Clinical Prediction Rule for Identifying the Stroke Patients who will Obtain Clinically Important Improvement of Upper Limb Motor Function by Robot-Assisted Upper Limb

BackgroundThe number of studies on the characteristics of patients with stroke who would benefit from robot-assisted upper limb rehabilitation is limited, and there are no clear criteria for determining which individuals should receive such treatment. The current study aimed to develop a clinical prediction rule using machine learning to identify the characteristics of patients with stroke who can the achieve minimal clinically important difference of the Fugl-Meyer Upper Extremity Evaluation (FMA-UE) after single-joint hybrid assistive limb (HAL-SJ) rehabilitation.MethodsThis study included 71 patients with subacute stroke who received HAL-SJ rehabilitation. The chi-square automatic interaction detector (CHAID) model was applied to predict improvement in upper limb motor function. Based the analysis using CHAID, age, sex, days from stroke onset to the initiation of HAL-SJ rehabilitation, and upper limb motor and cognitive functions were used as independent variables. Improvement in upper limb motor function was determined based on the minimal clinically important difference of the FMA-UE, which was used as a dependent variable.ResultsAccording to the CHAID model, the FMA-UE score during the initiation of HAL-SJ rehabilitation was the most significant predictive factor for patients who are likely to respond to the intervention. Interestingly, this therapy was more effective in patients with moderate upper limb motor dysfunction and early initiation of HAL-SJ rehabilitation. The accuracy of the CHAID model was 0.89 (95% confidence interval: 0.81–0.96).ConclusionWe developed a clinical prediction rule for identifying the characteristics of patients with stroke whose upper limb motor function can improve with HAL-SJ rehabilitation.     

针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效

目的观察针刺结合康复训练治疗老年脑卒中后上肢功能障碍的疗效。方法选择我院2015-09-2016-11收治的脑卒中合并上肢功能障碍患者112例,根据随机数字表法将所有患者分为2组,每组56例。对照组给予常规康复训练,观察组在此基础上联合针刺治疗,比较2组临床疗效、日常生活能力评分、疼痛评分、上肢运动功能评分及神经功能评分。结果治疗后2组临床疗效相比,观察组优于对照组,差异具有统计学意义(P0.05);2组治疗前ADL、FMA、VAS、NDS评分相比,差异无统计学意义(P0.05);治疗后ADL、FMA、VAS、NDS评分均优于治疗前,组间相比,观察组优于对照组,差异具有统计学意义(P0.05)。结论针刺结合康复训练可改善老年脑卒中后上肢功能障碍,减少神经功能损伤和疼痛,提高日常生活能力。     

EFFICACY OF MIRROR THERAPY AND CONSTRAINT INDUCED MOVEMENT THERAPY ON UPPER EXTREMITY FUNCTION AND ACTIVITIES OF DAILY LIVING IN STROKE

BackgroundStroke has been identified as an epidemic and an important cause of morbidity and mortality globally, and at least 85% of stroke survivors experience hemiplegia and upper-extremity function of at least 69% of patients are affected. Over 50% of stroke survivors have impairment of motor function of the upper extremity; therefore there is pertinent need to use functional rehabilitation approaches such as; mirror therapy and constraint induced movement therapy for stroke survivors to regain upper extremity motor function.AimsTo compare the efficacy of mirror therapy (MT) with constraint induced movement therapy (CIMT) on the upper extremity motor function and activities of daily living (ADL) in chronic stroke survivors.Methods30 stroke survivors were recruited for this study. They were randomized into three groups, the MT plus conventional therapy group, CIMT plus conventional therapy group and control group. Upper extremity motor function and ADL were assessed. Participants were assessed at baseline and after seven weeks of intervention.ResultsThe MT and CIMT groups’ intervention both had significant improvement on upper extremity motor function and ADL, however, there was no significant difference on upper motor function (p=0.503) and ADL (p=0.133) across the three groups.ConclusionThis study concluded that neither of MT nor CIMT had an additional significant improvement compared to conventional therapy alone on recovery of motor function in the upper extremity and performance of ADL.     

镜像训练引导的运动想象疗法对急性缺血性脑卒中偏瘫患者上肢功能的康复效果

目的:本研究旨在对镜像训练引导的运动想象疗法是否能够更有效地改善急性缺血性脑卒中后偏瘫患者的上肢功能以及日常生活能力进行评价。方法:研究对象为2014年1月1日—2016年6月30日符合病例选择标准的76例急性缺血性脑卒中后偏瘫患者。将76例患者随机分入镜像训练引导的运动想象疗法组(38例)和单纯的运动想象疗法组(38例),在常规康复训练的基础上,分别接受镜像训练引导的运动想象疗法和单纯的运动想象疗法,共治疗4周。对2组治疗前后的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、Barthel指数、上肢动作研究量表(Action Research Arm Test,ARAT)评分和Fugl-Meyer上肢运动功能评分进行比较。结果:2组患者治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分均较治疗前显著改善(P值均0.05)。镜像训练引导的运动想象疗法组治疗后的NIHSS评分、Barthel指数、ARAT评分和Fugl-Meyer上肢运动功能评分的改善幅度均显著大于单纯的运动想象疗法组(P值均0.05)。结论:镜像训练引导的运动想象疗法应用于急性缺血性脑卒中后偏瘫患者上肢功能的康复治疗,与单纯的运动想象疗法相比,可以更好地改善患者的上肢功能和生活自理能力。     

Neuroprosthesis for Retraining Reaching and Grasping Functions in Severe Hemiplegic Patients

During the course of rehabilitation hemiplegic patients who have Chedoke McMaster Stages of Motor Recovery scores 4 and 5 measured three weeks after onset of stroke often improve their arm and hand function to the point that they can later use it in the activities of daily living (ADL) ( 1 ). These patients can be considered to have mild arm and hand paralysis since they can grasp objects and manipulate them with minor restrictions in the range of movement and force. On the other hand, hemiplegic patients who have Chedoke McMaster Stages of Motor Recovery scores 1 and 2 measured three weeks after onset of stroke, during the course of rehabilitation seldom improve their arm and hand function, and when they do, the improvements are not sufficient to allow these patients to use the arm and hand in ADL ( 1 ). These patients can be also described as patients who have severe arm and hand paralysis. Patients with severe arm and hand paralysis cannot move their arm and hand voluntarily at all or have very limited voluntary movements that cannot be used to carry out ADL. In recent years a variety of treatments such as constraint induced therapy, functional electrical therapy, biofeedback therapy, and robotics assisted therapies, were proposed which main objective is to improve reaching and grasping functions in subjects with unilateral arm paralysis. These therapies have shown encouraging results in patients with mild arm and hand paralysis. However, the efficacy of these therapies was limited when they were applied to patients with severe arm and hand paralysis. This article describes a new rehabilitation technique that can improve both reaching and grasping functions in hemiplegic patients with severe unilateral arm paralysis. A neuroprosthesis that applies surface electrical stimulation technology was used to retrain hemiplegic patients who had severe arm and hand paralysis to reach and grasp. The neuroprosthesis was applied both to acute and long‐term hemiplegic patients. Patients who were treated with the neuroprosthesis were compared to those patients who were administered only standard physiotherapy and occupational therapy appropriate for hemiplegic patients with unilateral upper extremity paralysis (controls). The treated and control patients had approximately the same time allocated for arm and hand therapy. After the treatment program was completed, the patients treated with the neuroprosthesis significantly improved their reaching and grasping functions and were able to use them in ADL. However, the majority of the control patients did not improve their arm and hand functions significantly and were not able to use them in ADL.     

早期康复治疗对急性脑卒中患者运动功能和生活能力的影响

目的探讨早期康复治疗对脑卒中患者运动功能和日常生活活动能力(ADL)的影响。方法将50例脑卒中偏瘫患者随机分成康复组(25例)和对照组(25例)进行临床对照研究,两组均进行常规神经内科药物治疗,康复组加以运动疗法,每例患者入组时、治疗第30d分别用Fugl-Meyer运动功能(FMA)量表测试运动功能和改良Barthel指数量表(MBI)测试ADL。结果MBI值:康复组治疗前、后分别为:20.68±8.98、72.36±17.39,对照组治疗前后分别为:21.24±12.59、51.29±18.52。FMA值:康复组治疗前、后分别为33.84±12.63、68.46±20.45,对照组治疗前、后分别为32.13±11.26、44.25±18.86。康复组和治疗组组间及组内比较差异具有显著统计学意义。结论康复治疗对偏瘫患者运动功能和日常生活活动能力具有良好的促进作用。可明显降低患者的依赖程度,提高其生活质量。     

急性脑卒中患者的早期中西医结合康复治疗

目的探讨3个月运动康复结合针灸治疗对急性脑卒中患者临床神经功能缺损程度(CNFD)以及日常生活能力(ADL)的影响。方法将105例急性脑卒中患者随机分为对照组、运动康复组、运动康复 针灸组,每组35例,进行3个月的康复治疗。治疗前后各进行一次临床神经功能缺损程度、日常生活能力评价。结果治疗前3组的临床神经功能缺损评分及日常生活能力评分差异均无统计学意义(P>0.05)。治疗后3组的临床神经功能缺损评分、日常生活能力评分均较治疗前差异有统计学意义(P<0.01),运动康复 针灸组的临床神经功能缺损评分最低、日常生活能力评分最高。结论3个月的运动康复结合针灸治疗能有效降低急性脑卒中患者的神经功能缺损程度,并促进日常生活活动能力的提高。     

The Adjunct of Electric Neurostimulation to Rehabilitation Approaches in Upper Limb Stroke Rehabilitation: A Systematic Review With Network Meta-Analysis of Randomized Controlled Trials

ObjectiveThis review analyzed the current evidence and the potential for the application of electric neurostimulation such as transcranial direct current stimulation (tDCS) and vagus nerve stimulation (VNS) in upper limb stroke rehabilitation.Materials and MethodsWe performed a systematic review of randomized controlled trials (RCTs) using network meta-analysis (NMA), searching the following data bases: PubMed, Web of Science, Cochrane, and Google Scholar, using specific keywords, from January 2010 to April 2021, and assessing the effects of “tDCS” or “VNS” combined with other therapies on upper limb motor function and activities of daily living (ADL) after stroke.ResultsWe included 38 RCTs with 1261 participants. Pairwise NMA showed transcutaneous VNS (tVNS) and anodal tDCS were effective in improving upper limb motor function (tVNS: mean difference [MD]: 5.50; 95% CI [0.67–11.67]; p < 0.05; anodal tDCS: MD: 5.23; 95% CI [2.45–8.01]; p < 0.05). tVNS and tDCS (anodal and cathodal) were also effective in improving ADL performance after stroke (tVNS: standard MD [SMD]: 0.96; 95% CI [0.15–2.06]; p < 0.05; anodal tDCS: SMD: 3.78; 95% CI [0.0–7.56]; p < 0.05; cathodal tDCS: SMD: 5.38; 95% CI [0.22–10.54]; p < 0.05). Surface under the cumulative ranking curve analysis revealed that tVNS is the best ranked treatment in improving upper limb motor function and performance in ADL after stroke. There was no difference in safety between VNS and its control interventions, measured by reported adverse events (VNS: risk ratio = 1.02 [95% CI = 0.48–2.17; I² = 0; p = 0.96]).ConclusionModerate- to high-quality evidence suggests that tVNS and anodal tDCS were effective in improving upper limb motor function in both acute/subacute and chronic stroke. In addition to tVNS and anodal tDCS, cathodal tDCS is also effective in improving ADL performance after stroke.     

Long term effects of intensity of upper and lower limb training after stroke: a randomised trial

OBJECTIVE: To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases. Design: A three group randomised controlled trial with repeated measures was used. METHOD: One hundred and one patients with a primary middle cerebral artery stroke were randomly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on (1) upper limb function, (2) lower limb function or (3) immobilisation with an inflatable pressure splint (control group). Follow up assessments within and between groups were compared at 6, 9, and 12 months after stroke. RESULTS: No statistically significant effects were found for treatment assignment from 6 months onwards. At a group level, the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained. However, no significant differences in functional recovery between groups were found for Barthel index (BI), functional ambulation categories (FAC),action research arm test (ARAT), comfortable and maximal walking speed, Nottingham health profile part 1(NHP-part 1), sickness impact profile-68 (SIP-68), and Frenchay activities index (FAI) from 6 months onwards. At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function (n=8 and 5, respectively) and lower limb function (n=19 and 9, respectively). Activities of daily living (ADL) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards. In particular, patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards. CONCLUSIONS: On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme. However, a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity, walking ability, and ADL beyond the error threshold.     

Constraint-induced movement therapy in treatment of acute and sub-acute stroke: a meta-analysis of 16 randomized controlled trials

OBJECTIVE: The aim of this meta-analysis was to evaluate the clinical efficacy of constraint-induced movement therapy in acute and sub-acute stroke.DATA SOURCES: The key words were stroke, cerebrovascular accident, constraint-induced therapy, forced use, and randomized controlled trial. The databases, including China National Knowledge Infrastructure, Wan Fang, Weipu Information Resources System, Chinese Biomedical Literature Database, Pub Med, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, were searched for studies on randomized controlled trials for treating acute or sub-acute stroke published before March 2016. DATA SELECTION: We retrieved relevant randomized controlled trials that compared constraint-induced movement therapy in treatment of acute or sub-acute stroke with traditional rehabilitation therapy(traditional occupational therapy). Patients were older than 18 years, had disease courses less than 6 months, and were evaluated with at least one upper extremity function scale. Study quality was evaluated, and data that met the criteria were extracted. Stata 11.0 software was used for the meta-analysis. OUTCOME MEASURES: Fugl-Meyer motor assessment of the arm, the action research-arm test, a motor activity log for amount of use and quality of movement, the Wolf motor function test, and a modified Barthel index.RESULTS: A total of 16 prospective randomized controlled trials(379 patients in the constraint-induced movement-therapy group and 359 in the control group) met inclusion criteria. Analysis showed significant mean differences in favor of constraint-induced movement therapy for the Fugl–Meyer motor assessment of the arm(weighted mean difference(WMD) = 10.822; 95% confidence intervals(95% CI): 7.419–14.226), the action research-arm test(WMD = 10.718; 95% CI: 5.704–15.733), the motor activity log for amount of use and quality of movement(WMD = 0.812; 95% CI: 0.331–1.293) and the modified Barthel index(WMD = 10.706; 95% CI: 4.417–16.966). CONCLUSION: Constraint-induced movement therapy may be more beneficial than traditional rehabilitation therapy for improving upper limb function after acute or sub-acute stroke.     

运动想象-动觉治疗对缺血性卒中患者手功能康复效果的研究

目的 研究运动想象-动觉治疗对缺血性卒中患者偏瘫侧手功能的康复效果,探索对缺血性卒中患者有效的手功能训练方法。方法 前瞻性入组2021年1月-2022年1月在首都医科大学附属北京天坛医院康复科住院及门诊诊疗的发病1个月内的缺血性卒中患者,将患者随机分为研究组（运动想象-动觉治疗组）和对照组（常规康复组）。研究组每日分别进行1次运动想象-动觉治疗和1次常规康复,治疗时间均为30 min,每周5 d,持续4周。对照组每日进行2次常规康复,每次治疗时间为30 min,每周5 d,持续4周。在治疗前对患者采用MoCA评定认知功能,采用混乱运动想象评估（chaotic motor imagery assessment battery,CMIA）和运动觉及视觉想象问卷（kinesthetic and visual imagery questionnaire,KVIQ）评定患者的运动想象能力,采用汉密尔顿抑郁量表（Hamilton depression scale,HAMD）评定患者是否存在抑郁。在治疗前、治疗4周后对患者进行Fugl-Meyer运动量表上肢部分（Fugl-Meyer assessment-upper extremity,FMA-UE）、Wolf上肢运动量表（Wolf motor function test,WMFT）、手臂动作调查测试（action research arm test,ARAT）进行手运动功能评定,采用日常生活能力（activity of daily living,ADL）量表评定日常生活能力,比较患者治疗前后上述指标的差异。结果 研究共入组67例患者,对照组33例,脱落1例,研究组34例,脱落3例。两组基线数据差异无统计学意义。在治疗4周后,研究组的FMA-UE量表[50（40～58）分 vs. 37（24～56）分,P=0.017]、WMFT量表评分等级[53（41～64）分 vs. 42（32～57）分,P=0.013]、ARAT量表[45（35～50）分 vs. 35（16～48）分,P=0.005]、ADL量表[80（70～85）分 vs. 65（60～85）分,P=0.008]均高于对照组,但WMFT上肢运动量表中的作业时间差异无统计学意义。     

The effects of electromyography-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients

Objective

The relation was investigated between hemiparetic arm function improvement and brain cortical perfusion (BCP) change during voluntary muscle contraction (VOL), EMG-controlled FES (EMG-FES) and simple electrical muscle stimulation (ES) before and after EMG-FES therapy in chronic stroke patients.

Methods

Sixteen chronic stroke patients with moderate residual hemiparesis underwent 5 months of task-orientated EMG-FES therapy of the paretic arm once or twice a week. Before and after treatment, arm function was clinically evaluated and BCP during VOL, ES and EMG-FES were assessed using multi-channel near-infrared spectroscopy.

Results

BCP in the ipsilesional sensory-motor cortex (SMC) was greater during EMG-FES than during VOL or ES; therefore, EMG-FES caused a shift in the dominant BCP from the contralesional to ipsilesional SMC. After EMG-FES therapy, arm function improved in most patients, with some individual variability, and there was significant improvement in Fugl–Meyer (FM) score and maximal grip strength (GS). Clinical improvement was accompanied by an increase in ipsilesional SMC activation during VOL and EMG-FES condition.

Conclusion

The EMG-FES may have more influence on ipsilesional BCP than VOL or ES alone.

Significance

The sensory motor integration during EMG-FES therapy might facilitate BCP of the ipsilesional SMC and result in functional improvement of hemiparetic upper extremity.     

现代康复技术在脑卒中恢复期运用初探

综合应用运动疗法，作业治疗及心理治疗等现代康复技术对３５例脑卒中患者进行系统治疗，同时设对照组２４例。所有虱在治疗前后均运用Ｂｒｅｕｎｎｓｔｒｏｍ运动能证实及日常生活活动能力的Ｂａｒｔｈｅｌ指数评测。结果显示，康复治疗组患肢的运动功能及日常生活活动能力的恢复明显优于对照组，故现代康复技术是提高脑卒中患者功能恢复的有效途径。     

Recovery of proximal and distal arm weakness in the ipsilateral upper limb after stroke

Conservation of the ipsilateral upper limb function is important in stroke subjects with contralateral hemiplegia, because often it must serve as a compensatory tool for activities of daily livings (ADLs). However, the amount of functional loss and/or the recovery pattern of the ipsilateral upper limb are not well known. We plan to investigate how to measure the progress of the ipsilateral upper limb function after the onset of stroke. Once a week we used the Manual Function Test (MFT) to evaluate the ipsilateral upper limb weakness of 72 stroke subjects with contralateral hemiplegia until maximum recovery. Proximal and distal arm weaknesses in the ipsilateral upper limb were maximally recovered within one month following the onset of hemispheric stroke, but their weakness was not to be completely recovered. Also the amounts of their recoveries were different from each other. These results indicate that the ipsilateral upper limb weakness in stroke is not a temporary event and that motor function of the proximal and distal arm might be mediated by different neuronal circuits.     

Improved quality of life following constraint-induced movement therapy is associated with gains in arm use,but not motor improvement

Background. Constraint-induced movement therapy (CI therapy) is one of few treatments for upper extremity (UE) hemiparesis that has been shown to result in motor recovery and improved quality of life in chronic stroke. However, the extent to which treatment-induced improvements in motor function versus daily use of the more affected arm independently contribute to improved quality of life remains largely unexplored.

Objective. The objective of this study is to identify whether motor function or daily use of a hemiparetic arm has a greater influence on quality of life after CI therapy.

Methods. Two cohorts of participants with chronic stroke received either in-person CI therapy (n = 29) or video-game home-based CI therapy (n = 16). The two cohorts were combined and the motor-related outcomes (Wolf Motor Function Test, Action Research Arm Test, Motor Activity Log [MAL]) and quality of life (Stroke-Specific Quality of Life) were jointly modeled to assess the associations between outcomes.

Results. The only outcome associated with improved quality of life was the MAL. Improvements in quality of life were not restricted to motor domains, but generalized to psychosocial domains as well.

Conclusions. Results suggest that improved arm use during everyday activities is integral to maximizing quality of life gains during motor rehabilitation for chronic post-stroke UE hemiparesis. In contrast, gains in motor function were not associated with increases in quality of life. These findings further support the need to implement techniques into clinical practice that promote arm use during daily life if improving quality of life is a main goal of treatment.

ClinicalTrials.gov Registration Numbers: NCT01725919 and NCT03005457     

Beyond motor recovery after stroke: The role of hand robotic rehabilitation plus virtual reality in improving cognitive function

Robot-assisted hand training adopting end-effector devices results in an additional reduction of motor impairment in comparison to usual care alone in different stages of stroke recovery. These devices often allow the patient to perform practical, attentive, and visual-spatial tasks in a semi-virtual reality (VR) setting. We aimed to investigate whether the hand end-effector robotic device Amadeo^TM could improve cognitive performance, beyond the motor deficit, as compared to the same amount of occupational treatment focused on the hand. Forty-eight patients (aged 54.3 ± 10.5 years, 62.5% female) affected by either ischemic or hemorrhagic stroke in the chronic phase were enrolled in the study. The experimental group (EG) underwent Amadeo^TM robotic training, while the control group (CG) performed occupational therapy involving the upper limb. Patients were assessed at the beginning and at the end of the rehabilitation protocol using a specific neuropsychological battery, as well as motor function tests. The EG showed greater improvements in different cognitive domains, including attentive abilities and executive functions, as well as in hand motor function, as compared to CG. Our study showed that task-oriented VR-based robotic rehabilitation enhanced not only motor function in the paretic arm but also global and specific cognitive abilities in post-stroke patients. We may argue that the hand robotic plus VR-based training may provide patients with an integration of cognitive and motor skill rehabilitation, thus amplifying the functional outcome achievement.     

Doing it with mirrors: a case study of a novel approach to neurorehabilitation

Arm amputees can experience the perception of movement of a phantom limb while looking at a mirror reflection of the moving, intact arm superimposed on the perceived phantom. Such use of a mirror to provide illusory visual feedback of movement can be useful in rehabilitation of hemiparetic patients. In this case report, we describe the successful application of "mirror therapy" to the post-stroke rehabilitation of a patient with poor functional use of an upper extremity, due mainly to somatosensory deficits. Mirror therapy facilitated employment of a motor copy strategy (bimanual movements) and later progression to "forced use" of the affected arm. The end result was increased functional use of the affected upper limb.     

Transcutaneous Auricular Vagus Nerve Stimulation with Upper Limb Repetitive Task Practice May Improve Sensory Recovery in Chronic Stroke

Background: Sensory impairment is associated with reduced functional recovery in stroke survivors. Invasive vagus nerve stimulation (VNS) paired with rehabilitative interventions improves motor recovery in chronic stroke. Noninvasive approaches, for example, transcutaneous auricular VNS (taVNS) are safe, well-tolerated and may also improve motor function in those with residual weakness. We report the impact of taVNS paired with a motor intervention, repetitive task practice, on sensory recovery in a cohort of patients with chronic stroke. Methods: Twelve participants who were more than 3 months postischemic stroke with residual upper limb weakness received 18 × 1 hour sessions over 6 weeks with an average of at least 300 repetitions of functional arm movements per session concurrently with taVNS at maximum tolerated intensity. Light touch and proprioception were scored as part of the Upper Limb Fugl-Meyer (UFM) assessment at baseline and postintervention (score range for sensation 0-12). Results: Eleven participants (92%) had sensory impairment at baseline of whom 7 (64%) regained some sensation (proprioception n = 6 participants, light touch n = 2, both modalities n = 1) postintervention. The maximal increase in UFM sensation score (3 points) was seen in the patient with the greatest improvement in motor function. Conclusions: taVNS paired with motor rehabilitation may improve sensory recovery in chronic stroke patients. The relative contribution of motor and sensory rehabilitation to overall functional recovery in chronic stroke needs further characterization in a larger, phase 2 study.     

基于PEO模式的家庭作业治疗对卒中偏瘫患者功能预后的影响

目的 研究基于人-环境-作业（person-environment-occupation,PEO）模式的家庭作业治疗对卒中偏瘫患者上肢功能、日常生活活动能力及生活质量的影响。方法 前瞻性、连续纳入2020年1月—2020年12月南京市浦口人民医院（原南京市浦口区中心医院）康复医学科出院的卒中偏瘫患者,随机分为试验组和对照组,并分别建立微信群聊,对照组定期更新康复小视频,有任何问题随时咨询。试验组基于PEO模式,个性化更新每位患者的小视频,两组分别于出院时、出院3个月、6个月和12个月分别进行Fugl-Meyer运动功能量表上肢部分（Fugl-Meyer assessment upper extremity scale,FMA-UE）、日常生活活动能力Barthel指数（Barthel index,BI）及卒中专用生活质量量表（stroke-specific quality of life scale,SS-QOL）的评定。结果 最终纳入卒中偏瘫患者60例,平均年龄（63.10±6.83）岁,其中男性30例。将入组患者随机分为对照组和试验组各30例。组内比较显示,试验组出院3个月BI评分...     

Delay in initiation and termination of muscle contraction, motor impairment, and physical disability in upper limb hemiparesis

The purpose of this study was to describe the relationship between the delay in initiation and termination of muscle contraction and clinical measures of motor impairment and physical disability in the affected upper limb of patients with hemiparesis. Electromyographic (EMG) activity of 26 long-term survivors of stroke was recorded during isometric wrist flexion and extension. Upper limb motor impairment and disability were assessed with the Fugl-Meyer motor assessment (FMA) and arm motor ability test (AMAT), respectively. Delay in initiation and termination of muscle contraction was significantly prolonged in the paretic arm. However, the delay was not significantly affected by stroke type, stroke level, side of hemiparesis, or presence of aphasia. Delay in initiation and termination of muscle contraction correlated significantly with FMA and AMAT. Abnormally delayed initiation and termination of muscle contraction may contribute to hemiparetic upper limb motor impairment and physical disability in hemiparetic patients.