadian Occupational Performance Measure and Performance Quality Rating Scale assessment surveys were the most commonly used. Conclusion: These findings can be used as basic data for research and education on CO-OP interventions for patients with stroke.

Effect of Constraint-Induced Movement Therapy (CIMT) on Upper Extremity Function in Stroke Patients

Background: Stroke is a leading cause of disability worldwide, with upper extremity impairments presenting significant rehabilitation challenges. Constraint-Induced Movement Therapy (CIMT) has emerged as a potential intervention for enhancing upper limb functionality, but its efficacy compared to traditional therapy methods requires further exploration. Objective: The study aimed to evaluate the effectiveness of CIMT versus traditional therapy in improving upper extremity function among stroke survivors. Methods: In this quasi-experimental study, 58 stroke patients from Aziz Fatima and Allied Hospital in Faisalabad were recruited and allocated to either the CIMT group (n=29) or the traditional therapy group (n=29). Eligible participants were those aged 30-50 years with ischemic or infarctive stroke and impaired use of their hemiparetic arm. The CIMT group received standard treatment plus CIMT, while the traditional group received only standard treatment, including manual therapy and TENS, for 8 weeks. Pre- and post-treatment assessments utilized the Upper Extremity Motor Activity Log (UEMAL) scales. Data analysis was conducted using SPSS version 25, employing independent t-tests. Results: The CIMT group showed a significant improvement in the UEMAL Amount Scale (pre-treatment: 1.64 ± 0.51, post-treatment: 3.04 ± 0.75; p=0.000) and the UEMAL How Well Scale (pre-treatment: 2.28 ± 0.57, post-treatment: 3.81 ± 0.55; p=0.000). The traditional therapy group also demonstrated gains but to a lesser extent (UEMAL Amount Scale pre-treatment: 1.08 ± 0.24, post-treatment: 1.69 ± 0.33; UEMAL How Well Scale pre-treatment: 1.47 ± 0.30, post-treatment: 2.11 ± 0.40; p=0.000 for both). Conclusion: CIMT provided significant functional improvements in upper extremity motor activity compared to traditional therapy, suggesting that CIMT may be a more effective approach for post-stroke rehabilitation of the upper limb.

Pediatric Performance-Based Outcome Measures for Upper Extremity Function: A Scoping Review and Linking to the International Classification of Functioning, Disability, and Health.

Background. Performance-based outcome measures (PBOMs) are objective measures that assess physical capacity or performance in specific tasks or movements. Purpose. 1) to identify which PBOMs are most frequently reported to evaluate upper extremity (UE) function in pediatric rehabilitation 2) to determine the link between constructs of the ICF and meaningful concepts extracted from each identified PBOM. Methods. Pediatric UE PBOMs were searched in four databases. The selection of outcome measures included an initial title and abstract screening, followed by full-text review of the articles to be included based on identified selection criteria. Two reviewers were appointed to link the meaningful concepts identified in the outcome measures independently and a third reviewer was consulted in case of ambiguity to make a final decision. Findings. After the initial screening, 1786 full-text articles were reviewed, 1191 met the inclusion criteria, in which 77 outcome measures were identified and 32 were included in the linking process. From the included 32 outcome measures, 538 items were extracted and linked to the ICF. The most commonly cited measures included Assisting Hand Assessment, Jebsen-Taylor Hand Function Test, Melbourne Assessment of Unilateral Upper Limb. The Activity and Participation domain represented 364 codes followed by the Body Functions domain domain which represented 174 codes. Implications. A majority of the outcome measures identified were linked with the Mobility, Fine Hand Use of the ICF. Therefore, when selecting a PBOM, careful considerations need to be made regarding which concept of health is to be assessed.

Attentional state-synchronous peripheral electrical stimulation during action observation induced distinct modulation of corticospinal plasticity after stroke.

Brain computer interface-based action observation (BCI-AO) is a promising technique in detecting the user's cortical state of visual attention and providing feedback to assist rehabilitation. Peripheral nerve electrical stimulation (PES) is a conventional method used to enhance outcomes in upper extremity function by increasing activation in the motor cortex. In this study, we examined the effects of different pairings of peripheral nerve electrical stimulation (PES) during BCI-AO tasks and their impact on corticospinal plasticity. Our innovative BCI-AO interventions decoded user's attentive watching during task completion. This process involved providing rewarding visual cues while simultaneously activating afferent pathways through PES. Fifteen stroke patients were included in the analysis. All patients underwent a 15 min BCI-AO program under four different experimental conditions: BCI-AO without PES, BCI-AO with continuous PES, BCI-AO with triggered PES, and BCI-AO with reverse PES application. PES was applied at the ulnar nerve of the wrist at an intensity equivalent to 120% of the sensory threshold and a frequency of 50 Hz. The experiment was conducted randomly at least 3 days apart. To assess corticospinal and peripheral nerve excitability, we compared pre and post-task (post 0, post 20 min) parameters of motor evoked potential and F waves under the four conditions in the muscle of the affected hand. The findings indicated that corticospinal excitability in the affected hemisphere was higher when PES was synchronously applied with AO training, using BCI during a state of attentive watching. In contrast, there was no effect on corticospinal activation when PES was applied continuously or in the reverse manner. This paradigm promoted corticospinal plasticity for up to 20 min after task completion. Importantly, the effect was more evident in patients over 65 years of age. The results showed that task-driven corticospinal plasticity was higher when PES was applied synchronously with a highly attentive brain state during the action observation task, compared to continuous or asynchronous application. This study provides insight into how optimized BCI technologies dependent on brain state used in conjunction with other rehabilitation training could enhance treatment-induced neural plasticity.

Ergonomic Evaluation of Sitting Postures in School Chairs of School-Age Children with Special Needs

ABSTRACT The aim of the study is to evaluate the sitting posture and upper extremity functionality of children with special needs. Children with special needs (n = 31) and typically developing children (n = 31) between the ages of 6–12 were included in the study. Posture was evaluated with the Seated Postural Control Measure Scale and Photographic Posture Analysis, and upper extremity function was evaluated with the Box Block Test. A significant difference was found between the groups in terms of Seated Postural Control Measurement (p < 0.001), Photographic Posture Analysis (p < 0.001) and Box Block Test (p < 0.001) results. Additionally, a statistically significant relationship was found between postural smoothness and upper extremity function of children with special needs (p < 0.05). It was found that children with special needs performed poorly in terms of postural regularity and upper extremity skills. It was observed that the upper extremity function worsened with the deterioration of the sitting posture.

The effects of shoulder stabilization exercises on muscle strength, proprioceptive sensory ability and performance in office workers with shoulder protraction

Objectives. Shoulder protraction is frequently seen in office workers because of working with excessive trunk flexion for a long time. This study aimed to compare the effectiveness of stabilization exercises (SE) given in addition to office exercises (OE). Methods. Sixty office workers with shoulder protraction were divided into SE + OE (n = 30) and OE (n = 30) groups by stratified random sampling for 8 weeks and followed up for 4 weeks. Shoulder protraction was assessed with a caliper, muscle strength with a hand-held dynamometer, proprioception with an isokinetic dynamometer, vibration sense with a vibrometer and upper extremity functional performance with the closed kinetic chain upper extremity stability test. Results. There were significant improvements in all parameters in the OE + SE group, while increases in the strength of the upper trapezius, pectoralis major and infraspinatus muscles and in upper extremity functional performance were also found in the OE group (p < 0.05). During detraining, shoulder protraction, muscle strength, proprioception and upper extremity performance showed longer-term improvement with SE + OE (p < 0.05). Conclusion. The results obtained with the exercises demonstrate the importance of SE + OE in terms of maintaining proper posture and improving shoulder proprioception, muscle strength and functional performance.

A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study.

The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20-30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.

Comparative efficacy of different noninvasive brain stimulation protocols on upper-extremity motor function and activities of daily living after stroke: a systematic review and network meta-analysis.

The objectives of the study were to systematically evaluate the rehabilitation effect of noninvasive brain stimulation (NIBS) on upper extremity motor function and activities of daily living in stroke patients and to prioritize various stimulation protocols for reliable evidence-based medical recommendations in patients with upper extremity motor dysfunction after stroke. Web of Science, PubMed, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM were searched to collect all randomized controlled trials (RCTs) of NIBS to improve upper extremity motor function in stroke patients. The retrieval time was from the establishment of all databases to May 2023. According to the Cochrane system evaluation manual, the quality of the included studies was evaluated, and the data were extracted. Statistical analysis was carried out by using RevMan 5.3, R 4.3.0, and Stata 17.0 software. Finally, 94 RCTs were included, with a total of 5546 patients. Meta-analysis showed that NIBS improved the Fugl-Meyer assessment (FMA) score (mean difference (MD) = 6.51, 95% CI 6.20 ~ 6.82, P < 0.05), MBI score (MD = 7.69, 95% CI 6.57 ~ 8.81, P < 0.05), ARAT score (MD = 5.06, 95% CI 3.85 ~ 6.27, P < 0.05), and motor evoked potential (MEP) amplitude. The modified Ashworth scale score (MD = - 0.37, 95% CI - 0.60 to - 0.14, P < 0.05), National Institutes of Health Stroke Scale score (MD = - 2.17, 95% CI - 3.32 to - 1.11, P < 0.05), incubation period of MEP (MD = - 0.72, 95% CI - 1.06 to - 0.38, P < 0.05), and central motor conduction time (MD = - 0.90, 95% CI - 1.29 to - 0.50, P < 0.05) were decreased in stroke patients. Network meta-analysis showed that the order of interventions in improving FMA scores from high to low was anodal-transcranial direct current stimulation (tDCS) (surface under the cumulative ranking curve (SUCRA) = 83.7%) > cathodal-tDCS (SUCRA = 80.2%) > high-frequency (HF)-repetitive transcranial magnetic stimulation (rTMS) (SUCRA = 68.5%) > low-frequency (LF)-rTMS (SUCRA = 66.5%) > continuous theta burst stimulation (cTBS) (SUCRA = 54.2%) > bilateral-tDCS (SUCRA = 45.2%) > intermittent theta burst stimulation (iTBS) (SUCRA = 34.1%) > sham-NIBS (SUCRA = 16.0%) > CR (SUCRA = 1.6%). In terms of improving MBI scores, the order from high to low was anodal-tDCS (SUCRA = 88.7%) > cathodal-tDCS (SUCRA = 85.4%) > HF-rTMS (SUCRA = 63.4%) > bilateral-tDCS (SUCRA = 56.0%) > LF-rTMS (SUCRA = 54.2%) > iTBS (SUCRA = 32.4%) > sham-NIBS (SUCRA = 13.8%) > CR (SUCRA = 6.1%). NIBS can effectively improve upper extremity motor function and activities of daily living after stroke. Among the various NIBS protocols, anodal-tDCS demonstrated the most significant intervention effect, followed by cathodal-tDCS and HF-rTMS.

Effectiveness of reinforced feedback in virtual environment for upper limb rehabilitation in acute stroke

Background. Motor impairments following stroke result in loss of upper extremity function which is often persistent and disabling. Reinforced feedback in the virtual environment (RFVE) could activate mirror neuron systems which are stimulated during action observation and action execution. This study aims to evaluate the activation of proximal muscles in paretic upper limb following RFVE training. Methodology. Twenty-four stroke patients were included in the study, 12 in control group received impairment specific training and 12 in experimental group received RFVE training using Oculus quest 2 in addition to impairment specific exercise training. Surface electromyography (SEMG) of shoulder muscles of affected upper limb were recorded in both groups. Arm motor recovery was recorded using Chedoke - McMaster stroke assessment scale (CMSA). Results. Paired t-test was used to analyze the results within the group which showed improvement in the both groups and unpaired t-test was used to test the outcomes between the groups where RFVE group showed significant improvement in average muscle activity in anterior deltoid, middle deltoid and CMSA scores than control group (p &lt; 0.005*). Conclusion. The results of this study demonstrated the beneficial effects of RFVE in upper limb training which showed improvements in muscle activation in SEMG and arm recovery in CMSA scores. RFVE training is a safe and well-accepted effective intervention in acute stroke rehabilitation that could become a successful intervention for early functional recovery.

Mental health screening in pediatric lower limb deficiency population.

Youth with lower limb deficiency (LLD) may be at increased risk for mental health difficulties. However, guidelines around psychosocial screening are not well established. To describe the implementation and results of a mental health screening process in a multidisciplinary prosthetics clinic. Survey. Outpatient specialty care clinic located within a children's hospital. All patients ages 0-18 years with LLD seen at a monthly multidisciplinary prosthetics clinic between September 2019 and January 2023 (n = 75). Not applicable. Quality of life was measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric proxy survey. Psychological functioning was measured using the Strengths and Difficulties Questionnaire (SDQ). Descriptive statistics were used to determine the proportion of patients who endorsed clinically significant concerns. Of the 75 clinic visits during the study time frame, the psychosocial screeners were completed at 38 (51%). A total of 25 unique patients completed the screeners; 12 patients completed the screener more than once. The most commonly endorsed concerns on the PROMIS were issues with physical mobility (65%) and upper extremity function (40%). The SDQ revealed that a majority (62.5%) of the screened patients had an overall score above the clinical cutoff, indicating psychosocial distress in more than one area. The most commonly reported mental health concern was peer problems (62.5%). Post hoc analysis of repeat screenings indicated that most problems identified during the first screening persisted at follow-up screenings. Clinically significant psychological concerns were common among the sample, indicating the need to address this aspect of patients' well-being. Preliminary data on repeat screenings suggest that clinically significant concerns may not self-resolve. Routine psychosocial screening is critical for early identification of mental health problems and timely referral to evidence-based psychological interventions.

Effects of Home-Based Pulmonary Training Program on Functional Exercise Capacity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease

Background: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality worldwide, characterized by persistent respiratory symptoms and airflow limitation. Despite the availability of various treatments, there is a growing interest in exploring more effective strategies to manage symptoms, enhance exercise capacity, and improve the quality of life for COPD patients. Pulmonary rehabilitation, including both supervised and home-based exercises, has emerged as a promising approach. Objective: The aim of this study was to evaluate the effectiveness of a combined approach of Active Cycle of Breathing Technique (ACBT) with a home-based exercise regimen in improving functional exercise capacity and quality of life in patients with COPD, compared to ACBT alone. Methods: This was a randomized controlled trial involving 44 COPD patients, divided into two groups: Group A received ACBT alone, while Group B participated in ACBT plus a home-based exercise program. The intervention lasted for four weeks. Outcome measures included the St. George’s Respiratory Questionnaire (SGRQ) for quality of life, the 30-second arm curl test for upper extremity function, and the 6-minute walk test (6MWT) for lower extremity function. Data were analyzed using SPSS version 25, with the Mann-Whitney and Wilcoxon tests for between-group and pre-post intervention comparisons, respectively. Results: Group B showed more significant improvements in exercise capacity and respiratory symptoms compared to Group A. Specifically, the 6MWT distances increased from an average of 365.60±57.81 meters to 370.40±54.29 meters in Group B, indicating enhanced lower extremity function. Similarly, the SGRQ scores, reflecting quality of life, demonstrated more substantial improvement in Group B, though specific numerical results for this and the 30-second arm curl test were not significantly different between groups. Conclusion: The study concludes that combining ACBT with a home-based exercise regimen significantly benefits COPD patients by improving functional exercise capacity and potentially enhancing the quality of life. This combined approach could serve as a viable addition to the COPD management strategy, emphasizing the importance of comprehensive, patient-centered care.

The relationship between kinesiophobia, balance, and upper extremity functions in patients with painful shoulder pathology.

Poor balance ability may contribute to shoulder pathology in patients with existing shoulder pathologies or vice versa. The relationship between kinesiophobia and chronic shoulder pain intensity has been researched, although the conclusions are conflicting. To our knowledge, no study in the literature explores the association between kinesiophobia and balance in patients with shoulder pain. To investigate the relationship between kinesiophobia, upper extremity functions, and balance abilities in patients with shoulder pain. Cross-sectional observational study. Physical medicine and rehabilitation hospital. Not applicable. A total of 44 patients with shoulder pain were included in the study. The pain severity was assessed using a visual analog scale (VAS). The Tampa Scale for Kinesiophobia (TSK), Berg Balance Scale (BBS), and Shoulder Pain and Disability Index (SPADI) were used to assess the patients. Ultrasound was used to diagnose underlying shoulder joint problems. Static and dynamic postural control was evaluated. The most common pathologies detected by ultrasound were supraspinatus tendinitis/rupture (77.3%), cortical irregularity (68.2%), and bursitis (63.6%). TSK score did not correlate with age, body mass index, symptom duration, or VAS score in rest (all p > .05), but it was associated with scores on the BBS (r = -0.437, p = .003), SPADI-pain (r = 0.474, p = .001), SPADI-disability (r = 0.355, p = .018), SPADI-total (r = 0.405, p = .006), and VAS in activity (r = 0.331, p = .028). According to multiple linear regression analysis, BBS score, SPADI-total score, and anterior-posterior sway length were significant predictors of TSK (r = 0.645, r2 = 0.416). According to the findings of this study, the main risk factors for high levels of kinesiophobia are poor balance, severe pain, and disability. In addition to mechanical causes of shoulder pain, diagnosing and intervening on underlying balance issues and psychosocial causes of shoulder pain will improve treatment success.

Therapists and patients perceptions of a mixed reality system designed to improve trunk control and upper extremity function

A prototype system aimed at improving arm function and trunk control after stroke has been developed that combines mixed-reality (MR) feedback with a mobile seat system (Holoreach). The purpose of this study was to assess the usability of Holoreach in a rehabilitation setting from both the patient and therapist perspective. Ten therapists (eight physiotherapists and two occupational therapists) used the device in their regular therapy programs for fifteen stroke patients with trunk control issues. Each patient received four individual therapy sessions with the device performed under the supervision of the therapist. Therapists and patients kept therapy diaries and used customized questionnaires. At the end of the study two focus groups were conducted to further assess usability. Generally, the prototype system is suitable for training trunk and arm control. The therapists expressed overall positive views on the impact of Holoreach. They characterized it as new, motivating, fresh, joyful, interesting, and exciting. All therapists and 80% of the patients agreed with the statement that training with Holoreach is beneficial for rehabilitation. Nonetheless, improvements are required in the hardware and software, and design. The prototype system contributes at various levels to the rapidly evolving advances in neurorehabilitation, particularly regarding the practical aspect of exercise delivery.

Effect of Home-Based Task-Based Mirror Therapy on Upper Extremity Function in Stroke Patients: A Four-Week Intervention Study

Objective: This study aimed to investigate the effect of task-based mirror therapy on upper extremity function, and daily living activities in individuals with stroke, after four weeks of training. Material and Methods: Participants were randomized into two groups, the task-based mirror therapy group and the task training as the control group: as 10 and 7 participants, respectively. The Action Research Arm Test (ARAT), the Fugl-Meyer Assessment (FMA), the Sirindhorn National Medical Rehabilitation Center Functional Assessment (SNMRC) and the Short-Form 36 (SF-36) were assessed before and after training, over a four week period. Results: The results showed that the home-based programs of both the task-based mirror therapy and the control group improved on all variables, but without statistical significance between groups. However, within group analysis, the task-based mirror therapy group exhibited significant differences between pre- and post-assessments for FMA; whereas, the control group did not. Conclusion: The home-based program of task-based mirror therapy, as a task-specific training approach, has demonstrated the potential to enhance the recovery of upper limb motor function after a four-week training period.

Constraint-induced movement therapy through telerehabilitation for upper extremity function in stroke

BackgroundStroke is considered to be a leading cause of impairment. After experiencing strokes, patients are frequently left with impaired motor function, making it difficult to carry out daily tasks. The most extensively researched method for treating stroke patients in recent decades is CIMT (constraint-induced movement therapy), which was developed to treat upper limb deficits following stroke. CIMT entails limiting the use of the unaffected limb, altering behavior to increase the use of the affected limb, and finally, mass-training of the affected limb. ObjectiveThe current study aimed to determine the effectiveness of CIMT through TR for upper extremity function in stroke patients. Materials and methodsThirty post-stroke participants were selected on the basis of inclusion and exclusion criteria, and allocated into group A and group B. Group A was treated with CIMT in the physiotherapy department and group B was treated with CIMT through TR. Outcome measures were the Fugl-Meyer Assessment scale for upper extremities (FMA-UE), the Wolf Motor Function Test (WMFT), and the Motor Activity Log (MAL). ResultsBoth groups showed significant improvements in FMA-UE, WMFT and MAL-A0U, MAL-Q0M scores. However, there were no significant differences between groups A and B in FMA-UE, WMFT, MAL-AOU, and MAL-QOM scores in the inter-group analysis. ConclusionCIMT via TR was equally effective than CIMT in physiotherapy department for upper extremity function in stroke. Further studies should be conducted to identify the long-term effectiveness of this approach.

Transcutaneous auricular vagus nerve stimulation with task-oriented training improves upper extremity function in patients with subacute stroke: a randomized clinical trial.

Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising brain stimulation modality in poststroke upper extremity rehabilitation. Although several studies have examined the safety and reliability of taVNS, the mechanisms underlying motor recovery in stroke patients remain unclear. This study aimed to investigate the effects of taVNS paired with task-oriented training (TOT) on upper extremity function in patients with subacute stroke and explore the potential underlying mechanisms. In this double-blinded, randomized, controlled pilot trial, 40 patients with subacute stroke were randomly assigned to two groups: the VNS group (VG), receiving taVNS during TOT, and the Sham group (SG), receiving sham taVNS during TOT. The intervention was delivered 5 days per week for 4 weeks. Upper extremity function was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT). Activities of daily living were measured by the modified Barthel Index (MBI). Motor-evoked potentials (MEPs) were measured to evaluate cortical excitability. Assessments were administered at baseline and post-intervention. Additionally, the immediate effect of taVNS was detected using functional near-infrared spectroscopy (fNIRS) and heart rate variability (HRV) before intervention. The VG showed significant improvements in upper extremity function (FMA-UE, ARAT) and activities of daily living (MBI) compared to the SG at post-intervention. Furthermore, the VG demonstrated a higher rate of elicited ipsilesional MEPs and a shorter latency of MEPs in the contralesional M1. In the VG, improvements in FMA-UE were significantly associated with reduced latency of contralesional MEPs. Additionally, fNIRS revealed increased activation in the contralesional prefrontal cortex and ipsilesional sensorimotor cortex in the VG in contrast to the SG. However, no significant between-group differences were found in HRV. The combination of taVNS with TOT effectively improves upper extremity function in patients with subacute stroke, potentially through modulating the bilateral cortex excitability to facilitate task-specific functional recovery.