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NeuroRehabilitation 2008Bilateral arm training has emerged as an approach that leads to positive outcomes in addressing upper extremity paresis after stroke. However, studies have not... (Review)
Review
Bilateral arm training has emerged as an approach that leads to positive outcomes in addressing upper extremity paresis after stroke. However, studies have not demonstrated improvements in all patients using current outcome measures. Furthermore, the rationale for using this type of training has been incompletely explained. The purpose of this article was to first review the theoretical justifications for the use of bilateral arm training by examining motor control and neural mechanisms underlying arm function and neural recovery, and second, to discuss examples of clinical studies using a variety of bilateral training strategies to identify who may benefit most from this approach. We argue that bilateral arm training is a necessary adjunct to unilateral training because bilateral re-training is important and best served through bilateral not unilateral training, and also, that bilateral training may help unilateral skill recovery through alternative putative mechanisms. Our review of the empirical evidence suggests that individuals at all levels of severity can benefit in some manner from bilateral training, but that not all approaches are effective for all severity levels. In addition to requesting more randomized controlled trials and studies of neurophysiological mechanisms we conclude the following: 1) Bilateral training can improve unilateral paretic limb functions of the upper extremity after stroke, however, specific training approaches need to be matched to baseline characteristics of the patients; 2) Given the importance of bilateral activities in daily life, there is a need to recognize, train and assess the important contribution of supportive role functions of the paretic arm used on its own and as part of complementary bilateral functional skills; 3) An assessment of bilateral and unilateral functioning which includes bilateral task analysis, as well as, evaluations of interlimb coordination should be included in all studies that include bilateral training; 4) Studies with thoughtful sequencing or combining of bilateral approaches or sequencing of bilateral and unilateral approaches are needed to assess if there are improved outcomes in paretic and bilateral limb function.
Topics: Arm; Exercise Therapy; Humans; Motor Activity; Neural Inhibition; Paresis; Psychomotor Performance; Stroke; Stroke Rehabilitation; Treatment Outcome
PubMed: 18356587
DOI: No ID Found -
Physical Therapy Apr 2010
Topics: Electromyography; Feedback; Hand; Humans; Paresis; Physical Therapy Modalities; Quality of Life; Randomized Controlled Trials as Topic; Range of Motion, Articular; Recovery of Function; Robotics; Stroke; Stroke Rehabilitation
PubMed: 20360055
DOI: 10.2522/ptj.20090160.ic -
Journal of Rehabilitation Medicine Nov 2009The aims of this study were to review robot-assisted motor and functional rehabilitation of the upper limb in patients with stroke and to outline possible clinical...
OBJECTIVE
The aims of this study were to review robot-assisted motor and functional rehabilitation of the upper limb in patients with stroke and to outline possible clinical applications of robotics in neuro-rehabilitation.
METHODS
Available active systems, with actuators driving the paretic arm, were sub-classified by scientific rationale and mechatronic structure as exoskeletons or operational-type machines (manipulators). Applicative studies were compared for indication of efficacy.
RESULTS AND CONCLUSION
Clinical and biomechanical evidence available to date suggests substantial efficacy of robot--assisted neuro-rehabilitation in the recovery of the paretic arm after stroke, enabling longer dedicated training sessions with no additional work for the therapist. Further investigation of large samples of patients is required to define the relationship between disability and residual function, to provide shared criteria of evaluation of disability/outcome and protocols of rehabilitation, and to identify the expected future role and application of robotics in neuro-rehabilitation.
Topics: Biomechanical Phenomena; Humans; Paresis; Recovery of Function; Robotics; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 19841823
DOI: 10.2340/16501977-0434 -
Journal of Neuroengineering and... Oct 2020Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired... (Review)
Review
Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.
Topics: Biomechanical Phenomena; Female; Gait Disorders, Neurologic; Humans; Leg; Locomotion; Male; Middle Aged; Paresis; Stroke; Stroke Rehabilitation; Walking
PubMed: 33087137
DOI: 10.1186/s12984-020-00747-6 -
The Cochrane Database of Systematic... Jun 2011Recent studies have attempted to disaggregate therapeutic intervention packages by looking at the impact of structure and process characteristics of environment upon... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent studies have attempted to disaggregate therapeutic intervention packages by looking at the impact of structure and process characteristics of environment upon outcome. However, what is commonly referred to as the 'black box' of therapy has yet to be comprehensively unpacked. This failure to analyse the components of therapy means that it remains unclear how much therapy should be provided, who should provide it, and which patients should be targeted to ensure that functional outcomes are maximized. This review, therefore, seeks to assess the effectiveness of specific therapeutic interventions in the rehabilitation of the paretic upper limb post stroke.
OBJECTIVES
To identify if specific hands-on therapeutic interventions enhance motor activity and function of the upper limb post stroke.
SEARCH STRATEGY
We searched the trials registers of the Cochrane Stroke Group (March 2010), the Cochrane Complementary Medicine Field (March 2010) and the Cochrane Rehabilitation and Related Therapies Field (March 2010); MEDLINE (1966 to March 2010); AMED (1985 to March 2010); EMBASE (1980 to March 2010); CINAHL (1982 to March 2010); the Physiotherapy Evidence Database (PEDro) (March 2010); and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1). In an effort to identify other published, unpublished and ongoing trials we planned to handsearch journals, searched ongoing trials registers, reviewed reference lists, and contacted relevant professional organizations.
SELECTION CRITERIA
Randomized controlled trials (RCTs) involving adults aged 18 years or over and including descriptions of specific hands-on interventions and techniques, rather than packages or approaches to treatment.
DATA COLLECTION AND ANALYSIS
Following completion of the searches, two review authors independently assessed the trials and extracted data using a data extraction pro forma. The same two review authors independently recorded and documented the methodological quality of the trials.
MAIN RESULTS
Three studies, involving a total of 86 participants, met all the selection criteria and were included in the review. However, extreme levels of heterogeneity were evident. Therefore, we could not undertake a meta-analysis of the results and completed a narrative synthesis instead.
AUTHORS' CONCLUSIONS
Overall, the review demonstrated that the limited evidence of benefit of stretching, passive exercises and mobilization, when applied to the hemiplegic upper limb following stroke, merits further research.
Topics: Adult; Electric Stimulation Therapy; Humans; Motor Activity; Muscle Stretching Exercises; Paresis; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 21678359
DOI: 10.1002/14651858.CD006609.pub2 -
BMJ Case Reports Aug 2013
Topics: Acute Disease; Aged; Humans; Male; Paresis
PubMed: 23912662
DOI: 10.1136/bcr-2013-200476 -
The Keio Journal of Medicine Dec 2003In persons with hemiparetic stroke, assessment and promotion of fitness have so far received limited attention, partly because of the lack of appropriate measures... (Review)
Review
In persons with hemiparetic stroke, assessment and promotion of fitness have so far received limited attention, partly because of the lack of appropriate measures applicable to them. Because these mobility-impaired persons are prone to inactivity, disuse and insulin resistance are likely to occur, and can aggravate the already significant health and economic consequences that stroke entails. It is therefore important to assess objectively their fitness to devize effective and efficient fitness promotion programs. Because of physical limitations, however, many persons with stroke cannot perform traditional stress testing using a treadmill or a cycle ergometer, and maximal oxygen consumption, which is regarded as a gold standard, is not a practical measure. In this article, we reviewed the current status of research on fitness in persons with hemiparetic stroke from the perspectives of evaluation, structure analysis of fitness, and longitudinal changes during a rehabilitation program. As a measure of fitness, indices obtainable with a submaximal exercise are proposed, such as anaerobic threshold and heart rate oxygen coefficient. Protocols applicable to persons with hemiparetic stroke with a variety of functional limitations have been developed (basic bedside activities, bridging activity, or single arm ergometry). The structure of their fitness is demonstrated to be described by a fitness model of healthy persons (cardiopulmonary, muscular and metabolic dimensions) if the paresis/activities of daily living dimension is added. Several studies suggest that fitness improves during a conventional stroke rehabilitation program. Studying the changes of the above four dimensions can help develop more effective fitness training programs.
Topics: Humans; Paresis; Physical Fitness; Stroke; Stroke Rehabilitation
PubMed: 14748473
DOI: 10.2302/kjm.52.211 -
British Medical Journal (Clinical...
Topics: Art; Humans; Intelligence; Male; Paresis; Syphilis
PubMed: 6797590
DOI: 10.1136/bmj.283.6307.1631-a -
Journal of Stroke and Cerebrovascular... Sep 2021The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a...
OBJECTIVES
The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a more reliable construct of fatigue. Our goal was to establish test-retest reliability of fatigability in stroke during 6-minute walk (6MW) testing. Relationships between post-stoke fatigability and other constructs were assessed.
MATERIALS AND METHODS
Twenty-three hemiparetic stroke survivors underwent two 6MW tests with portable metabolic monitoring performed at least 48 hours apart. Fatigability was defined as ratio of change in walking speed to distance covered during the 6MW. 6MW oxygen consumption (VO), peak aerobic capacity (VOpeak), walking speed over-ground, dynamic gait index, fatigue, falls efficacy, and BMI were measured.
RESULTS
Fatigability was highly correlated between both 6MW trials (ICC = 0.99, p < 0.001) with no significant difference between trials (0.08, p = 0.48). The strongest correlation was between fatigability and 6MW VO trial 1 and 2 (r = 0.92, p < 0.001 and r = 0.95, p < 0.001, respectively). Moderate-to-strong relationships were observed between fatigability for 6MW and fastest-comfortable walking speed (r = -0.82 and -0.77), self-selected walking speed (r = -7.8 and -0.78), 6MW walking speed (r = -0.80 and 0.80, VOpeak (r = -0.47 and -0.48) (p < 0.001), and DGI (r = -0.70 and -0.68, p < 0.001).
CONCLUSION
This study establishes test-retest reliability for an objective measure of fatigue in stroke-related disability. The strong correlations between fatigability and other functional measures also provides insight into the contributors underlying fatigability in this population.
REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01322607.
Topics: Adult; Aged; Aged, 80 and over; Cardiorespiratory Fitness; Chronic Disease; Cross-Sectional Studies; Exercise Tolerance; Fatigue; Female; Humans; Male; Middle Aged; Oxygen Consumption; Paresis; Predictive Value of Tests; Reproducibility of Results; Stroke; Time Factors; Walk Test; Walking
PubMed: 34242857
DOI: 10.1016/j.jstrokecerebrovasdis.2021.105895 -
Folia Neuropathologica 2022Spontaneous spinal epidural haematoma (SSEH) is a rare disease that requires emergency decompression or haematoma evacuation to prevent permanent neurological deficits.... (Review)
Review
Spontaneous spinal epidural haematoma (SSEH) is a rare disease that requires emergency decompression or haematoma evacuation to prevent permanent neurological deficits. Hemiparesis is an extremely rare presentation of SSEH, commonly misdiagnosed as stroke. With the help of case studies and references, this paper comprehensively discusses the effective methods to distinguish SSEH from stroke and provides theoretical support and ideas for rapid and accurate identification of SSEH. Herein, we report on the case of a 51-year-old man with SSEH who presented with acute hemiparesis and posterior neck pain. Cervical computed tomography (CT) revealed cervical degeneration. A carotid CT angiogram revealed a high-density mass in the C2-C5 right posterolateral epidural region. Cervical spine magnetic resonance imaging showed SSEH. The patient was conservatively treated and discharged following a full recovery. Rapid identification of SSEH continues to present a great challenge for neurologists. A soft tissue CT scan can be used to quickly and accurately identify SSEH; however, in the absence of cranial signs, Brown-Sequard syndrome, Lhermitte's sign and Horner syndrome should be used to differentiate SSEH from stroke.
Topics: Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Paresis; Stroke; Tomography, X-Ray Computed
PubMed: 35950479
DOI: 10.5114/fn.2022.116940