Recovery Of Limb Function Research Articles

Wristband Accelerometers to motiVate arm Exercise after Stroke (WAVES): study protocol for a pilot randomized controlled trial

BackgroundLoss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities. A wrist-worn device has been developed that monitors and provides ‘live’ upper limb activity feedback to remind patients to use their stroke arm in daily activities (The CueS wristband). The aim of this trial is to assess the feasibility of a multi-centre, observer blind, pilot randomised controlled trial of the CueS wristband in clinical stroke services.Methods/designThis pilot randomised controlled feasibility trial aims to recruit 60 participants over 15 months from North East England. Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy. Each participant will be randomised to an intervention or control group. Intervention participants will wear a CueS wristband (between 8 am and 8 pm) providing “live” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme (reviewed twice weekly by an occupational/physiotherapist). Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘sham’ CueS wristband that monitors upper limb activity but provides no feedback. Outcomes will determine study feasibility in terms of recruitment, retention, adverse events, adherence and collection of descriptive clinical and accelerometer motor performance data at baseline, 4 weeks and 8 weeks.DiscussionThe WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke. The study will establish whether the study protocol can be supported by clinical stroke services, thereby informing the design of a future multi-centre randomised controlled trial of clinical and cost-effectiveness.Trial registration ISRCTN:82306027. Registered 12 July 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1628-2) contains supplementary material, which is available to authorized users.

The concept of limb function recovery in traumatic injury of peripheral nerves

Purpose. To develop key principles in the treatment of traumatic injury of peripheral nerves basing on analysis of injury of peripheral nerves severity, and structural and functional condition of muscles. Materials and methods. We analyzed the results of treatment of 726 patients with injury of peripheral nerves of the extremities. Injury of the upper extremity had 345 (47.5%) patients, with lower limb trauma 381 (52.5%) patients. Electromyography study was performed to 460 patients on “Neuroscreen” (Toenis, Germany) and “Viking Quest” (Nicollet, USA). Ultrasound of muscles was performed to 185 patients on HDI 3500 device and HD 11 XE (Philips) with a multifrequency linear transducer (5–12 MHz). Results. In 70.2 % of cases, nerve injury has polystructural injury of two or more anatomical and functional structures. Based on the analysis of clinical examination, ultrasound and EMG data characteristics we proposed the concept of the treatment of peripheral nerve injuries in limbs trauma and highlighted its main points: the definition of the level and severity of the nerve damage, forecast its recovery and muscle reinnervation; assessment of the nature and degree of severity of the key muscle (denervation or a combination of several pathological processes), assessment of damage to other structures of the injured limb segment allowing for the polystructural injury treatment algorithm.

Application of PDCA cycles in the normal limb position of stroke patients with hemiplegia

Objective To explore the application effect of PDCA cycles on the normal limb position of stroke patients with hemiplegia. Methods The stroke patients with hemiplegia(128 cases)were selected as study subjects. Patients(62 cases)during January to September 2014 were set as the control group, and received routine nursing care. Patients(66 cases)during October 2014 to July 2015 were set as the experimental group, and used PDCA cycles management on the normal limb position additionally. The application effect of PDCA cycles on the normal limb position was evaluated through comparing two groups with qualification rates of normal limb position and incidence of complications. Results The qualification rates of normal limb position in the control group was 38.71%(24/62), which was higher than that of the control group, which was 75.76%(50/66)(χ2=16.504, P<0.01). The complications occurred in the control group were strephenopodia(11 cases), foot drop(16 cases), dislocation of shoulder(9 cases), omodynia(27 cases)and myospasm(34 cases), and they were 3 cases, 7 cases, 2 cases, 15 cases and 18 cases in the experimental group respectively. The incidence of complications was lower than those of the control group(χ2=4.001-8.961, P < 0.05), and the difference was statistically significant between two groups. Conclusions PDCA cycles management could improve the qualification rates of normal limb position and reduce the incidence of complications, which was beneficial to the recovery of limb function. Key words: Stroke; Hemiplegia; Rehabilitation; PDCA cycle; Normal limb position

Application of ACE-Star evidence-based nursing model on functional exercise of breast cancer patients with modified radical mastectomy

Objective To investigate the effects of ACE-Star model on functional recovery of affected limb in breast cancer patients with modified radical mastectomy. Methods A total of 120 patients with breast cancer were recruited from the department of general surgery, Shandong Provincial Hospital between June 2014 and August 2015.Control group included 58 cases from June 2014 to January 2015 and experimental group included 62 cases from February 2015 to August 2015. The patients in experimental group were given ACE-Star evidence-based nursing, and patients in control group received routine nursing. The incidence of limb swelling at the 3rd day of post-operation, the wound effusion, bleeding and wound dehiscence within 14 days of post-operation, and the functional recovery of affected limb at the 4th week of post-operation were compared between two groups. Results Both groups had limb swelling, wound effusion and bleeding to some extent, but the incidence was significantly lower in experimental group comparing with control group (P 0.05). The recovery of limb function in experimental group was better than control group at the 4th week of post-operation (P<0.05). Conclusions The application of ACE-Star evidence-based nursing in breast cancer patients with modified radical mastectomy can effectively reduce the incidence of limb swelling, wound effusion, bleeding and dehiscence, and significantly improve the functional recovery of affected limb. Key words: ACE-Star evidence-based nursing; Modified radical mastectomy; Functional exercise; Complication

Case studies in poststroke hemiplegic patients using SEMUL: a passive 2-DOF rehabilitation robot.

Following stroke, rehabilitation exercises paired with medical treatment are important for the recovery and maintenance of upper limb function. We developed a 2-DOF passive haptic system for upper limb rehabilitation and software focusing on reaching exercises, known as the coin collecting program, which provides training and evaluation of motor function, particularly dexterity. Past studies have revealed quantitative, reproducible evaluation indices using this software. In this paper, we compared case studies of post-stroke patients with results from healthy participants, and confirmed the reliability of the evaluation indices in grading or scoring motor skills.

The effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture: A retrospective case-control study.

The purpose of this study was to explore the effect of lower limb rehabilitation gymnastics on postoperative rehabilitation in elderly patients with femoral shaft fracture after undergoing intramedullary nail fixation surgery.We collected medical records of elderly patients aged ≥ 60 years with femoral shaft fracture between 03/2010 and 03/2015 in Longyao County Hospital. Totally, 160 patients were identified and divided into the intervention group (n = 80) and the control group (n = 80). During the postoperative period, the intervention group received lower limb rehabilitation gymnastics treatment for 3 months, but the control group did not. All patients were routinely asked to return hospital for a check in the 1st postoperative week, as well as the 2nd week, the 1st month, and the 3rd month, after surgery. The clinical rehabilitation effect was evaluated by checking lower limb action ability, detecting the lower limb deep venous thrombosis (DVT), scoring muscle strength of quadriceps and visual analog scale (VAS) score, and performing satisfaction survey.At the 1st week and 2nd week after surgery, the clinical rehabilitation effect in the intervention group was better regarding lower limb action ability, lower limb DVT, muscle strength of quadriceps, VAS score, and patient satisfaction, as compared with the control group. However, there was no significant difference at the 1st month and the 3rd month after surgery when comparing the intervention group to the control group.In the early postoperative stage, lower limb rehabilitation gymnastics can effectively improve the recovery of lower limb function, beneficial to reducing postoperative complications such as lower limb DVT and muscle atrophy, and increasing patient satisfaction rate.

Intermittent hypoxia promotes recovery of respiratory motor function in spinal cord-injured mice depleted of serotonin in the central nervous system.

We examined the effect of repeated daily exposure to intermittent hypoxia (IH) on the recovery of respiratory and limb motor function in mice genetically depleted of central nervous system serotonin. Electroencephalography, diaphragm activity, ventilation, core body temperature, and limb mobility were measured in spontaneously breathing wild-type (Tph2(+/+)) and tryptophan hydroxylase 2 knockout (Tph2(-/-)) mice. Following a C2 hemisection, the mice were exposed daily to IH (i.e., twelve 4-min episodes of 10% oxygen interspersed with 4-min normoxic periods followed by a 90-min end-recovery period) or normoxia (i.e., sham protocol, 21% oxygen) for 10 consecutive days. Diaphragm activity recovered to prehemisection levels in the Tph2(+/+) and Tph2(-/-) mice following exposure to IH but not normoxia [Tph2(+/+) 1.3 ± 0.2 (SE) vs. 0.3 ± 0.2; Tph2(-/-) 1.06 ± 0.1 vs. 0.3 ± 0.1, standardized to prehemisection values, P < 0.01]. Likewise, recovery of tidal volume and breathing frequency was evident, although breathing frequency values did not return to prehemisection levels within the time frame of the protocol. Partial recovery of limb motor function was also evident 2 wk after spinal cord hemisection. However, recovery was not dependent on IH or the presence of serotonin in the central nervous system. We conclude that IH promotes recovery of respiratory function but not basic motor tasks. Moreover, we conclude that spontaneous or treatment-induced recovery of respiratory and motor limb function is not dependent on serotonin in the central nervous system in a mouse model of spinal cord injury.

Transplantation of cryopreserved rat fetal neural cells in suspension and in multicellular aggregates into rats with spinal cord injury

Today cell transplantation is one of the promising approaches of spinal cord injuries treatment. The aim of the work was to study the effect of cryopreserved fetal neural cell transplantation in suspensions and cell aggregates for motor activity recovery of rats with experimental spinal cord injury.Materials and methods. Cells were isolated from the brain tissue of rat fetuses 15-16 days of gestation. The formation of aggregates was performed during short-term cultivation at a concentration of 8·106cells/mL in medium with 10 % adult rat serum. Cell transplantation was performed into the damaged area of spinal cord in aggregates or suspension. To fix transplanted cells in the damaged area we used alginate gel.Results. Transplantation of cryopreserved fetal neural cells in alginate gel had the positive effect on dynamics of rats’ motor activity recovery. That was manifested in the extensive mobility of three joints of one limb and the limited mobility of two joints of the other with simultaneous recovery of the sensitivity of the hind limbs.Conclusion. Cryopreserved fetal neural cells aggregates had a high therapeutic potential on rat traumatic spinal cord injury compared with cell suspension by improving the structure of forming nervous tissue and significantly increasing the rate of hind limb function recovery.

Conditional Sox9 ablation improves locomotor recovery after spinal cord injury by increasing reactive sprouting

The absence of axonal regeneration after spinal cord injury (SCI) has been attributed to the up-regulation of axon-repelling molecules, such as chondroitin sulfate proteoglycans (CSPGs) present in the glial scar that forms post-SCI. We previously identified the transcription factor SOX9 as a key up-regulator of CSPG production and also demonstrated that conditional Sox9 ablation leads to decreased CSPG levels and improved recovery of hind limb function after SCI. We herein demonstrate increased neural input onto spinal neurons caudal to the lesion in spinal cord injured Sox9 conditional knock out mice as indicated by increased levels of the presynaptic markers synaptophysin and vesicular glutamate transporter 1 (VGLUT1) compared to controls. Axonal sparing, long-range axonal regeneration and reactive sprouting were investigated as possible explanations for the increase in neural inputs caudal to the lesion and for the improved locomotor outcomes in spinal cord-injured Sox9 conditional knock out mice. Whereas retrograde tract-tracing studies failed to reveal any evidence for increased axonal sparing or for long-range regeneration in the Sox9 conditional knock out mice, anterograde tract-tracing experiments demonstrated increased reactive sprouting caudal to the lesion after SCI. Finally we demonstrate that application of a broad spectrum MMP inhibitor to reduce CSPG degradation in Sox9 conditional knock out mice prevents the improvements in locomotor recovery observed in untreated Sox9 conditional knock out mice. These results suggest that improved recovery of locomotor function in Sox9 conditional knock out mice after SCI is due to increased reactive sprouting secondary to reduced CSPG levels distal to the lesion.

Niacin promotes revascularization and recovery of limb function in diet-induced obese mice with peripheral ischemia.

Niacin can reduce vascular disease risk in individuals with metabolic syndrome, but in light of recent large randomized controlled trials outcomes, its biological actions and clinical utility remain controversial. Niacin can improve endothelial function, vascular inflammation, and vascular regeneration, independent of correcting dyslipidemia, in various lean rodent models of vascular injury. Here, we tested whether niacin could directly improve endothelial cell angiogenic function during combined exposure to excess fatty acids and hypoxia, and whether intervention with niacin during continued feeding of western diet could improve revascularization and functional recovery in obese, hyperlipidemic mice with peripheral ischemia. Treatment with niacin (10 μmol/L) increased human microvascular endothelial cell angiogenic function during exposure to high fatty acids and hypoxia (2% oxygen), as determined by tube formation on Matrigel. To assess revascularization in vivo, we used western diet‐induced obese mice with unilateral hind limb femoral artery ligation and excision. Treatment for 14 days postinjury with once daily i.p. injections of a low dose of niacin (50 mg/kg) improved recovery of hind limb use, in association with enhanced revascularization and decreased inflammation of the tibialis anterior muscle. These effects were concomitant with decreased plasma triglycerides, but not increased plasma apoAI. Thus, niacin improves endothelial tube formation under lipotoxic and hypoxic conditions, and moreover, promotes revascularization and functional hind limb recovery following ischemic injury in diet‐induced obese mice with hyperlipidemia. These data may have implications for niacin therapy in the treatment of peripheral ischemic vascular disease associated with metabolic syndrome.

Sensorimotor cortex injury effects on recovery of contralesional dexterous movements in Macaca mulatta

The effects of primary somatosensory cortex (S1) injury on recovery of contralateral upper limb reaching and grasping were studied by comparing the consequences of isolated lesions to the arm/hand region of primary motor cortex (M1) and lateral premotor cortex (LPMC) to lesions of these same areas plus anterior parietal cortex (S1 and rostral area PE). We used multiple linear regression to assess the effects of gray and white matter lesion volumes on deficits in reaching and fine motor performance during the first month after the lesion, and during recovery of function over 3, 6 and 12months post-injury in 13 monkeys. Subjects with frontoparietal lesions exhibited larger deficits and poorer recovery as predicted, including one subject with extensive peri-Rolandic injury developing learned nonuse after showing signs of recovery. Regression analyses showed that total white matter lesion volume was strongly associated with initial post-lesion deficits in motor performance and with recovery of skill in reaching and manipulation. Multiple regression analyses using percent damage to caudal M1 (M1c), rostral S1 (S1r), LPMC and area PE as predictor variables showed that S1r lesion volumes were closely related to delayed post-lesion recovery of upper limb function, as well as lower skill level of recovery. In contrast, M1c lesion volume was related primarily to initial post-lesion deficits in hand motor performance. Overall, these findings demonstrate that frontoparietal injury impairs hand motor function more so than frontal motor injury alone, and results in slower and poorer recovery than lesions limited to frontal motor cortex.

Minimally Invasive Plate Osteosynthesis (MIPO) for Proximal and Distal Fractures of The Tibia: A Biological Approach.

Introduction: The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity.Methods: We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days.Results: The mean operative time was 72.6 minutes ( range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure.Conclusions: The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.

Abstract 112: Predicting REcovery Potential of Upper Limb Function After Stroke to Increase Rehabilitation Efficiency

Introduction: The PREP algorithm combines clinical assessment [Shoulder Abduction Finger Extension (SAFE) score], transcranial magnetic stimulation (TMS) and diffusion-tensor imaging to predict potential for upper limb recovery following stroke. Patients’ recovery potential is predicted to be Complete, Notable, Limited or None. Hypothesis: The PREP algorithm may be used in a ‘real world’ clinical setting to set individual rehabilitation goals. Methods: This study recruited 194 patients with upper limb weakness within 3 days of stroke. Assessments were made at baseline and 12 weeks by assessors blinded to PREP algorithm prediction. The initial benchmarking phase recruited 85 patients and PREP algorithm information was not shared with clinical teams or patients. The results were used to refine the algorithm and guide implementation in three ways. First, patients with a SAFE score &gt; 7, predicted to have Complete upper limb recovery, were given a self-directed therapy program. Second, patients with a SAFE score of 5-7 could be given a Notable recovery prognosis, without requiring TMS. Third, 19% of patients exceeded their predicted upper limb recovery, so this possibility was conveyed to patients and clinical teams. The implementation phase recruited 109 patients, and PREP algorithm predictions were shared with patients and clinical teams. Results: Interim analyses (n = 135) find that the PREP algorithm correctly predicted upper limb function at 12 weeks for 85% of patients. Implementation of the algorithm decreased length of stay by 7 days (95%CI 2 - 15 days, p &lt; 0.05) and increased the proportion of patients discharged home from the acute stroke unit from 28% to 49% (p &lt; 0.01). Implementation also decreased upper limb therapy dose (p &lt; 0.01), yet patient outcomes were similar between the two phases. Primary endpoint analysis will be complete in November 2015. Conclusions: Making predictions about the potential for recovery of upper limb function, and setting individual rehabilitation goals accordingly, may increase the efficiency of post-stroke rehabilitation.

Abstract WP149: Greater Recovery of Upper Limb Function in Moderate/Severely Impaired Chronic Stroke in Response to Customized Whole Limb vs Prescribed Focused Training

Introduction: The purpose of this study was to compare the following three treatments of upper limb motor impairment in chronic moderate/severely impaired stroke survivors: 1) Customized whole limb motor learning (Whole ML), including shoulder/elbow robotics (ROB) and functional electrical stimulation (FES); 2) prescribed shoulder/elbow ROB + motor learning (S/E ROB ML); and 3) prescribed wrist/hand FES + ML (W/H FES ML). Methods: Subjects with chronic stroke were stratified according to relative level of impairment (Fugl-Meyer coordination Test) in wrist/hand versus shoulder/elbow. Their stratification category dictated the treatment group to which they were allocated, as follows: 1) WHOLE ML (n=18), equal distal and proximal impairment; 2) S/E ROB ML (n=10 ), greater shoulder/elbow impairment; and 3) FES ML (n=8), greater wrist/hand impairment. Treatment was 5 days/wk, 5 hrs/day, 60 sessions. Primary measure was the Arm Motor Assessment Tool, 13 complex tasks, Functional Scale (AMAT-F), acquired at baseline and at follow-up, 3 months after last treatment. Secondary measures were subscales, AMAT-F Shoulder/Elbow (AMAT-F S/E) and AMAT Wrist/Hand (AMAT-F W/H). Statistical analyses were Kruskal Wallace model to account for group size differences; group comparisons and within-group pre-/follow-up comparisons were analyzed (and multiple comparisons corrections). Results: All three groups had significant within-group gain for AMAT-F (p=.0007; p=.039; p=.047, respectively; similar results were shown for AMAT S/E subscale. Only the Whole ML group had significant gain in AMAT W/H (p=.007). Gain for all three groups exceeded the threshold for clinically significant gain in AMAT-F (.21 points), as follows: Whole ML (.66 points, 3 x’s the threshold); S/E ROB ML (.53 points, 2.5 x’s); W/H FES ML (.46 points, 2 x’s). Conclusion: For the customized whole limb motor learning group there was greater improvement in upper limb function versus the two groups that received prescribed, focused training for either shoulder/elbow or wrist/hand, according to the AMAT-F clinically significant threshold and according to the AMAT-F W/H subscale.

Attenuating spinal cord injury by conditioned medium from human umbilical cord blood-derived CD34+ cells in rats

ObjectiveIntravenous or intraspinal transplantation of human umbilical cord blood cells-derived CD34+ cells (human CD34+ cells) or mesenchymal stem cells after spinal cord injury (SCI) improved hind limb functional recovery in adult rats. The objective of this study is to ascertain whether SCI in rats can be attenuated by conditioned medium (CM) or secretome obtained from cultured human CD34+ stem cells. Materials and methodsSprague-Dawley rats were assigned to one of the following five groups: the sham group, the SCI group treated with vehicle solution (SCI + V), the SCI group treated with CM (SCI + CM), the SCI group treated with 17β-estradiol E2 (10 μg; SCI + E2), and the SCI group treated with CM plus E2 (SCI + CM + E2). A 0.5-mL volume of CM or vehicle solution was administered intravenously immediately after SCI. ResultsCompared with the sham group, the (SCI + V) group had significantly higher scores of neurological motor dysfunction as well as inflammation apoptosis, oxidative stress, and astrogliosis in the injured spinal cord. The neurological deficits, numbers of apoptotic cell, extent of inflammation, oxidative stress, and astrogliosis in the injured spinal cord were significantly attenuated by CM, E2, or CM plus E2, but not by the vehicle solution. In addition, the neuroprotective effect exerted by a combination of CM and E2 is superior to that exerted by CM- or E2-alone therapy. ConclusionThe neuroprotective effects of CM from cultured human CD34+ cells are similar to those of human CD34+ cells and the CM was found to enhance the neuroprotective effects of E2 in rat SCI.

The California Tri-pull Taping Method in the Treatment of Shoulder Subluxation After Stroke: A Randomized Clinical Trial.

Background:Shoulder subluxation is a frequent occurrence in individuals following a stroke. Although various methods of treatment are available, none of them address all possible consequences of the subluxation pain, limited range of motion, the subluxation, and decreased functional use of the arm.Aims:The purpose of this study was to evaluate the effectiveness of California tri-pull taping (CTPT) method on shoulder subluxation, pain, active shoulder flexion, and upper limb functional recovery after stroke.Materials and Methods:This was a randomized control study on 30 participants. All participants received conventional neurorehabilitation 5 days a week over 6 weeks. Half of the participants also received the CTPT. Pre- and post-assessment scores were taken on all participants for the amount of shoulder subluxation, pain, active shoulder flexion, and functional recovery.Results:The CTPT method demonstrated a significant reduction of pain in the treatment group from baseline, a significant improvement in active shoulder flexion and a significant improvement in proximal arm function as measured on the proximal subscale on the Fugl-Meyer upper extremity functional Scale but not the distal or total Fugl-Meyer subscales. Shoulder subluxation was not statistically significant.Conclusions:The CTPT method is an effective treatment for the hemiplegic subluxed shoulder.

Robotic Finger Rehabilitation Support Device for Home Use—An Analysis of the Effect of Finger Rehabilitation for the Upper Limb Function Recovery

Robotic Finger Rehabilitation Support Device for Home Use—An Analysis of the Effect of Finger Rehabilitation for the Upper Limb Function Recovery

Action observation training to improve motor function recovery: a systematic review.

Following the discovery of Mirror Neuron System (MNS), Action Observation Training (AOT) has become an emerging rehabilitation tool to improve motor functions both in neurologic and orthopedic pathologies.The aim of this study is to present the state of the art on the use of AOT in experimental studies to improve motor function recovery in any disease.The research was performed in PubMed, PEDro, Embase, CINAHL and Cochrane Central Register of Controlled Trials (last search July 2015). Randomized controlled trials (RCTs) that analyse efficacy of AOT for recovery of motor functions, regardless of the kind of disease, were retrieved. The validity of the included studies was assessed using the Cochrane Collaboration tool for evaluating risk of bias.Twenty RCTs were eligible. Four studies showed AOT efficacy in improving upper limb functional recovery in participants with chronic stroke, two studies in sub-acute ones and one in acute ones. Six articles suggested its effectiveness on walking performance in chronic stroke individuals, and three of them also suggested an efficacy in improving balance. The use of AOT was also recommended in individuals with Parkinson’s disease to improve autonomy in activities of daily living, to improve spontaneous movement rate of self-paced finger movements and to reduce freezing of gait. Other two studies also indicated that AOT improves upper limb motor function in children with cerebral palsy. The last two studies, showed the efficacy of AOT in improving motor recovery in postsurgical orthopedic participants. Overall methodological quality of the considered studies was medium.The majority of analyzed studies suggest the efficacy of AOT, in addition to conventional physiotherapy, to improve motor function recovery in individuals with neurological and orthopedic diseases. However, the application of AOT is very heterogeneous in terms of diseases and outcome measures assessed, which makes it difficult to reach, to date, any conclusion that might influence clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s40945-015-0013-x) contains supplementary material, which is available to authorized users.

Different surgical approaches and their clinical efficacy in elderly patients with multi-level cervical spondylosis

Objective To investigate the clinical effect of different surgical approaches on multi-level cervical spondylosis in elderly patients. Methods A total of 53 aged patients with multi-level cervical spondylosis (≥70 years old) who received operation in our department during May 2007 to May 2014 were retrospectively studied, and divided into anterior cervical surgical group (n=22) and posterior cervical group (n=31), according to the surgical approach. The operation duration, intra-operative blood loss, hospitalization time, postoperative complications, Japanese orthopedics association (JOA) scores, Neck disability index (NDI), postoperative subjective improvement of clinical symptoms and spinal fusion of the two groups were evaluated and compared respectively. Results The mean operative time was longer in the anterior surgical group than in the posterior surgical group〔(2.7±0.5)h vs. (1.9±0.3) h, P 0.05〕. NDI score was lower in anterior surgical group than in posterior surgical group 3, 6, 12 months after operation and at the last follow-up. Among the 41 patients, radiographic outcomes showed that there were 16 cases of anterior surgical group with no bony fusion at the follow-up 3 months after operation, and all the 16 patients achieved bony fusion at the follow-up 1 year after operation, and there were 4 cases with titanium mesh subsidence (<3 mm). Conclusions Both anterior cervical decompression and fusion and posterior cervical single open-door laminoplasty have good efficacy in the treatment of multilevel cervical spondylosis in elderly patients, which have advantages on the limb functional recovery time and cervical function assessment. When anterior cervical surgical contraindications were excluded, the anterior cervical decompression and fusion may be a good choice for the treatment of multilevel cervical spondylosis in aged patients. Key words: Cervical spondylosis; Spinal fusion; Verterbroplasty

Functional rehabilitation of upper limb apraxia in poststroke patients: study protocol for a randomized controlled trial.

BackgroundUpper limb apraxia is a common disorder associated with stroke that can reduce patients’ independence levels in activities of daily living and increase levels of disability. Traditional rehabilitation programs designed to promote the recovery of upper limb function have mainly focused on restorative or compensatory approaches. However, no previous studies have been completed that evaluate a combined intervention method approach, where patients concurrently receive cognitive training and learn compensatory strategies for enhancing daily living activities.Methods/DesignThis study will use a two-arm, assessor-blinded, parallel, randomized controlled trial design, involving 40 patients who present a left- or right-sided unilateral vascular lesion poststroke and a clinical diagnosis of upper limb apraxia. Participants will be randomized to either a combined functional rehabilitation or a traditional health education group. The experimental group will receive an 8-week combined functional program at home, including physical and occupational therapy focused on restorative and compensatory techniques for upper limb apraxia, 3 days per week in 30-min intervention periods. The control group will receive a conventional health education program once a month over 8 weeks, based on improving awareness of physical and functional limitations and facilitating the adaptation of patients to the home. Study outcomes will be assessed immediately postintervention and at the 2-month follow-up. The primary outcome measure will be basic activities of daily living skills as assessed with the Barthel Index. Secondary outcome measures will include the following: 1) the Lawton and Brody Instrumental Activities of Daily Living Scale, 2) the Observation and Scoring of ADL-Activities, 3) the De Renzi Test for Ideational Apraxia, 4) the De Renzi Test for Ideomotor Apraxia, 5) Recognition of Gestures, 6) the Test of Upper Limb Apraxia (TULIA), and 7) the Quality of Life Scale For Stroke (ECVI-38).DiscussionThis trial is expected to clarify the effectiveness of a combined functional rehabilitation approach compared to a conservative intervention for improving upper limb movement and function in poststroke patients.Trial registrationClinical Trial Gov number NCT02199093. The protocol registration was received 23 July 2014. Participant enrollment began on 1 May 2014. The trial is expected to be completed in March 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-1034-1) contains supplementary material, which is available to authorized users.