Transfer of training effects in stroke patients with apraxia: an exploratory study

The goal of the present study was to examine the transfer of the effects of cognitive strategy training for stroke patients with apraxia from trained to non-trained tasks. In strategy training, the occurrence of transfer is expected as the training programme is aimed, not at relearning specific tasks, but at teaching patients new ways to handle the problems resulting from the impairment. Exploratory analyses were conducted on data previously collected in a randomised controlled trial on the efficacy of the strategy training. A total of 113 left hemisphere stroke patients were randomly assigned to a strategy training group and a group receiving occupational therapy as usual. Assessment of apraxia, motor functioning and activities of daily living (ADL) took place at baseline, after an eight-week treatment period, and five months after baseline. The primary outcome measure consisted of standardised ADL observations of trained and non-trained tasks. The analyses showed that in both treatment groups, the scores on the ADL observations for non-trained tasks improved significantly after eight weeks of training as compared with the baseline score. Change scores of non-trained activities were larger in the strategy training group as compared with the usual treatment group. By using previously collected data we are able to illustrate the potential transfer of treatment effects in a large sample of stroke patients. We found indications for the occurrence of transfer, although the study was not originally designed for the purpose of evaluating transfer. Therefore these results are worth exploring more profoundly. We will further investigate our preliminary conclusions in a new prospective study which is specifically designed to examine the transfer of training effects.     

Efficacy of strategy training in left hemisphere stroke patients with apraxia: A randomised clinical trial

The objective of the present study was to determine in a controlled study the efficacy of strategy training in left hemisphere stroke patients with apraxia. A total of 113 left hemisphere stroke patients with apraxia were randomly assigned to two treatment groups; (1) strategy training integrated into usual occupational therapy and (2) usual occupational therapy only. Assessments took place at baseline, after an 8 week treatment period and 5 months after baseline (follow-up). Patients were assessed on apraxia, motor functioning and activities of daily living (ADL). The primary outcome measure was a standardised ADL observation by a blinded research assistant. Additional ADL measures were used as secondary outcome measures (Barthel ADL index, ADL judgement by occupational therapist and by patient). After 8 weeks of treatment, patients who received strategy training (n = 43) improved significantly more than patients in the usual treatment group (n = 39) on the ADL observations (mean change .24; 90% CI, .15–.34 vs. .12, .03–.21). This reflects a small to medium effect (effect size .37) of strategy training on ADL functioning. With respect to the secondary outcome measures a medium effect (effect size .47) was found on the Barthel ADL index. No beneficial effects of strategy training were found after 5 months (at follow-up). In this trial evidence was found for the short-term effectiveness of strategy training in left hemisphere stroke patients with apraxia.     

Transfer effects of a cognitive strategy training for stroke patients with apraxia

The objective of this study was to evaluate transfer effects of cognitive strategy training for stroke patients with apraxia. During 8 weeks, 29 apraxic patients received cognitive strategy training to teach them how to perform activities of daily living (ADL) as independently as possible. ADL functioning was assessed at the rehabilitation centre at baseline and after 8 weeks of training. In addition, assessment took place at the patients' own homes after 8 weeks of training and 5 months after the start of the training. The performance of both trained and nontrained tasks was observed. Patients performed trained tasks and nontrained tasks at the same level of independency at the rehabilitation centre as well as at home, indicating transfer of training effects. These effects turned out to be stable over time.     

Measuring disabilities in stroke patients with apraxia: A validation study of an observational method

The objective of the present study was to determine the clinical and construct validity of the assessment of disabilities in stroke patients with apraxia. Disabilities were assessed by means of observation of activities of daily living (ADL), such as washing the face and upper body and putting on a blouse or shirt. The study was carried out at occupational therapy departments in general hospitals, rehabilitation centres, and nursing homes. Patients diagnosed to have had a stroke in the left hemisphere and to have apraxia participated in the study (n = 45, 21 males, 24 females age 39–91). Guidelines were offered for the ADL observations and the assessment of disabilities in these activities. Clinical validity was investigated by comparing the scores of the patients with those of a group of stroke patients without apraxia (n = 36, 14 males, 22 females age 35–88). Construct validity was examined by investigating relationships between several measures of interest: an apraxia test, a motor functioning test, a set of ADL observations, and the Barthel index as a general measure of disability. Comparison of the results of the patients with apraxia with the control group of stroke patients without apraxia showed that the clinical validity of the ADL observations is good: On the basis of the ADL observations, differences between patients with apraxia and patients without apraxia are measured. Correlation analyses of the group of patients with apraxia showed that the ADL observations were highly associated with apraxia, but only to a lesser degree with motor impairments; while motor impairments correlated strongly with the Barthel index (a general measure of physical disability), but only marginally with ADL observations. A LISREL analysis supported these findings. The results indicate that ADL observations have clinical validity and that the construct validity of the observational method is good. ADL observations appear to measure disability ties caused by apraxia in stroke patients.     

Assessment and therapy of complex activities of daily living in apraxia

Four complex activities of daily living (ADL) such as preparing coffee or fixing and starting a tape recorder were assessed in six patients with chronic apraxia after left hemisphere infarction, six patients with left hemisphere infarction but without apraxia, and controls using only their left hand. Performance was rated for the number of errors and for the amount of assistance needed to complete the task, and errors were categorised. Whereas there was good inter-rater agreement on the total numbers of errors and amount of assistance, reliability of error categorisation was low. Apraxic patients had more difficulties than left brain damaged patients without apraxia, who in turn had more difficulties than the healthy controls. The six apraxic patients were part of a therapy study aimed at restoring the ability to perform the four ADL. Two methods of treatment were compared: Direct training of the activity based on the guided performance of the whole activity and exploration training aimed at teaching the patient structure-function relationships underlying correct performance but which did not involve actual completion of the activity. Performance improved with repeated testing of untrained activities during an initial baseline, but there was no reduction of errors or amount of assistance required for untrained activities during training of other activities. Exploration training had no effect on performance, whereas direct training of the activity reduced errors and need for assistance. Training effects were largely preserved at follow up, but the rate of errors increased when the trained activities were tested with a partially different set of objects. As therapeutic results were restricted to the trained activity and to some degree even to the very objects that were used for training, therapy of complex ADL should be tailored to the specific needs and desires of patients and their relatives, and it should be tied as closely as possible to the normal routine of the patient's daily life.     

Rehabilitation of limb apraxia improves daily life activities in patients with stroke

We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and 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。     

Effects of limb apraxia intervention in patients with stroke: A meta-analysis of randomized controlled trials

ObjectiveLimb apraxia, a complication of stroke, causes difficulties in performing activities of daily living (ADL). To date, there are no studies on the effectiveness of limb apraxia interventions. We conducted a meta-analysis to assess the effectiveness of limb apraxia interventions in reducing its severity and improving ADL.MethodsWe conducted a search of randomized controlled trials (RCTs) related to limb apraxia till December 2021 using the databases of PubMed, Embase, CINAHL, and the Cochrane Library. We measured the outcome variables in the subgroups of total apraxia (TA), ideational apraxia (IA), ideomotor apraxia (IMA), and ADL. The Physiotherapy Evidence Database (PEDro) scale was used to assess the quality.ResultsFive RCTs were selected, and of the 310 participants, 155 were in the experimental and 155 in the control group. A random-effects model was used for the effect size distribution. The limb apraxia intervention methods included gesture and strategy training (three and two studies, respectively). The effect sizes of the outcome variables in the subgroups were small for the TA and IA, with 0.475 (95% confidence interval [CI]: -0.151-1.102; p = 0.137) and 0.289 (95% CI: -0.144-0.722; p = 0.191), respectively. IMA had a medium effect size of 0.731 (95% CI: -0.062-1.525; p = 0.071), not statistically significant, whereas ADL effect size was small and statistically significant, 0.416 (95% CI: 0.159-0.673; p = 0.002).ConclusionsGesture and strategy training had statistically significant effects on ADL as limb apraxia interventions. Therefore, the effectiveness of the apraxia interventions needs to be further evaluated through continuous RCTs.     

低频电刺激联合早期康复训练治疗急性脑梗死

目的 探讨双乳突法头部低频电刺激及早期康复训练对急性脑梗死患者神经功能缺损程度及日常生活能力(ADL)恢复的影响.方法 90例急性脑梗死患者,随机分为低频电刺激及早期康复训练组(A组)、低频电刺激组(B组)和对照组(C组),每组30例.A、B两组均采用低频电刺激、常规药物治疗,A组在发病48h内进行早期康复训练.分别观察治疗后第21天神经功能缺损评分及ADL的变化.结果 三组在治疗前神经功能缺损评分、ADL评分差异均无统计学意义(P＞0.05),A组治疗后神经功能缺损评分、ADL评分明显优于B组及对照组,差异有显著统计学意义(P＜0.01).结论 低频电刺激及早期康复训练对急性脑梗死患者具有明显的临床疗效.     

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。     

临床路径在脑卒中患者健康教育中的应用研究

目的 探讨临床路径在脑卒中患者健康教育中的应用效果.方法 将300例住院脑卒中患者随机分为2组,各150例,对照组给予常规健康教育,试验组应用临床路径实施健康教育,分别在入院时及出院时评价2组患者的疾病相关知识得分、日常生活活动能力评分.结果 干预前2组患者基线均衡,出院时试验组患者的疾病相关知识得分为89.30±5.27,对照组为71.08±6.01,试验组日常生活活动能力评分85.19±9.58,对照组74.87±8.97,差异有统计学意义（P〈0.05）.结论 应用临床路径对脑卒中患者实施健康教育可以提高其疾病知识掌握水平,提高日常生活活动能力.     

The effects of vibrotactile biofeedback training on trunk sway in Parkinson's disease patients

BackgroundPostural instability in Parkinson's disease (PD) can lead to falls, injuries and reduced quality of life. We investigated whether balance in PD can improve by offering patients feedback about their own trunk sway as a supplement to natural sensory inputs. Specifically, we investigated the effect of artificial vibrotactile biofeedback on trunk sway in PD.MethodsTwenty PD patients were assigned to a control group (n = 10) or biofeedback group (n = 10). First, all patients performed two sets of six gait tasks and six stance tasks (pre-training assessment). Subsequently, all subjects trained six selected tasks five times (balance training). During this training, the feedback group received vibrotactile feedback of trunk sway, via vibrations delivered at the head. After training, both groups repeated all twelve tasks (post-training assessment). During all tasks, trunk pitch and roll movements were measured with angular velocity sensors attached to the lower trunk. Outcomes included sway angle and sway angular velocity in the roll and pitch plane, and task duration.ResultsOverall, patients in the feedback group had a significantly greater reduction in roll (P = 0.005) and pitch (P < 0.001) sway angular velocity. Moreover, roll sway angle increased more in controls after training, suggesting better training effects in the feedback group (P < 0.001).ConclusionsOne session of balance training in PD using a biofeedback system showed beneficial effects on trunk stability. Additional research should examine if these effects increase further after more intensive training, how long these persist after training has stopped, and if the observed effects carry over to non-trained tasks.     

The benefits of simultaneous tDCS and working memory training on transfer outcomes: A systematic review and meta-analysis

BackgroundTranscranial direct current stimulation (tDCS) has shown potential as an effective aid to facilitate learning. A popular application of this technology has been in combination with working memory training (WMT) in order to enhance transfer effects to other cognitive measures after training.ObjectiveThis meta-analytic review aims to synthesize the existing literature on tDCS-enhanced WMT to quantify the extent to which tDCS can improve performance on transfer tasks after training. Furthermore, we were interested to evaluate the moderating effects of assessment time point (immediate post-test vs. follow-up) and transfer distance, i.e., the degree of similarity between transfer and training tasks.MethodsUsing robust variance estimation, we performed a systematic meta-analysis of all studies to date that compared WMT with tDCS to WMT with sham in healthy adults. All procedures conformed to PRISMA guidelines.ResultsAcross 265 transfer measures in 18 studies, we found a small positive net effect of tDCS on improving overall performance on transfer measures after WMT. These effects were sustained at follow-up, which ranged from 1 week to one year after training, with a median of 1 month. Additionally, although there were no significant differences as a function of transfer distance, effects were most pronounced for non-trained working memory tasks.ConclusionsThis review provides evidence that tDCS can be effective in promoting learning over and above WMT alone, and can durably improve performance on trained and untrained measures for weeks to months after the initial training and stimulation period. In particular, boosting performance on dissimilar working memory tasks may present the most promising target for tDCS-augmented WMT.     

Activity Index - a complementary ADL scale to the Barthel Index in the acute stage in patients with severe stroke

OBJECTIVE: It was the aim of this study to compare the Barthel Index (BI) and the activities of daily living (ADL) component of the Activity Index [AI(ADL)] regarding floor and ceiling effects, responsiveness and the predictive value for survival during the first week until 3 months after stroke onset. PATIENTS AND METHODS: Basic ADL were assessed in 75 patients with ischaemic stroke. RESULTS: There was a strong concordance between BI and AI(ADL) scores at all time points (Kendall's taub = 0.7878, p < 0.0001 at baseline; Kendall's taub = 0.8901, p < 0.0001 at 1 week; Kendall's taub = 0.9027, p < 0.0001 at 3 months). BI had a significantly more pronounced floor effect at baseline and at 1 week compared with AI(ADL) in patients with severe stroke. Both scales had a substantial ceiling effect at 3 months. At 1 week, the baseline BI score was significantly higher in patients being alive as compared with those who had died, while their AI(ADL) score did not differ significantly. At 3 months, baseline BI and AI(ADL) scores were significantly higher in patients being alive as compared with those who had died. The predictive value of being alive at 1 week and 3 months did not differ between BI and AI(ADL). CONCLUSION: AI(ADL) is recommended to be used in addition as a complement to BI in patients with severe stroke since the floor effect with BI in the acute stage is significantly more pronounced than with AI(ADL), thus hampering the responsiveness.     

氟西汀治疗脑卒中后抑郁症临床观察

目的探讨氟西汀治疗脑卒中后抑郁症的临床疗效。方法选取脑卒中患者80例全部通过临床CT或MRI证实,治疗组40例,Zung抑郁自评量表≥40分,或者GDS老年抑郁量表5～10分;对照组40例是有部分抑郁症状但尚未达到抑郁标准的脑卒中患者。2组患者均给予相似的脑血管病常规治疗,针对治疗组增加氟西汀（百忧解胶囊）,每天晨服1粒（20mg）,连服8周。结果治疗组患者的Zung量表和GDS量表评分,在服用氟西汀治疗后4周和8周抑郁症状均不同程度好转,第8周与第4周相比好转更加明显。分析表明优势半球卒中和多发性脑卒中患者抑郁症状更为突出,治疗后疗效也更加明显;ADL评分发现治疗组总体疗效好于对照组,第8周好于第4周,亚组分析仅提示优势半球脑卒中治疗组的ADL疗效明显好于对照组。结论氟西汀能够调节5-羟色胺浓度,改善抑郁症状,促进ADL功能恢复。     

日常生活功能量表评定阿尔茨海默病患者日常生活功能的信度与效度及其应用

目的探讨ADL在评定阿尔茨海默病患者日常生活功能中的应用。方法173例阿尔茨海默病（AD）患者应用ADL进行基线期评定,脱落16例。83例在进行为期16周盐酸美金刚治疗后进行第二次评定。74例未治疗者在4周后重复评定。逐步回归分析影响ADL分值相关因素,比较治疗组患者治疗前后ADL分值的。结果逐步回归分析显示MMSE总分、年龄和性别影响ADL总分。中度AD患者在盐酸美金刚治疗16周后ADL总分及IADL分减少。两次不同测定各单项分之间ICC值为0．84—0．96,分半信度为0．91。结论ADL总分受MMSE总分、年龄和性别的影响,盐酸美金刚能够一定程度改善中度AD患者的日常生活功能。ADL具有较好的信度。     

Efficacy of RehaCom cognitive rehabilitation software in activities of daily living,attention and response control in chronic stroke patients

BackgroundOur world is unfortunately facing a huge number of stroke. Attention, response control and activities of daily living (ADL) are important cognitive functions affected by stroke. In line with this explanation, we aimed to investigate the effect of RehaCom rehabilitation software on ADL, attention and response control in chronic stroke patients with damage to middle and anterior cerebral arteries.MethodFor selecting participants, among chronic stroke patients who referred to our special rehabilitation clinic for patients with stroke, fifty patients selected. Participants were assigned to control (n = 25) and experimental (n = 25) groups. The experimental group was compared with the control group before and after using RehaCom (ten 45-min sessions in five weeks).ResultsThere is a significant enhancement in ADL, attention and response control scores in the experimental group compared with the control group. In fact, treatment with RehaCom significantly improved the score of all studied variables in chronic stroke patients.ConclusionsIn conclusion, RehaCom cognitive rehabilitation software has improvement effect on ADL, attention and response control in patients with chronic stroke. Our study reveals a new information about the efficacy of computerized training in the rehabilitation of stroke patients.     

综合康复治疗对脑卒中偏瘫患者日常生活能力的疗效观察

目的观察早期综合康复治疗对脑梗死及脑出血偏瘫患者日常生活能力（ADL）的影响及其差异。方法急性脑卒中偏瘫患者42例分为脑梗死康复脑梗死组和脑出血康复脑出血组各21例。2组均接受神经内科常规药物治疗及配合康复治疗,1次／d,30rain／次,其余时间由家属协助训练;2组治疗30d后采用Barthel指数评分。结果脑梗死组和脑出血组治疗前ADL评分具有可比性（P〉0．05）;治疗后ADL评分分别增加135．69％和199．51％,且2组治疗前后ADL评分差异均显著（P〈0．01）;治疗后脑出血组增加的ADL评分与脑梗死组相比较多（17．52±3．62）分,且2组治疗后ADL评分差异明显（P〈0．05）。结论药物并配合康复治疗可提高2组的整体疗效和ADL指数,且脑出血康复组更显著。     

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 effect of early versus late antidepressant treatment on physical impairment associated with poststroke depression: is there a time-related therapeutic window?

Impairments in activities of daily living (ADL) are common after stroke and may be related to poststroke depression. We have demonstrated that remission of poststroke major depression was associated with improvement in ADL. The administration of antidepressants within the first 3 months after stroke has been shown to prevent poststroke depression, early administration might also improve recovery of ADL among patients with stroke. This study examines the effect of early versus late treatment with antidepressants on recovery in ADL. Among 62 patients after stroke, the therapeutic effect of a 3-month course of antidepressants begun during the first month after stroke was compared with the effect of treatment begun after 1 month. The severity of impairment was measured using the Functional Independence Measure (FIM) and post-treatment outcome was assessed over the following 21 months. Although both the early and late treatment groups showed improvements in FIM scores during the 3 months of treatment, the early treatment group improved significantly more than the late treatment group. After the treatment, the early treatment group maintained this improvement over 2 years while the late treatment group deteriorated over time. There were no significant differences in the 2 groups that would explain the findings. Recovery in ADL impairment after stroke appeared to be enhanced by the use of antidepressant medication if treatment was started within the first month after stroke. These findings are consistent with the hypothesis that there may be a time-related therapeutic window in the treatment of physical impairment associated with poststroke depression.