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Journal of Stroke and Cerebrovascular... Jun 2021This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided... (Randomized Controlled Trial)
Randomized Controlled Trial
This blind randomized clinical trial evaluated the effect of CIMT on the functionality and quality of life (QOL) of chronic hemiparetics. Thirty volunteers were divided into two groups: Control (CG) and CIMT (CIMTG); evaluated before and after 12 and 24 intervention sessions. The scales used were: adapted Fugl-Meyer Motor Assessment (FMA), Modified Ashworth, Stroke Specific Quality Of Life (SS-QOL) and the Functional Reach Test (FRT). The scores for all FMA variables in the CIMTG increased until the 24th session, differing from the pre-treatment. In the CG, the scores increased for pain, coordination/ speed and sensitivity. In the FRT there was an increase in the scores in both groups; after the 12th and 24th sessions, the result of the CIMTG was superior to the CG. For the SS-QOL in the CIMTG, the general score and most of the variables increased, as well as in the CG. Muscle tone in CIMTG was lower compared to CG after 24 sessions. Both protocols used in the study were effective, the CIMT protocol showed benefits in recovering the functionality of the paretic upper limb, in the functional range and in reducing muscle tone, with a consequent improvement in quality of life.
Topics: Aged; Brazil; Exercise Therapy; Female; Functional Status; Humans; Male; Middle Aged; Motor Activity; Paresis; Patient Compliance; Prospective Studies; Quality of Life; Recovery of Function; Stroke; Stroke Rehabilitation; Time Factors; Treatment Outcome; Upper Extremity
PubMed: 33848906
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105774 -
Otolaryngologic Clinics of North America Aug 2019This article discusses vocal fold paresis as a separate and distinct condition from vocal fold paralysis. The signs and symptoms of paresis may be different and less... (Review)
Review
This article discusses vocal fold paresis as a separate and distinct condition from vocal fold paralysis. The signs and symptoms of paresis may be different and less obvious than those for paralysis, so this condition is often misdiagnosed or underdiagnosed. Elements necessary to heighten clinical suspicion are included to assist in educating practitioners on these subtle findings. Once paresis is suspected, associated respiratory or sensory abnormalities also should be sought, because these may change the treatment plan when recognized. Utility of laryngeal electromyography is discussed along with potential treatment options for both the motor and often-present sensory symptoms.
Topics: Diagnosis, Differential; Electromyography; Humans; Paresis; Prognosis; Stroboscopy; Vocal Cord Paralysis; Vocal Cords
PubMed: 31088695
DOI: 10.1016/j.otc.2019.03.008 -
Pediatrics Nov 2021With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT).
METHODS
CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures.
RESULTS
Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment).
CONCLUSIONS
CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.
Topics: Cerebral Palsy; Child; Child, Preschool; Conditioning, Operant; Exercise Movement Techniques; Female; Humans; Immobilization; Male; Paresis; Time Factors; Treatment Outcome
PubMed: 34649982
DOI: 10.1542/peds.2020-033878 -
NeuroRehabilitation 2021In hemiparetic patients, the skeletal muscle is mainly affected with a combination of abnormalities (denervation, remodeling, spasticity, and eventually muscular... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In hemiparetic patients, the skeletal muscle is mainly affected with a combination of abnormalities (denervation, remodeling, spasticity, and eventually muscular atrophy).
OBJECTIVE
This study examined the role of eccentric exercise in strengthening muscles of the lower extremity and ultimately improving autonomy in patients with post-stroke hemiparesis during gait.
METHODS
Thirty-seven patients hemiparetic adults were recruited, randomized into a control group (n = 19) and an intervention group receiving eccentric muscle strengthening (n = 18). The protocol consisted of three sets of five repetitions of eccentric contraction of the paretic limb after determining the maximum repetition (1 MRI). Evaluation of the 1RM, 10 meters and 6WMT was performed before and after the exercise for each group. Manova test was used to compare the differences between the control and intervention groups.
RESULTS
The paretic limb showed significant increase in one-repetition maximum (1RM) between before and after rehabilitation (p≤0.00003). The two groups of Patients increased their walking speed (p≤0.0005), but we observed a significant difference between groups only for the 6MWT and not on the 10 meters Test.
CONCLUSIONS
Eccentric training can be useful in strengthening the muscles of the lower limbs, and promoting gait performance. Eccentric training could complement other methods of managing patients with post-stroke hemiparesis.
Topics: Adult; Aged; Exercise Therapy; Humans; Male; Middle Aged; Muscle, Skeletal; Paresis; Stroke; Stroke Rehabilitation; Walking Speed
PubMed: 33967063
DOI: 10.3233/NRE-201601 -
The Veterinary Clinics of North... Dec 2022Physiotherapeutic exercises aimed at stimulating motor control, flexibility, and stability are regularly employed in human physical therapy programs. Specifically, the... (Review)
Review
Physiotherapeutic exercises aimed at stimulating motor control, flexibility, and stability are regularly employed in human physical therapy programs. Specifically, the use of such exercises has been shown to reduce both pain and reinjury. Pursuant to the equine patient, several core strengthening exercises and their role in activating deep epaxial musculature to subsequently improve postural motor control and alter thoracolumbar kinematics have been investigated. Both baited and passive exercises offer opportunities to facilitate stretching during dynamic phases and strengthening during static phases of exercise. Blanket recommendations regarding prescription of exercises is not advised, individual patient prescription should be considered in context of handler safety, specific rehabilitation goals, and patient ability to effectively complete the exercise.
Topics: Humans; Horses; Animals; Horse Diseases; Proprioception; Exercise Therapy; Paresis; Ataxia
PubMed: 36244936
DOI: 10.1016/j.cveq.2022.06.010 -
Nature Medicine Mar 2023Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However,...
Cerebral strokes can disrupt descending commands from motor cortical areas to the spinal cord, which can result in permanent motor deficits of the arm and hand. However, below the lesion, the spinal circuits that control movement remain intact and could be targeted by neurotechnologies to restore movement. Here we report results from two participants in a first-in-human study using electrical stimulation of cervical spinal circuits to facilitate arm and hand motor control in chronic post-stroke hemiparesis ( NCT04512690 ). Participants were implanted for 29 d with two linear leads in the dorsolateral epidural space targeting spinal roots C3 to T1 to increase excitation of arm and hand motoneurons. We found that continuous stimulation through selected contacts improved strength (for example, grip force +40% SCS01; +108% SCS02), kinematics (for example, +30% to +40% speed) and functional movements, thereby enabling participants to perform movements that they could not perform without spinal cord stimulation. Both participants retained some of these improvements even without stimulation and no serious adverse events were reported. While we cannot conclusively evaluate safety and efficacy from two participants, our data provide promising, albeit preliminary, evidence that spinal cord stimulation could be an assistive as well as a restorative approach for upper-limb recovery after stroke.
Topics: Humans; Cervical Cord; Paresis; Spinal Cord; Spinal Cord Injuries; Spinal Cord Stimulation; Stroke; Upper Extremity; Female; Adult; Middle Aged
PubMed: 36807682
DOI: 10.1038/s41591-022-02202-6 -
Annals of Physical and Rehabilitation... Sep 2019Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).
OBJECTIVE
This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.
METHODS
We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n=22, and RAT, n=23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.
RESULTS
In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P=0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P=0.02) and patient social participation (Stroke Impact Scale +18%; P=0.01). Participants' abilities to perform manual activities and activities of daily living improved similarly in both groups.
CONCLUSION
For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.
Topics: Aged; Disability Evaluation; Exercise Therapy; Female; Humans; Male; Middle Aged; Paresis; Recovery of Function; Robotics; Single-Blind Method; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity
PubMed: 31028900
DOI: 10.1016/j.rehab.2019.04.002 -
Acta Medica (Hradec Kralove) 2020Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia, the activity of toxins or in patients...
Acute compartment syndrome occurs most frequently in connection with injuries, terminal or chemical damage of tissues, ischemia, the activity of toxins or in patients with tissue ischemia or muscle necrosis. Clinical findings have found pronounced pain, followed by paresthesias, pallor, and paresis. Decreased pulsation of arteries has also been a frequent finding. In severe forms decompressive fasciotomy has been indicated within the first 12-24 hours after diagnosis. In the following paper, the authors present the case report of a 68-year woman who swallowed 1500 mg of trazodone as an attempt at suicide. After 12 hours her husband found her lying on the carpet with compression of the left arm under the trunk. The patient was treated conservatively and followed clinically, examined by ultrasonography, EMG and finally MRI.
Topics: Aged; Antidepressive Agents, Second-Generation; Compartment Syndromes; Computed Tomography Angiography; Conservative Treatment; Female; Forearm; Humans; Magnetic Resonance Imaging; Neurologic Examination; Paresis; Suicide, Attempted; Trazodone; Treatment Outcome; Ultrasonography
PubMed: 33002399
DOI: 10.14712/18059694.2020.26 -
The Cochrane Database of Systematic... May 2020Stroke is caused by the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels within the brain (hemorrhagic stroke) and may lead to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stroke is caused by the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels within the brain (hemorrhagic stroke) and may lead to changes in perception, cognition, mood, speech, health-related quality of life, and function, such as difficulty walking and using the arm. Activity limitations (decreased function) of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities.
OBJECTIVES
To determine whether MP improves outcomes of upper extremity rehabilitation for individuals living with the effects of stroke. In particular, we sought to (1) determine the effects of MP on upper extremity activity, upper extremity impairment, activities of daily living, health-related quality of life, economic costs, and adverse effects; and (2) explore whether effects differed according to (a) the time post stroke at which MP was delivered, (b) the dose of MP provided, or (c) the type of comparison performed.
SEARCH METHODS
We last searched the Cochrane Stroke Group Trials Register on September 17, 2019. On September 3, 2019, we searched the Cochrane Central Register of Controlled Trials (the Cochrane Library), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science, the Physiotherapy Evidence Database (PEDro), and REHABDATA. On October 2, 2019, we searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We reviewed the reference lists of included studies.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) of adult participants with stroke who had deficits in upper extremity function (called upper extremity activity).
DATA COLLECTION AND ANALYSIS
Two review authors screened titles and abstracts of the citations produced by the literature search and excluded obviously irrelevant studies. We obtained the full text of all remaining studies, and both review authors then independently selected trials for inclusion. We combined studies when the review produced a minimum of two trials employing a particular intervention strategy and a common outcome. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks, called upper extremity activity. Secondary outcomes included upper extremity impairment (such as quality of movement, range of motion, tone, presence of synergistic movement), activities of daily living (ADLs), health-related quality of life (HRQL), economic costs, and adverse events. We assessed risk of bias in the included studies and applied GRADE to assess the certainty of the evidence. We completed subgroup analyses for time since stroke, dosage of MP, type of comparison, and type of arm activity outcome measure.
MAIN RESULTS
We included 25 studies involving 676 participants from nine countries. For the comparison of MP in addition to other treatment versus the other treatment, MP in combination with other treatment appears more effective in improving upper extremity activity than the other treatment without MP (standardized mean difference [SMD] 0.66, 95% confidence interval [CI] 0.39 to 0.94; I² = 39%; 15 studies; 397 participants); the GRADE certainty of evidence score was moderate based on risk of bias for the upper extremity activity outcome. For upper extremity impairment, results were as follows: SMD 0.59, 95% CI 0.30 to 0.87; I² = 43%; 15 studies; 397 participants, with a GRADE score of moderate, based on risk of bias. For ADLs, results were as follows: SMD 0.08, 95% CI -0.24 to 0.39; I² = 0%; 4 studies; 157 participants; the GRADE score was low due to risk of bias and small sample size. For the comparison of MP versus conventional treatment, the only outcome with available data to combine (3 studies; 50 participants) was upper extremity impairment (SMD 0.34, 95% CI -0.33 to 1.00; I² = 21%); GRADE for the impairment outcome in this comparison was low due to risk of bias and small sample size. Subgroup analyses of time post stroke, dosage of MP, or comparison type for the MP in combination with other rehabilitation treatment versus the other treatment comparison showed no differences. The secondary outcome of health-related quality of life was reported in only one study, and no study noted the outcomes of economic costs and adverse events.
AUTHORS' CONCLUSIONS
Moderate-certainty evidence shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity activity. Moderate-certainty evidence also shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity impairment after stroke. Low-certainty evidence suggests that ADLs may not be improved with MP in addition to other treatment versus the other treatment. Low-certainty evidence also suggests that MP versus conventional treatment may not improve upper extremity impairment. Further study is required to evaluate effects of MP on time post stroke, the volume of MP required to affect outcomes, and whether improvement is maintained over the long term.
Topics: Arm; Combined Modality Therapy; Female; Humans; Imagination; Male; Paresis; Practice, Psychological; Randomized Controlled Trials as Topic; Recovery of Function; Stroke; Stroke Rehabilitation
PubMed: 32449959
DOI: 10.1002/14651858.CD005950.pub5 -
Journal of Voice : Official Journal of... May 2022The normal aging process affects many human functions profoundly. The voice is no exception, and some aging effects on the voice are obvious including vocal fold...
BACKGROUND
The normal aging process affects many human functions profoundly. The voice is no exception, and some aging effects on the voice are obvious including vocal fold atrophy, bowing, stiffness, more prominent vocal fold processes, and glottic insufficiency. The study's primary aim was to determine the correlation between presbylarynx and laryngeal electromyography (LEMG) results and to compare these electromyography (EMG) results with young and old voice patients without evidence of presbylarynx changes on strobovideolaryngoscopy.
METHODS
Medical records for voice patients seen in the senior author's (RTS) practice between 2015 and 2019 were reviewed retrospectively. Patients with presbylarynx confirmed by strobovideolaryngoscopy were identified and compared to two control groups. The first control group included patients with ages and American Society of Anesthesiologists scores similar to the experimental group but no presbylarynx. The second control group included younger patients (ages ranging between 18 and 35 years with mean age of 24.57 years) with vocal fold paresis. All groups had undergone LEMG because of suspected paresis clinically. Social and medical factors reviewed and compared between groups included smoking history, alcohol consumption, occupation (voice demanding versus not voice demanding occupation), Voice Handicap Index score at the initial office visit, medical comorbidities, medications, and LEMG results.
RESULTS
There was no significant difference in the recruitment results for three pairs of muscles (cricothyroid, thyroarytenoid and posterior cricoarytenoid) between the presbylarynx group and both control groups. Rate of asthma was higher in presbylarynx group compared with the first control group. Rates of corticosteroid inhaler use, thyroid medications, smoking, and Voice Handicap Index score were higher in presbylarynx group compared with the second control group. There was no significant difference in occupation type and alcohol consumption between groups.
CONCLUSION
There was no significant difference found in the neuromuscular function based on laryngeal EMG between presbylarynx patients and both old and young patients with vocal fold paresis but without presbylarynx. Corticosteroid inhaler is associated with atrophic changes seen in presbylarynx. There still could be differences in the neuromuscular function which weren't detected. More research is needed to confirm or refute these findings.
Topics: Adolescent; Adult; Electromyography; Humans; Laryngeal Muscles; Paresis; Retrospective Studies; Vocal Cord Paralysis; Vocal Cords; Voice Quality; Young Adult
PubMed: 32928604
DOI: 10.1016/j.jvoice.2020.06.029