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Annals of Physical and Rehabilitation... Nov 2014Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of post-stroke rehabilitation to... (Review)
Review
Stroke rehabilitation has undergone a revolution over the last three decades. Cohort studies have consistently reinforced the importance of post-stroke rehabilitation to stimulate recovery, but the concepts of empirical methods originally proposed by therapists to rehabilitate these patients have not withstood clinical analysis. Functional neuroimaging and animal models have unveiled the mechanisms underlying functional recovery and helped teams understand its limitations and improvement modalities. These neuroscience discoveries constitute the grounds needed to understand the emergence of new technologies: robotics and virtual reality. The objective of this review of the literature was to select key works in this field to better understand current therapeutic possibilities.
Topics: Animals; Functional Neuroimaging; Hemiplegia; Humans; Recovery of Function; Robotics; Stroke
PubMed: 25282582
DOI: 10.1016/j.rehab.2014.08.004 -
JPMA. the Journal of the Pakistan... Sep 2022Stroke is a debilitating neurological disorder with hemiplegia as most common presentation. Hemiplegic shoulder pain (HSP) affects a large number of stroke survivors and... (Review)
Review
Stroke is a debilitating neurological disorder with hemiplegia as most common presentation. Hemiplegic shoulder pain (HSP) affects a large number of stroke survivors and is associated with significant morbidity and low quality of life (QoL). The etiology is multifactorial and therefore the management is multipronged. Traditionally, oral analgesics have been advised with physical therapy and intra-articular steroid injections. This narrative review discusses emerging treatment strategies for HSP. It focuses on four key new treatments; electric stimulation, the use of robotics, intraarticular injections of novel anti-inflammatory agents, and pulsed radiofrequency treatment. Multiple studies have assessed the efficacy of these techniques and have found the efficacy and side effect profile to be comparable or superior to current management strategies for HSP. Integrating these interventions in the multidisciplinary rehabilitation programmes for stroke patients, can improve the management of HSP and reduce stroke related morbidity and disability.
Topics: Humans; Shoulder Pain; Hemiplegia; Quality of Life; Stroke; Analgesics
PubMed: 36281002
DOI: 10.47391/JPMA.22-97 -
Physical Medicine and Rehabilitation... Nov 2015This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke... (Review)
Review
This article reviews the most common therapeutic and neuroprosthetic applications of neuromuscular electrical stimulation (NMES) for upper and lower extremity stroke rehabilitation. Fundamental NMES principles and purposes in stroke rehabilitation are explained. NMES modalities used for upper and lower limb rehabilitation are described, and efficacy studies are summarized. The evidence for peripheral and central mechanisms of action is also summarized.
Topics: Electric Stimulation Therapy; Hemiplegia; Humans; Quality of Life; Recovery of Function; Stroke; Upper Extremity
PubMed: 26522909
DOI: 10.1016/j.pmr.2015.06.002 -
Neurologia (Barcelona, Spain) May 2012The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome.
DEVELOPMENT
We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions.
CONCLUSIONS
Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain.
Topics: Activities of Daily Living; Botulinum Toxins; Hemiplegia; Humans; Pain Management; Physical Therapy Modalities; Shoulder Injuries; Shoulder Pain; Stroke
PubMed: 21514698
DOI: 10.1016/j.nrl.2011.02.010 -
European Journal of Physical and... Feb 2016Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
Early/intensive mobilization may improve functional recovery after stroke but it is not clear which kind of "mobilization" is more effective. Proprioceptive neuromuscular facilitation (PNF) and cognitive therapeutic exercise (CTE) are widespread applied in post-stroke rehabilitation but their efficacy and safety have not been systematically investigated.
AIM
To compare PNF and CTE methods in a two different time setting (early versus standard approach) in order to evaluate different role of time and techniques in functional recovery after acute ischemic stroke.
DESIGN
We designed a prospectical multicenter blinded interventional study of early versus standard approach with two different methods by means of both PNF and CTE.
SETTING
A discrete stroke-dedicated area for out-of-thrombolysis patients, connected with two different comprehensive stroke centres in two different catchment areas.
POPULATION
Three hundred and forty consecutive stroke patient with first ever sub-cortical ischemic stroke in the mean cerebral artery (MCA) territory and contralateral hemiplegia admitted within 6 and 24 hours from symptoms onset.
METHODS
All patients were randomly assigned by means of a computer generated randomization sequence in blocks of 4 to one to the 4 interventional groups: early versus delayed rehabilitation programs with Kabat's schemes or Perfetti's technique. Patients in both delayed group underwent to a standard protocol in the acute phase.
PRIMARY OUTCOME
disability at 3-12 months. Disability measures: modified Rankin Score and Barthel Index. Safety outcome: immobility-related adverse events.
SECONDARY OUTCOME MEASURES
Six-Minute Walking Test, Motricity Index, Mini-Mental State Examination, Beck Depression Inventory.
RESULTS
Disability was not different between groups at 3 months but Barthel Index significantly changed between early versus delayed groups at 12 months (P=0.01). Six-Minute Walking Test (P=0.01) and Motricity Index in both upper (P=0.01) and lower limbs (P=0.001) increased in early versus delayed groups regardless rehabilitation schedule.
CONCLUSIONS
A time-dependent effect of rehabilitation on post stroke motor recovery was observed, particularly in lower limb improvement. According to our results, rehabilitation technique seems not to affect long term motor recovery.
CLINICAL REHABILITATION IMPACT
These results show a significant effect of time but not of technique that may impact the decision making in the acute phase of care.
Topics: Aged; Brain Ischemia; Cognitive Behavioral Therapy; Female; Hemiplegia; Humans; Male; Middle Aged; Proprioception; Recovery of Function; Single-Blind Method; Stroke; Stroke Rehabilitation; Time Factors; Treatment Outcome
PubMed: 26220327
DOI: No ID Found -
Pain Management Mar 2019
Topics: Chronic Pain; Hemiplegia; Humans; Shoulder Pain; Stroke
PubMed: 30681020
DOI: 10.2217/pmt-2018-0075 -
Journal of Rehabilitation Medicine Mar 2017To investigate the effects of Kinesio taping for stroke patients with hemiplegic shoulder pain. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate the effects of Kinesio taping for stroke patients with hemiplegic shoulder pain.
DESIGN
Double-blind, placebo-controlled clinical trial.
SUBJECTS
Twenty-one stroke patients with hemiplegic shoulder pain within 6 months of stroke onset in the rehabilitation ward of a medical university hospital in Taiwan.
METHODS
A 3-week intervention involving a conventional rehabilitation protocol and therapeutic Kinesio taping was conducted with an experimental group of 11 stroke patients. A control group of 10 stroke patients underwent an identical conventional rehabilitation programme and sham Kinesio taping on the hemiplegic shoulder. Numerical rating scale scores, Shoulder Pain and Disability Index, ultrasound findings and pain-free passive range of motion of the affected shoulder, were evaluated before and after the intervention. Mann-Whitney test was used to compare within-group continuous variables before and after the intervention. Wilcoxon signed-rank test was used to analyse the differences and changes in values between study and control groups.
RESULTS
There was no statistical difference in demographic variables between the 2 groups. Both groups showed improvement in passive range of motion of the shoulder, (mean numerical rating scale 2.36 (standard deviation (SD) 1.03)), and mean Shoulder Pain and Disability Index (16.64 (SD 2.62)) after the intervention (p < 0.001); however, no significant between-group differences were observed in the numerical rating scale score, pain-free passive ROM, and ultrasound findings for the shoulder after 3 weeks of treatment. Concerning the variables changes, the therapeutic Kinesio taping group showed more improvement in the numerical rating scale (p = 0.008), shoulder flexion (p = 0.008), external rotation (p = 0.006), internal rotation (p = 0.040), and Shoulder Pain and Disability Index (p < 0.001) than the sham Kinesio taping group.
CONCLUSION
Stroke patients with hemiplegic shoulder pain can experience greater reductions in Shoulder Pain and Disability Index, pain, and improvement in shoulder flexion, external, and internal rotation after 3 weeks of Kinesio taping intervention compared with sham Kinesio taping. Kinesio taping may be an alternative treatment option for stroke patients with hemiplegic shoulder pain.
Topics: Athletic Tape; Disability Evaluation; Double-Blind Method; Female; Hemiplegia; Humans; Kinesiology, Applied; Male; Middle Aged; Pain Measurement; Range of Motion, Articular; Shoulder Pain; Stroke; Taiwan; Treatment Outcome
PubMed: 28233009
DOI: 10.2340/16501977-2197 -
Journal of Neurology, Neurosurgery, and... Jul 1990Two short tests of motor function, the Motricity Index (MI) and the Trunk Control Test (TCT), were assessed at regular intervals after stroke and compared with a...
Two short tests of motor function, the Motricity Index (MI) and the Trunk Control Test (TCT), were assessed at regular intervals after stroke and compared with a detailed physiotherapy test, the Rivermead Motor Assessment (RMA). The MI and TCT were valid and reliable tests which were usually quicker to perform than the RMA. The TCT was of predictive value when related to eventual walking ability. All three tests appeared to be of equal sensitivity in detecting change.
Topics: Adolescent; Adult; Aged; Cerebrovascular Disorders; Disability Evaluation; Female; Follow-Up Studies; Hemiplegia; Humans; Male; Middle Aged; Neurologic Examination
PubMed: 2391521
DOI: 10.1136/jnnp.53.7.576 -
Computational and Mathematical Methods... 2022To analyze the effect of hand intensive training on upper limb function of stroke patients with hemiplegia. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To analyze the effect of hand intensive training on upper limb function of stroke patients with hemiplegia.
METHODS
110 stroke patients were randomly divided into two groups: the reference group and the observation group. 55 patients in the reference group were treated with routine rehabilitation treatment, including routine joint activity training, bed training, exercise therapy, and ADL ability training; 55 cases in the observation group received intensive hand training on the basis of routine rehabilitation treatment, including inducing the patient's five finger extension, forcibly pulling the fingers and wrist joints, and suddenly opening his fist after clenching his fist.
RESULTS
The treatment period of the two groups was 5 weeks. In the comparison results of Fugl-Meyer (FMA), the exercise effect of the observation group with increased hand intensive training was significantly better than that of the control group with stroke hemiplegia treated with conventional methods. The difference was statistically significant, < 10.000, < 0.05; In the comparative analysis of upper limb function test (UEFT), the effect of the observation group was significantly higher than that of the reference group treated with routine rehabilitation nursing (all < 0.05); In the comprehensive comparison of exercise ability results, the observation group was higher than the reference group in the flexibility, fineness, and fineness of activity behavior after treatment.
CONCLUSION
Strengthening hand intensive training can further improve the upper limb motor function of stroke patients with hemiplegia, reduce the severity of hemiplegia, and improve the recovery effect of stroke patients. It is worthy of clinical promotion and application.
Topics: Hemiplegia; Humans; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity
PubMed: 35371277
DOI: 10.1155/2022/6844680 -
Journal of Traditional Chinese Medicine... Oct 2020To evaluate the efficacy of scalp-acupuncture on subjects with hemiplegic paralysis of acute ischaemic stroke (AIS). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the efficacy of scalp-acupuncture on subjects with hemiplegic paralysis of acute ischaemic stroke (AIS).
METHODS
One hundred and twenty patients with hemiplegic paralysis of 1 to 7 d post stroke, aged 40 to 75 years, were randomly allocated to receive either standard care (control group) or standard care plus 30 min of scalp-acupuncture applied to the bilateral anterior oblique line of the vertex-temporal (MS6) for 14 d (6 d/week) (trial group). The outcome measures included the National Institutes of Health Stroke scale (NIHSS) for neurological deficits, the Fugl-Meyer assessment (FMA) for limb impairment, and Barthel index (BI) for activities of daily living before and after intervention. The manual muscle test (MMT) was assessed at pre-intervention, at the first post-intervention immediately, and at the 14th day after intervention commencement. Measurements were recorded by a blinded investigator at different time points after initiating the intervention.
RESULTS
The trial group had a greater increase in MMT (P < 0.05), FMA, and BI scores (P < 0.01), and a greater decrease in NIHSS scores (P < 0.01) from pre-intervention to post-intervention, and the control group had a greater increase in MMT scores (P < 0.05), and a greater decrease in NIHSS scores(P < 0.01) from pre-intervention to post-intervention. The improvement in MMT (P < 0.01), FMA, BI (P < 0.05), and NIHSS (P < 0.01) scores in the trial group was superior to that of the control group. Meanwhile, scalp-acupuncture intervention had an immediate effect on myodynamia of patients with hemiplegic paralysis after acute ischaemic stroke in this randomized controlled trial.
CONCLUSION
The early scalp-acupuncture intervention after stroke effectively increased myodynamia of the affected limbs, improved neurological deficit degrees, and daily living ability.
Topics: Acupuncture Points; Acupuncture Therapy; Adult; Aged; Brain Ischemia; Female; Hemiplegia; Humans; Ischemic Stroke; Male; Middle Aged; Scalp; Treatment Outcome
PubMed: 33000586
DOI: 10.19852/j.cnki.jtcm.2020.05.015