Jebsen-Taylor Test Research Articles

Effects of a Game Therapy program with Leap Motion Sensor on the Manual Function in Adults with Cerebral Palsy

Hand motor rehabilitation programs require long-term therapy and they are generally uninteresting and repetitive for the patient who is not always motivated to achieve them. The literature shows that Virtual Reality (VR) can increase motivation and engagement in motor rehabilitation programs. The aim of this study was to evaluate the effects of game therapy program for adults with cerebral palsy. The study included five adults with CP, levels 3 and 4 from Manual Ability Classification System (MACS). The manual function was evaluated before and after the game programs by the Box and Blocks and Jebsen-Taylor tests. The program was offered in 15 sessions, twice a week, in a care association for people with CP. The results indicated the stability of the condition, which can be expected for the adult population. Some games were more motivating and through testimonials, participants demonstrated satisfaction and suggested technical changes for better usability of the games. Motivators therapeutic resources should be considered in adult therapy with CP.

Developmental and acquired brain injury have opposite effects on finger coordination in children.

The ability to coordinate finger forces to dexterously perform tasks develops in children as they grow older. Following brain injury, either developmental (as in cerebral palsy-CP) or acquired (as in traumatic brain injury-TBI), this developmental trajectory will likely be impaired. In this study, we compared finger coordination in a group of children aged 4-12 with CP and TBI to a group of typically developing children using an isometric pressing task. As expected, deficits were observed in functional tests (Jebsen Taylor test of hand function, Box and Block test) for both groups, and children in both groups performed the pressing task less well than the control group. However, differing results were observed between the CP and TBI groups when using the uncontrolled manifold hypothesis to look at the synergy index. This index measures the relative amount of "good" (does not affect the outcome measure) and "bad" (does affect the outcome measure) variability, where in this case the outcome measure is the total force produced by the fingers. While children with CP were more variable in their performance, their synergy index was not significantly different from typically developing children, suggesting the development of compensatory strategies. In contrast, the children following TBI showed performance that got worse as a function of age (i.e., the older children with TBI performed worse than the younger children with TBI). These differences between the groups may be a result of different areas of brain injury typically observed in CP and TBI, and the different amount of time that has passed since the injury.

Studying the Immediate Effects of Two Types of Thumb Splints on the Pain, Grip Strength, and Hand Function in People With De Quervain Tenosynovitis

Objective: The prevention of thumb joints flexion help cure de Quervain tenosynovitis. The thumb, therefore, is being immobilized in the abduction position by splinting. Thumb abduction can be away from the palm (palmar abduction) or from the fingers (radial abduction), which are done in two different planes. To the authors' knowledge, the literature has not specified which kind of thumb abduction has better treatment outcomes and functions. This study aimed to compare the immediate efficacy of palmar abduction and radial abduction splinting on the severity of pain, handgrip, palmar and lateral pinch strength, and hand function in people with de Quervain tenosynovitis. Materials & Methods: In this quasi-experimental study, 30 volunteer patients (24 females) with de Quervain tenosynovitis referred to clinical centers were selected via convenience sampling. The participants were randomly assigned to three study groups (without the splint, palmar abduction splint, and radial abduction splint). The splints' height was two-thirds of the elbow. The splints were designed to immobilize the carpometacarpal and metacarpophalangeal joint of the thumb but allow the interphalangeal joint to move. One splint immobilizes the thumb in palmar abduction, while another immobilizes the thumb in radial abduction. The outcomes were studied and measured immediately after the intervention and in a single session. The intended outcomes included pain severity, handgrip strength, palmar and lateral pinch strength, and hand function measured with a visual analog scale, hand dynamometers, and the Jebsen-Taylor test, respectively. The repeated measures analysis of variance was performed for statistical analysis using SPSS software, version 16. Results: All participants completed all study assessments. The results showed a significant reduction of pain, handgrip strength, lateral and palmar pinch, and hand function after using a thumb splint compared to without the splint condition (P<0.05). The pain severity in gripping objects was lower after using a palmar abduction splint than the radial abduction splint. Also, the strength reduction in taking objects by gripping, lateral pinch, and palmar was lower after using the palmar abduction splint than the radial abduction splint (P<0.05). Still, both splints were not significantly different in slowing the hand function in the Jebsen-Taylor test (P>0.05). Conclusion: The positioning of the thumb in palmar abduction with splinting could be more effective for pain reduction and manipulation of objects with the hand and fingers.

Comparison of Constrained Induced Movement Therapy and Bimanual Training on Functional Outcome of Hemiplegic Cerebral Palsy

OBJECTIVES The aim of this study was to compare the effects of constrained induced movement therapy (CIMT) and BimanualIntensive Training (BIT) on functional outcomes of hemiplegic cerebral palsy children. METHODOLOGY Cerebral palsy children with age groups of 5 to 12 years were included with a total sample size of 38. Simplerandom sampling was done, and data was collected from Islamabad. Two groups were formed and named groupA: constrained induced movement therapy with 19% and group B: bimanual training with 19% respectively. Thefunctional outcome for the CIMPT and for the BIT group was assessed on the pretest and post-test scoreevaluation of QUEST and JTHF tests. RESULTS Statistically significant (p <0.05) improvement was found in The Quality of Upper Extremity Skills Test (QUEST)and Jebsen-Taylor Test of Hand Function (JTHF) in the between -group analysis. For within the group analysisthe p-value <0.05 suggests that there was a significant diffe rence in within-group analysis too. The values forgrasp and dissociated movements suggest that QUEST post-test values are impactful in the CMIT group whereasin the BIT group simultaneous and spontaneous movement was increased but JTHF post -test values were moresignificant in CMIT. CONCLUSION BIT is more beneficial for both hand’s simultaneous and spontaneous movement, whereas CMIT is morebeneficial for grip and overcoming the “learned-nonuse” phenomena in cerebral palsy children.

Alterations in dexterity and manual function in patients with focal hand dystonia

IntroductionFocal hand dystonia is a movement disorder whose symptoms cause alterations in the performance of tasks requiring a high level of dexterity. Currently, there is no model for interpreting the disease and few studies have identified the difficulties of patients with dystonia in carrying out activities of daily living (ADL). This study aims to describe manipulative dexterity and its influence on ADLs in patients with focal hand dystonia. Materials and methodsWe performed an observational, cross-sectional, case-control study including 24 participants (12 patients with focal hand dystonia and 12 controls). The patients were referred by the neurology department of Hospital Ramón y Cajal. We gathered sociodemographic data, as well as retrospective clinical data for patients. We subsequently administered evaluation tests, in the following order: Nine-Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT), and Jebsen-Taylor Test of Hand Function (JTTHF). ResultsThe study sample included a total of 24 participants, 7 women and 17 men, with a mean age (standard deviation) of 50.79 (14.40) years. In the patient group, neuromuscular involvement or psycho-emotional problems were not detected in half of cases; smaller numbers of patients presented difficulties associated with the right shoulder (25%) and anxious state (33.3%). ConclusionsOur results indicate that focal hand dystonia affects manipulative dexterity in these patients, who showed poorer performance and required more time to complete the tasks.

Robotic mapping of motor cortex in children with perinatal stroke and hemiparesis.

Brain stimulation combined with intensive therapy may improve hand function in children with perinatal stroke‐induced unilateral cerebral palsy (UCP). However, response to therapy varies and underlying neuroplasticity mechanisms remain unclear. Here, we aimed to characterize robotic motor mapping outcomes in children with UCP. Twenty‐nine children with perinatal stroke and UCP (median age 11 ± 2 years) were compared to 24 typically developing controls (TDC). Robotic, neuronavigated transcranial magnetic stimulation was employed to define bilateral motor maps including area, volume, and peak motor evoked potential (MEP). Map outcomes were compared to the primary clinical outcome of the Jebsen–Taylor Test of Hand Function (JTT). Maps were reliably obtained in the contralesional motor cortex (24/29) but challenging in the lesioned hemisphere (5/29). Within the contralesional M1 of participants with UCP, area and peak MEP amplitude of the unaffected map were larger than the affected map. When comparing bilateral maps within the contralesional M1 in children with UCP to that of TDC, only peak MEP amplitudes were different, being smaller for the affected hand as compared to TDC. We observed correlations between the unaffected map when stimulating the contralesional M1 and function of the unaffected hand. Robotic motor mapping can characterize motor cortex neurophysiology in children with perinatal stroke. Map area and peak MEP amplitude may represent discrete biomarkers of developmental plasticity in the contralesional M1. Correlations between map metrics and hand function suggest clinical relevance and utility in studies of interventional plasticity.

Somatosensory Cortex Repetitive Transcranial Magnetic Stimulation and Associative Sensory Stimulation of Peripheral Nerves Could Assist Motor and Sensory Recovery After Stroke.

BackgroundWe investigated whether transcranial magnetic stimulation (rTMS) over the primary somatosensory cortex (S1) and sensory stimulation (SS) could promote upper limb recovery in participants with subacute stroke.MethodsParticipants were randomized into four groups: rTMS/Sham SS, Sham rTMS/SS, rTMS/SS, and control group (Sham rTMS/Sham SS). Participants underwent ten sessions of sham or active rTMS over S1 (10 Hz, 1,500 pulses, 120% of resting motor threshold, 20 min), followed by sham or active SS. The SS involved active sensory training (exploring features of objects and graphesthesia, proprioception exercises), mirror therapy, and Transcutaneous electrical nerve stimulation (TENS) in the region of the median nerve in the wrist (stimulation intensity as the minimum intensity at which the participants reported paresthesia; five electrical pulses of 1 ms duration each at 10 Hz were delivered every second over 45 min). Sham stimulations occurred as follows: Sham rTMS, coil was held while disconnected from the stimulator, and rTMS noise was presented with computer loudspeakers with recorded sound from a real stimulation. The Sham SS received therapy in the unaffected upper limb, did not use the mirror and received TENS stimulation for only 60 seconds. The primary outcome was the Body Structure/Function: Fugl-Meyer Assessment (FMA) and Nottingham Sensory Assessment (NSA); the secondary outcome was the Activity/Participation domains, assessed with Box and Block Test, Motor Activity Log scale, Jebsen-Taylor Test, and Functional Independence Measure.ResultsForty participants with stroke ischemic (n = 38) and hemorrhagic (n = 2), men (n = 19) and women (n = 21), in the subacute stage (10.6 ± 6 weeks) had a mean age of 62.2 ± 9.6 years, were equally divided into four groups (10 participants in each group). Significant somatosensory improvements were found in participants receiving active rTMS and active SS, compared with those in the control group (sham rTMS with sham SS). Motor function improved only in participants who received active rTMS, with greater effects when active rTMS was combined with active SS.ConclusionThe combined use of SS with rTMS over S1 represents a more effective therapy for increasing sensory and motor recovery, as well as functional independence, in participants with subacute stroke.Clinical Trial Registration[clinicaltrials.gov], identifier [NCT03329807].

Effects of Repetitive Peripheral Sensory Stimulation in the Subacute and Chronic Phases After Stroke: Study Protocol for a Pilot Randomized Trial.

BackgroundRepetitive peripheral nerve sensory stimulation (RPSS) is a potential add-on intervention to motor training for rehabilitation of upper limb paresis after stroke. Benefits of RPSS were reported in subjects in the chronic phase after stroke, but there is limited information about the effects of this intervention within the 1st weeks or months. The primary goal of this study is to compare, in a head-to-head proof-of-principle study, the impact of a single session of suprasensory vs. subsensory RPSS on the upper limb motor performance and learning in subjects at different phases after stroke subacute and chronic phases and mild upper limb motor impairments after stroke. In addition, we examine the effects of RPSS on brain perfusion, functional imaging activation, and γ-aminobutyric acid (GABA) levels. Subjects with mild upper limb motor impairments will be tested with MRI and clinical assessment either at an early (7 days to 3 months post-stroke) or at a chronic (>6 months) stage after stroke.MethodsIn this multicenter, randomized, parallel-group, proof-of-principle clinical trial with blinded assessment of outcomes, we compare the effects of one session of suprasensory or subsensory RPSS in patients with ischemic or hemorrhagic stroke and upper limb paresis. Clinical assessment and MRI will be performed only once in each subject (either at an early or at a chronic stage). The primary outcome is the change in performance in the Jebsen–Taylor test. Secondary outcomes: hand strength, cerebral blood flow assessed with arterial spin labeling, changes in the blood oxygenation level-dependent (BOLD) effect in ipsilesional and contralesional primary motor cortex (M1) on the left and the right hemispheres assessed with functional MRI (fMRI) during a finger-tapping task performed with the paretic hand, and changes in GABA levels in ipsilesional and contralesional M1 evaluated with spectroscopy. The changes in outcomes will be compared in four groups: suprasensory, early; subsensory, early; suprasensory, chronic; and subsensory, chronic.DiscussionThe results of this study are relevant to inform future clinical trials to tailor RPSS to patients more likely to benefit from this intervention.Trial RegistrationNCT03956407.

Feasibility of High Repetition Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

Aims In pediatric upper extremity rehabilitation, feasible repetition rates are unknown. Our objectives were to examine repetition rates during rehabilitation and their impact on outcomes. Methods Children with unilateral cerebral palsy due to perinatal stroke (n = 55, median 10 y 7 mo, 30 males) received Constraint-Induced Movement Therapy (CIMT) followed by Bimanual Therapy, each for 5 days. Repetitions were documented during one-on-one therapy (1.5 h/day). Outcomes included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF), and Box and Block Test (BBT). Means and standard deviations for motor outcomes and frequencies for repetition rates were calculated. Factors associated with repetition rates and outcome change were explored using standard linear regression. Results Repetitions/hour averaged 365 ± 165 during CIMT and 285 ± 103 during Bimanual Therapy. Higher repetition rates were associated with higher baseline function by older age, a main effect of younger age, and improving motor skill (p < .05). Higher repetition rates corresponded with improvement of the AHA and BBT (p < .05, standardized ß = 0.392, 0.358). Conclusions Results suggest high repetition therapy is feasible in school-aged children with perinatal stroke, albeit with high individual variability. Multiple associations between repetition rates and baseline function and change point to the clinical importance of this measurable and potentially modifiable factor.

Влияние метода профессора Козявкина на функцию руки у детей с церебральным параличом

Актуальность. Нарушение функции руки является одним из факторов, которые больше всего ограничивают самообслуживание и выполнение повседневных действий пациентами с церебральным параличом (ЦП). В исследованиях последних лет продемонстрирована эффективность интенсивных многокомпонентных методов реабилитации для улучшения функции руки у детей с ЦП. Одним из таких методов является система интенсивной нейрофизиологической реабилитации, известная также как метод профессора Козявкина, — многокомпонентная система, объединяющая разносторонние вмешательства в один интенсивный курс. Целью этого исследования было оценить изменения функции руки у детей с ЦП после двухнедельного курса реабилитации по методу Козявкина. Материалы и методы. В исследовании принимали участие 32 пациента в возрасте 6–15 лет со спастическими формами ЦП (двустороннее поражение, I–III уровень по Системе классификации функции руки). Все пациенты проходили двухнедельный курс реабилитации по методу Козявкина. Лечение продолжалось до 5 часов в день и состояло из физической терапии, эрготерапии, биомеханической коррекции позвоночника, рефлексотерапии, мобилизации суставов, компьютерной игротерапии и других лечебных воздействий. Основным инструментом оценки был тест функции руки Джебсена — Тэйлора, а дополнительными — опросник ABILHAND-kids, тест «Кубики в коробке» и динамометрия кисти. Результаты. Статистически достоверное улучшение на 14,9 ± 38,0 секунды было обнаружено при выполнении теста Джебсена — Тэйлора для доминантной руки. Изменения теста «Кубики в коробке» также были статистически достоверными и составляли 2,0 ± 3,7 пункта для доминантной руки и 1,8 ± 2,8 пункта — для недоминантной. Сила руки не изменилась; увеличение оценки по опроснику ABILHAND-kids не было статистически достоверным. Выводы. После двухнедельного курса лечения по методу Козявкина у детей с церебральным параличом улучшились функции руки, в частности ловкость обеих рук и функционирование доминантной руки.

Personality Profile in Focal Hand Dystonia: A Cross-Sectional Study.

It has been suggested that focal hand dystonia (FHD) should be viewed as a neuropsychiatric disorder rather than as a pure movement disorder. We aimed to compare the personality factors that are common to people with FHD and evaluate how personality factors could affect the functionality of the upper limbs and community participation. We conducted a cross-sectional case–control study in which 12 people with FHD were matched with 12 age and gender matched healthy control participants. The Big Five Questionnaire; the Quick Disabilities, Arm, Shoulder, and Hand questionnaire; and the Jebsen–Taylor Test of Hand Function were used as assessment measures. Control of emotions was the only variable for which a significant difference was found, with participants with FHD displaying lesser control. Correlations were not observed between different personality profiles, the functionality of the upper limbs and the perceived participation of people with FHD in activities of daily living. People with FHD may present with low emotional stability, but this does not have a negative impact on the functionality of the upper limbs and activities of daily living. These findings have clinical implications to be considered for interventions, as they suggest that personality aspects, such as extraversion, may not predict for better functionality and perceived participation in activities of daily living.

Assessment of the upper limb of the tetraplegic patient

The aim of our study is to describe the assessment of the upper limb in tetraplegic patients to follow his (her) neurological progression and to define the medical or surgical treatment program. We selected upper limb assessment tools and scales for tetraplegic patients described in the medical literature through a PubMed search over the last four decades. For each method, we present the implementation rules and its metrological properties, including its validity in French. We selected five clinical scales for functional evaluation of grasping, as well as four scales for evaluating the overall function of these patients. Finally, we identified three complementary precision assessment tools. The AIS (ASIA Impairment Scale) classification describes the level and the severity of the spinal cord lesion. The Giens classification is more practical for describing the upper limb in middle and low tetraplegia. Impairments can be assessed with most common generic scales and nonspecific measurement devices: range of motion, strength, sensory loss, spasticity, joint pain. Measurement of pinch and grip strength is widely used and easy to perform. The Capabilities of Upper Extremity (CUE) and the Jebsen Taylor Test are the best validated and usable scales. At a general functional level, the Spinal Cord Independence Measure (SCIM) is the most relevant scale in these patients. Motor nerve blocks, electromyography, movement analysis and echography are promising additional methods. Assessment of the upper limb of tetraplegic patients relies both on generic and specific assessment tools and scales.

Intensive Bimanual Intervention for Children Who Have Undergone Hemispherectomy: A Pilot Study.

To conduct a pilot study to assess the feasibility and effectiveness of an intensive bimanual intervention on upper limb function in children who have undergone hemispherectomy. Thirteen children received 90 hours of intensive bimanual training (Hand-Arm Bimanual Intensive Therapy, HABIT). The Jebsen-Taylor Test of Hand Function (JTTHF), Box and Block Test (BBT), Assisting Hand Assessment (AHA), ABILHAND-Kids, and Canadian Occupational Performance Measure (COPM) were assessed by a masked clinician twice before, immediately, and 6 months after treatment. Significant improvements over time were found in the JTTHF, AHA, ABILHAND-Kids, and COPM. Completion of HABIT was feasible for children with hemispherectomy. Improvement of bimanual function and functional goals can be related to the nature of the activities prioritized in HABIT training.

Corpus Callosum Integrity Relates to Improvement of Upper-Extremity Function Following Intensive Rehabilitation in Children With Unilateral Spastic Cerebral Palsy

Background The corpus callosum (CC) plays an important role in upper extremity (UE) function. The impact on UE function in children with unilateral spastic cerebral palsy (USCP) and improvements following intensive interventions remain unknown. Objectives To examine the (1) relationship between UE function and CC integrity and (2) relationship between CC integrity and changes in UE function following intensive interventions. Methods We retrospectively analyzed clinical and neuroimaging data from a sample of convenience of 44 participants (age 9.40 ± 3.10 years) from 2 larger trials. Participants received 90 hours of Hand-Arm Bimanual Intensive Therapy (HABIT) or Constraint-Induced Movement Therapy (CIMT). Unimanual dexterity (Jebsen-Taylor Test of Hand Function [JTTHF]) and bimanual performance (Assisting Hand Assessment [AHA]) were assessed preintervention and postintervention. CC tractography was reconstructed with diffusion tensor imaging (DTI) and segmented into 3 regions (genu, midbody, splenium). Pearson correlations and regression were used to assess the relationship between outcomes and DTI parameters (ie, fractional anisotropy [FA], number of streamlines, and mean, radial, and axial diffusivity). Results Both groups improved in bimanual performance (P < .01). The CIMT group improved in unimanual dexterity (P < .01). Baseline unimanual dexterity and bimanual performance correlated with FA and number of streamlines for most CC regions (P < .05). Following CIMT, pre-post changes in JTTHF were negatively correlated with axial and radial diffusivity of the CC, and AHA with splenium and number of streamlines for the CC, midbody, and splenium (all P < .05). Following HABIT, midbody FA was positively correlated with pre-post AHA changes (r = 0.417; P = .042). Conclusions CC integrity is important for UE function in children with USCP.

Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial.

Background/Objectives: Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP. Prior studies have suggested that children with an ipsilateral CST controlling the affected UE may improve less following CIMT than children with a contralateral CST. We tested the hypothesis that improvements in UE function after intensive training depend on CST laterality.Study Participants and Setting: Eighty-two children with USCP, age 5 years 10 months to 17 years, University laboratory setting.Materials/Methods: Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST connectivity pattern. Children were stratified by age, sex, baseline hand function and CST connectivity pattern, and randomized to receive either CIMT or Bimanual training, each of which were provided in a day-camp setting (90 h). Hand function was tested before, immediately and 6 months after the intervention with the Jebsen-Taylor Test of Hand Function, the Assisting Hand Assessment, the Box and Block Test, and ABILHAND-Kids. The Canadian Occupational Performance Measure was used to track goal achievement and the Pediatric Evaluation of Disability Inventory was used to assess functioning in daily living activities at home.Results: In contrast to our hypothesis, participants had statistically similar improvements for both CIMT and Bimanual training for all measures independent of their CST connectivity pattern (contralateral, ipsilateral, or bilateral) (p < 0.05 in all cases).Conclusions/Significance: The efficacy of CIMT and Bimanual training is independent of CST connectivity pattern. Children with an ipsilateral CST, previously thought to be maladaptive, have the capacity to improve as well as children with a contralateral or bilateral CST following intensive CIMT or Bimanual training.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02918890.

Intermanual Transfer Effects on Performance Gain Following Dominant Hand Training in Community-Dwelling Healthy Adults: A Preliminary Study.

PurposeThis study aimed to evaluate the intermanual transfer effects of dominant hand training on the functional task of the untrained hand.MethodsFifty community-dwelling healthy adults (mean age, 23.4 ± 2.5 Y; females, 60%) were participated. Participants in the experimental group received 15 minutes of right-hand training on a pegboard apparatus twice a week for four weeks. The control group received no training. The Jebsen Taylor test (JTT) and a 16-hole pegboard test were used for the assessment of hand function and dexterity.ResultsMost of the JTT subtests except the writing and simulated feeding subtests and the performance of pegboard task by untrained hand were significantly improved in the experimental group after 4 weeks of training. However, no changes in the untrained hand function after 4 weeks in the control group. There were no significant differences in the pegboard task and JTT subtests found at baseline between the two groups. There were significant differences in the pegboard task between the two groups after dominant hand training. The experimental group took 4.3- and 2.5-second lesser time to complete the pegboard task using the dominant and non-dominant hand, respectively. Similarly, most of the JTT subtests except the writing and simulated feeding subtests were significantly better in the training group than the control group.ConclusionThis study indicates that the function of the untrained non-dominant hand may be improved after functional training of the dominant hand. Since this study included only healthy young adults, results of this study cannot be generalized to other groups of people such as the elderly. While this study suggests that intermanual transfer could have a therapeutic value in many clinical situations, more longitudinal studies are warranted to examine the intermanual transfer effects of functional gain in different clinical conditions, such as stroke, parkinsonism, rheumatoid arthritis, and so on.

Motor Compensation Strategies for Reduced Upper Limb Function Among Individuals With Duchenne Muscular Dystrophy.

The purpose of this longitudinal study was to identify and verify the compensatory motor strategies for upper limb functioning of individuals with Duchenne Muscular Dystrophy (DMD). We evaluated 32 patients diagnosed with DMD (aged 6-19 years) for cognitive and motor functioning using the Mini Mental State Examination (MMSE), Vignos Scale Jebsen Taylor Test (JTT) and Functional Skill Scale (FSS) at baseline testing and over retest intervals of six and 12 months. We used the MMSE to screen participants for capacity to engage in the research, and we analyzed absolute and percentile changes in the frequency distribution of motor strategies participants used on each JTT subtest. We also used analysis of variance with repeated measures and Bonferroni post-hoc testing of multiple comparisons to identify disease progression through FSS scores. We observed an increased frequency of compensatory motor strategies over six months. We recommend the associated use of the JTT and FSS to assess patients with DMD, since we observed worsened movement quality over a time interval of six months even while essential motor competence was maintained.

Trunk Control and Upper Limb Function of Walking and Non-walking Duchenne Muscular Dystrophy Individuals

ABSTRACT Aim: To verify and compare trunk control and upper limb functionality (ULs) in walking and non-walking DMD individuals, with that of individuals without dystrophinopathies.Method: Cross-sectional study, with children without dystrophinopathy (healthy control group) and in walking and non-walking DMD children evaluated by the following scales: Segmental Control Evaluation Trunk (SATCo); Performance of Upper Limb (PUL) and Jebsen-Taylor Test (JTT).Results: There was a difference between the groups in trunk control and ULs function by the PUL scale, but there was no difference between walking and the reference group in all JTT subtests; The JTT writing subtest was not different between groups. There was a strong correlation between PUL and SATCo, both had a strong correlation with disease staging and a weak correlation with JTT.Conclusions: There is relevance to the evaluation of trunk control and ULs function of walking and non-walking DMD.

The use of transdermal electroneurostimulation in the rehabilitation of patients after surgical decompression of the carpal tunnel

To study the effectiveness of transdermal electroneurostimulation (TENS) in the rehabilitation of patients with residual neurological deficit after surgical DCT. We observed 45 patients after DCT (6-12 months), aged 30 to 50 years (mean age 42±3 years). All patients were diagnosed with primary carpal tunnel syndrome with a lesion of the dominant hand, of which 15 patients received pharmacotherapy; 15 patients - in addition to pharmacotherapy, received a course of low-frequency high-amplitude TENS (NTENS) and 15 patients - a course of high-frequency low-amplitude TENS (VTENS). The regression of positive sensory symptoms was more pronounced against the background of VTENS and NTENS than after the use of pharmacotherapy, on average 6.6 times (p<0.01). At the same time, VTENS turned out to be more effective than NTENS by 28.5% (p<0.05). In the long-term follow-up period (2 months), the severity of positive sensory symptoms decreased in patients who received VTENS and NTENS, by an average of 58.1% compared with the baseline values before treatment (p<0.05). The severity of Tinel's symptom in patients who received a course of VTENS decreased by 44%, after a course of NTENS - by 67%, and after pharmacotherapy - by 14%. It was found that NTENS compared with VTENS was 51% more effective in reducing Tinel's symptom (p<0.05) and by 64% - Falen's symptom (p<0.05). The decrease in the time to perform the Jebsen-Taylor test (JTT) after the use of pharmacotherapy was on average 9% (p>1.00), and after TENS - 23% (p<0.05). When comparing VTENS and NTENS among themselves, NTENS turned out to be more effective on average by 68% (p<0.05). An improvement in electro-kymographic parameters was revealed only after the use of VTENS. At the same time, the decrease in the residual latency was 21.3% and the increase in the amplitude of the M-response was 14.3%. Transdermal electroneurostimulation is a highly effective method used in the complex treatment of patients with residual neurological disorders after undergoing surgical decompression of the carpal tunnel. The maximum regression of positive sensory symptoms develops against the background of high-frequency low-amplitude transcutaneous electroneurostimulation, and the maximum anti-inflammatory effect, the greatest improvement in the function of small hand muscles and statistically significant neurophysiological restoration of the function of the median nerve are revealed after the application of a course of low-frequency high-amplitude transcutaneous electroneurostimulation. At the same time, positive dynamics after low-frequency high-amplitude transcutaneous electroneurostimulation and high-frequency low-amplitude transcutaneous electroneurostimulation persists in the long-term period.

Hand-arm bimanual intensive therapy and daily functioning of children with bilateral cerebral palsy: a randomized controlled trial.

To examine the efficacy of Hand-Arm Bimanual Intensive Therapy (HABIT) on daily functioning, unimanual dexterity, and bimanual performance of children with bilateral cerebral palsy (CP) compared with customary care. Forty-one children with bilateral CP, aged 4 to 16 years, classified in levels I to III of the Manual Ability Classification System, were randomly assigned to HABIT (90h) (n=21) or to customary care (4.5h) (n=20). Participants' daily functioning (Pediatric Evaluation of Disability Inventory [PEDI], Canadian Occupational Performance Measure [COPM]), unimanual dexterity (Jebsen-Taylor Test of Hand Function, Box and Blocks Test [BBT]), and bimanual performance (Both Hands Assessment) were assessed pre-, post-, and 6months after the intervention. Linear mixed-effects models were used for inferential analysis. Children participating in HABIT showed greater improvements in daily functioning (COPMperformance : =9.50, p<0.01; COPMsatisfaction : =5.07, p<0.05; PEDIfunctional skills : =6.81, p<0.01; PEDIcaregiver assistance : =6.23, p<0.05) and in the dexterity of the dominant hand (BBT: =3.99, p<0.05) compared with children maintaining customary care. Group or time effects did not explain any variance in bimanual performance or in the dexterity of the non-dominant hand. HABIT may be beneficial for children with bilateral CP, with benefits evidenced for daily functioning outcomes. Hand-Arm Bimanual Intensive Therapy (HABIT) improved daily functioning of children with bilateral cerebral palsy (CP). Bimanual performance, measured by the Both Hands Assessment, did not change after HABIT in children with bilateral CP. Children with asymmetric and symmetric hand use exhibited similar improvements after HABIT.