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Medicine Mar 2024Spastic paralysis is one of the most common sequelae of stroke, severely affecting patients' limb function and reducing their quality of life. Scalp acupuncture (SA) has... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Spastic paralysis is one of the most common sequelae of stroke, severely affecting patients' limb function and reducing their quality of life. Scalp acupuncture (SA) has been shown to significantly improve cerebral blood supply and reduce the severity of limb spasticity. This meta-analysis aims to systematically evaluate the clinical efficacy of SA in the treatment of post-stroke spastic paralysis, providing evidence-based medicine for clinical management of this condition.
METHODS
We comprehensively searched databases including China National Knowledge Infrastructure, Wanfang Data, VIP Chinese Science and Technology Periodical Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library. Randomized controlled trials investigating the efficacy of SA in post-stroke spastic paralysis were identified until July 28, 2023. Meta-analysis was conducted using RevMan 5.4 and Stata17.0.
RESULTS
A total of 16 studies were included. Meta-analysis showed that the modified Ashworth spasticity assessment scale in the SA group was significantly higher than that in the rehabilitation group (mean difference [MD] = -0.56, 95% confidence interval [CI] [-0.75, -0.37], Z = 5.67, P < .00001). The simplified Fugl-Meyer motor function assessment scale in the SA group was significantly higher than that in the rehabilitation group (MD = 5.86, 95% CI [3.26, 8.46], Z = 4.41, P < .0001). The modified Barthel index assessment scale in the SA group was significantly higher than that in the rehabilitation group (MD = 5.79, 95% CI [4.73, 6.84], Z = 10.77, P < .00001). Additionally, the clinical effective rate in the SA group was significantly higher than that in the rehabilitation group (relative risk = 1.25, 95% CI [1.16, 1.36], Z = 5.42, P < .00001).
CONCLUSION
SA combined with rehabilitation therapy has certain advantages in reducing limb spasticity, improving limb function, and enhancing activities of daily living in patients with post-stroke spastic paralysis. This study provides reference and theoretical support for the promotion of SA in the treatment of this condition.
Topics: Humans; Activities of Daily Living; Muscle Spasticity; Quality of Life; Scalp; Stroke; Acupuncture Therapy; Stroke Rehabilitation; Hemiplegia; Paralysis; Upper Extremity; Paresis
PubMed: 38428878
DOI: 10.1097/MD.0000000000037167 -
Burns : Journal of the International... Mar 2020Direct current (DC) powered equipment and devices, including photovoltaic systems, high-voltage direct current power lines and novel concepts in electromobility have...
BACKGROUND
Direct current (DC) powered equipment and devices, including photovoltaic systems, high-voltage direct current power lines and novel concepts in electromobility have become increasingly popular in recent years. However, under adverse circumstances by malfunction or mishandling of these applications electrical injuries may occur when electric current passes through the human body. This review aimed at systematically summarizing the medical consequences of DC electrical injuries described in case reports and case series.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided the methodological conduct and reporting.
RESULTS
Sixteen case reports and 3 case series were eligible for this review and included 70 patients. The reviewed articles were very heterogeneous regarding sources of DC electrical injuries and the reported medical consequences, including burns and skin lesions (n=67), neurological consequences (n=11), unconsciousness (n=10), cardiac consequences (n=8) and bone fractures (n=6). Seventeen individuals did not survive the electrical injuries.
CONCLUSION
From the few available data and partly incomplete documentations of cases we could gather hints of DC medical consequences, however, it was not possible to identify well-defined medical consequences for various circumstances of DC electrical injuries in occupational and non-occupational settings. To achieve this goal, additional studies are required, each providing a comprehensive description of the medical consequences and the circumstances of the electrical injuries.
Topics: Adolescent; Adult; Age Distribution; Arrhythmias, Cardiac; Brain Concussion; Burns, Electric; Child; Electric Injuries; Female; Fractures, Bone; Headache; Heart Arrest; Humans; Infant, Newborn; Lethargy; Male; Middle Aged; Nervous System Diseases; Occupational Injuries; Paraparesis; Paraplegia; Pregnancy; Psychotic Disorders; Sex Distribution; Unconsciousness; Young Adult
PubMed: 31208768
DOI: 10.1016/j.burns.2018.11.020 -
The Journal of Hand Surgery... Dec 2022There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review...
There are numerous options available for restoration of wrist and finger extension following radial nerve palsy. The aim of this study is to conduct a systematic review of the effectiveness of nerve transfer for radial nerve palsy. Electronic literature research of PubMed, Cochrane, Scopus and Lilacs database was conducted in June 2021 using the terms 'Distal nerve transfer' AND 'Radial nerve injury' 'Radial nerve palsy' OR 'Radial nerve paresis' OR 'Median nerve transfer' OR 'wrist extensor' OR 'finger extension' OR 'thumb extension' OR 'wrist motion'. The data extracted included the study details, demographic data, procedure performed and final functional outcome according to the muscle research council scale. A total of 92.59% and 56.52% had satisfactory outcome following distal nerve transfer of median nerve to restore wrist and finger extension respectively. No significant correlation was found between time to injury duration and satisfactory outcomes. Outcomes of nerve transfers are comparable to tendon transfers. Multi-centric studies are needed to compare the results amongst various surgical procedures described. Level III (Therapeutic).
Topics: Humans; Wrist; Nerve Transfer; Fingers; Wrist Joint; Radial Neuropathy; Paralysis
PubMed: 36550081
DOI: 10.1142/S2424835522500953 -
Archives of Physical Medicine and... May 2021This systematic review sought to determine the effectiveness of mental practice (MP) on the activity limitations of the upper limb in individuals after stroke, as well... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review sought to determine the effectiveness of mental practice (MP) on the activity limitations of the upper limb in individuals after stroke, as well as when, in whom, and how MP should be delivered.
DATA SOURCES
Ten electronic databases were searched from November 2009 to May 2020. Search terms included: Arm, Practice, Stroke rehabilitation, Imagination, Paresis, Recovery of function, and Stroke. Studies from a Cochrane review of MP (up to November 2009) were automatically included. The review was registered with the PROSPERO database of systematic reviews (reference no.: CRD42019126044).
STUDY SELECTION
Randomized controlled trials of adults after stroke using MP for the upper limb were included if they compared MP to usual care, conventional therapy, or no treatment and reported activity limitations of the upper limb as outcomes. Independent screening was conducted by 2 reviewers.
DATA EXTRACTION
One reviewer extracted data using a tool based on the Template for Intervention Description and Replication. Data extraction was independently verified by a second reviewer. Quality was assessed using the PEDro tool.
DATA SYNTHESIS
Fifteen studies (n=486) were included and 12 (n=328) underwent meta-analysis. MP demonstrated significant benefit on upper limb activities compared with usual treatment (standardized mean difference [SMD], 0.6; 95% confidence interval [CI], 0.32-0.88). Subgroup analyses demonstrated that MP was most effective in the first 3 months after stroke (SMD, 1.01; 95% CI, 0.53-1.50) and in individuals with the most severe upper limb deficits (weighted mean difference, 7.33; 95% CI, 0.94-13.72).
CONCLUSIONS
This review demonstrates that MP is effective in reducing activity limitations of the upper limb after stroke, particularly in the first 3 months after stroke and in individuals with the most severe upper limb dysfunction. There was no clear pattern of the ideal dosage of MP.
Topics: Humans; Imagination; Practice, Psychological; Randomized Controlled Trials as Topic; Recovery of Function; Stroke Rehabilitation; Upper Extremity
PubMed: 33250142
DOI: 10.1016/j.apmr.2020.09.391 -
The American Journal of Occupational... May 2023This systemic review synthesizes the existing literature to determine whether constraint-induced movement therapy (CIMT) is more effective than other approaches in...
IMPORTANCE
This systemic review synthesizes the existing literature to determine whether constraint-induced movement therapy (CIMT) is more effective than other approaches in improving upper extremity function in children diagnosed with hemiparesis associated with cerebral palsy (CP).
OBJECTIVE
To advance the knowledge of the effectiveness of CIMT for occupational therapy practitioners by critiquing research conducted over the past 20 yr.
DATA SOURCES
Databases used in the search were CINAHL, Health Source: Nursing/Academic Edition, PsycINFO, PubMed, Research Gate, and Google Scholar. Studies published from 2001 to 2021 were reviewed.
STUDY SELECTION AND DATA COLLECTION
Articles were included if (1) the primary diagnosis was hemiparesis associated with CP; (2) participants were younger than age 21 yr; (3) constraint-induced therapy, CIMT, or other modified forms of CIMT were offered as an intervention; and (4) there was at least one group in the study.
FINDINGS
Forty studies were included in the analysis. The results demonstrate that CIMT produces improved affected upper extremity function when compared with general rehabilitation. However, there were no differences in outcomes when bimanual approaches were compared with CIMT.
CONCLUSIONS AND RELEVANCE
The data support that CIMT is a beneficial and effective treatment when used to improve the upper extremity function of children with hemiparesis associated with CP. However, more Level 1b studies are needed to compare CIMT with bimanual therapy to determine which one is most effective and under which conditions. What This Article Adds: This systematic review demonstrates that CIMT is an effective intervention when compared with other therapeutic approaches. This intervention can be used by occupational therapy practitioners who work with children diagnosed with hemiparesis associated with CP.
Topics: Child; Humans; Young Adult; Adult; Cerebral Palsy; Physical Therapy Modalities; Upper Extremity; Treatment Outcome; Paresis; Movement
PubMed: 37358836
DOI: 10.5014/ajot.2023.050152 -
Annals of Palliative Medicine Feb 2022This study aimed to investigate the efficacy and safety of mecobalamin combined with vestibular rehabilitation training in acute vestibular neuritis and to improve the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This study aimed to investigate the efficacy and safety of mecobalamin combined with vestibular rehabilitation training in acute vestibular neuritis and to improve the clinical therapeutic effect in vestibular nerve disease.
METHODS
We performed a literature search of the PubMed, Medline, China National Knowledge Infrastructure (CNKI), and other databases from the date of establishment of the database until the present. The search terms included "mecobalamin", "vestibular rehabilitation training", "vestibular rehabilitation therapy", and "vestibular neuritis". References of the comparative study of vestibular rehabilitation training and vestibular rehabilitation training combined with mecobalamin were screened. Boolean logic retrieval was adopted, and Review Manager software was employed.
RESULTS
Meta-analysis was conducted on a total of four studies with a low risk of bias. The activities specific balance confidence scale (ABC) scores of the two groups were heterogeneous (Chi2=8.56, I2=88%, P=0.003), and a fixed-effect model (FEM) analysis indicated that there were no significant differences in the ABC between the groups after treatment (Z=0.67, P=0.50). It may be that mecobalamin combined with vestibular rehabilitation training effectively alleviated the symptoms of vestibular neuritis in the experimental group, thereby reducing the canal paresis (CP) value. In addition, there was no heterogeneous dizziness handicap inventory (DHI) between the groups after treatment (Chi2=20.75, I2=86%, P=0.0001); finite element method (FEM) analysis showed that the DHI of the experimental group after 6 months of treatment was notably lower compared to that of the control group (Z=3.20, P=0.001).
DISCUSSION
Mecobalamin combined with vestibular rehabilitation training can effectively improve vertigo and other symptoms of acute vestibular neuritis patients, with high effectiveness and safety.
Topics: Dizziness; Humans; Vertigo; Vestibular Neuronitis; Vitamin B 12
PubMed: 35249325
DOI: 10.21037/apm-21-3171 -
Current Journal of Neurology Apr 2022Over the past decades, wearable robotic gloves due to their positive features are used by clinicians to improve motor function in the upper extremity. This systematic... (Review)
Review
Over the past decades, wearable robotic gloves due to their positive features are used by clinicians to improve motor function in the upper extremity. This systematic review aims to evaluate the studies that investigated the therapeutic effects of wearable robotic gloves to improve hand function in stroke patients. The most related databases including MEDLINE (PubMed), ISI Web of Knowledge, Scopus, IEEE, and Google Scholar were systematically searched and studies were collected up to September 2021. The methodological quality assessment was done using an adapted version of the Downs and Black checklist. Of the 2674 articles searched, 5 studies were recognized as being relevant in this systematic review. The methodological quality of all included studies was between 7 to 10 points of adapted 12-point score of Downs and Black checklist. All studies concluded that the introduced robotic device had a good therapeutic effect on investigated patients' hand function. The studies had limitations in terms of the level of evidence, sample size, stroke patient groups, and therapeutic process. There is no standard approach with definite intervention timing to evaluate the effect of such devices. Therefore, more comprehensive studies are needed to confirm the therapeutic effects of wearable robotic gloves on improving hand function after a stroke.
PubMed: 38011474
DOI: 10.18502/cjn.v21i2.10496 -
Frontiers in Human Neuroscience 2022Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have...
BACKGROUND
Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke.
AIM
Synthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke.
METHODS
PubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols.
RESULTS
Twenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI -0.18 to 0.46, I 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI -0.34 to 1.18, I 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline.
CONCLUSION
This review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.
PubMed: 35669202
DOI: 10.3389/fnhum.2022.897870 -
Otolaryngology--head and Neck Surgery :... Apr 2024To analyze the rates of complications after pediatric temporal bone fractures (TBF) and the utility of the longitudinal, transverse, and mixed versus the otic capsule... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze the rates of complications after pediatric temporal bone fractures (TBF) and the utility of the longitudinal, transverse, and mixed versus the otic capsule sparing (OCS) and otic capsule violating (OCV) classification systems in predicting these complications.
DATA SOURCES
PubMed, Scopus, and CINAHL.
REVIEW METHODS
Per PRISMA guidelines, studies of children with TBFs were included. Meta-analyses of proportions were performed.
RESULTS
A total of 22 studies with 1376 TBFs were included. Children with TBF had higher rates of conductive hearing loss (CHL) than sensorineural hearing loss (SNHL) (31.3% [95% confidence interval [CI] 23.2-40.1] vs 12.9% [95% CI 8.9-17.5]). No differences in both CHL and SNHL were seen between longitudinal and transverse TBFs; however, OCV TBFs had higher rates of SNHL than OCS TBFs (59.3% [95% CI 27.8-87.0] vs 4.9% [95% CI 1.5-10.1]). Of all patients, 9.9% [95% CI 7.2-13.1] experienced facial nerve (FN) paresis/paralysis, and 13.4% [95% CI 5.9-23.2] experienced cerebrospinal fluid otorrhea. Transverse TBFs had higher rates of FN paresis/paralysis than longitudinal (27.7% [95% CI 17.4-40.0] vs 8.6% [95% CI 5.2-12.8]), but rates were similar between OCS and OCV TBFs.
CONCLUSION
CHL was the most common complication after TBF in children; however, neither classification system was superior in identifying CHL. The traditional system was more effective at identifying FN injuries, and the new system was more robust at identifying SNHL. While these results suggest that both classification systems might have utility in evaluating pediatric TBFs, these analyses were limited by sample size. Future research on outcomes of pediatric TBFs stratified by type of fracture, mainly focusing on long-term outcomes, is needed.
Topics: Humans; Child; Skull Fractures; Retrospective Studies; Fractures, Bone; Temporal Bone; Hearing Loss, Sensorineural; Skull Fracture, Basilar; Facial Paralysis; Hearing Loss, Conductive; Bell Palsy; Paresis
PubMed: 38168743
DOI: 10.1002/ohn.638 -
Medicine Dec 2021To investigate prognosis prediction of motor outcome in anterior choroidal artery (AChA) infarction patients using radiologic and transcranial magnetic stimulation (TMS)... (Meta-Analysis)
Meta-Analysis
Prognosis prediction of motor outcome in hemiparetic patients with anterior choroidal artery infarction: Radiologic and transcranial magnetic stimulation prognostic validation studies (STROBE).
To investigate prognosis prediction of motor outcome in anterior choroidal artery (AChA) infarction patients using radiologic and transcranial magnetic stimulation (TMS) studies.Twenty six patients with complete weakness of the affected hand were recruited. The Motricity Index (MI), Medical Research Council (MRC) scores for the affected finger extensors, Modified Brunnstrom classification (MBC) and Functional Ambulation Category (FAC) were evaluated twice: at onset and the chronic stage (3-4 months after onset). Patients were assigned according to the presence of infarction at the corona radiata (CR); the CR-positive group (infarct presence at the CR and posterior limb of internal capsule [PLIC], 11 patients) and CR-negative group (infarct presence at the PLIC, 15 patients), and the presence of motor evoked potentials at the affected hand muscle: the TMS-positive group (11 patients) and the TMS-negative group (15 patients).At the second evaluation, the MI scores were significantly different between the CR-positive (45.10 ± 7.06) and CR-negative groups (57.90 ± 11.56), and between the TMS-positive (60.37 ± 11.53) and TMS-negative groups (46.70 ± 7.99) (P < .05). The MRC scores for the finger extensors were also significantly different between the CR-positive (0.95 ± 1.01) and CR-negative (2.57 ± 1.33) groups and between the TMS-positive (3.05 ± 0.88) and TMS-negative (1.03 ± 1.14) groups (P < .05). Fourteen (53.85%) of the 26 patients recovered to have a functional hand score (MBC ≥5) and 19 (73.07%) of the 26 patients recovered to have an independent gait score (FAC ≥3) on their second evaluation.The results show that CR involvement in addition to the presence of a PLIC lesion and a TMS-negative response were related to poor motor outcomes in patients with an AChA infarction. Consequently, radiologic and TMS studies can be considered for motor outcome prognosis prediction in patients with an AChA infarction.
Topics: Aged; Cerebral Infarction; Evoked Potentials, Motor; Female; Humans; Male; Middle Aged; Paresis; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Transcranial Magnetic Stimulation
PubMed: 34941175
DOI: 10.1097/MD.0000000000028397