Upper Limb Function In Patients Research Articles

Augmented efficacy of intermittent theta burst stimulation on the virtual reality-based cycling training for upper limb function in patients with stroke: a double-blinded, randomized controlled trial

BackgroundVirtual reality and arm cycling have been reported as effective treatments for improving upper limb motor recovery in patients with stroke. Intermittent theta burst stimulation (iTBS) can increase ipsilesional cortical excitability, and has been increasingly used in patients with stroke. However, few studies examined the augmented effect of iTBS on neurorehabilitation program. In this study, we investigated the augmented effect of iTBS on virtual reality-based cycling training (VCT) for upper limb function in patients with stroke.MethodsIn this randomized controlled trial, 23 patients with stroke were recruited. Each patient received either 15 sessions of iTBS or sham stimulation in addition to VCT on the same day. Outcome measures were assessed before and after the intervention. Primary outcome measures for the improvement of upper limb motor function and spasticity were Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Modified Ashworth Scale Upper-Extremity (MAS-UE). Secondary outcome measures for activity and participation were Action Research Arm Test (ARAT), Nine Hole Peg Test (NHPT), Box and Block Test (BBT) and Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Wilcoxon signed-rank tests were performed to evaluate the effectiveness after the intervention and Mann–Whitney U tests were conducted to compare the therapeutic effects between two groups.ResultsAt post-treatment, both groups showed significant improvement in FMA-UE and ARAT, while only the iTBS + VCT group demonstrated significant improvement in MAS-UE, BBT, NHPT, MAL and SIS. The Mann–Whitney U tests revealed that the iTBS + VCT group has presented greater improvement than the sham group significantly in MAS-UE, MAL-AOU and SIS. However, there were no significant differences in the changes of the FMA-UE, ARAT, BBT, NHPT and MAL-QOM between groups.ConclusionsIntermittent TBS showed augmented efficacy on VCT for reducing spasticity, increasing actual use of the affected upper limb, and improving participation in daily life in stroke patients. This study provided an integrated innovative intervention, which may be a promising therapy to improve upper limb function recovery in stroke rehabilitation. However, this study has a small sample size, and thus a further larger-scale study is warranted to confirm the treatment efficacy.Trial registration This trial was registered under ClinicalTrials.gov ID No. NCT03350087, retrospectively registered, on November 22, 2017

Arm activity measure (ArmA): psychometric evaluation of the Swedish version

BackgroundPatient Reported Outcomes Measure (PROM) are commonly used in research and essential to understand the patient experience when receiving treatment. Arm Activity Measure (ArmA) is a valid and reliable self-report questionnaire for assessing passive (section A) and active (section B) real-life arm function in patients with disabling spasticity. The original English version of ArmA has been psychometrically tested and translated into Thai.AimsTranslate and cross-culturally adapt ArmA to Swedish language and context. Further, to evaluate the reliability, validity and sensitivity of the Swedish version of the questionnaire (ArmA-S) in patients with disabling upper limb spasticity caused by injuries to the central nervous system (CNS).Materials and methodsArmA was translated and cross-culturally adapted according to established guidelines. Validity and reliability were evaluated in 61 patients with disabling spasticity. Face and content validity was evaluated by expert opinions from clinicians and feedback from patients with upper limb spasticity. Internal consistency reliability was assessed with Cronbach’s alpha and test-retest reliability was assessed using the quadratic weighted kappa.ResultsArmA-S was shown to be clinically feasible, with good face and content validity and no floor or ceiling effects. Internal consistency of ArmA-S was high and equivalent to ArmA; with Chronbach´s alpha coefficients values of 0.94 and 0.93 for section A and B, respectively. Test-retest reliability was good, with kappa values of 0.86 and 0.83 for section A and B, respectively. Some layout modifications of ArmA-S were made to further increase the user-friendliness, test-retest reliability, and responsiveness.ConclusionArmA-S was shown to be a reliable and valid self-report questionnaire for use in clinical practice and research to assess improvements in passive and active upper limb function in patients with disabling spasticity.

The Effect of Trunk Stability Training Based on Visual Feedback on Trunk Stability, Balance, and Upper Limb Function in Stroke Patients: A Randomized Control Trial.

This study aimed to investigate the effects of trunk stability training based on visual feedback on trunk stability, balance, and upper limb function in patients with stroke. Twenty-eight patients with chronic stroke were randomly assigned to either a trunk support group (n = 14) or a trunk restraint group (n = 14) that practiced upper limb training with trunk support and trunk restraint, respectively, based on visual feedback for 30 min per day, three times per week, for 4 weeks. The postural assessment scale for stroke (PASS) was used to assess the stability of patients, and the functional reaching test (FRT) was performed to assess balance. To assess upper extremity function, a range of motion (ROM) test, manual muscle testing (MMT), and Fugl–Meyer assessment-upper limb (FMA-upper limb) were performed. Consequently, both groups showed significant differences before and after training in the PASS, FRT, shoulder flexion ROM, triceps brachii MMT, and FMA-upper limb (p < 0.05), while the trunk support group showed more significant improvements than the trunk restraint group in the PASS, FRT, and FMA-upper limb (p < 0.05). Trunk support-based upper limb training effectively improved trunk stability, balance, and upper limb function and is beneficial as an upper limb training method. Providing trunk support is more effective than restricting the trunk; trunk support-based upper limb training is expected to promote voluntary participation when combined with visual feedback.

Instruments to assess upper‐limb function in children and adolescents with neuromuscular diseases: a systematic review

To synthesize clinical and scientific evidence regarding the instruments available to assess upper-limb function in paediatric patients with neuromuscular disease (NMD). This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines (Prospective Registry of Systematic Reviews no. CRD42020140343). Two independent reviewers searched the PubMed/MEDLINE, LILACS, Embase, and Scopus databases. Inclusion criteria were cross-sectional or longitudinal studies or randomized controlled trials that used scales or questionnaires to assess upper-limb function in paediatric patients with NMDs. The COSMIN Risk of Bias checklist and criteria for good measurement properties were applied to assess the methodological quality of the instruments. In total, 34 articles and 12 instruments were included. The Brooke Upper Extremity (n=16) and Performance of Upper Limb (PUL) (n=12) instruments were the most used tools. The PUL and Duchenne muscular dystrophy (DMD) Upper Limb patient-reported outcome measures (PROMs) tested more measurement properties and provided higher methodological quality scores for patients with DMD. Likewise, the Revised Upper Limb Module (RULM) was the most suitable instrument for patients with spinal muscular atrophy. No instrument has been devised to assess upper-limb function in patients with Charcot-Marie-Tooth disease and no other disease-specific instruments were found. The PUL, DMD Upper Limb PROM, and RULM are the most suitable instruments to assess upper-limb function in the two most prevalent paediatric NMDs. The identified gaps and methodological flaws of the available instruments indicate a need to develop high-quality instruments to assess other types of paediatric NMDs. What this paper adds The most suitable observer-rater instrument to assess upper-limb function in Duchenne muscular dystrophy (DMD) is the Performance of Upper Limb. The most suitable observer-rater instrument to assess upper-limb function in spinal muscular atrophy is the Revised Upper Limb Module. The DMD Upper Limb patient-reported outcome measure is recommended to assess the upper-limb performance of patients with DMD. Literature gaps and methodological flaws indicate the need to develop high-quality instruments to assess other types of paediatric neuromuscular disease.

HoMEcare aRm rehabiLItatioN (MERLIN): telerehabilitation using an unactuated device based on serious games improves the upper limb function in chronic stroke

BackgroundHoMEcare aRm rehabiLItatioN (MERLIN) is an unactuated version of the robotic device ArmAssist combined with a telecare platform. Stroke patients are able to train the upper limb function using serious games at home. The aim of this study is to investigate the effect of MERLIN training on the upper limb function of patients with unilateral upper limb paresis in the chronic phase of stroke (> 6 months post stroke).MethodsPatients trained task specific serious games for three hours per week during six weeks using an unactuated version of a robotic device. Progress was monitored and game settings were tailored through telerehabilitation. Measurements were performed six weeks pre-intervention (T0), at the start (T1), end (T2) and six weeks post-intervention (T3). Primary outcome was the Wolf Motor Function Test (WMFT). Secondary outcomes were other arm function tests, quality of life, user satisfaction and motivation.ResultsTwelve patients were included, ten completed the training. From start of the intervention to six weeks follow up, WMFT improved significantly with 3.8 points (p = .006), which is also clinically relevant. No significant changes in quality of life were observed. Patients were overall satisfied with the usability of the device. Comfort and the robustness of the system need further improvements.ConclusionPatients in the chronic phase of stroke significantly improved their upper limb function with the MERLIN training at home.Trial registration This study is registered at the Netherlands Trial Register (NL7535). Registered 18–02-2019, https://www.trialregister.nl/trial/7535.

Functional connectivity and upper limb function in patients after pediatric arterial ischemic stroke with contralateral corticospinal tract wiring

To develop individualized motor rehabilitation, knowledge of the relationship between neuroplastic reorganization and motor recovery after pediatric arterial ischemic stroke (AIS) is crucial. Thus, we investigated functional connectivity in patients after AIS with good motor outcome and in patients with hemiparesis compared with typically developing peers. We included 18 patients (n = 9 with hemiparesis, n = 9 with good motor outcome) with pediatric AIS in the chronic phase (≥ 2 years after diagnosis, diagnosed > 16 years) and 18 peers matched by age and gender. Participants underwent a standardized motor assessment, single-pulse transcranial magnetic stimulation to determine the type of corticospinal tract wiring, and resting-state functional magnetic resonance imaging to examine motor network connectivity. Corticospinal tract wiring was contralateral in all participants. Patients with hemiparesis had lower interhemispheric connectivity strength compared with patients with good clinical outcome and peers. Patients with good clinical outcome had higher intrahemispheric connectivity strength compared with peers. Further, higher intrahemispheric connectivity was related to better motor outcome in patients. Our findings suggest that better motor outcome after pediatric AIS is related to higher motor network connectivity strength. Thus, resting-state functional connectivity might be predictive for motor recovery after pediatric AIS.

Using brain functional magnetic resonance imaging to evaluate the effectiveness of acupuncture combined with mirror therapy on upper limb function in patients with cerebral ischemic stroke: a study protocol for a randomized, controlled trial

BackgroundUpper limb and hand motor dysfunction is one of the challenges in rehabilitation after cerebral ischemic stroke (CIS), and the clinical efficacy of rehabilitation needs to be improved. This study aims to combine Jin’s three-needle acupuncture (JTN) therapy with mirror therapy (MT) for hemiplegia after CIS, objectively evaluate the clinical effects and safety of JTN to treat upper limb dysfunction, and use functional magnetic resonance imaging (fMRI) of the brain to investigate the central mechanisms of the effects, which would provide a powerful evidence-based medical basis for further supporting the application of JTN combined with MT.Methods/designThis trial will be a single-blind, randomized controlled study. Patients who meet the study criteria will be recruited and randomly assigned to either the combined treatment group (JTN+MT) or the JTN group. Both interventions will be conducted for 6 days per week and last for 4 weeks. The primary outcome will be the effective rate based on the Fugl–Meyer Assessment for Upper Extremity (FMA-UE). Other outcome measures will include scores on the motor assessment scale (MAS), action research arm test (ARAT), activities of daily living (ADL) scale, and fMRI analyses. For safety evaluation, adverse events will be observed and recorded.DiscussionThis study may help to identify the efficacy and safety of acupuncture combined with MT for upper limb dysfunction after CIS and explore the central mechanisms with brain fMRI.Trial registrationChinese Clinical Trial Registry ChiCTR-IOR-17012174. Registered on 5 April 2017.

Impact of Sensory Impairment on Improvement of Upper-limb Function in Patients under 75 Years of Age with Subacute Stroke: A Preliminary Study.

ABSTRACTObjectives:The aim of this study was to investigate whether an interaction exists between sensory impairment and age with respect to the recovery of upper-limb function in patients with subacute stroke.Methods:This retrospective observational study included 83 patients recovering from subacute stroke in a rehabilitation hospital ward. The recovery of upper-limb function in four groups classified by age and sensory impairment were compared using analysis of covariance. Furthermore, multiple regression analysis was performed with recovery of upper-limb function as the dependent variable and with binarized sensory impairment and binarized age and their interaction term as the independent variables.Results:The estimated marginal means of upper-limb recovery were significantly higher in the non-late elderly (≤74 years) without sensory impairment group than in the other three groups. No significant differences were observed among the following three groups: the non-late elderly with sensory impairment, the late elderly (≥75 years) without sensory impairment, and the late elderly with sensory impairment. In multiple regression analysis, the interaction term between sensory impairment and age was significantly associated with improvement in upper-limb function (β=0.16, P <0.05). Age alone was significant, but sensory impairment alone was not significant.Conclusions:Sensory impairment in patients with subacute stroke affects the recovery of upper-limb function as a result of age interactions.

Лечение ризартроза внутрисуставным введением гиалуроновой кислоты с использованием ультразвуковой навигации

Osteoarthritis (OA) is the most common disease in orthopedic practice, which is characterized by chronic pain in the joints and joint dysfunction. OA of the carpometacarpal joint (CMCJ) of the thumb is the most common type of hand osteoarthritis. The aim of the work was to evaluate the effect of ultrasound-guided intraarticular injection of hyaluronic acid (HA) for osteoarthritis of the CMCJ of the thumb (stage II–III Kellgren–Lawrence) in patients with persistent pain syndrome for 3 months and with failure of NSAIDs therapy. The study included 18 patients with stage II–III CMCJ OA who received intraarticular injection of HA drugs with a mass of 2400,000 kDa in the volume of 1.0 ml twice with an interval of 10 days. Demographic characteristics, body mass index, stage of osteoarthritis (CMCJ), severity of pain syndrome according to visual analog scale (VAS) and upper limb function assessed with the DASH questionnaire (disabilities of the arm, shoulder, and hand) were evaluated. Data was collected at the start of the study and in 1, 3 and 6 months after the first injection. DASH and VAS scores were compared using a variance analysis of repeated measurements. The non-parametric Friedman criteria was used to check the differences in proportions. The value of p&lt;0.05 was considered statistically significant. There was a significant improvement in DASH values in 1, 3 and 6 months after injection. There were statistically significant differences between DASH values at the start of treatment and 6 months after therapy: χ²=45.7; df 3, p&lt;0.001. There was also a significant decrease in the average VAS score during the study in 1, 3 and 6 months after the first injection. The differences in VAS score at the start of treatment and in 6 months reached statistical significance: χ²=47.1; df 3, p&lt;0.001. Improvement occurred after 1 month after first injection and persisted throughout the entire follow-up period for 6 months. HA injections provide pain relief and improve upper limb function in patients who are resistant to analgesics and physiotherapy. A significant decrease in pain was observed as early as 1 month after the first intra-articular injection of GNC. The obtained results already allow us to recommend the use of HA drugs for CMCJ OA.

Montreal Cognitive Assessment and Frontal Assessment Battery test as a predictor of performance of unaffected hand function after subcortical stroke.

The objective of this study was to elucidate the association between unaffected hand function and cognitive impairment and to determine whether the cognitive screening test can be a predictor of unaffected upper limb function in patients with unilateral subcortical strokes. A retrospective study of 37 patients with unilateral first-ever subcortical stroke was conducted through a review of medical records. The unaffected hand function and cognitive screening tests were measured upon admission to the neurorehabilitation unit and then 4 weeks later at discharge. The relationship between unaffected hand function and cognitive function was investigated with multiple linear regression analysis. Comparing the initial evaluation of unaffected hand function and cognitive function with the evaluation at discharge, cognitive function improved significantly at discharge; however, grip strength and dexterity of the unaffected hand were stationary except for three-point pinch strength, tip pinch strength, and finger tapping speed. The Montreal cognitive assessment (MoCA) score was found to be a significant predictor of unaffected grip strength (R2 = 0.33, P = 0.004) and three-point pinch strength (R2 = 0.16, P = 0.04) at discharge and the Frontal Assessment Battery (FAB) score to be a predictive value of the unaffected finger tapping test (R2 = 0.46, P < 0.001) at discharge. In subcortical stroke patients with low MoCA and FAB scores, clinicians must ensure that patients participate in rehabilitation therapy including bimanual activity with careful attention to the patient's unaffected hand function.

Accuracy of the Upper Limb Prediction Algorithm PREP2 Applied 2 Weeks Poststroke: A Prospective Longitudinal Study

Background The Predict Recovery Potential algorithm (PREP2) was developed to predict upper limb (UL) function early after stroke. However, assessment in the acute phase is not always possible. Objective To assess the prognostic accuracy of the PREP2 when applied in a subacute neurorehabilitation setting. Methods This prospective longitudinal study included patients ≥18 years old with UL impairment following stroke. Patients were assessed in accordance with the PREP2 approach. However, 2 main components, the shoulder abduction finger extension (SAFE) score and motor-evoked potentials (MEPs) were obtained 2 weeks poststroke. UL function at 3 months was predicted in 1 of 4 categories and compared with the actual outcome at 3 months as assessed by the Action Research Arm Test. The prediction accuracy of the PREP2 was quantified using the correct classification rate (CCR). Results Ninety-one patients were included. Overall CCR of the PREP2 was 60% (95% CI 50%-71%). Within the 4 categories, CCR ranged from the lowest value at 33% (95% CI 4%-85%) for the category Limited to the highest value at 78% (95% CI 43%-95%) for the category Poor. In the present study, the overall CCR was significantly lower (P < .001) than the 75% reported by the PREP2 developers. Conclusions The low overall CCR makes PREP2 obtained 2 weeks poststroke unsuited for clinical implementation. However, PREP2 may be used to predict either excellent UL function in already well-recovered patients or poor UL function in patients with persistent severe UL paresis.

The Correlation Between Reach and Grasp Kinematic Measures and Clinical Measures of Manual Dexterity in Patients With Parkinson Disease

Background and Objectives: To investigate the correlation between reach and grasp kinematic measures and clinical measures of gross and fine manual dexterity in patients with idiopathic Parkinson Disease (PD). Methods: Sixty patients (44 men, 16 women) with idiopathic PD (Mean±SD of age: 59.85±11.89 years) were recruited in this non-experimental cross-sectional study using a non-probability sampling method. Their gross and fine manual dexterity were assessed using the Box and Block Test (BBT) and Nine Hole Peg Test (NHPT), respectively. Also, reach and grasp kinematic measures (including normalized movement time, peak velocity, Maximum Grip Aperture [MGA], and percentage of movement time in which MGA occurred [PMGA]) were measured in the more affected hand. Results: The results showed a significant and moderate correlation between reach kinematic measures (i.e. normalized movement time and peak velocity) and both gross and fine manual dexterity assessed by BBT (P=0.000) and NHPT (P=0.000), respectively. However, there was not a significant correlation between grasp kinematic measures (i.e. MGA and PMGA) and gross manual dexterity measured by BBT (P&gt;0.05) as well as fine manual dexterity assessed by NHPT (P&gt;0.05). Conclusion: This study showed no to moderate correlation between reach and grasp kinematic measures and clinical measures of gross and fine manual dexterity in patients with PD, supporting the significance of multi-level evaluation using both clinical and kinematic measures in the evaluation of upper limb function in patients with PD.

집단 거울치료가 지역사회 거주 뇌졸중 환자의 상지 운동과 감각 기능에 미치는 효과

The purpose of this study was to demonstrate the effects of a group mirror therapy on upper limb and sensory functions in community-living individuals with chronic stroke. Seven patients with chronic stroke living in the community volunteered for this study, and they underwent a group mirror therapy. Measurements were made with Fugl-Meyer assessment (FMA) and monofilament test, which were evaluated before and after the intervention, and 2-week follow-up. A group mirror therapy was performed for average 90 minutes daily, 5 times a week for 2 weeks (a total of 10 sessions), consisting of trainings for the upper extremity: Warm-up, main training (active range of motion exercise and functional task training), and cool-down. A Friedman test was used to compare the changes of measurement values. The results of the study showed that FMS scores were statistically significantly improved after intervention, and gain was maintained at the 2-week follow-up (p<.05). However, there was not significantly different for the monofilament test scores after the intervention and the follow-up, despite of positive change after the intervention (p>.05). These findings suggest that a group mirror therapy might be beneficially used to improve the upper limb function of patients with stroke. Further studies with robust design warrant study results.

The Effects of Lower Extremity Strengthening Program on Balance, Gait and Upper Limb Function in Patients with Stroke

The Effects of Lower Extremity Strengthening Program on Balance, Gait and Upper Limb Function in Patients with Stroke

Efficacy of Integrated Therapy of rTMS and rPMS on Upper Limb Function in Patients With Stroke

Efficacy of Integrated Therapy of rTMS and rPMS on Upper Limb Function in Patients With Stroke

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.

Italian translation and psychometric validation of the Manual Ability Measure-36 (MAM-36) and its correlation with an objective measure of upper limb function in patients with multiple sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system with an unpredictable course. During its course, deficits affecting upper limb functions may occur. Hence, there is a need for self-administered scales providing a comprehensive assessment of upper limb functions. The Manual Ability Measure-36 (MAM-36), which investigates patients' performance in activities of daily living requiring upper limb function, has not been adapted and validated in the Italian context. We develop an Italian translation and validation of the MAM-36 in a population of people with MS (PwMS), explore its psychometric properties and investigate its associations with clinical data and the Nine Hole Peg Test (9-HPT). The multicentre study involved five Italian neurological centres. Subjects were evaluated using EDSS, 9-HPT and the MAM-36 scale. We used confirmatory factor analysis and Rasch analysis to investigate the properties of the MAM-36. We enrolled 218 PwMS. Results supported the unidimensionality of the MAM-36, and adequatefunctioning of rating scale and items. Additionally, the MAM-36 showed weak negative associations with age and disease duration, and moderate associations with EDSS and 9-HPT scores. The adapted MAM-36 showed adequate psychometric properties. However, indications of problematic targeting to PwMS with low disability emerged. For this reason, use of the scale appears to be more suitable among patients with moderate-to-severe disability.

Motor relearning program along with electrical stimulation for improving upper limb function in stroke patients: A quasi experimental study.

Objective:To determine the effectiveness of motor relearning program along with electrical stimulation for improving upper limb function in patients with sub-acute stroke.Methods:A quasi experimental study was conducted at Physiotherapy Department of SAIDU Group of Teaching Hospitals Swat Khyber Pakhtunkhwa from January to June 2019. Forty four subjects with post stroke duration of 3-9 months (sub-acute) participated in the study. Subjects received electrical stimulations for the effected arm for 15 minutes along with motor relearning programme for an hour five days a week for six weeks. The upper limb sub scales of motor assessment scale were used to collect pre and post treatment data. SPSS version 20 was used to analyze the data.Results:The mean age of the participants was 54.95±13.2 years. Out of 44 participants 31(70.5%) were male and 13 (29.5%) were female. Pretreatment upper arm function, hand movement and advance hand activities scores were 1.36 ± 0.49, 1.18 ± 0.39 and 1.04 ± 0.21 respectively while their post treatment scores were 5.18 ± 0.96, 4.77 ± 1.02 and 3.95 ± 1.21 respectively. There was significant differences (P<0.05) between pre and post treatment scores of upper arm function, hand movement and advance hand activities.Conclusion:Motor relearning program along with electrical stimulation significantly improves upper limb function in patients with sub-acute stroke.

Relationship between upper limb function and functional neural connectivity among motor related-areas during recovery stage after stroke

ABSTRACTBackgrounds: Neural biomarkers to predict motor recovery have been used in the field of rehabilitation. Functional connectivity (FC) among the brain regions recorded by functional magnetic resonance imaging systems have been reported, but convenient method to estimate FC for clinical situation has not been established.Objectives: This observational study investigated the relationship between neural functional connectivity obtained by electroencephalography (EEG) and the upper limb function in patients during recovery stage after stroke.Methods: Twenty-four patients in the recovery stage between 4 and 8 weeks after the onset of stroke (mean age: 62 ± 12 (SD)) were enrolled. The EEG signals were obtained by five electrodes placed on the motor-related areas (C3, C4, FC3, FC4, and FCz in the International 10–20 system) for 60 sec at rest and during finger movement on the affected side, and amplitude envelope correlations as measures of FC among the areas were calculated. Fugl-Meyer Assessment (FMA) was used to assess upper limb motor function.Results: The FMA scores evaluated at 4W (33 ± 24 (SD)) were improved by 8W (42 ± 23) (p < .001). The FCs in α and β bands calculated between the electrodes in the ipsi-lesional hemisphere were correlated negatively with the FMA score at 4W after stroke. The FCs obtained at 4W could be used to predict the FMA score at 8W after stroke.Conclusions: The FCs recorded at rest, as well as during the finger motor task, by the five electrodes placed on motor-related areas could be used to predict the motor function and recovery of the upper limb affected by stroke. The results indicate the possibility of using FCs recorded by conventional EEG with electrodes as biomarkers to predict motor recovery after stroke.

Effect of visual feedback training using mirror neuron theory on limb function and activities of daily living in patients with hemiplegia during early stroke

Objective To explore the effect of visual feedback training using mirror neuron theory in patients with hemiplegia in early stroke. Methods From July 2014 to July 2017, 122 early stroke patients with hemiplegic stroke in the First People's Hospital of Wenling were selected in the study.After the patients' condition was stable, visual feedback training based on mirror neuron theory was performed.The functional status of upper limbs before and after treatment was evaluated by the simplified Fugl-Meyer motor function evaluation.The modified Ashworth scale was used to evaluate the upper limb muscle tension before and after treatment.The Barthel index was used to evaluate the ability of daily living activities before and after treatment. Results The FMA score of patients after treatment was (35.74±11.24)points, which was significantly higher than that before treatment [(28.81±9.68)points, t=5.160, P=0.000]. The BI score after treatment was (76.24±14.77)points, which was significantly higher than before treatment[(52.93±12.28)points, t=13.404, P=0.000]. After treatment, the muscle tension of the flexor elbow muscle group was (1.57±0.76)grades, which was significantly lower than before treatment [(3.24±0.72)grades, t=17.619, P=0.000]. The forearm pronation muscle group muscle tension grade was (2.14±0.96)grades, which was significantly lower than before treatment [(3.28±0.75)grades, t=10.336, P=0.000]. Conclusion Visual feedback training based on mirror neuron theory can help improve the upper limb function of patients with hemiplegia in early stroke, alleviate the symptoms of paralysis, improve the ability of daily living activities of patients, and has positive effect on promoting their rehabilitation. Key words: Cerebrovascular disorders; Feedback, psychological; Mirror neurons; Early hemiplegia; Upper limb function; Activity of daily living