Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Olivier Rémy-Néris ◽  
Anaïs Le Jeannic ◽  
Angelina Dion ◽  
Béatrice Médée ◽  
Emmanuel Nowak ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Multicenter Trial ◽  
Cost Utility ◽  
Phase Iii ◽  
Control Group ◽  
Unique Identifier ◽  
Assessment Score ◽  
Subacute Stroke ◽  
Upper Extremity Impairment

Background and Purpose: Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. The primary aim was to compare the effects of self-rehabilitation using a mechanized device with control self-exercises on upper extremity impairment in patients with stroke. Methods: Phase III, parallel, concealed allocation, randomized controlled, multicenter trial, with 12-month follow-up. Patients aged 18 to 80 years, 3 weeks to 3 months poststroke with a Fugl-Meyer Assessment score of 10 to 40 points, were randomized to the Exo or control groups. All undertook two 30-minute self-rehabilitation sessions/day, 5 days/wk for 4 weeks in addition to usual rehabilitation. The Exo group performed games-based exercises using a gravity-supported mechanical exoskeleton (Armeo Spring). The control group performed stretching plus basic active exercises. Primary outcome was change in upper extremity Fugl-Meyer Assessment score at 4 weeks. Results: Two hundred fifteen participants were randomly allocated to the Exo group (107) or the control group (108). Mean age (SD), 58.3 (13.6) years; mean time poststroke, 54.8 (22.1) days; and mean baseline Fugl-Meyer Assessment score, 26.1 (9.5). There was no between-group difference in mean change in Fugl-Meyer Assessment score following the intervention: 13.3 (9.0) in the Exo group and 11.8 (8.8) in the control group ( P =0.22). There were no significant between-group differences in changes for any of the other outcomes at any time point (except for perception of the self-rehabilitation). There was no between-group difference in cost utility at 12 months. Conclusions: In patients with moderate-to-severe impairment in the subacute phase of stroke, the purchase and use of complex devices to provide additional upper limb training may not be necessary: simply educating patients to regularly move and stretch their limbs appears sufficient. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01383512.

scholarly journals Ocrelizumab reduces progression of upper extremity impairment in patients with primary progressive multiple sclerosis: Findings from the phase III randomized ORATORIO trial

2018 ◽  
Vol 24 (14) ◽  
pp. 1862-1870 ◽  
Author(s):  
Edward J Fox ◽  
Clyde Markowitz ◽  
Angela Applebee ◽  
Xavier Montalban ◽  
Jerry S Wolinsky ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Upper Extremity ◽  
Progressive Multiple Sclerosis ◽  
Phase Iii ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
Intention To Treat ◽  
Disability Status ◽  
Upper Extremity Impairment ◽  
Post Hoc

Background: Upper extremity (UE) impairment is common with primary progressive multiple sclerosis (PPMS). Objective: This exploratory analysis examined the effects of ocrelizumab on confirmed progression (CP) and confirmed improvement (CI) in UE impairment in patients from ORATORIO. Methods: Patients with PPMS received ocrelizumab 600 mg or placebo every 24 weeks for ⩾120 weeks. The Nine-Hole Peg Test (9HPT) was administered at baseline (BL) and every 12 weeks thereafter. Prespecified exploratory endpoints included change in 9HPT time and proportion of patients with CP of ⩾20% in 9HPT. Analysis populations included intention-to-treat (ITT) patients and subgroups stratified by BL 9HPT time and Expanded Disability Status Scale. Post hoc analyses included the proportion of patients achieving more severe thresholds of CP and the proportion achieving CI in 9HPT. Results: Among ITT patients, ocrelizumab significantly reduced the change in 9HPT time over 120 weeks, the risk of CP of ⩾20% in 9HPT time for both hands and the risk of more severe 9HPT progression versus placebo. Numerical trends also favoured ocrelizumab versus placebo with respect to achieving CI. Consistent directional trends were observed in subgroup analyses. Conclusion: Ocrelizumab reduces the risk of UE disability progression and may increase the possibility of improvement versus placebo in PPMS.

Motor Training of Upper Extremity With Functional Electrical Stimulation in Early Stroke Rehabilitation

2008 ◽  
Vol 23 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Sabine Mangold ◽  
Corina Schuster ◽  
Thierry Keller ◽  
Andrea Zimmermann-Schlatter ◽  
Thierry Ettlin
Keyword(s):  
Electrical Stimulation ◽  
Upper Extremity ◽  
Shoulder Pain ◽  
Functional Electrical Stimulation ◽  
Intervention Group ◽  
Passive Movement ◽  
Control Group ◽  
Motor Training ◽  
Stroke Patients ◽  
Subacute Stroke

Background. Functional electrical stimulation (FES) allows active exercises in stroke patients with upper extremity paralysis. Objective. To investigate the effect of motor training with FES on motor recovery in acute and subacute stroke patients with severe to complete arm and/or hand paralysis. Methods. For this pilot study, 23 acute and subacute stroke patients were randomly assigned to the intervention (n = 12) and control group (n = 11). Distributed over 4 weeks, FES training replaced 12 conventional training sessions in the intervention group. An Extended Barthel Index (EBI) subscore assessed the performance of activities of daily living (ADL). The Chedoke McMaster Stroke Assessment (CMSA) measured hand and arm function and shoulder pain. The Modified Ashworth Scale (MAS) assessed resistance to passive movement. Unblinded assessments were performed prior to and following the end of the training period. Results. The EBI subscore and CMSA arm score improved significantly in both groups. The CMSA hand function improved significantly in the FES group. Resistance to passive movement of finger and wrist flexors increased significantly in the FES group. Shoulder pain did not change significantly. None of the outcome measures, however, demonstrated significant gain differences between the groups. Conclusions. We did not find clear evidence for superiority or inferiority of FES. Our findings, and those of similar trials, suggest that the number of sessions should be at least doubled to test for superiority of FES in these highly impaired patients and approximately 50 participants would have to be assigned to each therapeutic intervention to find significant differences.

scholarly journals Study protocol for a randomised, double-blinded, placebo-controlled phase III trial examining the add-on efficacy, cost–utility and neurobiological effects of low-dose naltrexone (LDN) in patients with fibromyalgia (INNOVA study)

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e055351
Author(s):  
Ariadna Colomer-Carbonell ◽  
Juan P Sanabria-Mazo ◽  
Halbert Hernández-Negrín ◽  
Xavier Borràs ◽  
Carlos Suso-Ribera ◽  
...  
Keyword(s):  
Pain Intensity ◽  
Low Dose ◽  
Cost Utility ◽  
Phase Iii ◽  
Control Group ◽  
Phase Iii Trial ◽  
Life Years ◽  
Double Blinded ◽  
Ecological Momentary ◽  
Low Dose Naltrexone

IntroductionThere is evidence that low-dose naltrexone (LDN; <5.0 mg/day) reduces pain and improves the quality of life of people with fibromyalgia syndrome (FMS). However, no randomised controlled trials with long-term follow-ups have been carried out. The INNOVA study will evaluate the add-on efficacy, safety, cost–utility and neurobiological effects of LDN for reducing pain in patients with FMS, with a 1-year follow-up.Methods and analysisA single-site, prospective, randomised, double-blinded, placebo-controlled, parallel design phase III trial will be performed. Eligibility criteria include being adult, having a diagnosis of FMS and experiencing pain of 4 or higher on a 10-point numerical rating scale. Participants will be randomised to a LDN intervention group (4.5 mg/day) or to a placebo control group. Clinical assessments will be performed at baseline (T0), 3 months (T1), 6 months (T2) and 12 months (T3). The primary endpoint will be pain intensity. A sample size of 60 patients per study arm (120 in total), as calculated prior to recruitment for sufficient power, will be monitored between January 2022 and August 2024. Assessment will also include daily ecological momentary evaluations of FMS-related symptoms (eg, pain intensity, fatigue and sleep disturbance), and side effects via ecological momentary assessment through the Pain Monitor app during the first 3 months. Costs and quality-adjusted life years will be also calculated. Half of the participants in each arm will be scanned with MRI at T0 and T1 for changes in brain metabolites related to neuroinflammation and central sensitisation. Inflammatory biomarkers in serum will also be measured.Ethics and disseminationThis study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and community engagement activities.Trial registration numberNCT04739995.

scholarly journals Effects of Neuromuscular Electrical Stimulation on Hemiplegic Upper Limb of Stroke Survivors: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Author(s):  
Wenyue Zhang ◽  
Shuye Pei ◽  
Juan Huang ◽  
Yao Tang ◽  
Huaidong Hu
Keyword(s):  
Electrical Stimulation ◽  
Randomized Controlled Trials ◽  
Upper Extremity ◽  
Upper Limb ◽  
Meta Analysis ◽  
Neuromuscular Electrical Stimulation ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background: Whether NMES helps the recovery of upper limb function in patients with hemiparesis has not been confirmed. We conducted this meta-analysis to examine the effectiveness of neuromuscular electrical stimulation (NMES) for upper limb hemiparesis after stroke.Methods: Data sources such as Pubmed, Embase and Cochrane library databases were searched for all relevant studies that were carried out before December 1, 2018.We selected the randomized controlled trials (RCTs) which included chronic and acute stroke patients with upper extremity dysfunction. Then the intervention group which applied NMES was compared with a control group without NMES. Results: A total of 16 RCTs involving 691 patients were discerned from 248 searched articles. According to the forest plot ,NMES had a significant benefit on FMA-ue scale(SMD=0.44,95%CI 0.13 to 0.74,P=0.006).Also, NMES was positive for ARAT(SMD=0.31,95%CI 0.05 to 0.58,P=0.019)and MAL-AOU(SMD=0.59,95%CI 0.15 to1.04,P=0.009),but not for wrist MAS(SMD=-0.12,95%CI -0.43 to 0.19,P=0.434) or BI(SMD=0.51,95%CI -0.65 to 1.66,P=0.392).Conclusion: NMES application has beneficial impacts on upper extremity motor function in patients with stroke. This study suggests that NMES ought to be applied as a beneficial rehabilitation means in improving the upper function.

scholarly journals The effect of virtual reality on motor anticipation and hand function in patients with subacute stroke: A randomised trial on movement-related potential.

2020 ◽  
Author(s):  
Ling Chen ◽  
Yi Chen ◽  
Wai Leung Ambrose Lo
Keyword(s):  
Virtual Reality ◽  
Reaction Time ◽  
Upper Limb ◽  
Cortical Excitability ◽  
Control Group ◽  
Post Intervention ◽  
Limb Function ◽  
Upper Limb Function ◽  
Subacute Stroke ◽  
Vr Training

Abstract Background: Impaired cognitive ability to anticipate the required control may affect functional recovery. The cortical excitability of task related motor anticipation for upper limb movement induced by virtual reality (VR) training is unknown. Aims: To investigate the changes of motor anticipation, cortical excitability and upper limb function induced by VR training in subacute stroke survivors. Methods: Upper limb hemiparesis resulting from the first occurrence of stroke within 1 to 6 months were recruited. Participants were randomly allocated to conventional therapy or VR intervention. Electroencephalogram (EEG) and electromyography (EMG) were simultaneously recorded during palmar grasp motion. Outcome measures of contingent negative variation (CNV) latency, mean peak amplitude, electromyography (EMG) reaction time, Upper Limb Fugl-Meyer Assessment (UL-FMA) and the Action Research Arm Test (ARAT) were recorded pre and post intervention. The EEG and EMG differences between the two groups were assessed by mixed model ANOVA (p=0.05). The differences in UL-FMA and ARAT were assessed Wilcoxon signed-rank test (p=0.05). Results: The reduction in EMG reaction time difference, CNV latency and mean peak amplitude were significantly lower in the VR group than the control group when executing movement with the paretic hand. ARAT and UL-FMA scores were significantly higher in the VR group than the control group post intervention. Conclusions: The findings indicated a reduction in brain computational demand during palmar grasp task. Improvements in clinical function in the VR group suggested that VR intervention may be more beneficial in improving upper limb function patients with subacute stroke. Improvement in upper limb function may be related to improvement of the neural anticipatory process. Trial registration: Chinese Clinical Trial Registry (Registration No.: ChiCTR-IOC-15006064). Registered on 11 May 2015. Retrospectively registered. http://www.chictr.org.cn/searchprojen.aspx

Effectiveness of Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy in Patients With Subacute Stroke

2011 ◽  
Vol 25 (9) ◽  
pp. 830-837 ◽  
Author(s):  
Keiichiro Shindo ◽  
Toshiyuki Fujiwara ◽  
Joji Hara ◽  
Hideki Oba ◽  
Fujiko Hotta ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Hand Function ◽  
Neuromuscular Electrical Stimulation ◽  
Control Group ◽  
Subacute Stroke ◽  
Hemiparetic Stroke ◽  
Electrical Stimulator ◽  
Hand Impairment ◽  
Wrist Splint ◽  
Dynamic Stimulation

Background and objective. Hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy was devised to facilitate the use of the hemiparetic upper extremity in daily life by combining assistive neuromuscular electrical stimulation, referred to as the integrated volitional electrical stimulator (IVES), with a splint. The aim of this study is to assess the effectiveness of HANDS therapy for patients with subacute stroke. Methods. The participants were 24 inpatients receiving rehabilitation for hemiparetic stroke within 60 days of onset. Entry criteria included inability to individuate finger extension. Patients were randomly assigned to 2 groups. The HANDS group (n = 12) used the IVES combined with a wrist splint for 8 hours a day for 3 weeks, and the control group (n = 12) wore a wrist splint alone. All patients received the same daily dose and length of standard poststroke multidisciplinary rehabilitation. Outcome measures were the upper extremity portion of the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Motor Activity Log-14 (MAL). Results. In all, 10 patients in each group completed the interventions. Compared with the control group, the HANDS group showed significantly greater gains in distal (wrist/hand) portion of the FMA ( P < .01) and improvement of the ARAT ( P < .05). The gains in the MAL did not differ. No adverse effects occurred and the HANDS therapy was well accepted. Conclusion. HANDS therapy in addition to conventional therapy may improve hand function in patients with moderate to severe hand impairment during early rehabilitation.

scholarly journals Proprioceptive Training with Visual Feedback Improves Upper Limb Function in Stroke Patients: A Pilot Study

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Jieying He ◽  
Chong Li ◽  
Jiali Lin ◽  
Beibei Shu ◽  
Bin Ye ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Motor Function ◽  
Visual Feedback ◽  
Upper Limb ◽  
Negative Impact ◽  
Controlled Trial ◽  
Sensory Stimulation ◽  
Control Group ◽  
Clinical Trial Registry ◽  
Proprioceptive Training

Proprioceptive deficit is one of the common sensory impairments following stroke and has a negative impact on motor performance. However, evidence-based training procedures and cost-efficient training setups for patients with poststroke are still limited. We compared the effects of proprioceptive training versus nonspecific sensory stimulation on upper limb proprioception and motor function rehabilitation. In this multicenter, single-blind, randomized controlled trial, 40 participants with poststroke hemiparesis were enrolled from 3 hospitals in China. Participants were assigned randomly to receive proprioceptive training involving passive and active movements with visual feedback (proprioceptive training group [PG]; n = 20 ) or nonspecific sensory stimulation (control group [CG]; n = 20 ) 20 times in four weeks. Each session lasted 30 minutes. A clinical assessor blinded to group assignment evaluated patients before and after the intervention. The primary outcome was the change in the motor subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-M). Secondary outcomes were changes in box and block test (BBT), thumb localization test (TLT), the sensory subscale of the Fugl-Meyer assessment for upper extremity (FMA-UE-S), and Barthel Index (BI). The results showed that the mean change scores of FMA-UE were significantly greater in the PG than in the CG ( p = 0.010 for FMA-UE-M, p = 0.033 for FMA-UE-S). The PG group was improved significantly in TLT ( p = 0.010 ) and BBT ( p = 0.027 ), while there was no significant improvement in TLT ( p = 0.083 ) and BBT ( p = 0.107 ) for the CG group. The results showed that proprioceptive training was effective in improving proprioception and motor function of the upper extremity in patients with poststroke. This trial is registered in the Chinese Clinical Trial Registry (ChiCTR2000037808).

scholarly journals Design and Preliminary Evaluation of a Tongue-Operated Exoskeleton System for Upper Limb Rehabilitation

2021 ◽  
Vol 18 (16) ◽  
pp. 8708
Author(s):  
Zhenxuan Zhang ◽  
Boris I. Prilutsky ◽  
Andrew J. Butler ◽  
Minoru Shinohara ◽  
Maysam Ghovanloo
Keyword(s):  
Upper Extremity ◽  
Upper Limb ◽  
Assistive Device ◽  
Preliminary Evaluation ◽  
Upper Limb Rehabilitation ◽  
Upper Limb Function ◽  
Tracking Tasks ◽  
Arm Reaching ◽  
Upper Extremity Impairment ◽  
Limb Rehabilitation

Stroke is a devastating condition that may cause upper limb paralysis. Robotic rehabilitation with self-initiated and assisted movements is a promising technology that could help restore upper limb function. Previous studies have established that the tongue motion can be used to communicate human intent and control a rehabilitation robot/assistive device. The goal of this study was to evaluate a tongue-operated exoskeleton system (TDS-KA), which we have developed for upper limb rehabilitation. We adopted a tongue-operated assistive technology, called the tongue drive system (TDS), and interfaced it with the exoskeleton KINARM. We also developed arm reaching and tracking tasks, controlled by different tongue operation modes, for training and evaluation of arm motor function. Arm reaching and tracking tasks were tested in 10 healthy participants (seven males and three females, 23–60 years) and two female stroke survivors with upper extremity impairment (32 and 58 years). All healthy and two stroke participants successfully performed the tasks. One stroke subject demonstrated a clinically significant improvement in Fugl-Meyer upper extremity score after practicing the tasks in six 3-h sessions. We conclude that the TDS-KA system can accurately translate tongue commands to exoskeleton arm movements, quantify the function of the arm, and perform rehabilitation training.

The Effectiveness of Mirror Therapy to Upper Extremity Rehabilitation in Acute Stroke Patients

2021 ◽  
Author(s):  
Phassakorn Klinkwan ◽  
Chalunda Kongmaroeng ◽  
Sombat Muengtaweepongsa ◽  
Wiroj Limtrakarn
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Upper Limb ◽  
Conventional Therapy ◽  
Motor Recovery ◽  
Stroke Recovery ◽  
Home Exercise ◽  
Control Group ◽  
Mirror Therapy ◽  
Stroke Patients

Rehabilitation is a crucial part of stroke recovery to help them regain use of their limb. The aim of this article was to compare the effectiveness of long-term training of mirror therapy with conventional rehabilitation therapy on neurological and recovery of upper limb in acute stroke patients. In this randomized and assessor-blinded control study, 20 acute stroke patients were analyzed in this study and allocated to a case (n = 10, 50.6 ± 17.90 years) and control group (n = 10, 55.9 ± 11.25 years). All the participants performed daily home exercise during 12 weeks. The patients in the control group were treated with conventional therapy (CT) and a group of cases were treated with mirror therapy (MT) alone program. The outcome measurements were assessed by a therapist blinded assessor using Fugl-Meyer Assessment (FMA) upper extremity score, Brunnstrom recovery stages (BRS), Modified Ashworth Scale (MAS) and Muscle Strength to evaluate upper limb motor function and motor recovery. Data were analyzed using Wilcoxon and Mann-Whitney U tests to compare within-groups and between-group differences. The results revealed that, after 12 weeks of treatment, patients of both groups presented statistically significant improvements in all the variables measured (p < 0.05). Compared with the control group, the patients of the MT group had greater improvement in the proximal movement portion of the FMA upper extremity mean score change (15.8 ± 3.2 versus 10.0 ± 2.7, p = 0.002) while there were no differences in other variables (p > 0.05). There were also no adverse events. It suggests that 12 weeks training of mirror therapy alone was likely to improve the motor recovery of the upper limb and activity of daily living in acute stroke patients than conventional therapy, if treated early.

scholarly journals Relationship Between Spasticity and Upper-Limb Movement Disorders in Individuals With Subacute Stroke Using Stochastic Spatiotemporal Modeling

2019 ◽  
Vol 33 (2) ◽  
pp. 141-152 ◽  
Author(s):  
Isgav Davidowitz ◽  
Yisrael Parmet ◽  
Silvi Frenkel-Toledo ◽  
Melanie C. Baniña ◽  
Nachum Soroker ◽  
...  
Keyword(s):  
Upper Limb ◽  
Voluntary Movement ◽  
Movement Time ◽  
Gaussian Mixture Models ◽  
Objective Measure ◽  
Gaussian Mixture ◽  
Control Group ◽  
Spatiotemporal Modeling ◽  
Subacute Stroke ◽  
Joint Range

Background. Spasticity is common in patients with stroke, yet current quantification methods are insufficient for determining the relationship between spasticity and voluntary movement deficits. This is partly a result of the effects of spasticity on spatiotemporal characteristics of movement and the variability of voluntary movement. These can be captured by Gaussian mixture models (GMMs). Objectives. To determine the influence of spasticity on upper-limb voluntary motion, as assessed by the bidirectional Kullback-Liebler divergence (BKLD) between motion GMMs. Methods. A total of 16 individuals with subacute stroke and 13 healthy aged-equivalent controls reached to grasp 4 targets (near-center, contralateral, far-center, and ipsilateral). Two-dimensional GMMs (angle and time) were estimated for elbow extension motion. BKLD was computed for each individual and target, within the control group and between the control and stroke groups. Movement time, final elbow angle, average elbow velocity, and velocity smoothness were computed. Results. Between-group BKLDs were much larger than within control-group BKLDs. Between-group BKLDs for the near-center target were lower than those for the far-center and contralateral targets, but similar to that for the ipsilateral target. For those with stroke, the final angle was lower for the near-center target, and the average velocity was higher. Velocity smoothness was lower for the near-center than for the ipsilateral target. Elbow flexor and extensor passive muscle resistance (Modified Ashworth Scale) strongly explained BKLD values. Conclusions. Results support the view that individuals with poststroke spasticity have a velocity-dependent reduction in active elbow joint range and that BKLD can be used as an objective measure of the effects of spasticity on reaching kinematics.

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