Limb Impairment In Patients Research Articles

Artificial Intelligence machine learning and conventional physical therapy for upper limb outcome in patients with stroke: a systematic review and meta-analysis.

The goal of this study was to compare the effect of different artificial intelligence (AI) machine learning and conventional therapy (CT) on upper limb impairments in patients with stroke. PubMed, PubMed Central, Google Scholar, MEDLINE, Cochrane Library, Web of Science, Research Gate, and Wiley Online Library were searched. Descriptive statistics about variables were reported to calculate standardized mean differences in outcomes of motor control (the primary outcome), functional independence, upper extremity performance, and muscle tone. The Physiotherapy Evidence Database (PEDro) Scale was used to assess qualitative papers. The primary outcomes of AI and CT have been included in the meta-analyses. Ten papers with a total of 481 stroke patients were included and upper limb rehabilitation, upper limb functioning, and basic manual dexterity were examined. The heterogeneity test of the whole included measures (I2=45%) was medium. There were significant differences between the included measures (p-value=0.03) with a total SMD of 0.10 [0.01, 0.19]. According to the test for subgroup difference, it was found that there was a highly significant difference between the subgroups of the included measures (p-value=0.01) and the heterogeneity test (I2=59.8%). AI is a feasible and safe method in post-stroke rehabilitation and improves upper-extremity function compared to CT. Significant AI post-treatment effects on upper-limb impairments have been observed. The findings showed that higher-quality evidence was detected in six assessment scales. However, a lower quality of evidence was detected in other scales. This indicated large or very large and consistent estimates of the treatment effects, and researchers were confident about the results. Therefore, the included observational studies are likely to provide an overestimate of the true effect.

Reliability and Validity of a New Diagnostic Device for Quantifying Hemiparetic Arm Impairments: An Exploratory Study.

ObjectiveTo assess test-retest reliability and validity of a new diagnostic device, the Shoulder Elbow Perturbator, to quantify muscle weakness, abnormal synergy, (muscle activity-related) spasticity, and changes in viscoelastic joint properties of the elbow.SubjectsStroke patients, adults with cerebral palsy and healthy controls.MethodsTest-retest reliability was evaluated using intra-class correlations (ICC) and assessment of measurement error. The device’s validity was evaluated by demonstrating differences between patients and healthy controls, and correlations of spasticity and abnormal synergy outcomes using the clinical Modified Tardieu Scale, the Fugl-Meyer Assessment, and the Test of Arm Selective Control.ResultsReliability was excellent, with an ICC > 0.75 for synergy and ICCs > 0.90 for all other impairments, with relatively small measurement errors. Validity was confirmed by group differences between patients and healthy controls for muscle weakness, spasticity, and viscoelastic joint properties, but not for abnormal synergy. Correlation analysis with clinical scales confirmed validity for spasticity, while, for synergy, correlations were found in the patients with stroke, but not those with cerebral palsy.ConclusionThis new diagnostic device is a reliable and valid instrument to assess multiple upper limb impairments in patients with neurological conditions, supporting its use in clinical practice. Further studies are needed to confirm these findings.LAY ABSTRACTReliable and valid quantitative measurement of arm impairments due to neurological conditions is important for clinical decision-making. Current clinical measurement tools are subjective and not reliable. The aim of this study was therefore to assess the reliability and validity of a new diagnostic device to quantify multiple arm impairments (muscle weakness, abnormal synergy, spasticity, changes in viscoelastic joint properties) in patients with stroke, adults with cerebral palsy (CP), and healthy controls. Reliability was excellent for all impairments and was analysed by testing the consistency of the results on 2 occasions in the same subject. Validity was confirmed by group differences between patients and healthy controls for all impairments, except for synergy. Also, correlations of the results with clinical measurement tools were found for spasticity and synergy, except for synergy in patients with CP. In conclusion, this new diagnostic device is a reliable and valid instrument to assess multiple impairments of the elbow in patients with neurological conditions. Further studies are needed to confirm these findings.

Approaches for improvement of upper limb impairment in patients with cerebrovascular disorders

Approaches for improvement of upper limb impairment in patients with cerebrovascular disorders

The Effects of Mirror Therapy on Upper Limb after Stroke: A Mini-Review

Stroke is one of the leading causes of disability and the improvement of upper limb function is one of the main challenges faced by them. Mirror therapy utilizes a table top mirror to create a reflection of one’s arm or hand, which used to help increase movement and decrease pain in limbs. The purpose of this current article is to review and collect the evidence for the effects of mirror therapy on upper limb impairment in patients with different stroke stages. Studies suggest that applied mirror therapy alone, or coupled with different methods such as electrical stimulation, can be helpful to improve motor recovery, motor performance, motor function, and activity of daily living.

Robot-assisted arm training for treating adult patients with distal radius fracture: a proof-of-concept pilot study.

Fracture of the distal radius is a common wrist injury. As to its management after orthopedic (conservative or surgical) treatment, there is weak evidence for conventional rehabilitation interventions. Despite the increasing interest for robot-assisted arm therapy as to neurological disabilities and its growing diffusion in rehabilitation facilities, no previous study investigated the feasibility of robotic training on arm orthopedic impairment. To evaluate the feasibility in terms of efficacy of robot-assisted arm training on upper limb impairment in patients with fracture of the distal radius. Proof-of-concept, pilot, randomized controlled trial. University hospital. Twenty adult outpatients with distal radius fracture due to wrist injury. All participants underwent ten, 1-hour (40 minutes of arm training + 20 minutes of conventional occupational therapy) training sessions, five days a week for two consecutive weeks. They were randomly assigned to two groups: patients allocated to the Robotic Arm Training group received arm training by means of a robotic device and patients allocated to the Conventional Arm Training group performed arm training following a conventional rehabilitation program. All patients were evaluated before, immediately after treatment and at four weeks of follow-up. The following outcomes were considered at the affected arm: forearm pronation/supination and wrist extension/flexion passive and active range of motion; maximal pinch and grip strength; the Patient-Rated Wrist and Hand Evaluation. No difference was found between groups as to the primary (wrist active and passive range of motion) and secondary (pinch and grip strength; Patient-Rated Wrist and Hand Evaluation Score) outcomes at all time points. Within-group comparisons showed similar improvements at all time points as to all outcomes considered in both groups. Our preliminary findings support the hypothesis that robot-assisted arm training might be a feasible tool for treating upper limb impairment in adult patients with distal radius fracture treated conservatively or surgically. The treatment of arm impairment consequent to distal radius fractures by means of robot-assisted arm training may allow therapists to focus on functional rehabilitation during occupational (individual) therapy and supervise (more than one) patients simultaneously during robotic training sessions.

Effects of modified-release fampridine on upper limb impairment in patients with Multiple Sclerosis

BackgroundModified-release 4-aminopyridine (fampridine-MR) is used in the symptomatic treatment of walking disability in patients with multiple sclerosis (MS). Its potential for use in other MS symptoms remains unproven and its mode of action in this context is uncertain. Interest is growing in the use of upper limb outcome measures in clinical trials in patients with Multiple Sclerosis, particularly in advanced or progressive disease. This study tests the following hypotheses: (1) Fampridine-MR improves upper limb function in patients with MS and upper limb impairment. (2) Treatment with fampridine-MR is associated with measurable alterations in objective electrophysiological parameters (evoked potentials and transcranial magnetic stimulation (TMS)) which may predict response to drug treatment. MethodsStudy population: patients with MS of any disease subtype, duration and severity who have symptomatic impairment of one or both upper limbs. A healthy control group was included for validation of clinical and electrophysiological measures. Study design: randomised double blind placebo-controlled trial. Treatment details: participants allocated to either fampridine-MR 10 mg bd or placebo of identical appearance for 8 weeks. Primary outcome: performance on 9-hole peg test (9HPT) after 4 weeks. Secondary outcomes: persistence of effect on 9HPT; grip strength; visual acuity and contrast sensitivity; modified fatigue impact scale score; sensory discrimination capacity; visual, somatosensory and motor evoked potentials; resting motor threshold; paired-pulse TMS; peripheral nerve conduction studies. Results40 patients with MS (60% female, median age 52, median disease duration 13.5 years, median EDSS 6.0) were enrolled. Treatment with fampridine-MR was not associated with any change in upper limb function as measured by the clinical primary or secondary outcomes. Treatment with fampridine-MR was also not associated with any difference in electrophysiological measures of upper limb function. This held true after adjustment for hand dominance, disease duration and severity. Four patients withdrew from the trial because of lack of efficacy or side-effects; all were in the placebo arm. Three patients were admitted to hospital during the study period; one with MS exacerbation (placebo group), one with syncope (drug group) and one with UTI (drug group); otherwise there were no serious adverse events. ConclusionTreatment with fampridine-MR was well-tolerated but did not produce clinical benefit in terms of upper limb function, vision or fatigue, nor was there any measurable effect on objective electrophysiological parameters.

Daily repetitive sensory stimulation of the paretic hand for the treatment of sensorimotor deficits in patients with subacute stroke: RESET, a randomized, sham-controlled trial

BackgroundRepetitive sensory stimulation (RSS) adapts the timing of stimulation protocols used in cellular studies to induce synaptic plasticity. In healthy subjects, RSS leads to widespread sensorimotor cortical reorganization paralleled by improved sensorimotor behavior. Here, we investigated whether RSS reduces sensorimotor upper limb impairment in patients with subacute stroke more effectively than conventional therapy.MethodsA single-blinded sham-controlled clinical trial assessed the effectiveness of RSS in treating sensorimotor deficits of the upper limbs. Patients with subacute unilateral ischemic stroke were randomly assigned to receive standard therapy in combination with RSS or with sham RSS. Patients were masked to treatment allocation. RSS consisted of intermittent 20 Hz electrical stimulation applied on the affected hand for 45 min/day, 5 days per week, for 2 weeks, and was transmitted using custom-made stimulation-gloves with built-in electrodes contacting each fingertip separately. Before and after the intervention, we assessed light-touch and tactile discrimination, proprioception, dexterity, grip force, and subtasks of the Jebsen Taylor hand-function test for the non-affected and the affected hand. Data from these quantitative tests were combined into a total performance index serving as primary outcome measure. In addition, tolerability and side effects of RSS intervention were recorded.ResultsSeventy one eligible patients were enrolled and randomly assigned to receive RSS treatment (n = 35) or sham RSS (n = 36). Data of 25 patients were not completed because they were transferred to another hospital, resulting in n = 23 for each group. Before treatment, sensorimotor performance between groups was balanced (p = 0.237). After 2 weeks of the intervention, patients in the group receiving standard therapy with RSS showed significantly better restored sensorimotor function than the control group (standardized mean difference 0.57; 95% CI -0.013–1.16; p = 0.027) RSS treatment was superior in all domains tested. Repetitive sensory stimulation was well tolerated and accepted, and no adverse events were observed.ConclusionsRehabilitation including RSS enhanced sensorimotor recovery more effectively than standard therapy alone. Rehabilitation outcome between the effects of RSS and standard therapy was largest for sensory and motor improvement; however, the results for proprioception and everyday tasks were encouraging warranting further studies in more severe patients.Trial registrationThe trial was retrospectively registered January 31, 2012 under DRKS00003515 (https://www.drks.de/drks_web/navigate.do;jsessionid=AEE2585CCB82A22A2B285470B37C47C8?navigationId=results).

Novel kinematic indices for quantifying upper limb ability and dexterity after cervical spinal cord injury.

Loss of motor function is a consequence after cervical spinal cord injury. Three-dimensional kinematic analysis equipments are used for quantifying human movements in clinical laboratories. These systems may provide objectivity to the patient assessments. Nowadays, the kinematic variables found in the literature have some deficiencies, and the efficient management of these data sets is a demand and a challenge in the clinical setting. The aim of the present paper is to propose a set of novel kinematic indices, as a combination of kinematic variables, for quantifying upper limb motor disorders in terms of characteristics in relation to ability and dexterity such as accuracy, efficiency, and coordination. These indices are defined for measuring patients' motor performance during the activity of daily living of drinking from a glass. This task is included within the upper limb rehabilitative process that patients receive. The main contribution of this research, with the aim of detecting upper limb impairments in patients, consists of the proposal of three kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.

49.: The fampridine upper limb study (FULS)

Modified-release 4-aminopyridine (fampridine) is licensed in Australia for the symptomatic treatment of walking disability in patients with multiple sclerosis (MS). Its potential for use in other neurological domains, its mode of action, and the reasons for widely variable responses in treated patients remain unknown. This study aims to test the following hypotheses: (1) modified-release fampridine is associated with improvements in upper limb impairment in patients with multiple sclerosis, and (2) objective electrophysiological measures differ between patients on and off treatment, and can potentially be used to differentiate clinical responders and non-responders. We conducted two substudies. Substudy 1 is a randomised, double-blind, placebo-controlled trial in patients with MS and upper limb impairment. Clinical and electrophysiological measurements are made at baseline, conclusion and on three occasions while participants are taking fampridine-modified release or placebo. Substudy 2 is a single-blind study in patients already taking fampridine for walking disability. Clinical and electrophysiological measurements are made in patients while on (twice) and off (once) the drug by a blinded assessor. Clinical measurements are nine-hole peg test, upper limb grip strength, sensory discrimination capacity, visual acuity and contrast sensitivity, and modified fatigue impact scale. Electrophysiological measurements were resting motor threshold, motor evoked potential recruitment curves, short interstimulus intervals paired pulse transcranial magnetic stimulation (TMS), median nerve somatosensory evoked potentials, visual evoked potentials, and median nerve conduction study. The primary outcome measure is clinical response to fampridine as measured by performance on the nine-hole peg test. Secondary outcome measures are correlation between clinical and electrophysiological measures in responders as compared with non-responders, changes in upper limb grip strength, visual acuity and sensory discrimination capacity, and changes in modified fatigue impact scale score. Our hypothesis is that clinical responders to fampridine will show increased motor pathway recruitment and cortical excitability with TMS measures, with improvements in latency and amplitude of evoked potential responses. This novel study seeks to determine whether fampridine can have beneficial effects in domains other than ambulation. By combining clinical and electrophysiological measures, we seek to better understand the mode of action of fampridine as a symptomatic therapy for MS and the reasons for the wide observed variation in clinical response.

Severity of patellofemoral joint disease is associated with increased functional limitations and lower limb impairments in patients with coexisting tibiofemoral osteoarthritis

Purpose: Although the knee joint is comprised of both the tibiofemoral and the patellofemoral joints, knee osteoarthritis (OA) has primarily been viewed as a disorder of the tibiofemoral joint alone. Therefore, the potential impact of coexisting patellofemoral joint disease has gone largely unconsidered. As such, it is currently unclear to what extent the severity of patellofemoral joint disease is associated with the symptoms, functional limitations, and lower limb physical impairments attributed to knee OA. The purpose of the present study was to compare the knee related functional limitations and lower limb physical impairments between individuals with tibiofemoral OA who have minimal patellofemoral joint disease and those presenting with tibiofemoral OA who have more advanced patellofemoral joint disease. Methods:Asecondaryanalysis of baseline data for 167 subjects (55men; 112 women) participating in a randomized clinical trial of exercise therapy for knee OA was performed. Subjects were included in the analysis if they met the American College of Rheumatology clinical criteria for knee OA as well as having a Kellgren & Lawrence (KL) radiographic grade of 2 or greater for tibiofemoral OA. Subjects with tibiofemoral OA were subsequently divided into two groups of minimal patellofemoral joint disease (KL grade 0-2 for patellofemoral joint; N1⁄496), mean age 63.8 9.1 yr, height 168.0 9.6 cm, body mass 84.2 19.0 kg, body mass index 29.8 6.4; or moderate to severe patellofemoral joint disease (KL grade 3-4 for patellofemoral joint; N1⁄471) age 63.8 8.7 yr, height 167.8 9.3 cm, body mass 89.6 17.4 kg, body mass index 31.9 6.1. The 24-itemWesternOntario andMcMaster Universities (WOMAC)OA Index and the 14-itemActivities of Daily Living Scale of the Knee Outcome Survey (ADLS) were used to gather information on pain and limitations during performance of specific functional tasks. Pain and functional limitations reported on the individual WOMAC and ADLS items were then dichotomized as normal/mild or moderate/extreme. The association of eachWOMAC and ADLS individual itemwith severity of patellofemoral disease was examined by multiple logistic regression adjusted for age and BMI. Additionally, independent sample t-testswere used to evaluate between-group differences in quantitative knee extension strength and knee range of motion. Results: More severe patellofemoral joint disease was associated with moderate/extreme limitations with going down stairs (OR 1⁄4 2.8; 95% CI: 1.4 to 5.6) and kneeling on the front of the knee (OR1⁄4 2.6; 95%: CI 1.2 to 5.8). In addition, moderate/extreme pain with going up and down stairs (OR 1⁄4 2.2; 95% CI: 1.1 to 4.0) was associated with more advanced patellofemoral joint involvement. Patients with severe patellofemoral joint disease also demonstrated decreased knee extension strength (4.0 1.8 Nm/BMI vs. 5.0 1.8 Nm/BMI; p<0.001) along with more pronounced range of motion limitations in Knee flexion (126.8 10.9 vs. 132.9 10.3 ; p<0.001) and knee extension (-6.0 6.1 vs. -4.4 5.7 ; p1⁄40.04). Conclusions: Coexistence of moderate to severe patellofemoral joint disease along with tibiofemoral OA appears to be associated with increased pain and difficulty with negotiating stairs and kneeling, as well as decreased knee extension strength and range of motion. Thus, specific treatment strategies targeting the patellofemoral joint may be needed if these specific functional problems and lower limb impairments are to be mitigated. Further efforts on clinical recognition of coexisting patellofemoral and tibiofemoral OA may be warranted.

Somatosensory evoked potentials reflect the upper limb motor performance in multiple sclerosis

Objective The aim of this multicentric study was to multidimensionally evaluate the relationship among somatosensory evoked potentials (SEPs) parameters, patient's perspective and clinical measures of the upper limb impairment in patients with multiple sclerosis (MS). Methods We consecutively enrolled 39 MS patients. For median nerve SEPs we acquired the N9, P14, N20 responses and the N9–P14 and P14–N20 interpeak latencies on the dominant side. We also used a validated patient-oriented questionnaire (Disabilities of the Arm, Shoulder and Hand — DASH) and a test of dexterity quantification as the 9-Hole Peg Test (9-HPT). Results A significant longer time to complete the 9-HPT ( p < 0.00006) was observed in patients with abnormal SEPs. Patients with undetectable N20 or P14 responses performed the 9-HPT in a significant longer time than patients with detectable responses ( p < 0.0006 and p < 0.001 respectively). Concerning the perspective of patient (evaluated with the DASH questionnaire) significant differences in patients with undetectable P14 response ( p < 0.01) were observed. Conclusions Our data provide further information useful for interpretation of SEPs results, being the median nerve SEPs related to the upper limb performance in MS patients. Significance These data increase the significance of SEPs both in clinical practice and in experimental studies in MS.