Manual Function Test Research Articles

Essential Medical Information for Stroke Patients Undergoing Interhospital Transfer: A Delphi Study.

For improving the efficiency of transferring medical records for stroke patients undergoing interhospital transfer, we evaluated what is the essential medical information for physicians using the Delphi method. We set up an expert panel of 31 physiatrists, who participated in this study. The 32 preliminary items of the transferred medical information were listed by a physiatrist for the first round of the Delphi method, and degree of necessity for these 32 items was evaluated using a 3-point scale ("very necessary," "necessary," and "not necessary"). We considered "very necessary" and "necessary" as "agreed to its necessity." According to the Delphi method, a satisfactory level of consensus can be achieved with the agreement of significant majority (≥80%) in the expert panel. Based on the experts' feedback, some items were added as the preliminary items. After the second round of the Delphi method, the items confirmed to be necessary information during interhospital transfer were motor and sensory evoked potentials, Barthel Index, Mini-Mental State Examination/Global Deterioration Scale, Motor-Free Visual Perception Test, Manual Function Test, Purdue Pegboard Test, hand grip power, monofilament, 2-point discrimination test, Manual Muscle Test, Nottingham Scale, modified Brunnstrom Classification, functional ambulation category, Glasgow Coma Scale, language function test, imaging study, videofluoroscopic swallowing study, rehabilitation goal, previous medical history, comorbidity, and medication information. If the previously mentioned necessary items are presented together at once during interhospital transfer, physicians who receive new stroke patients can evaluate patients' medical information more easily and completely.

Developing an anti-spastic orthosis for daily home-use of stroke patients using smart memory alloys and 3D printing technologies

Spasticity is an important factor limiting independency and activity of daily living for post-stroke patients. Our aim was to develop a cost effective, customized, lightweight active orthosis, which is convenient for daily home use.The study describes the steps of the development by using cutting edge technologies, as 3D printing for the frame of the device and nitinol smart memory alloy as the active part of the orthosis. Polyamide and thermoplastic polyurethane materials were characterized in terms of mechanical behaviour in different ambient conditions. To access the feasibility of the orthosis 6 voluntary post-stroke patients were asked to test the functionality with manual function test, daily living functionality tests and Likert scale. Movement analysis was used to evaluate the range of movement in the orthosis.The results showed significantly higher functionality by using the orthosis on manual function test, most of the daily functional tests, also the overall personal impressions accessed by Likert scale were positive.The new anti-spastic orthosis is a smart, active, lightweight, personalized device, which seems to be effective help for post-stroke patients to overcome spasticity. According to the initial data it is suitable for home use, therefore offers a convenient solution for advanced rehabilitation.

Effects of Seated Exercise of Thoracic and Abdominal Muscles on Upper Extremity Function and Trunk Muscles Activity in Patients with Chronic Stroke

Background: Weakness of the abdominal and mid thoracic muscles the lead to thoracic kyphosis of stroke patients. The trunk muscles activity of stroke patients is significantly related to upper extremity. Objectives: To investigate the effect of seated exercise of thoracic and abdominal muscles on upper extremity function and trunk muscles activity in stroke patients. Design: One-group pretest-posttest design. Methods: A total of 27 stroke patients were recruited. All stroke patient were given seated abdominal exercise (posterior pelvic tilt exercises) and thoracic exercise (postural-correction exercise). All exercises were conducted for 30 minutes, three times a week for four weeks. The manual function test (MFT) and electromyography (EMG) were measured, and EMG electrodes were attached to thoracic paraspinal muscles and lower rectus abdominal muscles. EMG signal is expressed as %RVC (reference voluntary contraction). Results: Experimental group showed significant increases in abdominal muscles, paraspinal muscles activity and MFT total score, items of arm motion (forward elevation of the upper extremity, lateral elevation of the upper extremity, touch the occiput with the palm) in MFT after four weeks. Conclusion: These results suggest that, in stroke patients, seated exercise of thoracic and abdominal muscles contribute to improve trunk muscles activity and upper extremity function in stroke patients.

The Effect of Action Observation Training Combined with Intrinsic Muscle Stimulation on the Upper Limb of Function in Stroke Patients

Background/Objectives: The aim of this study was to investigate the effect of action observation training combined with intrinsic muscle stimulation intervention on the function of upper extremity in patients with stroke.Method/Statistical Analysis: Twenty-two stroke patients were prospectively randomized to action observation training with intrinsic muscle stimulation group (N = 11) or action observation (N = 11). The upper limb of motor function and sensory function were evaluated before intervention, and intervention was performed 3 times a week, 40 minutes, 4 weeks, and the same evaluation was performed after intervention. The outcome measure was used by manual function test and sensory test.Findings: The results of this study showed that there was a significant difference in the test within the group. There was statistically significant difference in manual function test and sensory test in the inter body test.Improvements/Applications: This study demonstrated that action observation training combined with intrinsic muscle stimulation significantly improves the function of patients with stroke.

Abstract WP199: Change of Corticospinal Tract Integrity and 6-month Motor Outcome After Stroke: DTI Study

Objective: Corticospinal tract (CST) changes with time after stroke. However, few studies have investigated longitudinal change of CST and its relationship with motor outcomes. Primary goal of this study is to investigate the changes of CST after stroke using diffusion tensor image (DTI) and the relationship between CST changes and functional motor outcome in upper and lower extremities at 6 months after onset of stroke. Methods: We collected data from STroke Outcome Prediction (STOP) database that is prospective data collecting system for functional recovery prediction after stroke based on neuroimaging study. Fifty-five patients with first-ever stroke who performed functional assessment and underwent DTI at 30 days and 6 months poststroke were included. Clinical evaluation included Fugl-Meyer Assessment (FMA), Manual Function Test (MFT), Berg Balance Scale (BBS), and Functional Ambulation Category (FAC). DTI parameters were fiber number (FN), average fiber length (AL), fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), radial diffusivity (RD), laterality index (LI) and delta (Δ) changes of these values. Also type of CST by diffusion tensor tractography was included for analysis. Results: FA decreased and diffusivity indices (AD, MD, RD) increased in ipsilesional hemisphere; Decrease of FA and increase of RD were also noted in contralesional side. Type of CST were changed in 19 patients (34.6%). Spearman correlation analysis showed strong correlations between DTI values (FN, AL, FA, RD) and motor outcomes (FMA, MFT, BBS, FAC) at 30 days and 6 months. However, ΔFA or ΔRD did not show significant correlation with Δ changes of motor outcomes. In the CART analysis, overall prediction accuracy of DTI parameters for 6-month motor outcome ranged from 81.8 to 90.9 %. Conclusion: The integrity of CST changed not only on the lesion side but also on contralesional side. Integrity of CST using DTI at early phase of rehabilitation is useful to predict 6-month motor outcome after stroke. Acknowledgement: No potential conflict of interests relevant to this article were reported. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2019R1A2C2003020).

Effects of Action Observation Training with 1 Hz Low Frequency Repeated Transcranial Magnetic Stimulation on Cerebral Cortex Activity and Hand Function in Patients with Ideomotor Apraxia after Stroke

The aim of this study was to investigate the effects of action observation training with low frequency repeated transcranial magnetic stimulation (rTMS) on cerebral cortex activity and hand function in patients with ideomotor apraxia after Stroke. Fourteen patients were randomly divided into two groups which in action observation training (AOT) with 1 Hz low-frequency rTMS and AOT without rTMS. Motor evoked potential (MEP) amplitude and latency were examined by TMS for cerebral cortex activity and hand function was evaluated by manual function test (MFT). As a result, there was a significant difference in MEP amplitude in group, but only AOT with rTMS group was a significant difference in MEP latency and MFT. In addition, there was a significant difference of MEP amplitude, latency and MFT between groups. These results suggest that application of AOT and rTMS can have a positive effect on the recovery of hand function in ideomotor apraxia after patients.

The Effect of Body Image on Functional Ability With Stroke Patients

목적: 뇌졸중 환자의 신체인식을 통한 자신의 신체 이미지 정도가 균형 능력 및 상지 기능에 미치는 영향을 조사하였다. 방법: 대상자 선정기준에 해당되는 뇌졸중 환자 59명을 선정하였다. 연구 대상자의 신체인식을 신체 이미지의 정도로 평가하기 위해 관절 자세 이미지와 압력 이미지로 나누어서 평가하였다. 균형 능력의 평가로는 버그 균형 검사(Berg Balance Test)를 실시하였으며, 상지 기능에 대한 평가로는 상지 기능 검사(Manual Function Test)를 실시하였다. 신체 이미지와 기능적 능력간의 상관성을 알아보기 위해 Pearson 상관분석과 신체 이미지가 기능적 능력에 미치는 영향을 알아보기 위해 회귀분석을 실시하였다. 통계학적 유의수준은 0.05로 설정하였다. 결과: 뇌졸중 환자의 신체인식을 통한 신체 이미지는 관절자세 이미지 중에서 하지 관절 자세의 정도가 균형 능력과 유의한 상관성이 있었고, 상지와 하지 관절 자세의 정도는 상지 및 하지 기능과 모두 유의한 상관성이 있었다(p<.05). 압력 이미지에서는 상지와 하지의 이미지 정도가 균형 능력과 모두 상관성이 있었고(p<.05), 상지 기능은 등, 엉덩이, 발목에서의 압력과 상관성이 있었다(p<.05). 발목 관절에서의 자세 이미지는 균형 능력에 영향을 주고, 등에서의 압력이미지는 상지 기능에 영향을 주는 것으로 나타났다(p<.05). 결론: 본 연구는 뇌졸중 환자의 신체인식을 통한 신체이미지 정도가 균형 및 상지 기능에 미치는 영향을 조사하여 뇌졸중 환자의 신체 인식에 대한 재활 치료에 대한 근거를 마련하였다.The effect of body image on the ability of balance and upper limb function through the body recognition of stroke patients was investigated. Fifty-nine patients with strokes were selected. In order to evaluate the body recognition of the subjects, the subjects were evaluated by dividing the joint posture image and the pressure image. A Berg balance test was performed to evaluate the balance ability, and a manual function test was performed to evaluate the upper extremity function. Pearson correlation analysis and regression analysis were performed to examine the effect of body image on functional ability. The statistical significance level was set to 0.05. The body image through the body recognition of stroke patients was significantly correlated with the balance ability of the lower extremity joint position among the joint position images, and the degree of upper and lower limb joint position was significantly correlated with the upper and lower limb function (p<.05). In pressure images, upper and lower limb images were correlated with balance ability (p<.05), and upper limb function was correlated with pressure in the back, hip, and ankle (p<.05). Postural images in the ankle joint affected balance ability and pressure images in the back affected upper limb function (p<.05). The purpose of this study was to investigate the effects of body image on the balance and upper extremity function of stroke patients.

A New Approach to Transcranial Direct Current Stimulation in Improving Cognitive Motor Learning and Hand Function with the Nintendo Switch in Stroke Survivors.

BackgroundTranscranial direct current stimulation (tDCS) is a noninvasive brain stimulation (NIBS) technique designed to improve cognitive and physical function of stroke survivors. There are many studies being conducted in the search for an effective intervention of tDCS. This study focused on cognitive motor learning in relation to hand function of stroke survivors.Material/MethodsWe enrolled 30 subjects with cognitive and hand function disorders. The participants in each group were inpatients at a hospital in Korea and had undergone neurorehabilitation training (60 min). Groups 1 and 3 had tDCS applied for 20 min, while group 2 received sham tDCS for the same duration. Afterwards, groups 1 and 2 played Nintendo games for 20 min, but group 3 did not. The total intervention period was 40 min/day, 2 days/week, for 8 weeks. The cognitive and hand function of the subjects were assessed using the Trail Making Test (TMT-A, TMT-B), Grip strength, Box and Block Test (BBT), and the Manual Function Test (MFT) before and after intervention.ResultsThe tDCS + Nintendo Switch game group showed significant differences in TMT-A, TMT-B, Grip strength, MFT, and BBT results compared to the other groups between before and after intervention (p<.05).ConclusionsOur results suggest that inclusion of motor tasks with the application of tDCS may be effective in improving cognitive and hand function of stroke survivors.

Effects of adjuvant mental practice using inverse video of the unaffected upper limb in subacute stroke: a pilot randomized controlled study.

Mental practice has shown some positive effects on arm and hand ability and mobility after stroke. This study's objective was to investigate the adjuvant effects of mental practice using an inverse video of the unaffected limb in subacute stroke patients with severe motor impairment on motor improvement, functional outcomes, and activities of daily living. Participants (n = 20) with severe hemiplegia after a unilateral first-ever stroke within 6 months were divided into two groups. The intervention group performed additional mental practice using an inverse video of the unaffected limb for 20 minutes before every session of their rehabilitation program. The primary outcomes were the Fugl-Meyer assessment for the upper extremity (FMA-UE) and manual function test (MFT). Assessments were performed at baseline and after 4 weeks of rehabilitation intervention. Significant differences were found from baseline to postintervention assessments within both groups on FMA-UE and FIM scores, whereas there were no statistically significant differences in mean FMA-UE, MFT, and FIM scores between groups. We cannot draw conclusions about the superiority of adjuvant mental practice training using inverse video compared with conventional occupation therapy alone in subacute poststroke patients.

The effect of motor imagery and mirror therapy on upper extremity function according to the level of cognition in stroke patients.

This study was conducted to investigate the effects of motor imagery (MI) and mirror therapy (MT) on upper extremity function according to the level of cognition in stroke patients. Twenty-four participants who were diagnosed with stroke were divided into a mild cognitive group (n = 12) and a severe cognitive group (n = 12). Then, the two groups were again divided into MI group (n = 6) and MT group (n = 6). The participants were evaluated for function of upper extremity using the Box and Block Test (BBT), the Jebsen-Taylor Hand Function Test (JTHFT), and Manual Function Test (MFT). There were significant differences between the two groups of cognitive function of mild level in the post-test of JTHFT (p < 0.05). In the MI group, significant differences were found in the pre- and post-test scores for all variance (p < 0.05). In the MT group, significant differences were found in the pre- and post-test scores for JTHFT and MFT (p < 0.05). There were significant differences between the two groups of cognitive function of severe level in the post-test of all variances (p < 0.05). Furthermore, in the MT group, significant differences were found in the pre- and post-test scores for all variances (P < 0.05). The results of this study suggest that applying MI to the mild cognitive group is effective and that applying MT to the severe cognitive group is effective.

Predictors of functional and motor outcomes following upper limb robot-assisted therapy after stroke.

Robot-assisted therapy is an effective treatment for stroke patients and has recently gained popularity. Clinicians and researchers are trying to identify predictors to stratify patients for ensuring better stroke rehabilitation outcomes. However, previous studies have reported controversial results regarding the predictors of upper limb recovery after robot-assisted therapy. Our objective was to determine whether the demographic and clinical characteristics of stroke patients influence the motor and functional outcomes after robot-assisted therapy. We conducted a retrospective analysis of 48 hemiplegic patients who performed upper limb goal-directed tasks using RAPAEL Smart Glove (Neofect, Gyeonggi-do, Republic of Korea). Robot-assisted therapy was administered for 5 days a week over 4 weeks, and each session was for 30 minutes. The parameters of the primary outcomes after robot-assisted therapy were measured with the manual function test and functional independence measure. Correlation analysis showed that age, initial cognitive function, and the initial manual function test and the Modified Ashworth Scale for upper extremity scores were significant factors for independently predicting functional outcomes after robot-assisted therapy. Linear regression analysis revealed that the initial Mini-Mental State Examination (P < 0.001) and initial manual function test (P < 0.001) scores were significant predictors of the primary outcomes. In conclusion, our study suggests that stroke patients presenting with less spasticity, better initial cognitive function, and better initial motor function have a significant correlation with the functional outcomes after robot-assisted therapy.

The Effects of Active Shoulder Exercise with a Sling Suspension System on Shoulder Subluxation, Proprioception, and Upper Extremity Function in Patients with Acute Stroke.

BackgroundThe aim of this study was to investigate the effect of active shoulder exercise with a sling suspension system on shoulder subluxation, proprioception, and upper extremity function in patients with acute stroke.Material/MethodsThirty-six patients with acute stroke and shoulder subluxation were randomly assigned into two groups. The study group (n=18) received active shoulder exercise with a sling suspension system, and the control group (n=18) received bilateral arm training for 40 minutes, for five days a week, for four weeks. The outcome measures before and after the intervention included measurement of shoulder subluxation distance, shoulder proprioception, the Fugl-Meyer assessment (FMA) scale, and the manual function test (MFT).ResultsComparison of the study group with the control group showed significant differences in all outcome scores post-intervention (p<0.05). The study group had significant improvement in shoulder subluxation distance, shoulder proprioception, the FMA score, and the MFT compared with the control group. There was a significant difference in shoulder subluxation (p=0.001), shoulder proprioception (p=0.046), the FMA score (p=0.002), and the MFT (p=0.007) between the two groups, which favored the study group.ConclusionsActive shoulder exercise with a sling suspension system may be effective in reducing shoulder subluxation, improving proprioception, and upper extremity function in patients following acute stroke.

Effects and safety of combined rTMS and action observation for recovery of function in the upper extremities in stroke patients: A randomized controlled trial.

Repetitive transcranial magnetic stimulation (rTMS) modulates cortical excitability and facilitates motor learning to improve motor recovery after stroke. Action observation (AO) therapy effectively facilitates physical training for motor memory formation. To compare the effectiveness of rTMS alone with that of combined rTMS and AO for the functional recovery of upper extremity function in subacute stroke patients and to verify the safety of the interventions. The present study was a prospective, randomized controlled trial involving subacute unilateral stroke patients. In total, 22 patients were randomly assigned to 2 groups: the trial group (rTMS with AO) and the control group (rTMS alone). Both groups received 1 Hz rTMS (intensity: 120% of resting motor threshold; rMT) over the contralesional primary motor cortex for 20 minutes on 10 consecutive days. Trial group received rTMS while watching a video of 5 different complex hand movements. The functional parameters were the Brunnstrom stage, Fugl-Meyer assessment (FMA) score of the upper extremity, Manual Function Test (MFT) score, and grip power. The following motor evoked potential (MEP) parameters were recorded from the abductor pollicis brevis muscle: rMT, latency, and amplitude. Both parameters were measured before and after the 2 week intervention. After the 2 week trial, the total FMA and MFT scores were significantly improved in both groups, but the MFT subscores of hand motor function and grip power were significantly improved in the combination therapy group only. In contrast, the changes (Δ) of FMA, MFT, grip power test, and MEP outcomes were not significantly different between the 2 groups. No adverse events or complications were reported. Distal upper extremity function, as measured by MFT and grip power, was improved after rTMS and AO in combination. The combination of rTMS with AO may be applied safely to improve upper extremity function after stroke.

Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial.

BackgroundMirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror.Material/MethodsA total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test.ResultsUpper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group.ConclusionsWe found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.

Effects of Whole-Body Vibration on Upper Extremity Function and Grip Strength in Patients with Subacute Stroke: A Randomised Single-Blind Controlled Trial.

Background Whole-body vibration has been used to improve motor function in chronic stroke patients, but its effect on patients with subacute strokes remains unclear. Objectives We explored the effect of whole-body vibration on patients with subacute strokes. Methods Participants were randomly allocated to a whole-body vibration (WBV) group (n = 30) or an upper- and lower-cycle (ULC) group (n = 30). Both groups received occupational therapy after these interventions. All participants received treatment for 30 min/day, 5 days/week, for 4 weeks. Both groups received the same conventional physical therapy. Results The manual function test (MFT) score and grip strength improved after both WBV (p = 0.001 and p = 0.001, respectively) and ULC (p = 0.002 and p = 0.001, respectively), but the improvement was more pronounced (MFT p = 0.016; GS p = 0.023) after WBV. Conclusions These findings suggest that the use of WBV and ULC was effective as remedial treatments for improving upper extremity motor function and increasing grip strength for patients with subacute strokes. The improvement was more pronounced for the WBV treatment. This trial is registered with KCT0003246.

Manual function of the unaffected upper extremity can affect functional outcome after stroke.

Traditionally, motor deficits of ipsilesional side, generally considered as the unaffected side, have been investigated less and the influence of the impairment is unknown. To evaluate the association between the manual function test (MFT) of nonparetic limb and poststroke functional outcome. We conducted a retrospective analysis of 71 hemiplegic patients with stroke. MFT on both sides was routinely measured at admission and 1 month later after admission by an experienced occupational therapist. The parameters of functional outcome after stroke were measured with the total score of functional independence measure (FIM) and the self-care subscore of FIM. Age, initial cognitive function, and MFT of the affected hand and unaffected hand were each significant factors for independently predicting short-term functional outcome after stroke. Linear regression analysis showed that initial MFT score of unaffected side is a significant predictor for 1 month follow-up subscore FIM (P<0.0001) and total FIM score (P<0.0001). Our findings suggests that initial MFT score of the nonparetic side has a significant correlation with functional outcome. Therefore, it is important to conduct MFT on the nonparetic side as well as the paretic side. Furthermore, it is necessary to undergo rehabilitation therapy on the nonparetic side.

Effects of Hand Training During the Aftereffect Period of Low-Frequency rTMS in Subacute Stroke Patients.

ObjectiveTo investigate the effects of hand training using low-frequency repetitive transcranial magnetic stimulation (rTMS) within the aftereffect period on hand function in patients with subacute stroke.MethodsThe subacute stroke patients with hand weaknesses were divided randomly into two groups. Patients in the intervention group underwent hand training within the aftereffect period, that is, immediately after receiving low-frequency rTMS treatment. Patients in the control group underwent hand training 2 hours after the low-frequency rTMS treatment. A manual function test (MFT) for ‘grasp and pinch’ and ‘hand activities’; a manual muscle test (MMT) for ‘grasp’, ‘release’, and ‘abductor pollicis brevis (APB)’; and the Modified Ashworth Scale for finger flexion were performed and measured before and immediately after combined therapy as well as 2 weeks after combined therapy.ResultsThirty-two patients with hand weakness were enrolled in this study. The intervention group patients showed more improvements in grasp MMT and MMT APB tested immediately after combined therapy. However, the changes in all measurements were not significantly different between the two groups 2 weeks after the combined therapy. In both groups, hand functions improved significantly immediately after combined therapy and 2 weeks after combined therapy.ConclusionHand training immediately after low-frequency rTMS showed more rapid improvement in the motor power of hands than hand training conducted 2 hours after low-frequency rTMS. Our results suggest that conducting hand training immediately after low-frequency rTMS could be an improved useful therapeutic option in subacute stroke patients.

Effects of Anodal Transcranial Direct Current Stimulation on Somatosensory Recovery After Stroke

The aim of this study was to evaluate the effect of anodal transcranial direct current stimulation over the primary somatosensory cortex on the recovery of somatosensation, motor function, and the activities of daily living in patients with subacute stroke. This study was a prospective, randomized sham controlled, double-blinded study. Patients with subacute stroke having somatosensory deficits (N = 24) were enrolled and assigned randomly to the anodal and sham stimulation groups. Patients received 10 consecutive anodal or sham transcranial direct current stimulations over the primary somatosensory cortex on the side of the stroke lesion. Before and after each stimulation session, Nottingham sensory assessments, Semmes Weinstein monofilaments examination, and manual function tests were performed, and modified Brunnstrom classification, modified Barthel index, and functional ambulation categories were assessed. Although there was no clear significant difference between the two groups, when the changes from baseline to posttreatment evaluation were compared between the groups, a partially significant improvement was observed in the anodal stimulation group compared with the sham stimulation group. Interestingly, the tactile sensation of the unaffected side also improved. Moreover, the greater improvement in activities of daily living function was observed in the anodal stimulation group too. Anodal transcranial direct current stimulation over the primary somatosensory cortex may be a useful adjuvant therapy for the recovery of somatosensation and activities of daily living function in patients with sensory deficits after stroke.

An investigation of factors influencing the participation of stroke survivors in social and leisure activities

Objective: Participation restrictions are serious problems that stroke survivors experience while reintegrating into family, work, community, and social situations after participating in rehabilitation programs. The purpose of this study was to explore the factors affecting participation in activities of daily living (ADL), as well as social and leisure activities of individuals with hemiparetic stroke. Design: Cross-sectional study. Methods: The study involved 96 participants who were diagnosed with a first stroke 6 months before the study (58 men, 38 women; 60.3±14.3 years). The Berg Balance Scale, Modified Barthel Index, Manual Function test, and Activity Card Sort were used to assess static and dynamic balance function, upper limb function, level of independence, and their level of participation within the community. A regression analysis was used to identify the influence of factors affecting participation in ADL, social and recreational activities. Results: The Activity Card Sort scores were significantly affected by the Manual Function test and Modified Barthel Index scores (p<0.05). Participation in leisure activities was affected by the level of independence. Participation in social activities was affected by the balance function and level of independence of the participants. Conclusions: The results of this study have shown that participation restrictions are affected by upper limb function, balance function, and the level of independence in individuals with hemiparetic stroke.

Modification of Cerebellar Afferent Pathway in the Subacute Phase of Stroke

This study aims to identify the relationship between corticopontocerebellar tract (CPCT) and corticospinal tract (CST) integrity as well as motor function after stroke. A total of 33 patients with stroke (18 left, 15 right hemispheric lesions) who underwent diffusion tensor imaging within 2 months of stroke onset and 17 age- and sex-matched healthy controls were retrospectively enrolled. Tract volume and the asymmetry index based on tract volume (AITV) of the CST and CPCT were used to identify structural changes in individual tracts and the correlation between those tracts. Motor function was assessed using the Medical Research Council (MRC) muscle scale, manual function test (MFT), functional ambulation category, and modified Barthel index. The volume of the affected CPCT was lower, and that of the unaffected CPCT was higher than the volumes in the control group (P < .001, P = .001, respectively). The CPCT AITV showed a strong positive correlation with the CST AITV in patients with either left or right hemispheric lesions (rs = .779, P < .001; rs = .732, P = .003, respectively). The CPCT AITV negatively correlated with the MRC muscle scale of the shoulder, wrist, and ankle muscles (r = -.490, -.490, -.416; P = .004, .004, .016, respectively). A higher unaffected CPCT volume was indicative of less affected upper extremity function, as assessed by MFT (rs = -.546, P = .029). Modification of the CPCT depended on CST integrity and was associated with the severity of hemiplegia and hemiplegic upper extremity function. The CPCT may complement the role of the CST and help to predict the motor function.