Hemiparesis Patients Research Articles

A preliminary investigation of error enhancement of the velocity component in stroke patients’ reaching movements

Background/aim: Patients with stroke who are suffering from impaired reaching movement experience insufficient spatial and temporal coordination, affecting upper limb functions and everyday life tasks. This study examines a new robot-assisted rehabilitation method for ameliorating arm reaching movements through velocity error enhancement training. The authors hypothesised that this robot-assisted rehabilitation training may encourage restoration of arm reaching abilities among post-stroke hemiparesis patients.Methods: Several clinical and kinematic measures were used to evaluate outcomes. Subjects were assigned either to an experimental group that underwent 5-week treatments with error enhanced forces, or to a control group that received passive treatment. The control group undertook reaching tasks over the same period while they were connected to the robot but without it applying any error enhancement forces to their upper limb. The robotic system was programmed based on previous kinematic data from healthy subjects, so any deviation from the relatively smooth, calculated, optimal trajectory, and velocity profile mean encountered error enhancing external forces.Results: The results showed an appreciable effect on smoothness and regularity of movement. After 5 weeks of velocity error enhancement treatment, all subjects in the experimental group displayed movements converging towards their optimal profiles, together with decreased variability in path trajectory. In contrast to the control group, their mean deviation was also significantly reduced. These positive changes in motor control patterns were paralleled by gains in functional capacity, as reflected by the Motor Assessment Scale test results. However, those results should be carefully inspected in regard to small sample size and un-matching of motor performance at the beginning of the trial between groups.Conclusion: The study demonstrates the potential of robotic rehabilitation that combines error enhancement and velocity component training to help stroke patients.

Analysis for Sit-to-Stand Performance According to the Angle of Knee Flexion in Individuals with Hemiparesis

[Purpose] Sit-to-stand (STS) is one of the important functional tasks people perform throughout the day. This study investigated whether varying angles of knee flexion affect STS patterns in individuals with hemiparesis by using a foot plantar pressure measurement system. [Methods] Fifteen stroke patients with hemiparesis participated for this study. They performed sit-to-stand with three angles of knee flexion (70°, 90°, and 110°). We measured the trajectory of the center of pressure, peak plantar pressure, and symmetry index using a Mat-scan system (Tekscan, South Boston, MA, USA). [Results] As a result, we found that there were significant differences among the three angle conditions (trajectory of center of pressure, peak plantar pressure on the affected side, and symmetry index). However, there was no significant difference in peak pressure according to the knee flexion on the unaffected side. [Conclusion] In the current study, we found that stroke patients with hemiparesis had a compensated STS pattern according to knee flexion angles. This indicates that the peak value of plantar pressure increased and that the trajectory of the center of pressure widened as the angle of knee flexion increased. We also suggest that hemiparesis patients should be more concerned about proper knee angle for symmetrical STS pattern.

활동관찰 훈련이 편마비 환자의 보행지수에 미치는 영향

본 연구는 활동관찰 훈련이 편마비 환자의 보행에 미치는 영향에 대하여 평가하였다. 본 연구에 참여자는 실험군 10명과 대조군 10명으로 무작위로 배정되었다. 두 그룹 모두 중추신경계 발달 치료를 6주 동안 1회당 1시간씩 주당 6회 훈련을 받았다. 실험군은 활동 관찰훈련을 6주 동안 1회당 10분씩 주당 3회를 중추신경계 발달치료와 병행하여 훈련받았다. 실험군과 대조군은 보행속도, 마비측 보장, 비마비측 보장, 마비측 활보장, 비마비측 활보장, 두발지지기, 분속수, 일어나 걸어가기 검사를 평가하였다. 활동관찰 훈련을 실시한 그룹에서 편마비 환자의 보행속도, 마비측 보폭, 마비측 활보장, 분속수, 일어나 걸어가기 검사에서 유의하게 향상되었다. 위의 결과를 통하여 활동관찰 훈련은 편마비 환자의 보행 능력을 향상하는 데 효과가 있음을 확인하였다. 따라서 활동관찰 훈련 결과는 편마비 환자들에게 유용하고 적절한 훈련으로 제안할 수 있을 것이다. This study was to evaluate the effects of an action observation to improve on gait in stroke patients. Participants were randomly allocated to two groups: experimental (n=10) and control (n=10). Both groups were trained for 60 minutes, 6 times a week during 6 weeks by neuro-development treatment. Experimental group practiced additional action observation for 3 session 10 minutes per week 6 weeks. Both groups were evaluated by gait velocity, affected step length, non affected step length, affected stride length, non affected stride length, double support time, cadence, and timed up and go to test. There were significantly increased by action observation in outcomes of the gait performance from the gait velocity, affected side step length, affected side stride length, cadence, timed up and go test. In conclusion, the action observation improves gait performance in stroke patients. The results suggest that action observation training is feasible and suitable for individuals with hemiparesis patients.

Impact of four weeks physical therapy on exaggerated muscle tonicity, balance and quality of life in hemi paresis patients

Impact of four weeks physical therapy on exaggerated muscle tonicity, balance and quality of life in hemi paresis patients

Cortical Reorganization Induced by Body Weight–Supported Treadmill Training in Patients With Hemiparesis of Different Stroke Durations

Yang Y-R, Chen I-H, Liao K-K, Huang C-C, Wang R-Y. Cortical reorganization induced by body weight–supported treadmill training in patients with hemiparesis of different stroke durations. Objective To investigate corticomotor changes induced by body weight–supported treadmill training (BWSTT) in patients with short or long poststroke duration. Design Single-blinded and randomized controlled trial. Setting Neurologic physical therapy research laboratory. Participants Hemiparesis patients (N=18) whose motor-evoked potentials could be induced participated in this study. Subjects in each hemiparesis postonset of short (<6mo) or long (>12mo) duration group were randomly assigned to either the control or experimental group. Interventions Subjects in the experimental groups participated in BWSTT for 4 weeks. Those in the control groups received the general exercise program. Main Outcome Measures The primary outcomes were motor threshold and map size of the abductor hallucis muscle in the ipsilesional hemisphere. The secondary outcome was Fugl-Meyer Assessment. Outcome measures were blindly assessed before and after completing the 4 weeks of training. Results The 4-week BWSTT resulted in a decrease of motor threshold and an increase of map size in subjects with hemiparesis of short duration, whereas only the expansion of the map size was noted in subjects with hemiparesis of long duration. Improvement of motor control occurred in subjects with hemiparesis of both short and long duration after BWSTT. Conclusions The BWSTT results in similar improvement in motor control but different patterns of treatment-induced cortical reorganization in subjects with different poststroke durations.

Efficacy of Constraint-Induced Movement Therapy for Post-Stroke Upper Extremity Hemiparesis Patients Attending a Day-Care Center

〔目的〕通所リハにおける在宅脳卒中患者を対象としたCI療法の効果について検討した。〔対象〕当院通所リハを利用の片側上肢機能不全を有する脳卒中患者で適応基準を満たした6名であった。〔方法〕非麻痺側上肢の運動制限を行いながら，麻痺側上肢の集中的な課題遂行型介入を1日5時間，2週連続（平日の10日間）で実施した。評価項目は，Wolf motor function test（WMFT），Motor activity log（MAL），Fugl-Meyer assessment scale（FM）とし，CI療法の実施前後，3ヶ月，6ヶ月後に実施した。〔結果〕WFMTのtimeおよびMALにおいて，介入前後で，有意な改善を認めた。また，評価が可能であったすべての症例で，3ヶ月後，6ヶ月後においても介入効果が持続していた。〔結語〕通所リハにおいて，一般的な手法に従ったCI療法実施は可能であり，上肢の機能改善および実用性が向上することが示唆された。

Aids and Orthoses in Patients with Stroke Consequences

The presence of alterations in the muscular tone and in the normal motorial synergies at an articular level causes interferences in the functional recovery of patients with stroke consequences. In the rehabilitative field there are some aids that are useful to replace the compromised functions and to make the patient as autonomous as possible in the common movements of the everyday life. The orthoses are used mainly in two cases: to prevent and/or to contain myofascial retractions (spasticity passive component) and to improve the neuromuscolar control of movement through integration of a partially or totally insufficient function. Hemiparesis patients mainly show synergy alteration of the heel muscles and especially of the peroneus, with the consequent tendency of equinism-supination deviation. Analysis of literature shows a scientific validation especially in the use of dynamic orthoses of legs, the most known being the ankle-foot-orthoses.

Distribution of Weakness at the Lower Extremity of Hemiparesis Patients

The maximal voluntary strength of knee extension and flexion on both the right and left sides was measured in patients with hemiparesis of upper motor neuron type and in a group of normal subjects. Significant differences of maximal voluntary strength were found between male and female but the ratio of flexor to extensor strength did not vary significantly between the sides, between the sex in normal subjects. The maximal voluntary strength of uninvolved side were not reduced significantly but involved side reduced significantly in patients. The ratio of flexor to extensor strength in hemiparetic side was significantly less than the ratio for the normal subjects but not significant difference in uninvolved side of patients. According to the above results, the maximal voluntary strength of flexion was more reduced than that of the extension in lower extremity of hemiparesis patients. The strength ratio of flexion to extension was a useful parameter for guiding the rehabilitation of hemiparesis.

Relation of regional cerebral blood flow to hemiparesis in chronic subdural hematoma

To investigate the causative mechanism of hemiparesis in chronic subdural hematoma, 38 patients with unilateral chronic subdural hematoma were studied on the relationship between their clinical manifestations and regional cerebral blood flow measured with 133xenon inhalation (16 detectors on each side of the head, Initial Slope Index). Twenty-five patients with hemiparesis (hemiparesis group) and 13 patients with headaches only and without any neurological deficits (headache group) were examined before surgery for chronic subdural hematoma. Among the hemiparesis patients, 15 were examined after surgery. Preoperative regional cerebral blood flow values in the headache group were normal in all regions bilaterally and showed no significant regional difference in one hemisphere or interhemispheric difference between the corresponding regions in both hemispheres, whereas preoperative regional cerebral blood flow values in the hemiparesis group were generally around the lower limit of the age-matched normal value and were subnormal in some areas, and the regional cerebral blood flow values were significantly lower on the hematoma side than on the intact side in most regions. The rolandic region especially showed the lowest regional cerebral blood flow value of 32.3 in the Initial Slope Index on average and the most significant interhemispheric differences of regional cerebral blood flow. Such a preoperative reduction of regional cerebral blood flow in the hemiparesis group normalized along with clinical improvement after evacuation of the hematoma. It was suggested that localized cerebral blood flow reduction at the rolandic cortical region under the hematoma might be one of the causative factors of hemiparesis in chronic subdural hematoma.