Upper Limb Rehabilitation In Patients Research Articles

Effects of combined transcranial direct current stimulation and physiotherapy for upper limb rehabilitation in patients with stroke: A controlled clinical trial

Effects of combined transcranial direct current stimulation and physiotherapy for upper limb rehabilitation in patients with stroke: A controlled clinical trial

Mental Practice and Mirror Therapy Associated with Conventional Physical Therapy Training on the Hemiparetic Upper Limb in Poststroke Rehabilitation: A Preliminary Study

Background: The presence of sensory and motor deficits is common in patients post stroke. Mental practice (MP) and mirror therapy (MT) can be used as therapeutic techniques for poststroke rehabilitation. Important results have been demonstrated, although they have not established the patients’ functional gain or related results of muscle electromyographic (EMG) data to functionality. Objective: The aim was to investigate EMG activity and sensory, motor, and functional performance in hemiparetic limbs of patients with stroke after intervention with MP and MT associated with conventional physical therapy training (CPTT). Methods: Seven patients were treated twice weekly during 8 weeks with MP and MT associated with CPTT of the affected upper limb. The Fugl-Meyer scale and the Barthel Index (BI) were applied to assess sensorimotor ability and independence of patients. Activation of the upper trapezius, biceps brachii, triceps brachii, flexor carpi ulnaris, and extensor carpi radialis was evaluated by means of EMG symmetry index and muscle co-activation measurements. Results: There were statistically significant differences between pre- and postassessment findings for the motor, sensory, and mobility domains of the Fugl-Meyer scale, as well as for BI evaluation. No statistically significant differences were observed when the pre- and posttest symmetry and co-activation data were compared, although there were qualitative changes. Conclusions: The protocol was effective for improving motor, sensory, and mobility aspects, as well as function involved in activities of daily living. Qualitative changes in symmetry and muscle co-contraction were found, indicating a possible improvement in upper limb rehabilitation of patients with stroke.

Upper Limb Exercise Prescription Following Cardiac Surgery via Median Sternotomy

Following cardiac surgery via median sternotomy, patients are routinely advised to adhere to upper limb restrictions to prevent the development of sternal complications. However, there is no definitive evidence to support the clinical application of such restrictions. The purpose of this study was to investigate current physiotherapy practice regarding upper limb exercise guidelines for this population, within outpatient cardiac rehabilitation in Australia. Physiotherapists working within outpatient cardiac rehabilitation programs in Australia were invited to complete a Web survey. The response rate was 77%. The majority of respondents (96%) prescribed upper limb exercises to patients following median sternotomy, with 95% placing restrictions on these exercises. At 6 weeks postoperatively, 58% and 73% of respondents still placed restrictions on unloaded and loaded unilateral upper limb elevation exercises respectively; similarly, 55% and 74% placed restrictions on unloaded and loaded bilateral upper limb elevation exercises, respectively. However, there was a lack of consensus on the type and timing of these restrictions, with patient-reported pain being the main parameter used to guide upper limb exercise prescription and progression. Only 43% reported screening for sternal instability, and if detected, the majority based their management on clinical experience. There is significant variation in practice with respect to the prescription and progression of upper limb exercises, within outpatient cardiac rehabilitation in Australia. Further research is warranted to establish evidence-based guidelines for the upper limb rehabilitation of patients following cardiac surgery via median sternotomy.

Stroke survivors talk while doing: Development of a therapeutic framework for continued rehabilitation of hand function post stroke

Study designQualitative study to identify themes and explore mechanisms underlying recovery of hand function post stroke for individuals discharged from rehabilitation services. Purpose of the studyPost-stroke hemiparesis frequently results in persistent hand dysfunction; the mechanisms of functional recovery are however poorly understood. We assessed the perspectives of community-dwelling individuals with chronic stroke on their hand function limitations and recovery to explore the feasibility of developing a theoretical framework for understanding the process of continued post-stroke recovery. MethodsEight subjects with chronic post-stroke hemiparesis were interviewed and videotaped while they performed a battery of 20 upper limb tasks. Qualitative analysis consisted of two investigators independently reviewing the videotapes and reading the transcribed conversations, identifying significant issues and then comparing their observations to determine common themes and develop emerging concepts. ResultsFour core themes pertaining to impairment and recovery of task-specific ability emerged: 1) spasticity can be overcome actively through task-specific attempts to use the affected arm and hand; 2) use of the affected arm can be facilitated by adopting positions that reduce the effect of gravity on the arm or enable gravity to act as a natural assist in the movement; 3) task-specific skill can be attained by repeatedly attempting specific component movements of tasks in the context of a variety of different tasks; and 4) frustration impedes task performance but a mental state of ‘detached focus’ can improve the motivation to use the affected arm. ConclusionsThese themes suggest a therapeutic framework for continued upper limb rehabilitation in patients' own environment to maximize functional recovery in individuals long after their stroke, and generate hypotheses which may lead to the development of new therapeutic protocols. Level of evidenceNA

A feasibility study using interactive commercial off-the-shelf computer gaming in upper limb rehabilitation in patients after stroke

Commercial off-the-shelf computer gaming devices have been making inroads into the rehabilitation arena, with the objective of making therapeutic exercise fun and contextual. One such device is the Nintendo Wii. Published clinical studies evaluating its acceptance, potential benefits and side-effects in the rehabilitation of patients with post-stroke weakness are few in number. The aim of this study is to assess the feasibility of using the Nintendo Wii as an adjunct to conventional rehabilitation of patients with post-stroke upper limb weakness. Twenty rehabilitation inpatients within 3 months after a stroke with upper limb weakness received 6 sessions of upper limb exercises via a Nintendo Wii over 2 weeks in addition to conventional rehabilitation. Outcome measures include a questionnaire, Fugl-Meyer Assessment of Upper Limb Motor Function and visual analogue scale of upper limb pain. A total of 16 subjects completed the study. All 16 found Nintendo Wii gaming enjoyable and comparable to, if not better than, conventional therapy. There were small but statistically significant improvements in the Fugl-Meyer Assessment and Motricity Index scores. Nintendo Wii appears to be a feasible adjunctive device to augment conventional therapy in a cohort of subacute stroke patients with moderate impairments of upper limb strength and function.