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11.
Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study
Wayne PM Krebs DE Macklin EA Schnyer R Kaptchuk TJ Parker SW Scarborough DM McGibbon CA Schaechter JD Stein J Stason WB 《Archives of physical medicine and rehabilitation》2005,86(12):660-2255
OBJECTIVE: To compare the effects of traditional Chinese acupuncture with sham acupuncture on upper-extremity (UE) function and quality of life (QOL) in patients with chronic hemiparesis from stroke. DESIGN: A prospective, sham-controlled, randomized controlled trial (RCT). SETTING: Patients recruited through a hospital stroke rehabilitation program. PARTICIPANTS: Thirty-three subjects who incurred a stroke 0.8 to 24 years previously and had moderate to severe UE functional impairment. INTERVENTIONS: Active acupuncture tailored to traditional Chinese medicine diagnoses, including electroacupuncture, or sham acupuncture. Up to 20 treatment sessions (mean, 16.9) over a mean of 10.5 weeks. MAIN OUTCOME MEASURES: UE motor function, spasticity, grip strength, range of motion (ROM), activities of daily living, QOL, and mood. All outcomes were measured at baseline and after treatment. RESULTS: Intention-to-treat (ITT) analyses found no statistically significant differences in outcomes between active and sham acupuncture groups. Analyses of protocol-compliant subjects revealed significant improvement in wrist spasticity (P<.01) and both wrist (P<.01) and shoulder (P<.01) ROM in the active acupuncture group, and improvement trends in UE motor function (P=.09) and digit ROM (P=.06). CONCLUSIONS: Based on ITT analyses, we conclude that acupuncture does not improve UE function or QOL in patients with chronic stroke symptoms. However, gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms. These results must be interpreted cautiously because of small sample sizes and multiple, unadjusted, post hoc comparisons. A larger, more definitive RCT using a similar design is feasible and warranted. 相似文献
12.
Maryam Fayazi Shohreh Noorizadeh Dehkordi Mehdi Dadgoo Masoud Salehi 《Medical journal of the Islamic Republic of Iran》2012,26(1):27-30
Background
The Motricity Index was used to measure strength in upper and lower extremities after stroke. The weighted score based on the ordinal 6 point scale of Medical Research Council was used to measure maximal isometric muscle strength. There is dearth of articles dealing with the reliability of this method. Therefore, the aim of this study was to determine the test retest reliability of Motricity Index strength assessments for paretic lower limb in 20 chronic stroke patients with one week interval.Methods
In a cross sectional study, intrarater reliability of lower extremity Motricity Index strength assessments with one week interval were measured.Results
The SPSS 18 was used for analysis of data. Two-way random-consistency model of ICC was used for assessment of test-retest reliability. The ICC values showed high reliability of strength measurement of Motricity Index (ICC=0.93).Conclusion
The Motricity Index can be a reliable instrument for measuring the strength of involved lower extremity when assessment is done by one rater following chronic stroke. 相似文献13.
Dunsky A Dickstein R Marcovitz E Levy S Deutsch JE Deutsch J 《Archives of physical medicine and rehabilitation》2008,89(8):1580-1588
Dunsky A, Dickstein R, Marcovitz E, Levy S, Deutsch J. Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis.
Objective
To test the feasibility and efficacy of a home-based motor imagery gait training program to improve walking performance of individuals with chronic poststroke hemiparesis.Design
Nonrandomized controlled trial.Setting
Local facility.Participants
Participants (N=17) were community-dwelling volunteers with hemiparesis caused by a unilateral stroke that occurred at least 3 months before the study.Intervention
Participants received 15 minutes of supervised imagery gait training in their homes 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training. Walking ability was evaluated by kinematics and functional scales twice before the intervention, 3 and 6 weeks after the intervention began, and at the 3-week follow-up.Main Outcome Measures
Spatiotemporal, kinematic, and functional walking measurements.Results
Walking speed increased significantly by 40% after training, and the gains were largely maintained at the 3-week follow-up. The effect size of the intervention on walking speed was moderate (.64). There were significant increases in stride length, cadence, and single-support time of the affected lower limb, whereas double-support time was decreased. Improvements were also noted on the gait scale of the Tinetti Performance-Oriented Mobility Assessment as well as in functional gait. Sixty-five percent of the participants advanced 1 walking category in the Modified Functional Walking Categories Index.Conclusions
Although further study is recommended, the findings support the feasibility and justify the incorporation of home-based motor imagery exercises to improve walking skills for poststroke hemiparesis. 相似文献14.
AbstractBackground:Consequences of stroke frequently comprise reduced movement ability of the upper extremity (UE) and subsequent long-term disability. Clinical scales are used to monitor and evaluate rehabilitation but are often insufficient, while technological advances in 3D motion capture provide detailed kinematics to more objectively quantify and interpret movement deficits.Objectives:To provide a comprehensive overview of research using kinematic movement analysis of the UE in individuals post-stroke with focus on objectives, methodology and findings while highlighting clinical implications and future directions.Major Findings:A literature search yielded 93 studies categorised into four groups: comparative (healthy, stroke, task condition), intervention (clinical trials), methodological and longitudinal. The majority of studies used optoelectronic systems, investigated discrete reaching and involved mainly individuals with moderate or mild stroke impairment in chronic stage. About 80% of the studies were published after year 2004. Speed-related variables were most frequently addressed followed by smoothness indicators, joint angles and trunk displacement. Movements in the hemiparetic side are generally slower, less smooth and show a compensatory movement pattern. Task specificity is crucial for kinematic outcomes. Tables summarising the main characteristics, objectives and results of all included studies are provided.Conclusions:There is still a lack of studies addressing reliability and responsiveness and involving more complex, everyday UE tasks with ecological validity. To facilitate the use of UE kinematic movement analysis in clinics, a research-based simpler data handling with pre-defined output for the results, as commonly used in gait analysis, is warranted. 相似文献
15.
Tyler Rickards Chelsey Sterling Edward Taub Christi Perkins-Hu Lynne Gauthier Michael Graham Angi Griffin Drew Davis Victor W. Mark Gitendra Uswatte 《Archives of physical medicine and rehabilitation》2014
Objective
To investigate the relationship of white matter integrity and path of the corticospinal tract (CST) on arm function before and after constraint-induced (CI) movement therapy in children with hemiparetic cerebral palsy (CP) and adults with chronic stroke.Design
Study 1 used a multiple-baseline pre-post design. Study 2 was a randomized controlled trial.Setting
Outpatient rehabilitation laboratory.Participants
Study 1 included children with hemiparetic CP (n=10; mean age ± SD, 3.2±1.7y). Study 2 included adults with chronic stroke (n=26; mean age ± SD, 65.4±13.6y) who received either CI therapy or a comparison therapy.Interventions
Children in study 1 received CI therapy for 3.5h/d for 15 consecutive weekdays. Adults in study 2 received either CI therapy or a comparison therapy for 3.5h/d for 10 consecutive weekdays.Main Outcome Measures
Diffusion tensor imaging was performed to quantify white matter integrity. Motor ability was assessed in children using the Pediatric Motor Activity Log–Revised and Pediatric Arm Function Test, and in adults with the Motor Activity Log and Wolf Motor Function Test.Results
Participants in both studies improved in real-world arm function and motor capacity. Children and adults with disrupted/displaced CSTs and children with reduced fractional anisotropy values were worse on pretreatment tests of motor function than participants with unaltered CSTs. However, neither integrity (fractional anisotropy) nor distorted or disrupted path of the CST affected motor improvement after treatment.Conclusions
Participants who had reduced integrity, displacement, or interruption of their CST performed worse on pretreatment motor testing. However, this had no effect on their ability to benefit from CI therapy. The results for children and adults are consistent with one another. 相似文献16.
Fiacchino F. Ariano C. Gemma M. Cerrato D. 《The Italian Journal of Neurological Sciences》1990,11(5):497-499
Supersensitivity to depolarization produced by succinylcholine and resistance to pancuronium were observed in paretic muscles
of a patient with a right frontoparietal tumor. The abnormal sensitivity to relaxants is compared with observations reported
in patients with myasthenia gravis and hemiparesis.
We hypothesize that upper motoneuron dysfunction may be followed by the appearance of “new” junctional receptors, which may
occasion a supersensitivity to depolarization and a poor affinity for both curare and anti-acetylcholine-receptor antibodies.
A decrease in acetylcholinesterase activity of “decentralized” muscles should also be considered.
Sommario Ipersensibilità all'effetto depolarizzante della succinilcolina e resistenza all'effetto paralizzante del pancuronio vengono osservate nella muscolatura paretica di un paziente di 72 anni nel corso di un intervento neurochirurgico per la rimozione di un tumore fronto-parietale destro. La duplice anomalia della risposta viene paragonata alle osservazioni effettuate in pazienti nei quali coesistono miastenia gravis ed emiparesi da lesione centrale. Viene formulata l'ipotesi che la disfunzione del motoneurone centrale possa essere seguita dalla comparsa di “nuovi” recettori acetilcolinici giunzionali dotati di ipersensibilità alla depolarizzazione e di scarsa affinità per il curaro e per gli anticorpi antirecettore. Come ipotesi alternativa viene considerata la possibilità che le risposte anomale esibite dalla muscolatura “decentralizzata” siano attribuibili ad una riduzione dell'acetilcolinesterasi provocata dalla lesione neurologica.相似文献
17.
18.
19.
Smorenburg AR Ledebt A Deconinck FJ Savelsbergh GJ 《Research in developmental disabilities》2012,33(3):971-981
This study examined the arm position sense in children with Spastic Hemiparetic Cerebral Palsy (SHCP) and typically developing children (TD) by means of a contralateral matching task. This task required participants to match the position of one arm with the position of the other arm for different target distances and from different starting positions. Results showed that children with SHCP exhibited with both arms larger matching errors than the TD group, but only when the distance between the arms at the start of the movement was large. In addition, the difference in errors between the less-impaired and the impaired limb changed as a function of the distance in the SHCP group whereas no interlimb differences were found in the TD group. Finally, spasticity and restricted range of motion in children with SHCP were not related to the proportion of undershoot and size of absolute error. This suggests that SHCP could be associated with sensory problems in conjunction with their motor problems. In conclusion, the current study showed that accurate matching of the arms is greatly impaired in SHCP when compared to TD children, irrespective of which arm is used. Moreover, this deficit is particularly present for large movement amplitudes. 相似文献
20.
This study analyzed the relationship between electrophysiological responses to transcranial magnetic stimulation (TMS), finger tracking accuracy, and volume of neural substrate in children with congenital hemiparesis. Nineteen participants demonstrating an ipsilesional motor-evoked potential (MEP) were compared with eleven participants showing an absent ipsilesional MEP response. Comparisons of finger tracking accuracy from the affected and less affected hands and ipsilesional/contralesional (I/C) volume ratio for the primary motor cortex (M1) and posterior limb of internal capsule (PLIC) were done using two-sample t-tests. Participants showing an ipsilesional MEP response demonstrated superior tracking performance from the less affected hand (p = 0.016) and significantly higher I/C volume ratios for M1 (p = 0.028) and PLIC (p = 0.005) compared to participants without an ipsilesional MEP response. Group differences in finger tracking accuracy from the affected hand were not significant. These results highlight differentiating factors amongst children with congenital hemiparesis showing contrasting MEP responses: less affected hand performance and preserved M1 and PLIC volume. Along with MEP status, these factors pose important clinical implications in pediatric stroke rehabilitation. These findings may also reflect competitive developmental processes associated with the preservation of affected hand function at the expense of some function in the less affected hand. 相似文献