上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能的疗效研究

目的:观察上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢运动功能的改善情况。方法:将50例脑卒中患者随机分为对照组和观察组,对照组每天进行2次常规康复训练,观察组每天进行1次常规康复训练及1次上肢康复机器人训练,每周治疗5d,共4周,治疗前后分别用Fugl-Meyer(上肢部分,FMA-UE)、改良日常生活能力(MBI)、肩关节主动关节活动度评价康复效果。结果:治疗后,2组患者的FMA-UE、肩关节主动关节活动度和MBI评估均有明显提高(P0.05),上肢康复机器人结合常规康复训练组的FMA-UE和肩关节前屈、水平内收、水平外展主动关节活动度与对照组相比提高更加明显(P0.05)。结论:上肢康复机器人结合常规康复训练对急性期脑卒中患者上肢功能有明显改善作用。     

Sensorimotor impairments and reaching performance in subjects with poststroke hemiparesis during the first few months of recovery

BACKGROUND AND PURPOSE: Little is known about the relationship between upper-extremity (UE) sensorimotor impairment and reaching performance during the first few months after stroke. The purpose of this study was to examine: (1) how measures of UE sensorimotor impairment are related to the speed, accuracy, and efficiency of reaching in subjects with hemiparesis during the subacute phase after stroke and (2) how impairments measured during the acute phase after stroke may predict the variance in reaching performance a few months later. SUBJECTS AND METHODS: Upper-extremity sensorimotor impairments and reaching performance were evaluated in 39 subjects with hemiparesis at 2 time points: during the acute phase (8.7+/-3.6 [X+/-SD] days) and the subacute phase (108.7+/-16.5 days) after stroke. Ten subjects who were healthy (control subjects) were evaluated once. Regression analyses were used to determine which impairments were the best predictors of variance in reaching performance in the subacute phase after stroke. RESULTS: Only a small amount of variance (<30%) in reaching performance was explained at the subacute time point, using either acute or subacute impairments as predictor variables. Of the impairments measured, UE strength deficits were the strongest, most consistent predictors of the variance in reaching performance during the first 3 months after stroke. DISCUSSION AND CONCLUSION: Surprisingly, the detailed clinical assessment of UE sensorimotor impairment, measured at the acute or subacute phase after stroke, did not explain much of the variance in reaching performance during the subacute phase after stroke. The findings that UE strength deficits (ie, decreased active range of motion and isometric force production) were the most common predictors of the variance in reaching performance during the first 3 months after stroke are consistent with the current viewpoint that impaired volitional muscle activation, clinically apparent as UE weakness, is a prominent contributing factor to UE dysfunction after stroke.     

Newer challenges to restore hemiparetic upper extremity after stroke: HANDS therapy and BMI neurorehabilitation

Because recovery of upper extremity (UE) functions to a practical level has been considered difficult in many patients with stroke, compensatory approaches have been emphasised. Recently, based on basic and clinical research indicating a greater potential for plastic changes in the brain, approaches directed toward functional restoration are becoming increasingly popular. Meta-analysis has indicated the effectiveness of constraint-induced movement therapy, electromyography biofeedback, electrostimulation, mental practice, and robot exercise to improve UE functions, but not hand functions. Therefore, we devised two new interventions to improve the paretic hand. One is hybrid assistive neuromuscular dynamic stimulation therapy, designed to facilitate daily use of the hemiparetic UE by combining electromyography (EMG)-triggered electrical stimulation with a wrist splint. We demonstrated improvement of motor function, spasticity, functional scores, and neurophysiologic parameters in chronic hemiparetic stroke. With a randomised controlled trial, we also demonstrated its effectiveness in subacute stroke. The other is brain-machine interface neurofeedback training, which provides real-time feedback based on analysis of volitionally decreased amplitudes of sensory motor rhythm during motor imagery involving extension of the affected fingers. This elicited new voluntary EMG activities, and improved finger functions and neurophysiological parameters. These interventions may offer powerful neurorehabilitative tools for improving hemiparetic UE function after stroke.     

急性脑梗死针刺与运动疗法对上肢运动功能的影响

目的：探讨急性脑梗死早期针刺及运动疗法后上肢运动功能恢复的程度及与其功能性活动的关系。方法：132例首发脑梗死偏瘫患者分为综合组和对照组各66例，均按神经内科常规处理，并进行运动疗法，综合组同时按照中医辩证法对患者上肢施以针刺。结果：治疗2月后，上肢运动功能积分．患腕主动活动范围．功能独立性评定量表中进食、梳洗、穿脱上衣等评分与治疗前比较，2组均提高（P〈0．05），综合组各项评分明显优于对照组（P〈0．05）。结论：脑梗死患者早期采用综合疗法可以明显促进日常生活能力的最大程度恢复，对患者预后有良好的影响。     

Retention of motor changes in chronic stroke survivors who were administered mental practice

Page SJ, Murray C, Hermann V, Levine P. Retention of motor changes in chronic stroke survivors who were administered mental practice.

Objective

To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice (MP) combined with repetitive task-specific (RTP) practice.

Design

Prospective, blinded, cohort, pre-post study.

Setting

Outpatient rehabilitation hospital.

Participants

Individuals (N=21) in the chronic stage of stroke (mean age ± SD, 66.1±8.1y; age range, 56–76y; mean time since stroke at study enrollment, 58.7mo; range, 13–129mo) exhibiting mild to moderate impairments of hand function.

Interventions

All individuals had been randomly assigned to receive a 10-week regimen consisting of MP emphasizing paretic upper extremity (UE) use during valued activities. Directly after each of these sessions, subjects were administered audiotaped MP. We assessed this group's paretic UE motor levels before, after, and 3 months after intervention.

Main Outcome Measures

The UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment (FM), the Action Research Arm Test (ARAT), the Arm Motor Ability Test (AMAT), and the Box and Block Test (BB).

Results

None of the scores significantly changed from the period directly after intervention to the 3-month posttesting period (FM: t=.817; ARAT: t=.923; AMAT: t=.898, t=.818, and t=.967 for the Functional Ability, Quality of Movement, and Time scales, respectively; BB: t=.892).

Conclusions

Changes in paretic UE movement realized through MP combined with RTP (MP + RTP) participation are retained 3 months after the intervention has concluded. This is the first study examining retention of motor changes after MP + RTP participation, and one of only a few studies examining long retention of motor changes after any intervention targeting stroke-induced hemiparesis.     

强制性使用运动疗法塑形技术对恢复期脑卒中上肢运动功能的康复作用

摘要 目的：探讨强制性使用运动疗法塑形技术对恢复期脑卒中偏瘫上肢运动功能的影响。 方法：恢复期脑卒中上肢运动功能障碍患者30例,随机分为3组：强制性使用运动疗法组（CIMT组）10例,塑形组10例,作业疗法组（OT组）10例。CIMT组采用塑形技术+行为技术+限制技术;塑形组采用塑形技术+限制技术;OT组采用作业疗法+限制技术。所有组连续康复治疗3h/d,5d/周,共2周。采用运动功能活动指数（MAL）评定患侧上肢在日常生活中的使用能力;采用Wolf运动功能评定法（WMFT）评定患侧上肢运动功能。所有组治疗前、治疗后1天、治疗后6个月及12个月进行MAL评定,治疗前后分别进行WMFT评定。 结果：与治疗前比较,所有组治疗后1d MAL指数提高明显（P＜0.01）;CIMT组治疗后6个月和12个月MAL指数提高明显（P＜0.01）,塑形组和OT组则无明显提高（P＞0.05）。治疗后组间MAL比较,CIMT组MAL指数提高最明显,与塑形组和OT组比较有显著性差异（P＜0.01）;而塑形组与OT组组间MAL比较无显著性差异（P＞0.05）。所有组治疗前后WMFT指数无明显变化（P＞0.05）。 结论：单纯塑形技术和强化作业疗法对运动功能具有同样的康复疗效;CIMT通过塑形技术和行为技术协同应用,显著提高康复疗效,并使康复疗效继续维持到治疗后1年;康复治疗中应重视行为因素的康复作用。     

镜像疗法结合通督醒神针法对脑卒中后上肢功能恢复的影响

目的 探讨镜像疗法（MT）结合通督醒神针法对脑卒中患者上肢功能恢复的影响。 方法 选取60例脑卒中后上肢运动功能障碍患者,采用随机数字表法将其分为镜像组、针刺组及观察组。所有患者均给予常规康复治疗,镜像组、针刺组则分别辅以MT治疗或通督醒神针法治疗,观察组则同时辅以MT治疗及通督醒神针法治疗,持续治疗4周。于治疗前、治疗2周、4周后分别采用Fugl-Meyer运动功能评分（FMA）上肢部分、Brunnstrom上肢和手分期、Barthel指数（BI）、偏瘫侧腕背伸时主动关节活动度（AROM）对3组患者进行疗效评定。于治疗前、治疗4周后对观察组患者进行功能性磁共振成像（fMRI）检查。 结果 治疗2周、4周后3组患者上肢FMA评分、上肢及手Brunnstrom分期、偏瘫侧腕背伸AROM及BI评分均显著优于治疗前水平（P<0.05）。组间比较发现,治疗2周、4周后观察组患者上肢FMA评分、上肢及手Brunnstrom分期、偏瘫侧腕背伸AROM均显著优于镜像组及针刺组（P<0.05）;治疗2周后观察组BI评分显著优于针刺组（P<0.05）,治疗4周后观察组BI评分均显著优于镜像组及针刺组（P<0.05）。6例观察组患者fMRI显示,治疗4周后其患侧初级运动区、运动前皮质区及辅助运动区均可见高强度激活区。 结论 镜像疗法联合通督醒神针法治疗脑卒中功能障碍患者具有协同作用,能进一步改善患者上肢运动功能,更有效提高患者日常生活活动能力,该联合疗法值得临床推广、应用。     

运动反馈训练对偏瘫患者上肢运动功能和日常生活活动能力的疗效

目的 探讨了Armeo Spring上肢运动反馈训练对偏瘫患者上肢运动功能和日常生活活动能力的疗效。 方法 52例偏瘫患者随机数字表法分为观察组和对照组,各26例。对照组进行常规康复训练的基础上增加每日1次作业疗法训练,观察组在常规康复训练的基础上增加每日1次Armeo Spring上肢运动反馈的作业疗法训练,2组治疗时间均为5个月,治疗前和治疗后分别对2组患者上肢和手的主动关节活动度测量（AROM）、改良Barthel 指数(Modify Barthel Index,MBI)、Fugl-Meyer 评定量表(Fugl-Meyer motor assessment scale,FMA）和简易上肢机能检查（Simple Test for Evaluating hand Function,STEF）进行评价。 结果 治疗前2组患者MBI、FMA和WMFT比较差异无统计学意义（P＞0.05）;治疗后2组患者MBI、FMA和WMFT较治疗前比较差异有统计学意义（P＜0.05）,观察组MBI、FMA和WMFT较对照组差异均有显著统计学意义（P<0.05）,且观察组各项指标改善均优于对照组。 结论 通过上肢运动反馈训练联合常规康复可明显改善偏瘫患者上肢运动功能和日常生活活动能力。     

Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study

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.     

Combination Transcranial Direct Current Stimulation and Virtual Reality Therapy for Upper Extremity Training in Patients With Subacute Stroke

Objective

To investigate the effects of combination cathodal transcranial direct current stimulation (tDCS) and virtual reality (VR) therapy for upper extremity (UE) training in patients with subacute stroke.

Design

Pilot randomized controlled trial. Patients were randomly assigned to 1 of 3 groups: group A received cathodal tDCS, group B received VR, and group C received combination therapy (cathodal tDCS was simultaneously applied during VR therapy).

Setting

University hospital.

Participants

Patients (N=59) with impaired unilateral UE motor function after stroke.

Intervention

Fifteen sessions of treatment over a 3-week period.

Main Outcome Measures

The Modified Ashworth Scale, manual muscle test (MMT), Manual Function Test (MFT), Fugl-Meyer Scale (FMS), and Box and Block Test were used to assess UE function. To evaluate activities of daily living, the Korean-Modified Barthel Index (K-MBI) was used. All outcomes were measured before and immediately after treatment.

Results

After treatment, all groups demonstrated significant improvements in MMT, MFT, FMS, and K-MBI scores. The change in MFT and FMS scores was different between the 3 groups. Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups.

Conclusions

In the present pilot study, the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone. This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke.     

Effectiveness of Surface Electromyographic Biofeedback-Triggered Neuromuscular Electrical Stimulation on Knee Rehabilitation

Background

Neuromuscular electrical stimulation initiated by a surface electromyographic biofeedback threshold (sEMG-triggered NMES) has been studied in populations of patients with neurological problems, but has not been applied to orthopedic populations.

Objectives

The purpose of this single-blinded, randomized clinical trial was to investigate sEMG-triggered NMES on knee extension active range of motion (AROM), function, and torque in patients with post-operative arthroscopic knee surgery.

Methods

Twenty-five participants were randomly assigned to either: (1) sEMG-triggered NMES with exercise group, or (2) exercise-only comparison group. Participants received outpatient physical therapy treatment 2 to 3 times a week for 12 visits. Knee AROM and function determined by the lower extremity functional scale (LEFS) were collected at the first, sixth, and twelfth visits. Peak isometric extensor torque was assessed using an electromechanical dynamometer at 3 months post surgery. Two analysis of variance tests with repeated measures were used to analyze knee AROM and LEFS data. An independent samples t-test was used to analyze the peak torque index (%) of the involved extremity compared to the uninvolved.

Results

A significant difference in AROM was found between groups. No significant difference was found between groups in the LEFS, nor in the peak isometric extensor torque. A 72.5% strength deficit was found compared to the uninvolved extremity.

Conclusion

Using sEMG-triggered NMES intervention improved extension AROM but did not improve function or torque.     

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke

Purpose: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects.

Methods: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits).

Results: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F?=?29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F?=?20.6; p< .0001).

Conclusions: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke.

• Implications for Rehabilitation

• Residual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1.

• It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

     

基于镜像运动神经元理论的模仿运动训练对中风偏瘫患者上肢功能、手部运动及表面肌电图的影响

目的分析基于镜像运动神经元理论的模仿运动训练对中风偏瘫患者上肢功能、手部运动及表面肌电图的影响。方法选择2016年9月至2018年9月我院收治的78例中风偏瘫患者为研究对象,将其均分为常规组和模仿运动训练组,各39例。常规组施行常规运动训练,模仿运动训练组施行基于镜像运动神经元理论的模仿运动训练。比较两组的训练效果。结果治疗3个月后,模仿运动训练组的FMA、MSS评分均高于常规组,AROM、手指最大伸展角度、手指最大屈曲角度均大于常规组,肱三头肌协同收缩率、肱二头肌协同收缩率均低于常规组(P<0.05)。结论基于镜像运动神经元理论的模仿运动训练对中风偏瘫患者上肢功能、手部运动及表面肌电图的改善效果显著,值得推广应用。     

Clinical factors in the prognosis of complex regional pain syndrome type I after stroke: a prospective study.

OBJECTIVE: To evaluate clinical prognostic factors of complex regional pain syndrome type I (CRPS I) in patients with stroke in an attempt to improve the Perrigot score, which does not include shoulder subluxation, unilateral neglect, or depression. DESIGN: This was a prospective study. The initial clinical data (first month) included motor index, Ashworth scale, de Bats score for shoulder subluxation, Montgomery-Asberg Depression Rating Scale, and sensory disorders evaluation. The prognosis of CRPS I was evaluated from the Perrigot score. A score of CRPS I severity was measured on entry and 3 mo later. RESULTS: Of the 71 patients with hemiplegia who were included, 34.8% had a CRPS I. The five main clinical factors in the prognosis of CRPS I were motor deficit, spasticity, sensory deficits, and initial coma. The prognostic score of Perrigot was strongly correlated with the CRPS I severity and was predictive of subsequent progression. CONCLUSION: Shoulder subluxation, unilateral neglect, and depression did not seem to be determinant predictive factors of CRPS I severity.     

术后早期应用静态进展性牵伸治疗对股骨中下段骨折患者膝关节功能的影响

目的:观察术后早期应用静态进展性牵伸治疗对股骨中下段骨折患者膝关节功能的影响。方法:选取在我院接受内固定手术的股骨中下段骨折患者48例,随机分为观察组和对照组各24例。术后3天,2组患者均采用物理因子治疗、CPM、运动功能训练等常规康复治疗,观察组在此基础上应用IK膝关节牵伸系统进行静态进展性牵伸治疗。分别于治疗前、术后4周和术后12周对2组患者进行疼痛视觉模拟评分(VAS)和膝关节主动关节活动度测量(AROM);于术后24周对2组患者用特种外科医院膝关节评分(HSS)评估膝关节功能、X线检查评估骨折愈合情况。结果:术后4及12周后,2组患者VAS评分均较治疗前呈明显下降趋势(均P0.05,0.01),且低于同时间点对照组(均P0.05)。术后4及12周后,2组患者AROM均较治疗前呈明显增加趋势(均P0.05);术后4周2组组间比较差异无统计学意义,术后12周观察组患者AROM明显高于同时间点对照组(P0.05)。术后24周,观察组患者HSS评分明显高于对照组(P0.05)。术后24周,2组患者X线检查均有骨痂通过骨折线,患肢无纵向扣击痛,不扶拐能行走3min,对比之前X线片骨折无变形,内固定无松动开裂,无骨不连发生。结论:对股骨中下段骨折患者,术后早期应用静态进展性牵伸治疗可有效缓解疼痛,扩大膝关节主动活动范围,提高膝关节功能,且不增加骨不连风险。     

Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.     

中风后的健侧上肢问题

大量证据表明 ,成年人中风后大脑损伤的同侧上肢感觉运动控制也出现异常。一些感觉运动缺损因脑损伤侧的功能不同而异 ,需要精确时序性的快速运动在左半球损伤的患者中对同侧上肢的影响大 ,相反在右半球损伤的患者中对有空间运动需要的同侧上肢影响较大 ,左侧中风的成年人同侧上肢的分离协调动作是正常的 ,但是连续协调动作则异常。中风后同侧上肢的感觉不受影响或仅受轻微影响 ,损伤同侧上肢有肌力缺陷 ,主要表现在右侧半球损伤患者 ,在要求一定时间完成的床功能检查中 ,见损伤同侧操作不能按时完成 ,这种操作缺陷可以反映损伤同侧的运动控制缺陷 ,这种缺陷往往被对侧偏瘫和偏身感觉丧失掩盖 ,集中于特殊运动控制缺陷的干预措施有助于双上肢的功能改善。     

Recovery of ambulation after traumatic brain injury

OBJECTIVES: To identify variables that are predictive of independent ambulation after traumatic brain injury (TBI) and to define the time course of recovery. DESIGN: Retrospective review of consecutive admissions of patients with severe TBI over a 32-month period. SETTING: Brain injury unit in an acute, inpatient rehabilitation hospital. PARTICIPANTS: Of 264 patients screened, 116 met criteria that included the ability to participate in motor and functional evaluation on admission to acute rehabilitation, and the absence of other neurologic disorders or fractures that affect one's ability to ambulate. INTERVENTION: Inpatient rehabilitation on a specialized TBI unit by an interdisciplinary team.Main outcome measures Recovery of independent ambulation and time to recover independent ambulation. RESULTS: Of eligible patients, 73.3% achieved independent ambulation by latest follow-up (up to 5.1 mo). Patients who achieved independent ambulation were significantly younger (P<.05), had better gait scores on admission (P<.05), and tended to be less severely injured-based on duration of posttraumatic amnesia (PTA; P=.058)-than those who did not ambulate independently. There were no differences in recovery based on neuropathologic profile. Mean time to independent ambulation +/- standard deviation was 5.7+/-4.3 weeks; of those achieving independent ambulation, 82.4% did so by 2 months and 94.1% by 3 months. If not independent by 3 months postinjury, patients had a 13.9% chance of recovery. Multivariate regression analysis generated prediction models for time to independent ambulation, using admission FIM instrument scores and age (38% of variance); initial gait score, loss of consciousness, and age (40% of variance); or initial gait score and PTA (58% of variance), when restricted to just those patients with diffuse axonal injury. CONCLUSIONS: Most patients with severe TBI achieved independent ambulation; the vast majority did so within 3 months postinjury. Functional measures, injury severity measures, and age can help guide prognosis and expectations for time to recover.     

Effect of spatial target reaching training based on visual biofeedback on the upper extremity function of hemiplegic stroke patients

[Purpose] The aim of this study was to determine the effect of spatial target reaching training (TRT) based on visual biofeedback (VB) on the upper extremity (UE) function of hemiplegic subjects. [Subjects and Methods] Forty subjects between six and eighteen months post-stroke were enrolled in this study. They were randomly allocated to an experimental group (EG, n=20) and a control group (CG, n=20). All subjects received an hour of routine therapy for stroke three times a week for four weeks. Subjects in EG received additional spatial TRT based on VB using a 2-dimensional motion capture analysis system. Both groups were tested at pre and post-intervention. The motor function of each subject’s UE was assessed using the Fugl-Meyer (FM) test of UE and the Wolf Motor Function Test (WMFT). The reaching speed, angle and maximum reach distance were recorded using the motion capture analysis system. The experimental data were analyzed using the paired and independent t-tests. [Results] The mean change scores of the FM Test of UE and WMFT show there was significantly more improvement at post-intervention in EG than in CG. Also, the speed and angle reached showed significantly more increase in the EG compared with the CG. [Conclusions] The findings indicate that UE motor recovery of hemiplegic stroke patients can be enhanced through the use of TRT based on VB.Key words: Target reaching training, Upper extremity function, Visual biofeedback