Material and methods: Two reviewers independently scrutinized the included studies. The selected studies underwent quality assessment by Physiotherapy Evidence Database (PEDro) scale. Randomized Controlled Trial (RCT) having a score of four or more were included in the review. A search was conducted in PUBMED, MEDLINE, CINAHL, EMBASE, PROQUEST, science direct, Cochrane Library, PEDro and Google Scholar.
Results: A total of 202 studies were identified. After removal of duplication, inclusion and exclusion criteria’s n?=?23 studies were included in the review process. For analysis, only the primary outcome measures of the studies were taken into account. Studies finally included in analysis were n?=?21. The included studies were 19 in stroke, 1 in cerebral palsy (CP) and 1 study in multiple sclerosis (MS). No RCTs were reportedly found in spinal cord injury (SCI), Parkinson and motor neuron disease (MND).
Conclusions: Studies related to stroke showed a clear definiteness in the improvement of upper extremity functions. On the contrary, there still remains a need for quality trials in CP, MS to establish the efficacy of robotics in upper extremity rehabilitation. 相似文献
Objectives: For this study, we systematically reviewed the evidence surrounding the use of orthoses for stroke-related upper extremity deficits.
Methods: Medical librarians searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, Health Technology Assessment Database, Physiotherapy Evidence Database, and OTSeeker using subject headings and keywords related to upper extremities, orthoses, and stroke. The resulting articles were evaluated for inclusion by the systematic review team. Articles that met the inclusion criteria were appraised for content and quality using the “Evaluation Guidelines for Rating the Quality of an Intervention Study” (EQIS).
Results: 14 studies were included, with the mean score of 31.29 (out of 48) for the EQIS using an ordinal scale with a range of 23–43.6 studies produced significant outcomes with effect sizes ranging from d = .52 (wrist flexion PROM) to d = 9.02 (patient satisfaction with orthosis).
Conclusion: Future studies should aim to utilize homogenous outcome measures while exploring variability in dosage and level of upper extremity impairment upon initiation. Additionally, universal guidelines for initiation period, duration, and type of orthosis for patients post-stroke need to be established. 相似文献
Summary of review: A database of articles published in the last decade was compiled using the following search terms combinations: (“upper extremity” OR “upper limb” OR arm) AND (kinematics OR motion OR movement) AND (analysis OR assessment OR measurement). The articles included in this review (1) had the purpose to analyze objectively a three-dimension kinematics of ULs, (2) studied functional movements or activities of daily living (ADL) involving uppers limbs, and (3) studied healthy and/or poststroke adults. Fourteen articles were included (four studied a healthy sample, three analyzed poststroke patients, and seven examined both poststroke and healthy participants).
Conclusion: Most of the recommended demographic and stroke information, such as some preexisting conditions to stroke, initial stroke severity, and stroke location, were not collected by all or most of the articles. Time poststroke onset was presented in all articles but showed great variability. Few articles identified anthropometric characteristics and adjusted task environment to them. Most of the samples were composed mainly by males and had a low mean age, which does not represent poststroke population. Most articles analyzed “functional movements”, namely simulations of ADL.
Implication of key findings: Future research should identify the recommended information to allow an adequate stratification. Acute phase after stroke, real ADL with different complexities, and ipsilesional UL should be studied. 相似文献
Objectives: The aim of this case series was to investigate the presentation of shoulder pain, motor impairment, shoulder passive range of motion (PROM) and alignment of the hemiplegic shoulder following acute stroke.
Methods: This study reported data that was collected as part of a pilot randomized controlled trial investigating kinesiology taping of the hemiplegic shoulder. Participants with a diagnosis of acute stroke and severe upper limb motor impairment were included. From 24-h post stroke and continuing every three days until discharge, measurements of shoulder pain (visual analogue scale, Ritchie Articular Index), motor impairment (Chedoke McMaster Stroke Assessment), PROM and alignment (both clinical measures) were collected. Clinical trial registry number – ACTRN12615000502538.
Results: Of 156 patients screened over six months, 10 of 15 eligible participants were recruited. On initial assessment, three participants reported pain and all had severe upper limb motor impairment. All participants initially demonstrated close to full shoulder PROM. Six participants had shoulder subluxation and five demonstrated scapula malalignment.
Conclusions: Given the severity of upper limb motor impairment, pain and reduced PROM were seen in a small number of participants. The clinical course of shoulder pain and PROM following stroke remains unclear. Large observational studies tracking shoulder characteristics from acute through to rehabilitation settings are needed. 相似文献
Objective: The aims of the study were to describe the characteristics of lower extremity pain conditions and to evaluate the impact of lower extremity pain on clinical variables, and health-related quality of life in patients with stroke.
Methods: One hundred and eighty-five patients with stroke who have self-reported pain in the lower extremity were included in the study. Lower extremity pain characteristics of stroke survivors including etiology, intensity, onset time, frequency, aggravating factors, relieving factors, site, and location of pain were evaluated and recorded. The Brunnstrom motor recovery scale, the functional ambulation category, the mini-mental state examination, the star cancellation test, the beck depression inventory, the Barthel Index, and the Short Form-36 Questionnaire (SF-36) were used.
Results: The causes of lower extremity pain were diagnosed as osteoarthritis (51.1%), central neuropathic pain (28.7%), mixed pain (10.3%), low back pain associated with leg pain (8.6%), greater trochanteric pain syndrome (5.2%), prior hip fracture (2.4%), heterotopic ossification (2%), developmental hip luxation (1%), hallux valgus (0.5%), and malignancy (0.5%). The intensity of lower extremity pain was a significant predictor of cognitive functions, ADL, depression, and all SF-36 subscales except emotional role and vitality. The duration of lower extremity pain was a significant predictor of depression and lower extremity spasticity.
Conclusions: Since lower extremity pain conditions have a significant important influence on clinical variables and health-related quality of life in stroke survivors, early identification and appropriate treatment of the lower extremity pain conditions should be carried out in order to reduce the level of disability in stroke patients. 相似文献
Method: A total of 367 persons with probable Alzheimer's disease, recruited from an Alzheimer's disease diagnostic center, were given three tests of lower extremity function and two tests of upper extremity function at 6 month intervals for up to 4 years. Gender, race, age and Mini-Mental State Examination (MMSE) score at baseline were used to predict subsequent decline in composite scores of lower and upper extremity function.
Results: At baseline, older age and lower MMSE scores were associated with lower scores on both lower and upper extremity function. Males performed better at baseline on lower extremity tests only. For each point higher on MMSE, a person declined 0.023 Standard Unit (SU) less per year (p = 0.0001) on lower extremity tests and declined 0.019 SU less per year (p < 0.0001) on upper extremity tests.
Conclusion: Physical performance was measured across a range of disease severities and declined over time. Lower cognitive score at baseline predicted faster decline in both lower and upper extremity function. Demographic heterogeneity in decline suggests other predictors may identify factors protective against physical decline. 相似文献
Methods: Twenty-five ischemic acute/subacute stroke subjects were enrolled in this randomized controlled trial. Experimental group 1 received low frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT) including activities to improve strength, flexibility, transfers, posture, balance, coordination, and activities of daily living, mainly focusing on upper limb movements; experimental group 2 received the same protocol combined with NMES to hand extensor muscles; and the control group received only PT. Functional magnetic resonance imaging (fMRI) scan was used to evaluate the activation or inhibition of the affected and unaffected primary motor cortex.
Results: No adverse effect was reported. Most of the clinical outcome scores improved significantly in all groups, however no statistically significant difference was found between groups due to the small sample sizes. The highest percent improvement scores were observed in TMS + NMES group (varying between 48 and 99.3%) and the lowest scores in control group (varying between 13.1 and 28.1%). Hand motor recovery was significant in both experimental groups while it did not change in control group. Some motor cortex excitability changes were also observed in fMRI.
Conclusion: LF-rTMS with or without NMES seems to facilitate the motor recovery in the paretic hand of patients with acute/subacute ischemic stroke. TMS or the combination of TMS + NMES may be a promising additional therapy in upper limb motor training. Further studies with larger numbers of patients are needed to establish their effectiveness in upper limb motor rehabilitation of stroke. 相似文献
Aim: In this prospective longitudinal study, we aimed to determine whether the integration of an electrophysiological measure of the motor network using Motor Evoked Potentials (MEPs) with an anatomical approach—diffusion-weighted MRI— in the acute phase of stroke can improve the prediction of recovery from post-stroke aphasia.
Methods and Procedures: Fifteen aphasic patients were included in the post-stroke acute phase. Electrophysiological assessment exploring resting motor threshold ratio (rMTr) of the two upper-limbs and neuroanatomy exploration using MRI and diffusion tensor imaging were performed in the acute phase. Language impairment was assessed at the same stage and six months after the stroke. Multivariate regression analyses were carried out on aphasia severity score at M6, on recovery rates (change of severity) and on speech and language features as the dependent variables.
Outcomes and Results: A first-level model, including only clinical variables (i.e., the initial severity) predicted severity at six months. When the rMTr of upper limbs was added in a second-level model, the predictive power significantly increased from 51% to 79%, as well as adding in a third-level model rMTr of upper limbs and the initial fibers number ratio (iFNr) of the corticospinal tracts (51% to 80%). With the changes in severity as the dependent variable, the same factors made a significant contribution and the predictive power of a second-level model increased from 23% to 50% to the same extent as in a third-level model (23% to 51%). A similar improvement when adding MEPs was noted for the prediction of articulatory agility and naming skills.
Conclusions: Our results suggest that MEPs of upper limbs measured within 15days post-stroke are strong determinants of the prediction of longitudinal severity of post-stroke aphasia as well as of changes in symptoms and that the combination of electrophysiological and anatomical biomarkers improve this prediction. 相似文献
Objectives: This study explored what factors affect rehabilitation and use of upper limb after stroke from a stroke survivor and healthcare professional perspective to better understand low engagement in UL rehabilitation in the chronic stages of stroke.
Method: Eight chronic stroke survivors and 21 healthcare professionals took part in semi-structured interviews or in one of three focus groups, respectively.
Results: Thematic analysis revealed three main themes: Availability of resources, Healthcare professional–patient relationship, and Psychosocial factors. Availability of resources and Healthcare professional–patient relationship indicated that due to resource pressures and a lack of communication and education, positive upper limb rehabilitation behaviors (e.g. engaging and integrating the upper limb in daily activity) were not always established in the early stages post-stroke. Psychosocial factors illustrated the cognitive and psychological barriers to sustained engagement with upper limb rehabilitation.
Conclusion: The findings indicate that stroke survivors and healthcare professionals have very similar understandings of barriers to UL activity, and positive upper limb rehabilitation behaviors are not always established early in recovery post-stroke. Increased resources and healthcare professional–patient relationships seem key factors to establishing positive perceptions of UL rehabilitation. Addressing psychosocial issues and resource limitations may help sustain engagement with UL rehabilitation. 相似文献
Objective: This study aimed to compare the effects of NMES, NTS, and the hybrid of NMES and NTS (“Hybrid”) on motor recovery of upper extremity (UE) for patients with stroke.
Methods: We conducted a prospective, single-blind randomized controlled trial with concealed allocation. Forty-three patients with chronic stroke (onset >6 months) were randomly assigned to three groups (NMES, NTS, and “Hybrid”). In addition to conventional rehabilitation, participants received 30 min of NMES or 30 min of NTS or 15 min of NTS followed by 15 min of NMES. The treatment period was 8 weeks, 3 days/week, 30 min/time. The UE subscale of Fugl-Meyer assessment (UE-FMA, the primary outcome), Motricity index, modified Ashworth scale, and Barthel index were administered by a blinded assessor at baseline, posttreatment, and one-month follow-up.
Results: Most of the participants had mild-to-moderate disability in activity of daily living. No significant differences in the outcome measures at posttreatment and one-month follow-up were found among the NMES group (n = 13), NTS group (n = 13), and the hybrid of NMES and NTS group (n = 17). However, significant score changes in UE-FMA (p < 0.025) from baseline to posttreatment and one-month follow-up were found for the “Hybrid” group.
Conclusions: This study reveals that the hybrid of NMES and NTS therapy appears to be beneficial to UE recovery after stroke but is not superior to NMES or NTS alone. 相似文献
